Abstract
Objectives:Celiac Disease (CD) is a disorder that impacts physical, social and emotional health. Requiring life-long treatment, it poses a major economic burden on the healthcare system. Our objective was to study CD in patients from initial presentation to diagnosis and to ascertain the effect of a low resource setting on improvement in disease process.Methods:This is a retrospective cross-sectional study conducted at a Aga Khan University Hospital (AKUH), a tertiary care center in Karachi, Pakistan. Medical records of patients (≥ 18 years) from 2008 to 2018 with a diagnosis of CD were reviewed. Data on demographics, presenting complaints, investigations, endoscopy results and follow up visits was collected.Results:One hundred and twenty-six patients were included (61.6% females, mean age 35.5 years). The most common intestinal and extra-intestinal symptoms were abdominal pain (56.3%) and fatigue (24.6%) respectively. After microcytic anemia (36.5%), increased ALT (27.2%) was the most common laboratory derangement. On endoscopy, visible fissuring (29.4%) and atrophic mucosa (29.4%) were reported. Biopsy findings showed increased intraepithelial lymphocytes (92.9%) and villous atrophy (77.8%). Improvement in at least one of three parameters (symptoms, laboratory values or EGD) was reported by 42.0% of subjects, whereas 48.4% subjects were lost to follow-up.Conclusion:The most commonly reported symptoms by CD patients were abdominal pain, diarrhea and anemia. Thus, patients presenting with vague abdominal symptoms and anemia should be worked up for CD. A concerning majority of subjects was lost to follow up for reasons such as inability to afford advised GFD and a poor understanding of the disease process.
Highlights
Celiac Disease (CD) is an immune-mediated systemic disorder that primarily affects the gastrointestinal tract but has widespread manifestations affecting the integumentary system, central nervous system, reproductive system and musculoskeletal system
It has been shown that almost 50% of newly diagnosed CD patients have an asymptomatic clinical course;[4] based on this, it can be reasonably extrapolated that countries without screening programs have a higher disease burden than reported
The authors aim to ascertain compliance and improvement in patients in a low resource setting. This is a retrospective observational study conducted in Aga Khan University Hospital (AKUH), a tertiary care center in the most populated city of Pakistan, Karachi
Summary
Celiac Disease (CD) is an immune-mediated systemic disorder that primarily affects the gastrointestinal tract but has widespread manifestations affecting the integumentary system, central nervous system, reproductive system and musculoskeletal system. Development of the disease occurs due to exposure to diet containing gluten in genetically predisposed individuals. CD is a poorly studied disease in most Asian countries because until a few decades ago it was considered to be a disease that affected individuals with European ancestry. Based on the scarce data that is present, the overall prevalence of CD in Asian countries is 0.5%.3. While these numbers may not look alarming, there are multiple reasons to suggest that the actual prevalence of the disease is much higher. It has been shown that almost 50% of newly diagnosed CD patients have an asymptomatic clinical course;[4] based on this, it can be reasonably extrapolated that countries without screening programs have a higher disease burden than reported. Recent studies have reported an increasing trend when studying the temporal changes in frequency of CD.[5]
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