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Celiac disease in children: Increasing prevalence and changing clinical presentations
Hasan M Isa1, Eman Farid2, Jaafar J Makhlooq3
1Pediatric Department, Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain.
Insights
Celiac disease (CD) prevalence increased significantly in Bahraini children over the last decade. Many children presented atypically, and adherence to the gluten-free diet (GFD) was poor.
Area of Science:
- Pediatric Gastroenterology
- Autoimmune Diseases
- Clinical Epidemiology
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten in genetically predisposed individuals.
- Its prevalence and clinical manifestations exhibit significant geographical and population-based variability.
Purpose of the Study:
- To investigate the prevalence and clinical characteristics of celiac disease (CD) in pediatric patients in Bahrain.
- To analyze trends in CD diagnosis and patient outcomes over a 30-year period.
Main Methods:
- Retrospective review of medical records for children diagnosed with CD (1988-2018) at Salmaniya Medical Complex, Bahrain.
- Documentation of clinical, serological, biochemical, and histopathological findings.
- Assessment of adherence to the gluten-free diet (GFD).
Main Results:
- A total of 67 children were included, with a CD prevalence of 0.02%, showing a significant increase in the last decade (P<0.0001).
- Pallor and failure to thrive were common presentations; iron-deficiency anemia was the most frequent associated condition (69.7%).
- Poor GFD adherence was observed in 64.3% of patients, with seropositive individuals being older and having more severe duodenal histology.
Conclusions:
- Celiac disease (CD) prevalence has markedly increased in Bahraini children over the past decade.
- Atypical presentations are common, and adherence to the gluten-free diet (GFD) remains a significant challenge.
- Findings highlight the need for increased awareness and improved management strategies for pediatric CD.
Background:
Celiac disease (CD) is a chronic autoimmune enteropathy. It results from genetic predisposition and exposure to gluten-containing food. The prevalence and presentation of CD vary among populations.
Purpose:
This study aimed to describe the prevalence and clinical characteristics of CD in children in Bahrain.
Methods:
We retrospectively reviewed the medical records of children diagnosed with CD in the pediatric department, Salmaniya Medical Complex, Bahrain, in 1988-2018. Their clinical, biochemical, serological, and histopathological findings were documented. Adherence to the recommended gluten-free diet (GFD) was assessed.
Results:
Of 86 patients with CD, 67 were included. The CD prevalence was 0.02%. A significant increase in prevalence in the last decade was observed (P<0.0001). Thirty-eight patients (56.7%) were males. The median (interquartile range) age at presentation was 4.45 (1.5-7.3) years. A family history of CD was positive in 13 out of 43 patients (30.2%). Pallor and failure to thrive were the most common presentations. The most frequent associated disease was iron-deficiency anemia in 23 patients (69.7%). Positive serology was found in 32 of 45 patients (71.1%). Marsh-Oberhuber type III was found in 16 of 35 patients (45.7%). Seropositive patients were significantly older (P=0.025) and had more severe duodenal histology (P=0.002). Adherence to GFD was poor in 27 patients (64.3%).
Conclusion:
This study revealed a significant increase in CD prevalence over the last decade. Atypical presentations were frequent. Most patients had poor adherence to GFD.
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