title: Celiac disease in children with diarrhea is more frequent than previously suspected.
abstract: 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.
authors.affiliation: Department of Pediatric Gastroenterology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Iran.
authors.forename: Farid
authors.initials: F
authors.lastname: Imanzadeh
authors.forename: Ali Akbar
authors.initials: AA
authors.lastname: Sayyari
authors.forename: Mohammad
authors.initials: M
authors.lastname: Yaghoobi
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Akbari
authors.forename: Hamed
authors.initials: H
authors.lastname: Shafagh
authors.forename: Ahmad Reza
authors.initials: AR
authors.lastname: Farsar
mesh_terms: 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
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D005983:Glutens; D005903:Gliadin; D000681:Amylases