Markers Of Celiac Disease Research Articles

Efficacy Study of Anti-Endomysium Antibodies for Celiac Disease Diagnosis: A Retrospective Study in a Spanish Pediatric Population.

The aim of this study was to assess the efficacy of anti-endomysium antibodies (EMA) as a serological marker for celiac disease (CD) diagnosis in a pediatric population. A retrospective study of pediatric patients who underwent a CD serological markers study: EMA and anti-tissue transglutaminase antibodies (anti-TG2). Clinical symptomatology, degree of histological lesion, human leukocyte antigen (HLA) haplotype compatible with CD (HLA DQ2 and/or DQ8), and final diagnosis were taken into account. We included 445 patients who were classified in two groups according to the final diagnosis. Group 1: 232 children with CD, 91.4% of whom exhibited small intestinal villous atrophy, 228 being EMA-positive and four EMA-negative. Group 2: 213 children with a non-CD diagnosis, 212 EMA negative and one EMA positive. Both antibodies, EMA and anti-TG2, reached similar sensitivities, 98% and 99% respectively, while EMA had a higher specificity (99%) than anti-TG2 (93%). By using both markers combined, compared to using anti-TG2 alone, 5.7% of patients are better diagnosed. However, when we compare the efficacy of EMA and anti-TG2 in asymptomatic and symptomatic patients, the sensitivity of EMA is 98% irrespective of symptoms, thus higher than for anti-TG2 ≥10 × upper limit of normal (ULN) (respectively 77% and 84%). Our results support the use of EMA to increase CD diagnostic accuracy in a non-biopsy approach, especially in asymptomatic children.

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Familial Celiac Disease Remission as a Result of a Full Donor Immunologic Recovery After Sibling Cord Blood Transplantation for Chronic Granulomatous Disease: A Case Report

We present a case report of a boy diagnosed with both chronic granulomatous disease (CGD) and familial celiac disease (CD) who underwent cord blood transplantation from a partially matched sibling donor. The presentation of CD resembled Crohn-like enteropathy, which is a canonical manifestation of CGD. Nearly 1 year post-hematopoietic stem cell transplantation (HSCT), a gluten-containing diet was reintroduced, and no reappearance of clinical, serologic, or histologic markers of CD was observed. The relatively high incidence of rare genetic diseases in pediatric patients suggests the need for additional caution in the interpretation of symptoms mimicking already known hallmarks of more common conditions. In addition, the presented data confirm the previous rare observations that allogeneic HSCT leads to durable induction of gluten tolerance in patients with CD, which can warrant its use in patients with refractory subtypes of CD.

Comprehensive Detection of Isopeptides between Human Tissue Transglutaminase and Gluten Peptides.

Celiac disease (CD) is a chronic inflammation of the small intestine triggered by the ingestion of gluten in genetically predisposed individuals. Tissue transglutaminase (TG2) is a key factor in CD pathogenesis, because it catalyzes both the deamidation of specific glutamine residues and the formation of covalent Nε-(γ-glutamyl)-lysine isopeptide crosslinks resulting in TG2–gluten peptide complexes. These complexes are thought to activate B cells causing the secretion of anti-TG2 autoantibodies that serve as diagnostic markers for CD, although their pathogenic role remains unclear. To gain more insight into the molecular structures of TG2-gluten peptide complexes, we used different proteomics software tools that enable the comprehensive identification of isopeptides. Thus, 34 different isopeptides involving 20 TG2 lysine residues were identified in a model system, only six of which were previously known. Additionally, 36 isopeptides of TG2-TG2 multimers were detected. Experiments with different TG2-gluten peptide molar ratios revealed the most preferred lysine residues involved in isopeptide crosslinking. Expanding the model system to three gluten peptides with more glutamine residues allowed the localization of the preferred glutamine crosslinking sites. These new insights into the structure of TG2-gluten peptide complexes may help clarify the role of extracellular TG2 in CD autoimmunity and in other inflammatory diseases.

The study of HLA markers susceptibility to celiac disease in women with recurrent pregnancy loss

Aim. Celiac disease (CD) is a multifactorial pathology with high genetic predisposition, and is associated with reproductive health disorders in women. The purpose of the study was to investigate the presence of HLA-DQ2.5 (HLA-DQA1 * 05:01 HLA-DQB1 * 02) and HLA-DQ8 (HLA-DQB1 *03:02) genotypes of predisposition to CD in women with recurrent pregnancy loss. Methods. PCR-SSP (polymerase chain reaction with sequence-specific primers). Results. The increased risk of recurrent pregnancy loss in women is associated with DQ2.5 - the pre-disposition genotype for CD (c2=4.35, P<0,05). Calculation of odds ratio (OR) showed more than 4-fold increase in recurrent pregnancy loss risk in women with HLA-DQ2.5 genotype. Conclusions. The study of HLA markers of celiac disease in women with reproductive loss is important for the purpose of preconceptional prevention of recurrent pregnancy loss. Keywords: celiac disease, recurrent pregnancy loss, HLA markers.

Dermatitis Herpetiformis: Novel Perspectives.

Dermatitis herpetiformis (DH) is an inflammatory disease of the skin, considered the specific cutaneous manifestation of celiac disease (CD). Both DH and CD occur in gluten-sensitive individuals, share the same Human Leukocyte Antigen (HLA) haplotypes (DQ2 and DQ8), and improve following the administration of a gluten-free diet. Moreover, almost all DH patients show typical CD alterations at the small bowel biopsy, ranging from villous atrophy to augmented presence of intraepithelial lymphocytes, as well as the generation of circulating autoantibodies against tissue transglutaminase (tTG). Clinically, DH presents with polymorphic lesions, including papules, vesicles, and small blisters, symmetrically distributed in typical anatomical sites including the extensor aspects of the limbs, the elbows, the sacral regions, and the buttocks. Intense pruritus is almost the rule. However, many atypical presentations of DH have also been reported. Moreover, recent evidence suggested that DH is changing. Firstly, some studies reported a reduced incidence of DH, probably due to early recognition of CD, so that there is not enough time for DH to develop. Moreover, data from Japanese literature highlighted the absence of intestinal involvement as well as of the typical serological markers of CD (i.e., anti-tTG antibodies) in Japanese patients with DH. Similar cases may also occur in Caucasian patients, complicating DH diagnosis. The latter relies on the combination of clinical, histopathologic, and immunopathologic findings. Detecting granular IgA deposits at the dermal-epidermal junction by direct immunofluorescence (DIF) from perilesional skin represents the most specific diagnostic tool. Further, assessing serum titers of autoantibodies against epidermal transglutaminase (eTG), the supposed autoantigen of DH, may also serve as a clue for the diagnosis. However, a study from our group has recently demonstrated that granular IgA deposits may also occur in celiac patients with non-DH inflammatory skin diseases, raising questions about the effective role of eTG IgA autoantibodies in DH and suggesting the need of revising diagnostic criteria, conceivably emphasizing clinical aspects of the disease along with DIF. DH usually responds to the gluten-free diet. Topical clobetasol ointment or dapsone may be also applied to favor rapid disease control. Our review will focus on novel pathogenic insights, controversies, and management aspects of DH.

Comparison of celiac disease markers in women with early recurrent pregnancy loss and normal controls.

Celiac disease (CD) is an autoimmune intestinal inflammatory disease triggered by gluten in the diet. Untreated CD has been associated with pregnancy loss and infertility. The purpose of this study was to screen unselected women with recurrent pregnancy loss (RPL) for markers of CD to determine whether a correlation exists between RPL and CD serum markers. Frequencies of three serum markers of CD [tissue transglutaminase (TTG) IgA, endomysial (EMA) IgA, and deaminated gliadin peptide (DGP) IgA] were determined by enzyme-linked immunoassay (ELISA). Seven hundred and eight women who had two or more failed clinical pregnancies (cases) and one hundred women with at least one live birth and no miscarriages (controls) were included in this study. All cases had a full workup for RPL based on the American Society for Reproductive Medicine 2013 guidelines. Antiphospholipid antibodies (aPL) were correlated with CD markers based on their potential prothrombotic role. Results The results show no significant difference in the prevalence of CD autoantibodies when comparing the RPL patients with the controls. Over half of the patients who tested positive for serum markers for CD also had positive aPL. Conclusion Screening unselected women with RPL who are asymptomatic for CD is not supported based on these data. Women who test positive for CD may be candidates for aPL testing based on the association of adverse pregnancy outcomes.

Electrochemical Immunosensor Based on Nanoelectrode Ensembles for the Serological Analysis of IgG-type Tissue Transglutaminase.

Celiac disease (CD) is a gluten-dependent autoimmune disorder affecting a significant percentage of the general population, with increasing incidence particularly for children. Reliable analytical methods suitable for the serological diagnosis of the disorder are urgently required for performing both the early diagnosis and the follow-up of a patient adhering to a gluten-free diet. Herein we report on the preparation and application of a novel electrochemical immunosensor based on the use of ensembles of gold nanoelectrodes (NEEs) for the detection of anti-tissue transglutaminase (anti-tTG), which is considered one reliable serological marker for CD. To this end, we take advantage of the composite nature of the nanostructured surface of membrane-templated NEEs by functionalizing the polycarbonate surface of the track-etched membrane with tissue transglutaminase. Incubation of the functionalized NEE in anti-tTG samples results in the capture of the anti-tTG antibody. Confirmation of the recognition event is achieved by incubating the NEE with a secondary antibody labelled with horseradish peroxidase (HRP): in the presence of H2O2 as substrate and hydroquinone as redox mediator, an electrocatalytic current is indeed generated whose increment is proportional to the amount of anti-tTG captured from the sample. The optimized sensor allows a detection limit of 1.8 ng mL−1, with satisfactory selectivity and reproducibility. Analysis of serum samples from 28 individuals, some healthy and some affected by CD, furnished analytical results comparable with those achieved by classical fluoroenzyme immunoassay (FEIA). We note that the NEE-based immunosensor developed here detects the IgG isotype of anti-tTG, while FEIA detects the IgA isotype, which is not a suitable diagnostic marker for IgA-deficient patients.

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Overlap of Characteristic Serological Antibodies in Rheumatoid Arthritis and Wheat-Related Disorders.

Background and Aims Rheumatoid arthritis (RA) and celiac disease (CD) are members of the autoimmune disease family while they have been shown to share multiple aspects in epidemiology and clinical manifestations. The aim of this study was to assess the presence of wheat protein antibodies in RA seropositive subjects and the presence of RA diagnostic markers in subjects with seropositive wheat-related disorders including CD. Methods Serum samples were collected from 844 subjects with joint pain and/or gastrointestinal symptoms and tested by a CD panel (anti-tTG and anti-DGP), a Wheat Zoomer (WZ) antibody panel (IgG/IgA to 14 wheat proteins), and a RA panel (anti-CCP and anti-RF). Retrospective analysis was completed using de-identified clinical data and test results. Results The prevalence of RA markers was first investigated in CD- or WZ-positive subjects and negative controls. 49 subjects were seropositive in the CD panel with 10 (20%) RA positivity. 605 subjects were seropositive in the WZ panel with 106 (18%) RA positivity. 222 subjects were seronegative in either panels with 12 (6%) RA positivity. Next, the frequency of the CD markers and the clinically relevant wheat protein antibodies were investigated in the RA-positive subjects and negative controls. 128 subjects in this cohort were seropositive in the RA panel with 10 (8%) CD positivity and 106 (83%) WZ positivity, compared to 716 RA seronegative controls with 39 (5%) CD positivity and 499 (70%) WZ positivity. Conclusions Our data presents an apparent trend of overlapped serological antibody biomarker positivity in RA and wheat-related disorders.

Growth and glycemic control in children with type 1 diabetes and asymptomatic celiac disease treated with a gluten -free diet for 1 year

To compare growth and glycemic control in children with type 1 diabetes and silent celiac disease treated with a gluten-free diet for 1 year with those of similar age and gender with type 1 diabetes but without celiac disease, 16 type 1 diabetes patients with silent celiac disease were enrolled and each celiac disease-positive case was matched for age, sex, and duration of diabetes with two type 1 diabetes controls with negative serologic markers of celiac disease. All 16 children with positive celiac disease serology had histologic features consistent with celiac disease despite the absence of symptoms. The mean growth and metabolic control values were similar between children with type 1 diabetes and celiac disease and those with type 1 diabetes but without celiac disease. This study seems to suggest that the early diagnosis of celiac disease and initiation of a gluten-free diet may prevent further deterioration in the nutritional status of children with type 1 diabetes and celiac disease and may reduce the prospect of celiac disease complications without any impact on type 1 diabetes control.

Unrecognised coeliac disease among men and women undergoing fertility treatment: A screening study.

Coeliac disease is an autoimmune disease triggered by dietary gluten and has been associated with several conditions influencing female and male reproduction. Due to unspecific symptoms, coeliac disease can be unrecognised for years. To estimate the prevalence of unrecognised coeliac disease among couples referred to fertility treatment. Cross-sectional screening for coeliac disease in men and women referred to fertility treatment using IgA tissue transglutaminase antibodies as a marker of coeliac disease and small-bowel biopsies to confirm the diagnosis. Participants answered a questionnaire on gluten intake, gastrointestinal symptoms and reproductive history. A total of 893 participants (51% women) were screened and eight were coeliac disease antibody positive. Small-bowel biopsies were obtained from seven antibody positive participants and unrecognised coeliac disease was confirmed in one woman and three men, corresponding to a prevalence of 0.45% (95% confidence interval 0.12-1.14). The total prevalence, combining already diagnosed and unrecognised CD cases, was 0.63% (95% confidence interval 0.29-1.12). The prevalence of unrecognised coeliac disease in a group of infertile patients was equivalent to that of the Danish general population and low compared with that observed in the majority of other screening studies of infertile patients. Surprisingly, it should be noted that more men than women had coeliac disease. This result does not support a need for routine screening among infertile patients.

Sensitivity of Serologic Markers in Celiac Disease in Children 2 Years Old or Younger

Introduction: Celiac disease (CD) is common immune mediated disorder that affects up to 1% of the general population in North America and Europe. Screening for CD starts with highly sensitive Immunoglobulin A (IgA) based serologic markers like anti-tissue transglutaminase antibodies (anti-TTG IgA) or endomysial antibodies (EMA). (3). However, it has been suggested that IgA based TTG or EMA are not as sensitive in younger children. We aimed to assess the sensitivity of positive IgA based serologic markers in children 2 year old or younger and to assess how many of the children with negative serology ended up with confirmed CD diagnosis. Methods: We performed retrospective chart review of the Mayo Clinic electronic medical records between 1997 and 2018. We included all children 2 year old and younger who have CD documented in their medical charts (clinical notes or pathology report listing CD as a differential diagnosis). Patients' age, clinical notes, labs, and pathology records were reviewed to confirm CD diagnosis based on NASPGHAN or ESPGHAN guideline. This study was approved by the Mayo Clinic's IRB. Results: We identified 60 children with CD documented in their charts (clinical notes or pathology reports), 41 (68%) were females with an average age (SD) of 21.6 months (7.9). Forty one (68%) were ≤ 24 months at the time of CD investigation with positive family history of CD in 15 (25%) of them. Of the 60 children, 42 (70%) children met the diagnostic criteria of CD (39 NASPGHAN and 3 ESPGHAN) while the remaining 18 children didn't meet the diagnostic criteria. All children with confirmed CD diagnosis had positive celiac serology markers {33 TTG-IgA, 1 TGG-IGG (IgA deficient) and 8 EMA (prior to TTG era)}, while in the children without CD, 17 had negative serology and 1 had positive TTGIgA. Fifty six (93%) children (39 confirmed CD and 17 without CD) underwent endoscopic assessment. The most common indication for endoscopic assessment and SBB was failure to thrive in 21(35%), followed by diarrhea in 16(27%) and abdominal pain in 7 (12%). Children with confirmed CD had partial villous atrophy (VA) in 8 children and complete VA in 34 children, while the unconfirmed cases 2 had normal SBB. Conclusion: IgA based serologic markers are sensitive screening test even in children 2 year old or younger with sufficient IgA level. Cases of negative serologic marker didn't meet diagnostic criteria on small bowel biopsy and were unlikely to be diagnosed with CD later in life.

Prevalence of markers of celiac disease in Colombian children with diabetes mellitus type 1.

Introduction: Although the association between diabetes mellitus type 1 (T1DM) and celiac disease (CD) is well established; there are only a few studies that focus on South American children, haplotypes and their possible associations. Objective: To determine the prevalence of CD markers in a group of children with T1DM and to analyze the associated clinical, immunological and genetic manifestations. Methods: A prevalence study focusing on children with T1DM who were assessed based on variables including sociodemographics, anthropometric information, disease characteristics, laboratory results and family medical history. In partitipants a positive tTG2 (Ig A anti-transglutaminase), a duodenal biopsy and genotype were performed. The proportion of children with T1DM and CD was estimated (CI 95%). Determinations of central tendency, univariate and bivariate analysis, were also performed; p <0.05 was considered significant. Results: Thirteen (8.4%) of the 155 children (53.6% girls, 11.0 ±3.6 years, 2-18 years) with T1DM were tTG2 positive, four had CD (2.6%), seven had potential CD (4.5%) and nine were HLA DQ2/DQ8 positive (5.8%). Children with T1DM and CD had their last ketoacidotic episode (21.5 ±30.4 months versus 69.5 ±38.8 months, p= 0.0260) earlier than children with T1DM and potential CD. There were no differences with anthropometry or with the laboratory results regarding glycemic control. Conclusions: The prevalence of CD in these children with T1DM is higher than that reported in other South American countries. The prevalence of CD was found to be associated with the time of presentation of T1DM and its main allele, the DQ2/DQ8. These findings are different from what has been described in other places around the world.

Prevalence of markers of celiac disease in Colombian children with diabetes mellitus type 1

Introduction: Although the association between diabetes mellitus type 1 (T1DM) and celiac disease (CD) is well established; there are only a few studies that focus on South American children, haplotypes and their possible associations. Objective: To determine the prevalence of CD markers in a group of children with T1DM and to analyze the associated clinical, immunological and genetic manifestations. Methods: A prevalence study focusing on children with T1DM who were assessed based on variables including sociodemographics, anthropometric information, disease characteristics, laboratory results and family medical history. In partitipants a positive tTG2 (Ig A antitransglutaminase), a duodenal biopsy and genotype were performed. The proportion of children with T1DM and CD was estimated (CI 95%). Determinations of central tendency, univariate and bivariate analysis, were also performed; p &lt;0.05 was considered significant. Results: Thirteen (8.4%) of the 155 children (53.6% girls, 11.0 ±3.6 years, 2-18 years) with T1DM were tTG2 positive, four had CD (2.6%), seven had potential CD (4.5%) and nine were HLA DQ2/DQ8 positive (5.8%). Children with T1DM and CD had their last ketoacidotic episode (21.5 ±30.4 months versus 69.5 ±38.8 months, p= 0.0260) earlier than children with T1DM and potential CD. There were no differences with anthropometry or with the laboratory results regarding glycemic control. Conclusions: The prevalence of CD in these children with T1DM is higher than that reported in other South American countries. The prevalence of CD was found to be associated with the time of presentation of T1DM and its main allele, the DQ2/DQ8. These findings are different from what has been described in other places around the world.

Prolonged Hypercupremia After Vertical Sleeve Gastrectomy Successfully Treated With an Excess of Oral Zinc

We have previously reported that hypercupremia occurs in up to 19% of individuals after bariatric surgery (Lee J, et al. Am J Gastroenterol, 2012). The national recommendation for two multivitamins with minerals daily for these patients (4 mg copper daily) may provide an excess of oral copper. A 30s-year-old female (BMI 49) underwent vertical sleeve gastrectomy with no immediate postoperative complication. When seen 5 months after surgery, she was taking two chewable multivitamins with minerals daily (4 mg elemental Cu and 24 mg elemental Zn daily). Hypercupremia was present, in association with elevated ceruloplasmin, noted in retrospect (see Table 1). Follow-up blood tests showed persistently normal levels of AST, ALT, alkaline phosphatase, and albumin. At 11 months after surgery, she was instructed to stop the multivitamins. At 12 months, when hypercupremia persisted, she started one Cu-free multivitamin daily. Despite this, high levels of serum Cu persisted at the 14-month visit. A search for underlying causes showed normal protein electrophoresis (no M-spike), negative celiac disease markers, and negative ANA. Of note, urinary copper excretion was normal at 15 mcg/24 hours (normal, < 35). She was instructed in a lowcopper diet. At the 2-year visit, she had realized a loss of 44% of her excess preoperative weight. Hypercupremia was still present. Slit lamp examination showed no Kayser-Fleischer rings. She was started on zinc sulfate 220 mg before meals twice daily (100 mg elemental Zn). On follow-up 2 months later, serum Cu and ceruloplasmin had essentially normalized. Hypercupemia after bariatric surgery may be related to ingestion of the high doses of Cu present in multivitamins with mineral supplements. In this case, the high levels of serum Cu correlated with high levels of ceruloplasmin. At the same time, the normal urinary Cu excretion and absence of K-F rings excluded a more general copper overload syndrome. It is unclear whether increased production of ceruloplasmin in this case was perhaps an independent response to significant weight loss, or was simply a reflection of an excess of available copper. Oral zinc can be an effective treatment to diminish copper overload in individuals with Wilson's disease. The mechanism of zinc's apparently beneficial effect in this patient is unclear, but may be related to suppression of ceruloplasmin secretion from the liver.2452 Figure 1 No Caption available.

The many faces of the problem of intolerance to gluten.

Rising incidence of different variants of gluten intolerance associated with changes in eating behaviorin many countries, changes in the technology of growing and processing crops, new culinary technologies. Until recently, celiac disease, dermatitis herpetiformis and wheat allergy were the only known disease with a proven role of gluten in their pathogenesis. Non-celiac gluten sensitivity (NCGS) - a new syndrome of intolerance to gluten. This pathology can be suspected in patients with persistent intestinal and extra-intestinal symptoms clearly associated with the intake of foods containing gluten, the absence of serological markers of celiac disease or suspected allergy to wheat. The paper presents the current data on the epidemiology, etiology and pathogenesis, clinical features and diagnosis NCGS.

Of Wheat and Men: Changes in Genetic Markers for Celiac Disease Over Time

In the recent past, sequencing of ancient human genomes has become increasingly common, leading to an immense amount of data to be explored. For this study we focused on comparing a set of ancient individuals with modern populations on behalf of markers for celiac disease. We analyzed a panel of 64 SNPs related to this disease, trying to detect changes in allele frequencies between ancient and modern individuals. We hope to make a contribution to the subject of genetic health throughout human history.

Detecting endomysial and tissue transglutaminase antibodies in patients with giardiasis

Celiac disease is a genetic disease diagnosed to be associated with chronic intestinal inflammation. Endomysial and tissue transglutaminase antibodies are the best serum markers for celiac disease (CD) diagnosis. This research aimed to determine the levels of endomysial and tissue transglutaminase antibodies in patients with giardiasis. Forty cases of giardiasis were selected among the referees to Milad Hospital in Tehran, as well as a children’s hospital and some health centers in Karaj. Euro-immune IgA immunofluorescence and ELISA were utilized to measure their titers of endomysial and tissue transglutaminase antibodies, respectively. Twenty random serum samples of negative Giardia and 16 serum samples of positive anti-(tissue transglutaminase) tTG antibodies were evaluated by using ELISA and endomysium antibody through immunofluorescence techniques. Among the 40 cases of giardiasis, 16 positive endomysial and transglutaminase antibodies (40%) were detected. Sixteen positive samples of endomysial antibody (EMA) were also positive for anti-tTG, and 20 random negative samples were negative for EMA and anti-tTG. The chi-square test revealed a significant association between antibodies and giardiasis (P = 0.001). Atrophy of the intestinal villi can arise after giardia infection by mimicking the behavioral patterns of anti-EMA and anti-tTG antibodies. Due to low specificity, anti-gliadin antibody test is not helpful in detecting CD in patients with giardiasis. In the present study on anti-EMA and anti-tTG in patients with giardiasis, these antibodies were positive in giardiasis. Thus, the best and most reliable way to diagnose CD and treat giardiasis is intestinal biopsy as the gold standard method.

Comparison of Endoscopic and Histological Findings between Typical and Atypical Celiac Disease in Children.

PurposeCeliac disease is a common non-communicable disease with varied presentations. Purpose of this study was to find the duodeno-endoscopic features in celiac disease and to compare duodeno-endoscopic and histological findings between typical and atypical celiac disease in children.MethodsHospital based observational study was conducted at Sir Padampat Mother and Child Health Institute, Jaipur from June 2015 to May 2016. Patients were selected and divided in two groups- typical and atypical celiac disease based upon the presenting symptoms. Upper gastrointestinal endoscopy and duodenal biopsy was performed for serology positive patients. Results were analysed using appropriate statistical test of significance.ResultsOut of 101 enrolled patients, 47.5% were male. Age ranged from 1 to 18 years. Study showed that 54.5% were typical and 45.5% were atypical. Patients presenting with atypical symptoms were predominantly of older age group. On endoscopy, scalloping, mosaic pattern, reduced fold height and absent fold height; and in histology, advanced Marsh stage were significantly higher in the typical group.ConclusionAwareness of atypical presentations as well as duodeno-endoscopic features may have considerable practical importance for the diagnosis of celiac disease in children. Scalloping, mosaic pattern, reduced fold height and nodularity are main endoscopic markers of celiac disease in children. Endoscopic markers of duodenal mucosa may be important in early diagnosis of celiac disease, in children subjected to endoscopy for atypical presentations or indication other than suspected celiac disease.