Spectrum of Clinical Presentation of Celiac Disease in Pediatric Population

Abstract

BackgroundClassic form of celiac disease (CCD) presents with diarrhea and is traditionally taught as malabsorption syndrome. This form of CD is diagnosed with ease but non-classical form presenting without diarrhea is often missed and heavily underdiagnosed. ObjectiveTo determine the clinical spectrum of patients with CD. MethodsThis study was conducted in the Department of Gastroenterology & Hepatology at the Children's Hospital, Lahore. Confirmed CD children according to NASPGHAN (North American Society of Pediatric Gastroenterology, Hepatology & Nutrition) criteria were enrolled in this study from June to September, 2020. Initial positivity followed by small bowel biopsy with Modified Marsh 2 and above is considered consistent with the diagnosis of CD. ResultsA total of 90 patients were selected according to NASPGHAN criteria, 77 (85.6%) patients had CCD whereas 13 (14.4%) patients had non-classical CD (NCCD). The mean ± SD age at diagnosis of CCD was 2.6 ± 2.3 years whereas mean ± SD in NCCD was 9 ± 1.8 years. Females clearly predominate in our cohort in general. Chronic diarrhea followed by failure to thrive (85%) were the most common symptoms in CCD whereas short stature (69%) was the most frequent feature in NCCD. Among CD patients, tissue transglutaminaseimmunoglobulin A (TTG-IgA) titre was significantly high (>10 times) in 80% of CD patients and the rest had positivity but not up to 10 times. There was no significant difference in titre of anti-TTG between CCD and NCCD. ConclusionClassical CD is still the most common in developing countries like Pakistan. High index of suspicion of CD should be maintained for patients who present with short stature, recurrent abdominal pain and refractory anemia.

Clinical Presentation of Pediatric Celiac Disease Patients in the Qassim Region Over Recent Years

“…detected in 91.5%, but there was no difference in titers between classical and non-classical CD. In another study conducted by Imran et al [9], they found that the tTG-IgA titer was significantly higher in 80% of the CD patients, which was also comparable with our results.…”

“…Furthermore, in our study, the majority of the pediatric patients were females (71.4%), with no difference between symptomatic and asymptomatic CD. A similar proportion of CD cases has been reported by Imran et al [9], where females have CD more than males, which is also consistent with the paper of Dehbozorgi et al…”

“…Studies suggest that the predominant symptom of CD is chronic diarrhea [5,7,9]. The most common symptoms were abdominal distention and chronic diarrhea among the ten symptomatic patients in this study.…”

“…A report showed low ferritin, a moderate to severe vitamin D deficiency, and anemia as extraintestinal signs [8]. Chronic diarrhea was followed by failure to thrive in the classical type, whereas short stature was the most frequent feature observed in non-classical CD [9].…”

Clinical Presentation Is Dependent on Age and Calendar Year of Diagnosis in Celiac Disease: A Hungarian Cross-Sectional Study

“…Unexpectedly, an older age at diagnosis was significantly associated with classical presentations in our study. The literature data are rather conflicting on this matter: classical presentation still prevails only in younger children (<3 years of age) [ 41 , 42 , 43 , 44 , 45 ]. Our results might be explained by the fact that CeD patients with non-classical presentations are less frequently—and less effectively—recognized in adulthood.…”