Celiac Disease in Children with Severe Acute Malnutrition (SAM): A Hospital Based Study
To evaluate the prevalence and clinical features of Celiac disease among children with severe acute malnutrition (SAM).
This prospective observational study was conducted in PBM Children Hospital, Bikaner from July 2012 through December 2013. All consecutively admitted children with SAM were recruited. All subjects were screened for Celiac disease by serological test for IgA-anti tissue Transglutaminase (IgA tTG) antibodies. All seropositive children underwent upper gastrointestinal endoscopy for small bowel biopsy for the confirmation. Clinical features of patients with and without celiac disease were compared.
The sero-prevalence (IgA tTg positivity) of Celiac disease was found to be 15.38% while prevalence of biopsy confirmed Celiac disease was 14.42% among SAM children. Abdominal distension, diarrhea, anorexia, constipation, pain in abdomen, vitamin deficiencies, edema, clubbing and mouth ulcers were more common in patients of Celiac disease compared to patients without Celiac disease but the difference was statistically significant only for abdominal distension and pain abdomen.
There is a high prevalence of Celiac disease in SAM. Screening for Celiac disease (especially in presence of pain abdomen and abdominal distension) should be an essential part of work-up in all children with SAM.
KeywordsCeliac disease Severe acute malnutrition IgA-anti tissue transglutaminase antibodies Screening
- 2.Guandalini S. Celiac disease. In: Guandalini S, editor. Textbook of pediatric gastroenterology and nutrition. London: Taylor & Francis Books Ltd; 2004. p. 435–50.Google Scholar
- 3.Bhatnagar S, Bhan MK. Serological diagnosis of celiac disease. Indian J Pediatr. 1996;66:S26–31.Google Scholar
- 7.Branski D, Troncone R, Fasano. Celiac disease. In: Kliegman R, Stanton B, Geme St J, Schor N, editors. Nelson textbook of pediatrics, Vol. 2. 20th ed. New Delhi: Reed Elseveier India Pvt Ltd; 2015. p. 1835–6.Google Scholar
- 12.Bhattacharya M, Dubey AP, Mathur NB. Prevalence of celiac disease in north Indian children. Indian Pediatr. 2009;46:41–7.Google Scholar
- 13.Deora NS, Deswal A, Dwivedi M, Mishra HN. Prevalence of coeliac disease in India: a mini review. Int J Latest Res Sci Technol. 2014;3:58–60. ISSN: 2278–5299.Google Scholar
- 15.Kumar M, Yaccha SK, Naik SR. Celiac disease in children. Indian J Gastroenterol. 1993;12:15.Google Scholar
- 18.WHO Multicentre Growth Reference Study Group. WHO child growth standards based on length/height, weight, and age. Acta Paediatr. 2006;450:S76–85.Google Scholar
- 20.Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child. 1990;65:909–11.Google Scholar
- 24.Walker Smith JA. Celiac disease. In: Walker Smith JA, editor. Disease of small intestine in childhood. 3rd ed. London: Butterworth Heinemann; 1985. p. 88–143.Google Scholar
- 25.Thapa BR. Celiac disease: Indian experience. In: Sachdev HPS, Choudhary P, editors. Nutrition in children developing country concerns. 1st ed. New Delhi: BI Publication Ltd; 1995. p. 355–75.Google Scholar
- 27.Andermann A, Blancquaert I, Beauchamp S, Dery V. Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. WHO Bull. 2008;86:241–320.Google Scholar