Pattern of celiac disease in a sample of Iraqi children

Abstract

Background: Celiac Disease(CD) presentation pattern is changing over the years with it's diagnostic criteria and different types of Celiac Disease is emerging.

Objectives: To evaluate CD cases in a sample of Iraqi clinically, serologically & histopathologically and to spot any atypical cases.

Patients and methods: Forty children diagnosed as Celiac Disease by positive serology were referred to the outpatient department of children Walfare Teaching Hospital & GIT center in Baghdad for further evaluation in the period from first of April 2011 till the first of Jan.2012 were studied. The clinical presentation, serological tests and histopahtological findings were recorded and analyzed. 

Results: Out of the 40 patients who had positive serology tests, 26 patients only (65%) had positive duodenal biopsy of CD, 9 of the 26 patient cases (34.6%) had GIT symptoms, the rest 17(65.4%) had non GIT symptoms (12 had type 1 Diabetes Mellitus, 3 with isolated short stature & 2 cases had thyroid problems). Constipation, abdominal pain & offensive stool were more significant findings than the usual diarrhea and abdominal distention in the cases presented with GIT symptoms. Height for age in 96.2% of them was -SD below the mean. Weight/height in (76.9%) & (54%) of the BMI were -2SD below the mean. Anti Endomyseal IgA antibodies was 14 cases (35%) with positive serology and negative duodenal biopsy result. 

Conclusion: The pattern of CD is changing with atypical clinical presentations and CD presents in a non gastrointestinal symptoms in about two third of the cases. Latent CD was found in one third of cases. Anti Endomyseal antibody was the most sensitive and specific serological marker in this study.