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Celiac disease in children: is it a problem in Kuwait?
Wafa'a Al-Qabandi1, Eman Buhamrah2, Dalia Al-Abdulrazzaq1
1Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait.
Insights
This study describes celiac disease (CD) in Kuwaiti children, finding a low frequency possibly due to underdiagnosis of atypical cases and poor adherence to gluten-free diets. Early diagnosis is crucial for managing this chronic inflammatory condition.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Public Health
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten, affecting the small intestine.
- Understanding the prevalence and characteristics of childhood CD in Kuwait is essential for public health initiatives.
Purpose of the Study:
- To report the experience and epidemiological data of pediatric celiac disease cases in Kuwait.
- To analyze the clinical presentation, diagnosis, and management of children with CD.
Main Methods:
- Retrospective review of medical records of children diagnosed with CD between 1998 and 2010.
- Inclusion criteria involved symptoms or positive antibody screening in high-risk groups (e.g., type 1 diabetes, Down syndrome).
Main Results:
- Forty-seven children were diagnosed with biopsy-proven CD (one exception).
- Symptomatic children were younger at diagnosis than screened cases; 66% were female, 77% Kuwaiti.
- Failure to thrive (72%), diarrhea (64%), and abdominal distension (56%) were common; 60% had atypical presentations.
Conclusions:
- The low incidence of childhood CD in Kuwait may stem from underestimating atypical presentations or inadequate screening.
- Adherence to a gluten-free diet remains a significant challenge in this population.
Background:
Celiac disease (CD) is a chronic inflammatory disease of the small intestine triggered by gluten ingestion. The objective of this study is to describe our experience with CD children in Kuwait.
Methods:
The records of children with CD seen in the pediatric gastroenterology unit between February 1998 and December 2010 were retrospectively reviewed. Patients were referred because of symptoms or positive CD antibody screening of a high-risk group (type 1 diabetes and Down syndrome).
Results:
Forty-seven patients were diagnosed: 53% were symptomatic and 47% were identified by screening. The median age at diagnosis was 66 (range 7-189) months. All cases were biopsy-proven except one. The symptomatic patients were significantly younger than those identified following screening (P<0.004). In the whole group, 66% were females and 77% were Kuwaitis; 9% had a positive family history of CD. The estimated cumulative incidence was 6.9/10(5). The median duration of symptoms before diagnosis was 8.5 (range 2-54) months. Failure to thrive was the most common presenting complaint (72%) followed by diarrhea (64%) and abdominal distension (56%). Atypical manifestations were seen in 60% of patients. Underweight and short stature were confirmed in 19% and 17% of patients, respectively. Overweight and obesity were detected in 14% and 6%, respectively. CD serology was based on a combination of antiendomysial and antigliadin antibodies. The median follow up was 24 (range 12-144) months. All patients were commenced on a gluten free diet, but good compliance was only achieved in 78%.
Conclusion:
The low frequency of childhood CD in Kuwait could probably be attributed to either an underestimation of the atypical presentations or failure of proper screening. Also, adherence to a gluten free diet is a major problem in our population.