Javaria Rasheed, Tajwer Khan, Muhammad Khalid, Fauzia Zafar.
Celiac Disease; a Medley of Clinical Features a Tertiary Care Hospital Experience.
Professional Med J Jan ;25(5):669-75.

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.

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