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Clinical spectrum & changing presentation of celiac disease in Indian children
Sadhna Bhasin Lal1, Vybhav Venkatesh1, Aradhana Aneja1
1Division of Paediatric Gastroenterology & Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Insights
Celiac disease (CD) in children presents differently based on age, with younger children showing classical symptoms and older children increasingly exhibiting non-classical forms. This trend suggests evolving diagnostic patterns for this gluten intolerance disorder.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Genetics
Background:
- Celiac disease (CD) is an immune-mediated disorder triggered by gluten intolerance.
- This study assesses the clinical, serological, and histological profile of pediatric CD in North India.
- It investigates changing trends in CD presentation over two decades.
Approach:
- Retrospective analysis of clinical data from 891 children diagnosed between 2000 and 2019.
- Evaluation of demographic information, symptoms, associated autoimmune conditions, serology, and biopsy findings.
- Analysis of gluten-free diet adherence and its correlation with clinical outcomes.
Key Points:
- Classical CD symptoms (diarrhea, abdominal distension, growth faltering) were common in younger children.
- Non-classical CD presentations were more prevalent in older children (>10 years) and those diagnosed after 2010.
- Associated autoimmune conditions like Type 1 Diabetes Mellitus (T1DM) and thyroid disorders were noted, with higher frequency in non-compliant patients.
Conclusions:
- Pediatric CD presentation varies significantly with age, shifting towards non-classical forms in recent years.
- Early diagnosis and adherence to a gluten-free diet are crucial for managing associated autoimmune conditions.
- This study highlights the largest single-center cohort of pediatric CD in North India, providing valuable insights into disease trends.
Background & Objectives:
Celiac disease (CD) is a genetic immune mediated disorder characterised by gluten intolerance. This single centre study, from north India was aimed to assess the clinical, serological and histological profile of CD in a large cohort of children and the changing trends in its presentation.
Methods:
A review of clinical details of CD children diagnosed between 2000 and 2019 and currently on follow up was performed. Information on demography, symptoms, associated conditions, serology, biopsy findings and gluten-free diet were analyzed.
Results:
The mean age (±standard deviation) of 891 children included in the study, at onset and at diagnosis was 4.0±2.7 and 6.2±3.1 yr, respectively. Growth faltering, abdominal pain, abdominal distension and diarrhoea were presenting symptoms in 70, 64.2, 61.2 and 58.2 per cent, respectively. A positive family history of CD was present in 14 per cent and autoimmune conditions in 12.3 per cent of children. Thyroid disorders were seen in 8.5 per cent of children and Type 1 diabetes mellitus (T1DM) in 5.7 per cent. The duration of breastfeeding had a weak positive correlation with age at onset and diagnosis of CD (P<0.001). Non-classical CD was significantly more common in children aged >10 yr and in those presenting after 2010 (P<0.01). T1DM and hypothyroidism occurred more frequently in non-compliant children.
Interpretation & Conclusions:
This was the largest single centre study, pertaining to the presentation and follow up of CD in children. Infants and young children were more likely to present with classical symptoms of diarrhoea, abdominal distension and growth failure while older children presented with non-classical CD. There was a trend towards non-classical forms of CD in recent years.
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