Celiac Disease Investigation with Marsh Classification in Paediatric Population

Abstract

Objective: To determine the celiac disease using Marsh classification in the paediatric population at the Pak Emirates Military Hospital.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Paediatrics, Pak Emirates Military Hospital Rawalpindi Pakistan, from Aug 2020 till Mar 2021.
 Methodology: Patients of either gender aged 1 to 14 years with three or more clinical features of celiac disease such as chronic diarrhoea, any degree of malnutrition, short stature, abdominal distension, anaemia, and clubbing at the time of admission, were included in this study.
 Results: There were 97 patients in this study. Among them, 61 (62.9%) were males, and 36 (37.1%) were females. There were 56 (57.7%) patients who were histology positive and 41 (42.3%) patients who were histology negative. There were 37 (38.1%) patients in Marsh III a, 15 (15.5%) were in Marsh III b, and 4 (4.1%) patients were in the Marsh III c category. Gender distribution showed that 33 (58.9%) males were positive compared to 23 (41.1%) females. Even though the frequency was higher among males, the difference was not statistically significant (p-value=0.23).
 Conclusion: Celiac disease is a possible reason for anaemia among patients with iron deficiency anaemia of unknown origin. Therefore, the histopathological diagnosis should be completed when celiac disease is suspected.

Celiac Disease in Moroccan Children: Diagnostic Characteristics and Determinants of Diagnosis Delay

“…In the Iranian series, biopsy showed that 90.4% of the studied population had villous atrophy of varying degrees [ 89 ], and histologic examination also showed atrophy in 92% of cases [ 90 ]. In contrast, a study from the United Arab Emirates showed histologic positivity in only 57.7% of cases [ 91 ].…”

“…Despite numerous studies, questions regarding delayed diagnosis remain unanswered [ 78 ]. In our context, possible explanations for the delay in diagnosis are (1) The erroneous belief that CD is rare and pediatric [ 91 , 98 , 99 ]; (2) lack of awareness of the variability of clinical presentation [ 37 , 75 , 85 , 91 ]; (3) difficulty of access to care in developing countries [ 45 , 57 , 100 , 101 ]; (4) lack of screening in at-risk individuals [ 58 , 75 , 85 ], and the nutritional and epidemiological transition that is currently undergoing in Morocco [ 102 , 103 ].…”

“…Despite numerous studies, questions regarding delayed diagnosis remain unanswered [78]. In our context, possible explanations for the delay in diagnosis are (1) The erroneous belief that CD is rare and pediatric [91,98,99];…”

“…(2) lack of awareness of the variability of clinical presentation [37,75,85,91]; (3) difficulty of access to care in developing countries [45,57,100,101]; (4) lack of screening in at-risk individuals [58,75,85], and the nutritional and epidemiological transition that is currently undergoing in Morocco [102,103].…”

Epidemiology of Celiac Disease in Western Iran during 2019-2021

“…However, in pediatric patients (under 14 years), the diagnosis was based solely on positive serological tests. In the current study, duodenal biopsy samples were assessed by a pathologist following the guidelines of Marsh's classification system [ 13 ], evaluating the presence of villous atrophy, crypt hyperplasia, and other histological features. Marsh stage 2 and above were considered positive.…”