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Changing spectrum of celiac disease in India
Pawan Rawal1, Babu Ram Thapa, Chander Kanwal Nain
1Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Celiac disease presentation in children is shifting away from classic symptoms like diarrhea and failure to thrive. Early diagnosis through serologic testing may explain this change in celiac disease manifestations.
Area of Science:
- Pediatric Gastroenterology
- Celiac Disease Pathophysiology
- Clinical Manifestations
Background:
- Celiac disease is a significant cause of chronic pediatric gastrointestinal issues.
- The typical presentation of celiac disease has evolved over recent years.
Purpose of the Study:
- To investigate the current clinical presentation of celiac disease in children.
- To determine if the mode of presentation has changed over time.
Main Methods:
- A prospective study of 134 children diagnosed with celiac disease.
- Data collection included clinical profiles, hemograms, liver function tests, IgA anti-tissue transglutaminase (anti-tTG), and upper gastrointestinal endoscopy.
Main Results:
- Key symptoms included diarrhea (54.5%), failure to thrive (52.2%), abdominal distension (41%), and anemia (40%).
- Short stature was observed in 60.4% of patients. Elevated serum transaminases were noted in 38.8%.
- Anti-tTG levels correlated with small intestinal damage severity; some serology-negative cases showed celiac disease histopathology.
Conclusions:
- Classical celiac disease presentations are less frequent.
- Widespread serologic testing and earlier recognition of atypical forms likely contribute to this shift.
Objective:
Celiac disease is an important cause of chronic diarrhea, failure to thrive, and anemia in children. Mode of presentation of celiac disease has changed in last few years. Study was conducted to determine the mode of clinical presentation of a large group of patients with celiac disease and whether there has been a change in the presentation with the time.
Methods:
A prospective study was conducted on 134 children diagnosed to be having celiac disease in the Pediatric Gastroenterology, PGIMER, Chandigarh, from July 1st 2006 to December 31(st) 2007. Their detailed clinical profile was recorded on a pretested proforma and all patients underwent hemogram, liver function tests, IgA anti-tissue transglutaminase (anti tTG), and upper gastro-intestinal endoscopy.
Findings:
Major symptoms at presentation were diarrhea (54.5%), failure to thrive (52.2%), abdominal distension (41%), anemia (40%), pain abdomen (19.4%), vomiting (15.7%) and constipation (2.2% of cases). 60.4% of patients had short stature. Anemia was microcytic hypochromic in 79.1% of patients, and dimorphic in 20.9%. Serum transaminases were raised in 38.8% of cases. The mean serum anti tTG level was 164.24U/ml (Range 0-749 U/ml) and levels correlated with the severity of small intestinal damage on biopsy. 15 patients were negative for the serology but 8 out of them had IgA deficiency and all had histopathology suggestive of celiac disease.
Conclusion:
Classical presentation of celiac disease is less commonly encountered these days probably related to the more widespread use of serologic testing and early recognition of atypical manifestations of celiac disease.
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