Frequency of Celiac Disease in Pediatric Patients With Chronic Diarrhea

Background Celiac disease (CD) is a prevalent immune-mediated disorder characterized by intestinal mucosal damage in individuals genetically predisposed to gluten sensitivity. The subsequent malabsorption results in gastrointestinal symptoms such as chronic diarrhea and systemic effects like impaired growth and development. Left untreated, CD can lead to various complications, including gastrointestinal malignancies. Therefore, timely diagnosis and management of CD are essential. Objective To determine the frequency of celiac disease in children with chronic diarrhea admitted to the Department of Pediatrics, Hayatabad Medical Complex, Peshawar, Pakistan. Materials and methods This cross-sectional study was conducted in the Department of Pediatrics, Hayatabad Medical Complex, Peshawar, Pakistan, from January 10, 2024, to March 15, 2025. Children under 14 years of age with a history of chronic diarrhea were enrolled in the study. Children on a gluten-free diet on clinical suspicion without formal testing, those with blood-stained diarrhea, and those with a history of abdominal surgery were excluded. A structured questionnaire was used to collect the following information: age, gender, weight in kilograms, height in centimeters, and history of CD in siblings or parents. Weight for age was categorized into underweight and normal. Similarly, height for age was categorized into short stature or normal stature. All study participants were screened for CD by determining the titers of anti-tissue transglutaminase IgA and IgG antibodies. Data were analyzed by IBM SPSS Statistics for Windows, Version 21 (IBM Corp., Armonk, NY). The presence of CD was stratified across gender, weight-for-age categories, height-for-age categories, and family history of CD. Post-stratification Chi-square test was employed to determine the statistical significance of differences in these variables between those with and without CD. Multivariate logistic regression analysis was carried out to control confounders. A p-value of less than 0.05 was considered significant for all analyses. Results Of the 165 patients, CD was diagnosed in 22 (13.3%). Of those with short stature, 15 out of 52 (28.8%) had CD compared to 07 out of 113 (6.2%) patients with normal height for age (p = <0.001). Patients with short stature were 4.4 times more likely than those with normal stature to have CD (95% CI: 1.57 - 12.38; p = 0.005). Compared to patients without a family history of CD, a significantly higher proportion (n =13, 21.3%, versus n = 09, 8.7%) of those with a positive family history were found to have CD (p = 0.021) in univariate analysis. The positive family history of CD lost its significance when adjusted for other risk factors (AOR: 2.25; 95% CI: 0.83 - 6.08; p = 0.109). Age, gender, and weight did not predict CD in these children. Conclusions Celiac disease was diagnosed in 22 out of 165 (13.3%) children with chronic diarrhea. Short stature is associated with CD in children with chronic diarrhea. Family history showed a notable but statistically insignificant association with CD. Weight was not found to be associated with CD. It is imperative that pediatricians consider the possibility of CD in patients presenting with chronic diarrhea, particularly in those with short stature.