Muhammad Yasin Alvi, Muhammad Abbas, Mushtaq Ahmed, Azhar Farooq, Muhammad Yaqub Kazi.
Clinical presentation of celiac disease in children.
Pak J Med Health Sci Jan ;4(4):552-4.

Objectives: To evaluate clinical features of celiac disease in pediatric patients. Materials & methods: The study was conducted at Department of Pediatrics, Services Institute of Medical Sciences (SIMS) and Services Hospital, Lahore. We performed retrospective data analysis of 70 patients in whom small bowel biopsy (SBB) was done with the suspicion of celiac disease. Forty six children had confirmed celiac disease on the basis of European Society for Pediatric Gastroenterology & Nutrition (ESPGAN) criteria. Twenty four patients due to lack of follow-up, equivocal response to gluten free diet (GFD) and non-specific histology were excluded from study. Clinical symptoms and signs, anthropometry and lab investigations were analyzed. Results: A total of 46 children with M:F = 1:1.2 fulfill the diagnostic criteria for celiac disease. Mean age at diagnosis and onset of symptoms was 6.7 years and 3.4 years respectively. Chronic diarrhea, failure to thrive and pallor were the commonest clinical features present in 82.6%, 89% and 95.6% children respectively. Abdominal distension and clubbing was noted in 65.2% and 17.4% patients. Four children presented with rickets and three had edema feet on clinical examination. Weight & height <5th centile was present in 91.3% and 86.9% patients respectively. Hemoglobin <10 g/dl was found in 45 children and raised ALT >40 I.U. was present in 13 patients. Conclusion: Chronic diarrhea, failure to thrive and anemia are three major clinical features in children with celiac disease. Diagnostic criteria should be fulfilled before labeling the child as celiac because GFD is recommended lifelong.

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