Background: Iron deficiency anemia (IDA) may be the sole manifestation of celi ac disease. The role of routine small bowel biopsies obtained during endoscopy i n the evaluation of IDA is unclear. This study assessed the usefulness of routin e small bowel biopsies in patients presenting with IDA. Study: Evaluation of 103 consecutive patients with IDA undergoing panendoscopy with routine small bowel biopsies was performed. All patients had a diagnosis of IDA with either a ferrit in less than 15 μg/L or iron saturation less than 8%. Celiac disease was defin ed as total or partial villous atrophy with intraepithelial lymphocytosis, histo logically, and a clinical response to gluten free diet. Gastrointestinal symptom s were recorded. Results: Nine patients (8.7%) were diagnosed with celiac disea se. Of these patients, endoscopic lesions potentially responsible for IDA were f ound in 33%. We found no statistically significant difference when comparing re ports of diarrhea, weight loss, abdominal pain, nausea or vomiting, aspirin or N SAID use, or menopausal status with celiac disease status. Conclusions: Routine small bowel biopsies to evaluate for celiac disease are indicated in the evaluat ion of patients with IDA. The finding of endoscopic lesions that may otherwise e xplain IDA should not preclude small bowel biopsy. Background: Iron deficiency anemia (IDA) may be the sole manifestation of celi ac disease. The role of routine small bowel biopsies obtained during endoscopy in the evaluation of IDA is unclear. This study assessed the usefulness of routin e small bowel biopsies in patients presenting All patients had a diagnosis of IDA with either a ferrit in less than 15 μg / L or iron saturation less than 8%. Celiac disease was defin ed as total or partial villous atrophy with intraepithelial lymphocytosis, histo logically, and a clinical response to gluten free diet. Gastrointestinal symptoms were recorded. Results: Nine patients (8.7%) were diagnosed with celiac disea se. Of these patients, We found no significant significant difference when comparing re ports of diarrhea, weight loss, abd ominal pain, nausea or vomiting, aspirin or N SAID use, or menopausal status with celiac disease status. Conclusions: Routine small bowel biopsies to evaluate for celiac disease are indicated in the evaluat ion of patients with IDA. The finding of endoscopic lesions that may otherwise e xplain IDA should not preclude small bowel biopsy.