Celiac disease: Confounding presentations of Jeopardy in Indians

Abstract

Background: Celiac disease (CD) (also called gluten-sensitive enteropathy and nontropical sprue) is a known entity since 1888, is a common immune-mediated enteropathy due to allergy to gluten, with a prevalence of approximately 1% worldwide. It has wide spectrum of manifestations ranging from failure to thrive, gastrointestinal symptoms to various autoimmune diseases and malignancies. Materials and Methods: The clinical profile of patients diagnosed as CD, presenting at tertiary care hospital of armed forces, was evaluated. The patients were diagnosed as CD as per ESPGHAN guidelines on the basis of symptoms, positive serology, and histological findings (duodenal biopsy). After history and clinical suspicion of CD, IgA anti-tissue transglutaminase antibody was done. Complete history, physical examination, and baseline investigations including complete blood counts, serum glucose, thyroid function tests, etc., were recorded. Results: The average age of the cohort was 21.03 years (range 3–75 years). The most common presentation was diarrhea (80.7%) followed by anemia (63.2%) and weight loss (56%). Anemia was found to be second most common presentation after diarrhea and was seen in 63.2%. The prevalence of autoimmune conditions, namely, type-1 diabetes mellitus and thyroiditis were seen in two cases (3.5% each). Conclusion: CD is a common immune-mediated condition though typically presenting with gastrointestinal symptoms, atypical manifestations are also not uncommon. Suspicion of this condition and the appropriate investigations should not be delayed in patients presenting with either typical manifestations or uncommon presentations.