CELIAC DISEASE

A MEDLEY OF CLINICAL FEATURES A TERTIARY CARE HOSPITAL EXPERIENCE.

Abstract

Background: Celiac disease (CD) is an immune-mediated enteropathy stimulated
by intake of gluten, rye and barley in genetically prone persons. In children, gastrointestinal
symptoms are usual if disease is diagnosed in first two years of life but as the age at onset of the
illness advances to late years, extra-intestinal manifestations have been increasingly recognized
affecting almost all organ systems. Objectives: To determine the prevalence of varied clinical
manifestations of CD in children. To assess classical and non-classical features in patients with
CD. Study Design: Cross sectional study. Setting: Nishtar Hospital Multan. Period: July 2016
to July 2017. Material & Methods: Ninety-six patients with celiac disease were analyzed. The
diagnosis was confirmed by serological antibodies and positive biopsy wherever needed. All
the cases were evaluated for different intestinal or extra-intestinal features. Also the cases were
categorized based on their primary clinical features into two groups. The classical group had
CD patients with usual symptoms. The non-classical group had atypical symptoms. Results:
The mean age of CD patients at the time of diagnosis was 5.98 ± 3.19 years. Median value
for duration of clinical symptoms was 24 months. The common typical clinical presentations
included failure to thrive 86 (89.6%), short stature 86 (89.6%), diarrhea 78 (81.3%), unexplained
anemia 78 (81.3%) and clubbing 41 (42.7%). The atypical features noted in our study were
constipation 21 (21.9%), hypertransaminasemia 38 (39.6 %) and neurological symptoms like
irritability/ behavioral changes 41 (42.7%). Family history of gluten allergy or other autoimmune
diseases was present in 29 (30.2%) of patients. Children presented with non-classical symptoms
were older than 2 years of age and they showed high prevalence of associated immune and
non immune diseases compared to those in classical group. Conclusion: The knowledge of
varied behavior of CD may prevent delay in diagnosis. CD must be particularly screened in
patients with unexpected anemia, rickets, clubbing, short stature and in cases with positive
history in family.