Non-Diarrheal Celiac Disease in Iraq: A Multicenter study

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Research

Background:

• Non-diarrheal celiac disease (NDCD) is increasingly recognized but often underdiagnosed in Iraq due to atypical presentations.
• Classical celiac disease symptoms are often absent, complicating early identification.

Purpose of the Study:

• To determine the clinical features of NDCD patients in Iraq.
• To identify relevant investigations for diagnosing NDCD.

Main Methods:

• A prospective study of 117 NDCD cases across Iraq.
• Evaluation of symptoms, serology, endoscopy, and histopathology.
• Exclusion of patients with classical diarrhea.

Main Results:

• NDCD predominantly affects young women (77%) and those with normal to obese BMI.
• Diagnosis is often delayed over a year, with epigastric pain (78.6%) and anemia (86.3%) being common symptoms.
• Gastroscopy identified suspected celiac disease in 84.6%, with 94% showing suggestive endoscopic and 75% Marsh grade 3 histopathological features.

Conclusions:

• NDCD is prevalent in young, normal-weight to obese females, often presenting with non-classical symptoms like epigastric pain and anemia.
• Delayed diagnosis is common, exceeding one year, underscoring the need for increased awareness.
• Gastroscopy and duodenal biopsies are crucial for diagnosis, revealing advanced histopathological changes in most NDCD patients.