Celiac disease in children with diarrhea is more frequent than previously suspected.
BACKGROUND
Celiac disease (CD) may be missed or diagnosed late in children with chronic diarrhea. In this study the authors estimated the frequency of CD among pediatric patients with chronic diarrhea based on serologic and pathologic examinations.


METHODS
During a 6-year period, all patients with chronic diarrhea of more than 6 weeks referred to the authors' department were included. For each patient, an asymptomatic control was enrolled from among the patients referred to our clinic for other reasons. Serologic tests for CD including immunoglobulin A endomysial antibody and immunoglobulin A antigliadin antibody were performed in all patients and controls. If positive, duodenal biopsy was performed to confirm the diagnosis. Patients subsequently diagnosed as CD were placed on a gluten-free diet and reevaluated after 6 months.


RESULTS
825 cases of diarrhea and 825 controls were enrolled. CD was diagnosed in 54 (6.5%) of the diarrhea patients and seven (0.8%) of the controls. After 6 months of gluten-free diet, 48 (88.8%) patients had significant improvement in symptoms and of these 41 (76.1%) were totally asymptomatic. Forty-two patients allowed repeat endoscopy after 6 months of gluten-free diet and 40 (95.2%) showed improvement in histologic findings.


CONCLUSIONS
CD is common among patients labeled as chronic diarrhea. In this subgroup, gluten-free diet may lead to a significant improvement in symptoms. Routine testing for CD may be indicated in all patients being evaluated for chronic diarrhea.
Imanzadeh
Farid
F
Department of Pediatric Gastroenterology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Iran.
Sayyari
Ali Akbar
AA
Yaghoobi
Mohammad
M
Akbari
Mohammad Reza
MR
Shafagh
Hamed
H
Farsar
Ahmad Reza
AR
D000293:Adolescent; D000681:Amylases / Q000097:blood; D001323:Autoantibodies / Q000032:analysis* / Q000097:blood / Q000276:immunology; D001706:Biopsy; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis* / Q000178:diet therapy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000178:diet therapy / Q000209:etiology*; D004386:Duodenum / Q000473:pathology; D005260:Female; D005903:Gliadin / Q000276:immunology; D005983:Glutens / Q000009:adverse effects; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007223:Infant; D008297:Male
D001323:Autoantibodies; D007070:Immunoglobulin A; D005983:Glutens; D005903:Gliadin; D000681:Amylases