Adult onset celiac disease in north India

Informations on celiac disease among Indian adults is scarce. With the availability of improved and more accessible diagnostic tools for celiac disease, the disease is being more frequently recognized among the adults. Therefore, a retrospective analysis of duodenal biopsies were performed to identify adult celiac disease among Indian patients.

A retrospective analysis of the patients, who had villous atrophy on duodenal biopsy between February, 1997 to June 2001, was performed. The clinical presentation, laboratory parameters, treatment and follow up details of patients diagnosed as adult onset celiac disease were analysed. Diagnosis of celiac disease was established in these patients as per ESPGAN criteria.

There were 68 duodenal biopsies during the study period. Thirteen (10 were under 15 years of age and 3 had followup biopsy) biopsies were excluded. Eleven (20%) out of 55 patients with villous atrophy in their duodenal biopsy satisfied the ESPGAN criteria for the diagnosis of celiac disease. The age at the time of diagnosis ranged from 15-56 years (mean 36.8 years). Male to female ratio was 5:6. Chronic diarrhea (99%) was the most common presentation followed by weight loss (88%) and anemia (66%). Only one patient had refractory iron deficiency anemia (11%). Histopathological examination showed, subtotal villous atrophy in 6 patients and partial villous atrophy in 5. Nine out of 11 patients had raised concentration of IgA antigliadin antibody. Two patients also had raised concentration of antiendomysial antibody. All of them showed favorable clinical response to Gluten free diet.

Coeliac disease is considered rare in the tropics. Our study shows that this disease may not be as infrequent as is thought.