title: The clinical presentation of celiac disease: experiences from northeastern iran.
abstract: BACKGROUND This study aimed to explore demographic characteristics and clinical presentations of celiac disease (CD) in Northeastern Iran. METHODS This was a cross-sectional retrospective study of 193 adults with CD who presented to Mashhad University Gastroenterology Clinic between 2008 and 2013. Patient data that included mode of presentation and the presence of any concomitant illnesses were collected. Intestinal biopsy and serum anti-tissue transglutaminase (anti-tTG) were used for diagnosis. Mucosal lesions were classified according to modified Marsh classification. RESULTS Overall, 132 females and 61 males, with a mean age at diagnosis of 32.6 ± 13.2 years were included. The patient's chief complaints in order of decreasing frequency were dyspepsia (24.6%), diarrhea (20%), anemia (12.8%), and flatulence (7.2%). Bone disease was seen (osteopenia, osteoporosis) in 30% of patients. A positive family history of CD was found in 17.9% of cases. There were 64% who had serum anti-tTG >200 units/ml and 78% had a Marsh classification grade 3 on duodenal biopsy. The histology grade (Marsh) did not show any correlation with anti-tTG serum levels, age, body mass index (BMI) or hemoglobin levels. CONCLUSION In Northeastern Iran, CD was seen more commonly in females and with non-diarrheal presentations. Abdominal discomfort, anemia and bone disease were most common primary presentations in this area. Histology grade showed no significant correlation with level of anti-tTG, BMI or hemoglobin levels. We suggest screening for CD in unexplained abdominal discomfort, bone disease and anemia.
authors.affiliation: Department of Gastroenterology and Hepatology, School of Medicine Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Azita
authors.initials: A
authors.lastname: Ganji
authors.affiliation: Department of Gastroenterology and Hepatology, School of Medicine Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Esmaielzadeh
authors.affiliation: Department of Gastroenterology and Hepatology ,faculty of medical science, neyshabour, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Aafzal Aghayee
authors.affiliation: Department of Gastroenterology and Hepatology, School of Medicine Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Ladan
authors.initials: L
authors.lastname: Goshayeshi
authors.affiliation: Department of Pathology, Research and Education Department, Razavi Hospital, Mashhad, Iran.
authors.forename: Kamran
authors.initials: K
authors.lastname: Ghaffarzadegan
keywords: Celiac Disease; Clinical Presentation; Iran