Skip to main content

Advertisement

SpringerLink
Log in

Celiac disease presentation in a tertiary referral centre in India: current scenario

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Nondiarrheal celiac disease (NDCD) is being increasingly reported but data from India is limited.

Aim

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

Method

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lo W, Sana K, Lebwohi B, Diamond B, Green PH. Changing presentation of adult celiac disease. Dig Dis Sci. 2003;48:395–8.

    Article  PubMed  Google Scholar 

  2. Farrel RJ, Kelly CP. Celiac sprue. N Engl J Med. 2002;346:180–8.

    Article  Google Scholar 

  3. Farrel RJ, Kelly CP. Diagnosis of celiac sprue. Am J Gastroenterol. 2001;96:3237–46.

    Article  Google Scholar 

  4. Murray JA, Van Dyke C, Pievak MF, Dierkhising RA, Zinsmeister AR, Melton LJ 3rd. Trends in the incidence and the clinical features of celiac diasease in North American community, 1950–2001. Clin Gastroenterol Hepatol. 2003;1:19–27.

    Article  PubMed  Google Scholar 

  5. Agarwal N, Puri AS, Grover R. Non-diarrheal celiac disease: a report of 31 cases from northern India. Indian J Gastroenterol. 2007;26:122–6.

    PubMed  Google Scholar 

  6. Poddar U. Celiac disease: clinical features and diagnostic criteria. Indian J Pediatr. 1999;66:S21–5.

    Article  PubMed  CAS  Google Scholar 

  7. Puri AS, Garg S, Monga R, Tyagi P, Saraswat V. Spectrum of atypical celiac disease in north Indian children. Indian Pediatr. 2004;41:822–7.

    PubMed  Google Scholar 

  8. Stenhammer L, Fallstrom SP, Jansson G, Jansson U, Lindberg T. Celiac disease in children of short stature without gastrointestinal symptoms. Eur J Pediatr. 1986;145:185–6.

    Article  Google Scholar 

  9. Varma S, Malhotra P, Kochhar R, et al. Celiac disease presenting as iron-deficiency anemia in northern India. Indian J Gastroenterol. 2001;20:234–6.

    PubMed  CAS  Google Scholar 

  10. Bushara KO. Neurologic presentation of celiac disease. Gastroenterology. 2005;128 4 Suppl 1:S92–7.

    Article  Google Scholar 

  11. Molteni N, Bardella MT, Bianchi PA. Obstetric and gynecological problems in women with untreated celiac sprue. J Clin Gastroenterol. 1990;12:37–9.

    Article  PubMed  CAS  Google Scholar 

  12. Zone JJ. Skin manifestations of celiac disease. Gastroenterology. 2005;128 4 Suppl 1:S87–91.

    Article  Google Scholar 

  13. Revised criteria for the diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterogy and Nutrition. Arch Dis Child. 1990;65:909–11.

    Google Scholar 

  14. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of celiac disease: time for standardized repot scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11:1185–94.

    Article  PubMed  CAS  Google Scholar 

  15. Rosenfeld RG, Cohen P. Disorders of growth hormone/insulin-like growth factor secretion and action. In: Sperling MA, ed. Pediatric Endocrinology. 3rd ed. Philadelphia: Saunders; 2008.

    Google Scholar 

  16. Kuloglu Z, Kirsaclioglu CT, Kansu A, Ensari A, Girgin N. Celiac disease: presentation of 109 children. Yonsei Med J. 2009;50:617–23.

    Article  PubMed  Google Scholar 

  17. Sharma A, Poddar U, Yachha SK. Time to recognize atypical celiac disease in Indian children. Indian J Gastroenterol. 2007;26:269–73.

    PubMed  Google Scholar 

  18. McGowan KE, Castiglione DA, Butzner DJ. The changing face of childhood celiac disease in North America: impact of serological testing. Pediatrics. 2009;124:1572–8.

    Article  PubMed  Google Scholar 

  19. Ascher H, Holm K, Kristiansson B, Maki M. Different features of coeliac disease in two neighbouring countries. Arch Dis Child. 1993;69:375–80.

    Article  PubMed  CAS  Google Scholar 

  20. Bardella MT, Fredella C, Saladino V, et al. Gluten intolerance: gender- and age-related differences in symptoms. Scand J Gastroenterol. 2005;40:15–9.

    Article  PubMed  Google Scholar 

  21. Donaldson MR, Firth SD, Wimpee H, et al. Correlation of duodenal histology with tissue transglutaminase and endomysial antibody lavels in pediatric celiac disease. Clin Gastroenterol Hepatol. 2007;5:567–73.

    Article  PubMed  CAS  Google Scholar 

  22. American Academy of Pediatrics. Subcommittee on Chronic Abdominal Pain. Chronic abdominal pain in children. Pediatrics. 2005;115:812–5.

    Article  Google Scholar 

  23. Bingley PJ, Williams AJ, Norcross AJ. Undiagnosed coeliac disease at age seven: population based prospective birth cohort study. BMJ. 2004;328:322.

    Article  PubMed  Google Scholar 

  24. Hoffenberg EJ, Emery LM, Barriga KJ. Clinical features of children with screening identified evidence of celiac disease. Pediatrics. 2004;113:1254–9.

    Article  PubMed  Google Scholar 

  25. Kumar PJ, Walker-Smith J, Milla P, Harris G, Colyer J, Halliday R. The teenage coeliac: follow up study of 102 patients. Arch Dis Child. 1988;63:916–20.

    Article  PubMed  CAS  Google Scholar 

  26. Mayer M, Greco L, Troncone R, Auricchio S, Marsh MN. Compliance of adolescents with coeliac disease with a gluten free diet. Gut. 1991;328:881–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, 110 002, India

    Malobika Bhattacharya, Seema Kapoor & Anand Prakash Dubey

Authors
  1. Malobika Bhattacharya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seema Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anand Prakash Dubey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Malobika Bhattacharya.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bhattacharya, M., Kapoor, S. & Dubey, A.P. Celiac disease presentation in a tertiary referral centre in India: current scenario. Indian J Gastroenterol 32, 98–102 (2013). https://doi.org/10.1007/s12664-012-0240-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-012-0240-y

Keywords

Search

Navigation