Authors : Dr. Maria Batool; Dr. Rao Saad Ali Khan; Dr. Shujaat Hussain; Dr. Taimoor Hafeez Janjua; Dr. Rao Zaid Ali Khan; Dr. Wajid Iqbal

Volume/Issue : Volume 9 - 2024, Issue 11 - November

Google Scholar : https://tinyurl.com/mtetdnse

Scribd : https://tinyurl.com/3h4n6rxd

DOI : https://doi.org/10.5281/zenodo.14524771

Abstract : Objective: To identify the common clinical presentation of coeliac disease in patients reporting to tertiary care hospital  Type of Study: Cross-sectional study  Place and Duration: Department of Gastroenterology, Pak Emirates Military Hospital Rawalpindi, from Feb - Aug 2023  Methodology: Patients with diagnosis of coeliac disease on the basis of serological, clinical and histopathological (biopsy) criteria were included. Patients with inflammatory bowel disease, chronic or acute diarrhea of any other origin, sepsis, and recent abdominal surgery were excluded. Laboratory investigations including full blood counts, liver function tests and serological tests for celiac disease were also performed. Patients with celiac serology positive underwent duodenal biopsies. Statistical analysis was conducted in Statistical Package for Social Sciences (SPSS) version 25.0.  Results: In this study, sixty-seven (n= 67) patients with median age of 37.00 (31.00-44.00) years were included. There were 30 (44.78%) males and 37 (55.22%) females with female predominance. In gastrointestinal system (GIT), the most common manifestation was diarrhea 35 (52.24%) sharing the place with abdominal pain 35 (52.24%). The least common manifestation was steatorrhea 5 (7.46%). In extra-intestinal manifestations, the anaemia 46 (68.66%) was the most common clinical abnormality followed by weight loss 24 (35.82%) and hypothyroidism 23 (34.23%). While idiopathic thrombocytopenic purpura (ITP) and limb ataxia was least common 2 (2.99%) extraintestinal feature.  Conclusion: The diarrhea and abdominal pain were most common gastrointestinal manifestation while anaemia, weight loss and hypothyroidism were the most common extraintestinal features.

Keywords : Anaemia, Autoimmune Diseases, Celiac Disease, Diarrhea.

References :

1. McAllister BP, Williams E, Clarke K. A Comprehensive Review of Celiac Disease/Gluten-Sensitive Enteropathies. Clin Rev Allergy Immunol. 2019;57(2):226-43. doi: 10.1007/s12016-018-8691-2.
2. Sciurti M, Fornaroli F, Gaiani F, Bonaguri C, Leandro G, Di Mario F, et al. Genetic susceptibilty and celiac disease: what role do HLA haplotypes play? Acta Biomed. 2018;89(9-S):17-21. doi: 10.23750/abm.v89i9-S.7953.
3. Cabanillas B. Gluten-related disorders: Celiac disease, wheat allergy, and nonceliac gluten sensitivity. Crit Rev Food Sci Nutr. 2020;60(15):2606-2621. doi: 10.1080/10408398.2019.1651689.
4. Brown NK, Guandalini S, Semrad C, Kupfer SS. A Clinician's Guide to Celiac Disease HLA Genetics. Am J Gastroenterol. 2019;114(10):1587-1592. doi: 10.14309/ajg.0000000000000310.
5. Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.
6. Jamila, Kiani RA, Ahmed I, Yousafzai JK, Mehmood W, Khan SA, et al. Celiac Disease in Different Age Groups and Gender in Pakistan. J Rawalpindi Med Coll. 2018;22(3):244-7.
7. Therrien A, Kelly CP, Silvester JA. Celiac Disease: Extraintestinal Manifestations and Associated Conditions. J Clin Gastroenterol. 2020;54(1):8-21. doi: 10.1097/MCG.0000000000001267.
8. Irvine AJ, Chey WD, Ford AC. Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis. Am J Gastroenterol. 2017;112(1):65-76. doi: 10.1038/ajg.2016.466.
9. Barker JM, Liu E. Celiac disease: pathophysiology, clinical manifestations, and associated autoimmune conditions. Adv Pediatr. 2008;55:349-65. doi: 10.1016/j.yapd.2008.07.001.
10. Jabeen S, Khan AU, Ahmed W, Ahmad MU, Jafri SA, Bacha U, et al. Disease specific symptoms indices in patients with celiac disease-A hardly recognised entity. Front Nutr. 2022;9:944449. doi: 10.3389/fnut.2022.944449.
11. Hussain A, Hafeez M, Naveed M, Shah SU, Khan MS, Cheema AA. Association of Malabsorption and Anaemia in Adults in Tertiary Care Hospital. Pak Armed Forces Med J. 2022;72(5): 1506-09. doi: 10.51253/pafmj.v72i5.4554.
12. Spencer M, Lenhart A, Baker J, Dickens J, Wissman J, Read AJ, et al. Primary care physicians are under-testing for celiac disease in patients with iron deficiency anemia: Results of a national survey. PLoS One 2017; 12(9): e0184754. doi:10.1371/journal. pone.0184754.
13. Butt N, Shahid B, Butt S, Channa MM, Reema S, Akbar A. Clinical Spectrum of Celiac Disease among Adult Population: Experience from Largest Tertiary Care Hospital in Karachi, Pakistan. Euroasian J Hepatogastroenterol. 2024;14(1):24-29. doi: 10.5005/jp-journals-10018-1420.
14. Jansson-Knodell CL, Hujoel IA, West CP, Taneja V, Prokop LJ, Rubio-Tapia A, et al. Sex Difference in Celiac Disease in Undiagnosed Populations: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2019;17(10):1954-1968.e13. doi: 10.1016/j.cgh.2018.11.013.
15. Kotze LMDS, Kotze LR, Arcie GM, Nisihara R. Clinical profile of Brazilian patients aged over 50 years at the diagnosis of celiac disease. Rev Assoc Med Bras (1992). 2023;69(4):e0221332. doi: 10.1590/1806-9282.20221332.
16. Hussain S, Sabir MU, Afzal M, Asghar I. Coeliac disease--clinical presentation and diagnosis by anti tissue transglutaminase antibodies titre in children. J Pak Med Assoc. 2014;64(4):437-41.
17. Abbas Z, Raza S, Yakoob J, Abid S, Hamid S, Shah H, et al. Varied presentation of celiac disease in Pakistani adults. J Coll Physicians Surg Pak. 2013;23(7):522-4.
18. Masood N, Shaikh IA. Clinical presentations and biochemical profile in adult celiac disease patients in Hyderabad: Pakistan. Pak J Med Sci. 2014;30(2):287–290. doi: 10.12669/pjms.302.3844.
19. Arshad V, Inam M, Awan S, Ismail FW. Clinical spectrum of Celiac Disease in adults at a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci. 2022;38(3Part-I):445-449. doi: 10.12669/pjms.38.3.4446.
20. Grode L, Bech BH, Jensen TM, Humaidan P, Agerholm IE, Plana-Ripoll O, et al. Prevalence, incidence, and autoimmune comorbidities of celiac disease: a nation-wide, population-based study in Denmark from 1977 to 2016. Eur J Gastroenterol Hepatol. 2018;30(1):83-91. doi: 10.1097/MEG.0000000000000992.
21. Binicier OB, Tosun F. Evaluation of adult celiac disease from a tertiary reference center: a retrospective analysis. Rev Assoc Med Bras (1992). 2020;66(1):55-60. doi: 10.1590/1806-9282.66.1.55.
22. Demirezer Bolat A, Akın FE, Tahtacı M, Tayfur Yürekli Ö, Köseoğlu H, Erten Ş, et al. Risk Factors for Polyautoimmunity among Patients with Celiac Disease: A Cross-Sectional Survey. Digestion. 2015;92(4):185-91. doi: 10.1159/000439586.
23. Beniwal N, Ameta G, Chahar CK. Celiac Disease in Children with Severe Acute Malnutrition (SAM): A Hospital Based Study. Indian J Pediatr. 2017;84(5):339-343. doi: 10.1007/s12098-017-2300-x.