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Serologic, endoscopic and pathologic findings in pediatric celiac disease: A single center experience in a low/middle
Hala H Mansour1, Nabil A Mohsen1, Mortada Hf El-Shabrawi2
1Department of Pediatrics, Faculty of Medicine Kasr Al Ainy, Cairo University, Cairo 12411, Egypt.
Insights
Celiac disease (CD) presentations in low/middle-income countries (LMICs) show clinical variability, similar to industrialized nations. Older age was a predictor for atypical CD, highlighting the need for global incidence studies.
Area of Science:
- Gastroenterology
- Pediatric Medicine
- Immunology
Background:
- Global celiac disease (CD) incidence data is incomplete, necessitating studies in Africa, Asia, and Latin America.
- Understanding CD in low/middle-income countries (LMICs) is crucial for a comprehensive global picture.
Purpose of the Study:
- To characterize serological, endoscopic, and histological findings in pediatric CD patients.
- To differentiate between typical and atypical CD presentations in an African LMIC setting.
Main Methods:
- Observational study of 199 pediatric CD patients (2010-2019).
- Patients categorized into typical (120) and atypical (79) groups based on symptoms.
- Serology, upper GI endoscopy with duodenal biopsies, and Marsh-Oberhuber classification used.
Main Results:
- Chronic diarrhea was the primary symptom in typical CD; anemia was the most common extraintestinal manifestation in both groups.
- Higher Marsh-Oberhuber grades (3b, 3c) correlated with seropositivity (P=0.007).
- Histological grade strongly correlated with clinical presentation (P<0.001); older age predicted atypical CD (P<0.001).
Conclusions:
- Pediatric celiac disease exhibits significant clinical variability in LMICs, mirroring findings in industrialized nations.
- Older age is a key predictor for atypical celiac disease presentation.
- Further global research is essential to fully understand celiac disease epidemiology.
Background:
Studies in Africa, Asia, and Latin America are needed to provide a comprehensive picture of the global incidence of celiac disease (CD).
Aim:
To describe the serology, endoscopic and histological findings in typical and atypical presentations of pediatric CD at a tertiary referral hospital in an African low/middle income country (LMIC).
Methods:
This observational study was conducted on 199 patients with CD from 2010 to 2019. The patients were divided into typical and atypical groups according to the presenting symptoms including 120 and 79 patients respectively. Serology, upper gastrointestinal endoscopy with duodenal biopsy were performed for patients who had symptoms suggestive of CD. The severity of the intestinal damage was graded according to the histo-pathologic Marsh-Oberhuber classification.
Results:
Chronic diarrhea was the main intestinal presentation in the typical group. Anemia was the most common extraintestinal symptom in both the typical and atypical group. Marsh-Oberhuber type 3b and 3c was significantly higher in the seropositive patients with a P value of 0.007. A significant correlation was observed between the histological grade of the biopsied duodenal mucosa and the clinical presentation (P < 0.001). Age was significantly higher in the atypical group (P value < 0.001).
Conclusion:
Although typical CD was observed in 120 patients in this study, the clinical variability of the condition was frequently observed. Age only was a significant predictor for the appearance of atypical CD. Therefore, CD presentations in LMIC are not different from industrialized countries.
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