Celiac Disease: A Disease With Varied Manifestations in Adults in India

Abstract

BackgroundIn India incidence of celiac disease is rising and more prevalent in the Northern part of the country, the so-called “coeliac belt”, a finding that is at least partially explained by the wheat-rice shift from the North to the South.Aim and MethodsThe aim of the present study was to determine clinical manifestations of celiac disease in western India. In retrospective analysis of prospectively maintained data at single tertiary health center, Patients diagnosed with CD based on modified ESPGHAN criteria were evaluated for clinical features, serology and histology of endoscopic duodenal biopsy.ResultA total of 75 patients diagnosed by modified ESPGHAN criteria (46 females, mean age 36±15 years) had positive serology- IgA Anti Endomyceal antibody (n-72), IgA Anti tTG antibody (n-3) and 6%, 28%, 3%, 62% patients had Marsh stage 0, 1, 2,and 3 respectively. Sixty-five percent of patients presented with typical diarrheal disease. One or more associated diseases were noted in 27 (36%) patients and most common being autoimmune disease (16%) (Hypothyroidism, grave’s disease, autoimmune hepatitis, DM type 1, Rheumatoid arthritis) followed by neurological conditions (9%) (Epilepsy, depression, schizophrenia, ataxia, migraine). Most common atypical manifestations were anaemia (76%) followed by elevated transaminases (39%), osteopenia (25%), neurological (4%) and infertility (1%).ConclusionCeliac disease is also common in western India and atypical manifestations and associated conditions should be actively screened in all CD patients. BackgroundIn India incidence of celiac disease is rising and more prevalent in the Northern part of the country, the so-called “coeliac belt”, a finding that is at least partially explained by the wheat-rice shift from the North to the South. In India incidence of celiac disease is rising and more prevalent in the Northern part of the country, the so-called “coeliac belt”, a finding that is at least partially explained by the wheat-rice shift from the North to the South. Aim and MethodsThe aim of the present study was to determine clinical manifestations of celiac disease in western India. In retrospective analysis of prospectively maintained data at single tertiary health center, Patients diagnosed with CD based on modified ESPGHAN criteria were evaluated for clinical features, serology and histology of endoscopic duodenal biopsy. The aim of the present study was to determine clinical manifestations of celiac disease in western India. In retrospective analysis of prospectively maintained data at single tertiary health center, Patients diagnosed with CD based on modified ESPGHAN criteria were evaluated for clinical features, serology and histology of endoscopic duodenal biopsy. ResultA total of 75 patients diagnosed by modified ESPGHAN criteria (46 females, mean age 36±15 years) had positive serology- IgA Anti Endomyceal antibody (n-72), IgA Anti tTG antibody (n-3) and 6%, 28%, 3%, 62% patients had Marsh stage 0, 1, 2,and 3 respectively. Sixty-five percent of patients presented with typical diarrheal disease. One or more associated diseases were noted in 27 (36%) patients and most common being autoimmune disease (16%) (Hypothyroidism, grave’s disease, autoimmune hepatitis, DM type 1, Rheumatoid arthritis) followed by neurological conditions (9%) (Epilepsy, depression, schizophrenia, ataxia, migraine). Most common atypical manifestations were anaemia (76%) followed by elevated transaminases (39%), osteopenia (25%), neurological (4%) and infertility (1%). A total of 75 patients diagnosed by modified ESPGHAN criteria (46 females, mean age 36±15 years) had positive serology- IgA Anti Endomyceal antibody (n-72), IgA Anti tTG antibody (n-3) and 6%, 28%, 3%, 62% patients had Marsh stage 0, 1, 2,and 3 respectively. Sixty-five percent of patients presented with typical diarrheal disease. One or more associated diseases were noted in 27 (36%) patients and most common being autoimmune disease (16%) (Hypothyroidism, grave’s disease, autoimmune hepatitis, DM type 1, Rheumatoid arthritis) followed by neurological conditions (9%) (Epilepsy, depression, schizophrenia, ataxia, migraine). Most common atypical manifestations were anaemia (76%) followed by elevated transaminases (39%), osteopenia (25%), neurological (4%) and infertility (1%). ConclusionCeliac disease is also common in western India and atypical manifestations and associated conditions should be actively screened in all CD patients. Celiac disease is also common in western India and atypical manifestations and associated conditions should be actively screened in all CD patients.