Celiac disease presentation in a tertiary referral centre in India: current scenario.
BACKGROUND
Nondiarrheal celiac disease (NDCD) is being increasingly reported but data from India is limited.


OBJECTIVE
We undertook this study to compare the clinical spectrum of NDCD with that of diarrheal/classical celiac disease (CCD).


METHODS
This facility-based retrospective observational study included consecutive patients diagnosed with celiac disease (CD) (as per modified ESPGHAN criteria) from October 2009 to August 2011.


RESULTS
A total of 381 patients were diagnosed with CD during the study period. NDCD was present in 192 (51.8 %). NDCD had higher mean age at presentation (5.8 ± 2.8 vs. 6.9 ± 2.9 years respectively; p = 0.003) and longer duration of symptoms prior to diagnosis (2.9 ± 1.7 years vs. 3.6 ± 2.2 years; p = 0.02) as compared to CCD. In the NDCD group, the most frequent gastrointestinal (GI) symptoms were recurrent abdominal pain [122 (63.5 %)] and abdominal distension [102 (53.1 %)] followed by constipation [48 (25 %)], vomiting [76 (39.6 %)] and recurrent oral ulcers [89 (46.4 %)]. Vomiting and constipation were more frequently seen in NDCD as compared to CCD (p < 0.001 in both). Commonly enumerated extraintestinal manifestations in NDCD included failure to thrive [109 (56.8 %)], isolated short stature [36 (18.8 %)], persistent anemia [83 (43.2 %)] and hepatomegaly/splenomegaly or both [56 (29.2 %)]. Associated comorbidities included autoimmune thyroiditis [11 (5.7 %)], type 1 diabetes mellitus [8 (4.2 %)], bronchial asthma [23 (11.9 %)], idiopathic pulmonary hemosiderosis [4 (2.1 %)], Down's syndrome [3 (1.6 %)], alopecia areata [6 (3.1 %)], polyarthritis [2 (1.0 %)], dermatitis herpetiformis [6 (3.1 %)] and chronic liver disease [6 (3.1 %)]. The number of patients with a Marsh score IIIb and above of duodenal biopsy was significantly more in the CCD group (p < 0.001).


CONCLUSIONS
NDCD is not uncommon in India. Long-term follow up is needed to evaluate the impact of the disease and of treatment in these children.
Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi 110 002, India. drmalvikab@gmail.com
Malobika
M
Bhattacharya
Seema
S
Kapoor
Anand Prakash
AP
Dubey
D015746:Abdominal Pain / Q000209:etiology; D000367:Age Factors; D000506:Alopecia Areata / Q000150:complications; D000740:Anemia / Q000209:etiology; D001168:Arthritis / Q000150:complications; D001249:Asthma / Q000150:complications; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis* / Q000178:diet therapy; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology; D003874:Dermatitis Herpetiformis / Q000150:complications; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003967:Diarrhea / Q000209:etiology*; D055050:Diet, Gluten-Free; D004314:Down Syndrome / Q000150:complications; D005183:Failure to Thrive / Q000209:etiology; D005260:Female; D006486:Hemosiderosis / Q000150:complications; D006529:Hepatomegaly / Q000209:etiology; D006801:Humans; D007194:India; D008107:Liver Diseases / Q000150:complications; D008171:Lung Diseases / Q000150:complications; D008297:Male; D019226:Oral Ulcer / Q000209:etiology; D012189:Retrospective Studies; D013163:Splenomegaly / Q000209:etiology; D013967:Thyroiditis, Autoimmune / Q000150:complications; D013997:Time Factors; D014839:Vomiting / Q000209:etiology; D000097545:Hemosiderosis, Pulmonary