Abstract
Objective:To determine clinical features and relevant laboratory investigations of patient with celiac disease (CD) and comparing classical celiac disease (CCD) with Non-diarrheal celiac disease (NDCD).Methods:This is a five years retrospective study conducted at The Aga Khan University Hospital Karachi, Pakistan from January 2010 to December 2015, enrolling children from one year to 15 years of either gender diagnosed as celiac disease in accordance with revised ESPGHAN criteria. Biopsy samples with grade 2 or more on Modified Marsh Classification were considered as consistent with celiac disease. Celiac patients were categorized into Classical celiac disease (with Chronic Diarrhea) and non-diarrheal celiac disease (Atypical celiac) and their clinical features and relevant laboratory investigations were documented.Results:Total 66 patients were selected with celiac disease according to inclusion criteria, 39 (59.09%) patients were labeled as CCD and 27 (40.91%) patients were labeled as NDCD. Marsh grading 3a and above were more marked in CCD as compared to NDCD. Mean titer for Tissue transglutaminase antibodies (TTG) were higher in CCD group in comparison to NDCD group. In CCD, the most common clinical presentations were abdominal distension whereas in NDCD, the most remarkable features were recurrent abdominal pain (62.9%). Frequency of failure to thrive is significantly high in CCD (82.05%) but patients merely with short stature were more common in NDCD (33.3%). Refractory anemia was present in 66.6% patients in NDCD group and 41.1% patients in CCD group. 74.3% patients in CCD group were vitamin D deficient whereas 85% patient had vitamin D deficiency in NDCD group (p= 0.03).Conclusion:NDCD is not uncommon in our population. Recurrent abdominal pain, failure to thrive or patients only with short stature and refractory anemia are prominent features in NCDC group whereas abdominal distension, failure to thrive and recurrent abdominal pain were noticeable features in CCD. High grade histopathology and raised antibodies titer is hallmark of CCD. Vitamin D deficiency is almost equally present in both groups.
Highlights
Total 66 patients were selected with celiac disease according to inclusion criteria, out of these 39 (59.09%) patients had classical presentation of celiac disease with chronic diarrhea and 27 (40.91%) patients had atypical presentation without chronic diarrhea labeled to have non-diarrheal celiac disease (NDCD)
Our study has revealed that 33% patient in NDCD group merely presented with short stature
Our study showed 41% patient in celiac disease (CCD) group and 66% patient in NDCD presented with refractory anemia
Summary
This is 5 years retrospective study conducted at Aga khan University Hospital Karachi, Pakistan from January 2010 to December 2015 enrolling children from 1 year to 15 years of either gender diagnosed as celiac disease (CD) in accordance with revised ESPGHAN criteria.[11]. Biopsy samples with grade 2 or more were considered as consistent with diagnosis of celiac disease. Celiac patients were categorized into Classical (with Chronic Diarrhea) and non-diarrheal celiac disease (Atypical celiac) and their clinical features and relevant laboratory investigations were documented. Both groups were started on gluten free diet and micronutrient supplements and their symptomatic improvement was documented after three months on gluten free diet. Markers of improvement include return of normal stool consistency with less liquidity (in CCD), improvement in weight (crossing up at least one centile line), and increase in hemoglobin level ≥2 g/dl (both in CCD and NDCD). Serum IgA levels were done for enrolled patients at the time of antibody screening along with TTG IgA profile to rule out IgA deficiency in order to identify possible false negative screening results
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