Clinical features of celiac disease in Indian children: are they different from the West?
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Published on: July 5, 2022
Ujjal Poddar1, Babu Ram Thapa, Kartar Singh
1Division of Pediatric Gastroenterology, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. ujjal@sgpgi.ac.in
Insights
Indian children with celiac disease (CD) often present late with classic symptoms like diarrhea and anemia. Increased awareness is needed for early diagnosis and management of CD in this population.
Area of Science:
- Pediatric Gastroenterology
- Clinical Immunology
- Public Health
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- Clinical presentation of CD can vary significantly between different populations.
- Limited data exists on the specific clinical features of CD in Indian children.
Purpose of the Study:
- To prospectively evaluate the clinical characteristics of celiac disease in Indian children.
- To compare the clinical presentation of CD in Indian children with those in Western countries.
- To identify factors contributing to delayed diagnosis of CD in India.
Main Methods:
- A 5-year prospective study involving 549 children (< or = 14 years) with suspected CD.
- Clinical features, investigations (hemogram, duodenal biopsy, serology), and follow-up data were collected.
- Diagnosis of CD was based on modified ESPGHAN criteria.
Main Results:
- Celiac disease was diagnosed in 300 children; 210 were included in the analysis.
- The mean age of diagnosis was 6.7 years with a mean symptom duration of 3.5 years.
- Common symptoms included diarrhea (84%), failure to thrive (91%), anemia (84%), wasting (87%), and stunting (60%). Tissue transglutaminase showed the best serological results.
Conclusions:
- Indian children with CD experience a significant delay in diagnosis.
- Classic symptoms such as diarrhea, failure to thrive, and anemia are prevalent.
- Enhanced awareness is crucial for identifying atypical CD presentations in Indian children.
Objective:
This study was designed to prospectively evaluate the clinical features of celiac disease (CD) in a large group of Indian children and to compare them with those from the West.
Patients And Methods:
Over a period of 5 years, a total of 549 children (< or = 14 years) with a clinical suspicion of CD were evaluated. Their detailed clinical features, investigations, and follow-up data were recorded. Complete hemogram, endoscopic duodenal biopsy, and celiac serology were done in all of the cases. Celiac disease was diagnosed on the basis of modified European Society of Paediatric Gastroenterology, Hepatology and Nutrition criteria.
Results:
Celiac disease was diagnosed in 300 children; 39 were excluded because of lack of follow-up or poor response to gluten-free diet. The remaining 210 had normal villous architecture and served as controls. The mean (+/- standard deviation) age of children with CD was 6.7 +/- 3 years, and the mean duration of symptoms was 3.5 +/- 2.5 years. The majority (84%) presented with diarrhea; other features were failure to thrive in 91%, anemia in 84%, wasting in 87%, and stunting in 60% of cases. Among the serological tests, the best results were obtained with tissue transglutaminase. On follow-up (19.4 +/- 15.5 months), symptoms subsided in all cases of CD with a significant weight and height gain.
Conclusions:
Indian children with CD present late, with a significant delay in diagnosis. The majority presents with classic symptoms of diarrhea, failure to thrive, and anemia. There is a need for increasing awareness to pick up the atypical forms of the disease.
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