Clinical Spectrum of Celiac Disease in Children: Experience from A Public Hospital in Pakistan
Objective: To evaluate the clinical and laboratory parameters of celiac disease (CD) in children and perform a comparison between classical and non-classical presentation. Study Design: A prospective observational study. Settings: DHQ hospital Toba Tek Singh Pakistan. Duration: From January 2005 to December 2018. Methodology: Children between 1 and 16 years of age, diagnosed with CD during this period were included in the study. Clinical features and relevant laboratory findings were documented at the time of presentation. Data was divided into classical and non-classical CD groups according to clinical presentation. Overall disease features were studied and necessary comparisons were made between classical and non-classical disease groups. Results: A total number of 323 patients with celiac disease were included in study. 195(60.03%) Patients had a classical presentation and 128 (39.97%) patients had a non-classical presentation. 292(90.4%) children had anemia, out of which n=84 (26%) required blood transfusion. Failure to thrive/under-weight n=293(90.7%), Short stature n=271(83.9%), Isolated short stature was the presenting complaint in 121 (37.4%) patients. Chronic diarrhea n=195(60.37%) abdominal distension n=187(57.9%), repeated vomiting n=130(40.4%), recurrent abdominal pain n=116(35.9%), constipation n=84 (26%), hypokalemic paralysis n=12 (3.71%), family history was positive in 29(9%), consanguineous marriage of parents was found in 196 (60.7%). Mean age at presentation for non-classical CD group (7.28±3.33) was significantly higher than classical CD group (4.98±2.91). Mean centiles for height in non-classical CD (4.39±7.43) were significantly lower as compared to classical CD (7.67±12.28). There was no significant difference in mean centiles for weight, mean hemoglobin and mean Anti-TTGs levels between two groups. Conclusion: The non-classical presentation of celiac disease is not uncommon. The diagnosis is significantly delayed in patients with non-classical features resulting in significantly compromised height at the time of diagnosis. Early diagnosis in patients with non-classical feature may ensure better growth centiles.