Non-Diarrheal Celiac Disease in Iraq: A Multicenter study

Non-diarrheal celiac disease (NDCD) is increasingly recognized in Iraq, but many cases are often missed or underdiagnosed because of its non-classical presentation. This study aimed to determine the clinical features and relevant investigations for patients with NDCD in Iraq.

This is a prospective study that includes 117 cases of NDCD collected from different centers across Iraq. The study evaluated presenting symptoms, associated features, serological markers, endoscopic findings, and histopathological features. Patients with classical diarrhea were excluded from the study.

90 patients (77%) were women, and 94 patients (80%) were younger than 40 years. More than half had a normal body mass index, while a quarter of patients were classified as overweight and obese. Only 22% of patients with NDCD received a diagnosis within one year of the onset of symptoms, and 99 patients (84.6%) were suspected of having celiac disease during gastroscopy. Common symptoms among patients with NDCD included epigastric pain and anemia reported by 78.6% and 86.3% of patients, respectively. Endoscopic features suggestive of celiac disease were present in 94% of cases, and Marsh grade 3 histopathological features were observed in 75% of patients.

NDCD is more prevalent in young, normal-weight, and obese female patients. Due to non-classical presentations such as epigastric pain or anemia, there is often a delay of more than one year in receiving a diagnosis. A gastroscopy performed by an experienced doctor yields a high diagnostic success rate in identifying NDCD. Furthermore, most patients with NDCD exhibit advanced histopathological features of celiac disease in their duodenal biopsies.