Document Type : original article
Authors
- Seyed Ali Jafari 1
- Atefeh Aatarian 2
- Hamidreza Kianifar 3
- Mohammadali Kiani 2
- Maryam Khalesi 4
- Forough Rakhshanizadeh 5
1 Department of Pediatric Gastroenterology, Ghaem Medical Center, Mashhad University of medical sciences, Mashhad, Iran.
2 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Department of Gastroenterology,Faculty of medicine,Mashhad university of medical sciences,Mashhad,Iran
4 Department of Pediatrics, Ghaem Medical Center, Mashhad University of medical sciences, Mashhad, Iran.
5 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
Background: The prevalence of celiac disease, which is gastrointestinal enteropathy, is increasing. This study aimed to assess the clinical presentations of celiac disease in children.
Methods: The current research is a descriptive-cross-sectional study conducted on 200 children with celiac disease who presented to the gastroenterology clinic of Ghaem Hospital. All patients with celiac disease, presented between 2016 and 2021 were included. For all patients, a checklist including demographic information such as age, sex, weight, weight Z score, height, height Z score, the initial clinical presentations leading to the diagnosis, laboratory examinations including CBC, Anti-TTG IgA, as well as pathological findings including biopsy, and Marsh score were recorded. Subsequently, the findings were described using the frequency table.
Results: Out of 200 children examined, 65.5% were girls, and 34.5% were boys. The average age of the patients was 7.70±3.71 years. The most common clinical presentations were: growth failure (38.5%), diabetes (21%), and abdominal pain (15.5%). The average Anti TTG (IgA) level of the patients in the study was 202.03, with a standard deviation of 146.05. Also, the weight z score for the age of the studied subjects varied between 64 and 147, and its average was 2.06 with a standard deviation of 10.85. The height Z score for age ranged between 6 and 6.7, with the average was 0.87, and a standard deviation of 1.63.
Conclusion: In the current study, growth failure was the most common clinical presentation. As children with celiac disease do not always have the typical presentations such as diarrhea, abdominal pain, steatorrhea, and bloating, it is recommended that the atypical presentations be also noted, particularly growth failure.
Keywords
- Rostami K, Malekzadeh R, Shahbazkhani B, Akbari MR, Catassi C. Coeliac disease in Middle Eastern countries: a challenge for the evolutionary history of this complex disorder?. Digestive and liver disease. 2004 Oct 1; 36(10):694-7.
- Sahin Y. Celiac disease in children: a review of the literature. World Journal of Clinical Pediatrics. 2021 Jul 7; 10(4):53.
- Gunnarsdottir S, Albrektsson H, Frydenbo J, Miron N, Kindblom JM, Størdal K, Mårild K. Celiac disease screening at a pediatric outpatient clinic: a feasibility study. Scandinavian Journal of Gastroenterology. 2022 Mar 31:1-9.
- Book L, Zone JJ, Neuhausen SL. PPrevalence of Celiac Disease Among Relatives of Sib Pairs With Celiac Disease in US Families. The American journal of gastroenterology. 2003;98(2):377
- Vitoria J, Arrieta A, Astigarraga I, Garcia-Masdevall D, Rodriguez-Soriano J. Use of serological markers as a screening test in family members of patients with celiac disease. Journal of pediatric gastroenterology and nutrition. 1994; 19(3):304-9.
- Rodrigo L. Celiac disease. World journal of gastroenterology: WJG. 2006; 12(41):6577.
- Abdulkarim A, Murray J. The diagnosis of coeliac disease. Alimentary pharmacology & therapeutics. 2003; 17(8):987-95.
- Farrell RJ, Kelly CP. Diagnosis of celiac sprue. The American journal of gastroenterology. 2001; 96(12):3237.
- James SP. National Institutes of Health consensus development conference statement on celiac disease, June 28–30, 2004. Gastroenterology. 2005; 128(4):S1-S9.
- Jericho H, Sansotta N, Guandalini S. Extraintestinal Manifestations of Celiac Disease: Effectiveness of the Gluten-Free Diet. J Pediatr Gastroenterol Nutr. 2017; 65:75–79.
- Nurminen S, Kivelä L, Huhtala H, Kaukinen K, Kurppa K. Extraintestinal manifestations were common in children with coeliac disease and were more prevalent in patients with more severe clinical and histological presentation. Acta Paediatr. 2019; 108:681–687.
- Dewar DH, Ciclitira PJ. Clinical features and diagnosis of celiac disease. Gastroenterology. 2005; 128(4):S19-S24.
- Giersiepen K, Lelgemann M, Stuhldreher N, Ronfani L, Husby S, Koletzko S, Korponay-Szabó IR, ESPGHAN Working Group on Coeliac Disease Diagnosis. Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report. Journal of pediatric gastroenterology and nutrition. 2012; 54(2):229-41.
- Agarwal J, Poddar U, Yachha SK, Srivastava A. Refeeding syndrome in children in developing countries who have celiac disease. Journal of pediatric gastroenterology and nutrition. 2012; 54(4):521-4.
- Catassi C. Celiac crisis/refeeding syndrome combination: New mechanism for an old complication. Journal of pediatric gastroenterology and nutrition. 2012; 54(4):442-3.
- Whitaker J, West J, Holmes G, Logan R. Patient perceptions of the burden of coeliac disease and its treatment in the UK. Alimentary pharmacology & therapeutics. 2009; 29(10):1131-6.
- Nilsen EM, Jahnsen FL, Lundin KE, Johansen FE, Fausa O, Sollid LM, Jahnsen J, Scott H, Brandtzaeg P. Gluten induces an intestinal cytokine response strongly dominated by interferon gamma in patients with celiac disease. Gastroenterology. 1998; 115(3):551-63.
- Lebwohl B, Rubio-Tapia A (2021) Epidemiology, Presentation, and Diagnosis of Celiac Disease. Gastroenterology 160(1):63–75
- Farrell RJ, Kelly CP. Celiac sprue. New England Journal of Medicine. 2002; 346(3):180-8.
- West J, Logan R, Hill P, Lloyd A, Lewis S, Hubbard R, Reader R, Holmes G K T, Khaw K-T. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut. 2003; 52(7):960-5.
- James MW, Scott BB. Coeliac disease: the cause of the various associated disorders? European journal of gastroenterology & hepatology. 2001; 13(9):1119-21.
- Wessels M, Auricchio R, Dolinsek J, Donat E, Gillett P, Mårild K, Meijer C, Popp A, Mearin ML. Review on pediatric coeliac disease from a clinical perspective. European Journal of Pediatrics. 2022 Jan 15:1-1.
- Shahbazkhani B, Malekzadeh R, Sotoudeh M, Moghadam KF, Farhadi M, Ansari R, Elahyfar A, Rostami K. High prevalence of coeliac disease in apparently healthy Iranian blood donors. European journal of gastroenterology & hepatology. 2003; 15(5):475 hyphen.
- Alvi MY, Abbas MU, Ahmed MU, Farooq A, Kazi MY. Clinical presentation of celiac disease in children. Pak J Med Health Sci. 2010; 4(4):552-4.
- Poddar U, Thapa BR, Singh K. Clinical features of celiac disease in Indian children: are they different from the West? Journal of pediatric gastroenterology and nutrition. 2006; 43(3):313-7.
- Hoffenberg EJ, Emery LM, Barriga KJ, Bao F, Taylor J, Eisenbarth GS, Haas JE, Sokol RJ, Taki I, Norris JM, Rewers M. Clinical features of children with screening-identified evidence of celiac disease. Pediatrics. 2004; 113(5):1254-9.
- Khuhro A, Parkash A, Cheema HA. Frequency of common clinical presentation of celiac disease in children. Eur Acad Res. 2015; 10:13223-31.
- Kuloğlu Z, Kırsaçlıoğlu CT, Kansu A, Ensari A, Girgin N. Celiac disease: presentation of 109 children. Yonsei medical journal. 2009; 50 (5):617-23.
)