Celiac disease in children: is it a problem in Kuwait?

Abstract

BackgroundCeliac disease (CD) is a chronic inflammatory disease of the small intestine triggered by gluten ingestion. The objective of this study is to describe our experience with CD children in Kuwait.MethodsThe records of children with CD seen in the pediatric gastroenterology unit between February 1998 and December 2010 were retrospectively reviewed. Patients were referred because of symptoms or positive CD antibody screening of a high-risk group (type 1 diabetes and Down syndrome).ResultsForty-seven patients were diagnosed: 53% were symptomatic and 47% were identified by screening. The median age at diagnosis was 66 (range 7–189) months. All cases were biopsy-proven except one. The symptomatic patients were significantly younger than those identified following screening (P<0.004). In the whole group, 66% were females and 77% were Kuwaitis; 9% had a positive family history of CD. The estimated cumulative incidence was 6.9/105. The median duration of symptoms before diagnosis was 8.5 (range 2–54) months. Failure to thrive was the most common presenting complaint (72%) followed by diarrhea (64%) and abdominal distension (56%). Atypical manifestations were seen in 60% of patients. Underweight and short stature were confirmed in 19% and 17% of patients, respectively. Overweight and obesity were detected in 14% and 6%, respectively. CD serology was based on a combination of antiendomysial and antigliadin antibodies. The median follow up was 24 (range 12–144) months. All patients were commenced on a gluten free diet, but good compliance was only achieved in 78%.ConclusionThe low frequency of childhood CD in Kuwait could probably be attributed to either an underestimation of the atypical presentations or failure of proper screening. Also, adherence to a gluten free diet is a major problem in our population.

Celiac disease in children: Increasing prevalence and changing clinical presentations

“…Moreover, a study from United Kingdom reported that the prevalence of CD among children older than two years had tripled over the 20 years between 1993 and 2012 13) . Similar to our study, most of the patients with CD from Kuwait were diagnosed in the second half of the study period (between 1998 and 2010) 14) .…”

“…This incidence is also low when compared to studies from Italy and United Kingdom which reported incidence of 11.9 and 11.8 per 100 000 person-years; respectively 12,13) . This variation in the prevalence and incidence of CD between different countries can be attributed to vague presentations and delayed diagnosis in one hand; and to increased number of screened high risk groups and/or increased awareness among physicians about CD on the other hand 6,14,29,30) . CD tends to manifest more in children aged 0-4 years 12) .…”

“…Recent spread of CD awareness encouraged food industries to produce ranges of harmless substitutes for gluten containing foods, but the choices are still restricted 3) . CD in children has been evaluated worldwide and in several neighboring countries to Bahrain [1][2][3][4][5][6][7][10][11][12][13][14][15][16][17][18][19][20][21] . To our knowledge, CD in children has not been evaluated in Bahrain.…”

Prevalence of celiac disease in Asia: A systematic review and meta‐analysis

“…15 While this meta-analysis has confirmed that CD is more common in women in Asia too as compared with that in men, the ratio of women to men was only 1.25, which is much lower than that observed in the Caucasian population where male-to-female ratio varies between 1:2-3. 55,56 The reason for the much lower difference in the prevalence in women and men in Asia could be secondary to inclusion of lesser number of women in the studies mentioned previously (total men, 13 067, and total women, 7502).…”

Prognostic Models for Survival in Patients with Stable Cirrhosis: A Multicenter Cohort Study

“…The discrimination ability of each proposed prognostic score was assessed by both the C-index and the Sommer"s D [21]. To adjust for overfitting, our results were internally validated with bootstrapping [22,23].…”