Coeliac disease in children with Down syndrome in Serbia

Abstract

Introduction. To determine the prevalence of coeliac disease (CD) in children with Down syndrome (DS) in Serbia and to analyse the clinical characteristics and laboratory data from patients with DS. Methods. A total of 91 children (50 boys and 41 girls, mean age of 6.3 years) with DS were examined. The total levels of IgA and IgA transglutaminase (IgA tTG) antibodies were determined. The levels of IgG transglutaminase (IgG tTG) and IgG anti-endomysial (IgG EMA) antibodies were determined in cases of IgA immunodeficiency. Enterobiopsies were performed in patients with positive antibody titres. Results. Of the children evaluated, 38 exhibited constipation (41.7%), 26 experienced vomiting and regurgitation (28.5%), 16 had anaemia (17.5%), and two had intermittent diarrhoea (2.2%). The DS-specific mean weight percentile was 15.2%±14.5% (range <5-75%). In four out of five of the children with positive levels of IgA tTG, an enterobiopsy showed the presence of CD (4.4%, 95% CI, 1.7%-10.7%). The levels of IgG tTG and IgG EMA were determined in five children with an IgA immunodeficiency. The IgG EMA was negative in all five of the children. Three of the children showed increased IgG tTG values and underwent an enterobiopsy, which showed a normal mucosa. Our analysis shows that the signs and symptoms of CD in children with DS are only of minor diagnostic value in the detection of the disease. Conclusion. These results suggest the need for systematic screening for CD in children with DS because symptoms that are characteristic of both diseases may overlap.