Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Celiac disease in children: increasing prevalence and changing clinical presentations

  • Isa, Hasan M. (Pediatric Department, Salmaniya Medical Complex, Arabian Gulf University) ;
  • Farid, Eman (Pathology Department, Salmaniya Medical Complex, Arabian Gulf University) ;
  • Makhlooq, Jaafar J. (Pediatric Department, Salmaniya Medical Complex) ;
  • Mohamed, Afaf M. (Puplic Health Department, Ministry of Health) ;
  • Al-Arayedh, Jumana G. (Pediatric Department, Salmaniya Medical Complex) ;
  • Alahmed, Fawzeya A. (Pediatric Department, Salmaniya Medical Complex) ;
  • Medani, Shima (Pathology Department, Salmaniya Medical Complex)
  • Received : 2020.03.05
  • Accepted : 2020.09.22
  • Published : 2021.06.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Celiac disease (CD) is a chronic autoimmune enteropathy. It results from genetic predisposition and exposure to gluten-containing food. The prevalence and presentation of CD vary among populations. Purpose: This study aimed to describe the prevalence and clinical characteristics of CD in children in Bahrain. Methods: We retrospectively reviewed the medical records of children diagnosed with CD in the pediatric department, Salmaniya Medical Complex, Bahrain, in 1988-2018. Their clinical, biochemical, serological, and histopathological findings were documented. Adherence to the recommended gluten-free diet (GFD) was assessed. Results: Of 86 patients with CD, 67 were included. The CD prevalence was 0.02%. A significant increase in prevalence in the last decade was observed (P<0.0001). Thirty-eight patients (56.7%) were males. The median (interquartile range) age at presentation was 4.45 (1.5-7.3) years. A family history of CD was positive in 13 out of 43 patients (30.2%). Pallor and failure to thrive were the most common presentations. The most frequent associated disease was iron-deficiency anemia in 23 patients (69.7%). Positive serology was found in 32 of 45 patients (71.1%). Marsh-Oberhuber type III was found in 16 of 35 patients (45.7%). Seropositive patients were significantly older (P=0.025) and had more severe duodenal histology (P=0.002). Adherence to GFD was poor in 27 patients (64.3%). Conclusion: This study revealed a significant increase in CD prevalence over the last decade. Atypical presentations were frequent. Most patients had poor adherence to GFD.

Keywords

References

  1. Cakir M, Baran M, Ucar F, Akbulut UE, Kaklikkaya N, Ersoz S. Accuracy of HLA-DQ genotyping in combination with IgA anti-tissue transglutaminase serology and a "scoring system" for the diagnosis of celiac disease in Turkish children. Turk J Pediatr 2014;56:347-53.
  2. Ertekin V, Selimoglu MA, Altinkaynak S. Celiac disease in childhood: evaluation of 140 patients. Eurasian J Med 2009;41:154-7.
  3. Alsarkhy A, Elmouzan MI, Elshazaly S, Alanazi A, Alghamdi S, Anil S, et al. Clinical characteristics of celiac disease and dietary adherence to gluten free diet among Saudi children. Pediatr Gastroenterol Hepatol Nutr 2015;18:23-9. https://doi.org/10.5223/pghn.2015.18.1.23
  4. Lionetti E, Castellaneta S, Francavilla R, Pulvirenti A, Tonutti E, Amarri S, et al. Introduction of gluten, HLA status, and the risk of celiac disease in children. N Engl J Med 2014;371:1295-303. https://doi.org/10.1056/NEJMoa1400697
  5. Szaflarska-Poplawska A, Parzccka M, Kuczynska R. The range of lesions in the small intestine of children with celiac disease determined by capsule endoscopy. Adv Clin Exp Med 2014;23:785-90. https://doi.org/10.17219/acem/37252
  6. Laass MW, Schmitz R, Uhlig HH, Zimmer KP, Thamm M, Koletzko S. The prevalence of celiac disease in children and adolescents in Germany. Dtsch Arztebl Int 2015;122:553-60.
  7. Dehghani SM, Ehsaei Z, Honar N, Javaherizadeh H. Frequency of celiac disease in children with chronic functional constipation in Shiraz-Iran. Middle East J Dig Dis 2015;7:166-9.
  8. Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol 2012;107:1538-44. https://doi.org/10.1038/ajg.2012.219
  9. Al Hatlani MM. Prevalence of celiac disease among symptom-free children from the Eastern Province of Saudi Arabia. Saudi J Gastroenterol 2015;21:367-71. https://doi.org/10.4103/1319-3767.170952
  10. Rawal P, Thapa BR, Nain CK, Prasad KK, Singh K. Changing spectrum of celiac disease in India. Iran J Pediatr 2010;20:459-65.
  11. Tanpowpong P, Broder-Fingert S, Katz AJ, Camargo Jr CA. Age-related patterns in clinical presentations and gluten-related issues among children and adolescents with celiac disease. Clin Transl Gastroenterol 2012;3:e9. https://doi.org/10.1038/ctg.2012.4
  12. Zingone F, West J, Auricchio R, Bevilacqua RM, Bile G, Borgheresi P, et al. Incidence and distribution of celiac disease in Campania (Italy): 2011-2013. United European Gastroenterol J 2015;3:182-9. https://doi.org/10.1177/2050640615571021
  13. Zingone F, West J, Crooks CJ, Fleming KM, Timothy RC, Ciacci C, et al. Socioeconomic variation in the incidence of childhood coeliac disease in the UK. Arch Dis Child 2015;100:466-73. https://doi.org/10.1136/archdischild-2014-307105
  14. Al-Qabandi W, Buhamrah E, Alabdulrazzaq D, Hamadi K, AlRefaee F. Celiac disease in children: is it a problem in Kuwait? Clin Exp Gastroenterol 2015;8:43-8. https://doi.org/10.2147/CEG.S73067
  15. Nurminen S, Kivela L, Taavela J, Huhtala H, Maki M, Kaukinen K, et al. Factors associated with growth disturbance at celiac disease diagnosis in children: a retrospective cohort study. BMC Gastroenterol 2015;15:125. https://doi.org/10.1186/s12876-015-0357-4
  16. Shahramian I, Dehghani SM, Haghighat M, Noori NM, Teimouri A, Sharafi E, et al. Serological evaluation of celiac disease in children with congenital heart defect; a case cohort study. Middle East J Dig Dis 2015; 7:98-103.
  17. Al-Lawati TT, Al-Musawi HS. Celiac disease in Oman: a tertiary centre experience. Oman Med J 2013;28:70-2. https://doi.org/10.5001/omj.2013.17
  18. Cruz NS, Barca AMC, Valenzuela JGH. Celiac disease in children from the northwest of Mexico: clinical characteristics of 24 cases. Rev Gastroenterol Mex 2013;78:211-8.
  19. Osman M, Taha M, Al Duboni G. Assessment of the response to gluten-free diet in an Iraqi population with coeliac disease. A histological and serological follow-up study. Arch Med Sci 2014;10:294-9. https://doi.org/10.5114/aoms.2012.31297
  20. Mubarak A, Wolters VM, Houwen RHJ, Kate FJWT. Immunohistochemical CD3 staining detects additional patients with celiac disease. World J Gastroenterol 2015;21:7553-7. https://doi.org/10.3748/wjg.v21.i24.7553
  21. Abdulsultan A, Crooks CJ, Card T, Tata LJ, Fleming KM, West J. Causes of death in people with coeliac disease in England compared with the general population: a competing risk analysis. Gut 2015;24:1220-6.
  22. Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders D, Cellier C, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J 2019;7:583-613. https://doi.org/10.1177/2050640619844125
  23. Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips jjA, Shamir R, et al. European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012;54:136-60. https://doi.org/10.1097/MPG.0b013e31821a23d0
  24. Song SM, Kim Y, Oh SH, Kim KM. Nutritional status and growth in Korean children with Crohn's disease: a single-center study. Gut Liver 2014;8:500-7. https://doi.org/10.5009/gnl13183
  25. Bouri S, Martin J. Investigation of iron deficiency anaemia. Clin Med 2108; l8:242-4.
  26. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva (Switzerland): World Health Organization, 2006:312.
  27. De Onis M, Onyango AW, Porghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth references for school-aged children and adolescents. Bull World Health Organ 2007;85:660-7. https://doi.org/10.2471/BLT.07.043497
  28. Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018;16:823-36. https://doi.org/10.1016/j.cgh.2017.06.037
  29. Popp A, Maki M. Changing pattern of childhood celiac disease epidemiology: contributing factors. Front Pediatr 2019;7:357 https://doi.org/10.3389/fped.2019.00357
  30. Nardecchia S, Auricchio R, Discepolo V, Troncone R. Extraintestinal manifestations of coeliac disease in children: clinical features and mechanisms. Front Pediatr 2019;7:56. https://doi.org/10.3389/fped.2019.00056
  31. Al-Haddad L, Al-Dubaib R, Al-Najem W, Al-Shaikh Z, Al-Ghawi A. Iron deficiency anemia among 3-year-old children and its management in primary health care in Bahrain. J Bahrain Med Soc 2017;29:35-40. https://doi.org/10.26715/jbms.29.3.2017.44a
  32. Meena DK, Akunuri S, Meena P, Bhramer A, Sharma SD, Gupta R. Tissue transglutaminase antibody and its association with duodenal biopsy in diagnosis of pediatric celiac disease. Pediatr Gastroenterol Hepatol Nutr 2019;22:350-7. https://doi.org/10.5223/pghn.2019.22.4.350
  33. SmarrazzoA,Misak Z, Costa S,Micetic-Turk D,Abu-ZekryM, KansuA, et al. Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: areal life prospective study. BMC Gastroenterol 2017;17:17. https://doi.org/10.1186/s12876-017-0577-x