Euroasian journal of hepato-gastroenterology

Register      Login

VOLUME 14 , ISSUE 1 ( January-June, 2024 ) > List of Articles

Original Article

Clinical Spectrum of Celiac Disease among Adult Population: Experience from Largest Tertiary Care Hospital in Karachi, Pakistan

Nazish Butt, Bushra Shahid, Sehrish Butt, Murk Mujahid Channa, Sehrish Reema, Ali Akbar

Keywords : Chronic diarrhea, Classical celiac disease, Refractory anemia

Citation Information : 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

License: CC BY-NC 4.0

Published Online: 12-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: Celiac disease (CD) is a systemic autoimmune enteropathy triggered by dietary gluten in genetically susceptible individuals. Celiac disease affects 0.6–1.0% of the population worldwide. The prevalence of CD in Pakistan is yet unknown due to under diagnosis and lack of awareness. Objective: To determine a vast variety of presenting features in subtypes of CD to overcome the burden of disease. Materials and methods: This was a prospective, comparative, cross-sectional study conducted at Gastroenterology department of Jinnah Postgraduate Medical Center, Karachi from December 2022 till June 2023. This study included all adult patients ≥18 years diagnosed with CD on the basis of clinical presentation, positive IgA and IgG anti-transglutaminase antibodies (value >12 IU/mL detected by ELISA followed by small intestinal biopsy classified as per Marsh criteria. The data obtained were analyzed on the statistical software SPSS version 23. Descriptive statistics were obtained by frequencies and percentages. Results: About 142 patients were enrolled in the study, 103 (91.5%) had classical CD (CCD) whereas 36 (25%) had non-classical (NCCD). About 89 (62.7%) were females and 53 (37.3%) were males. The mean age was found to be 23 ± 6 years. Nutritional deficiencies including anemia, B12, folate, osteopenia and low body mass index (BMI) <18 was found more in CCD group as compared with NCCD group with significant p-values. Titers of anti-TTG between CCD and NCCD were not statistically significant. Hypothyroidism and PCOS were the most common associated conditions observed in adult CD patients. Conclusion: In conclusion, CD in adults and has diverse presentations. Adults with unexplained extra-intestinal symptoms like anemia and bone pain should be investigated for CD.


PDF Share
  1. Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: Systematic review and meta-analysis. Clinical Gastroenterol Hepatol 2018;16(6):823–836. DOI: 10.1016/j.cgh.2017.06.037.
  2. Makovicky P, Makovicky P, Caja F, et al. Celiac disease and gluten-free diet: Past, present, and future. Gastroenterol Hepatol Bed Bench 2020;13(1):1. PMID: 32190218.
  3. Dunne MR, Byrne G, Chirdo FG, et al. Coeliac disease pathogenesis: The uncertainties of a well-known immune mediated disorder. Front Immunol 2020;11:1374. DOI: 10.3389/fimmu.2020.01374.
  4. Makharia GK, Singh P, Catassi C, et al. The global burden of coeliac disease: Opportunities and challenges. Nat Rev Gastroenterol Hepatol 2022;19(5):313–327. DOI: 10.1038/s41575-021-00552-z.
  5. Lebwohl B, Sanders DS, Green PH. Coeliac disease. Lancet 2018;391(10115):70–81. DOI: 10.1016/S0140-6736(17)31796-8.
  6. Husby S, Koletzko S, Korponay-Szabó I, et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition guidelines for diagnosing coeliac disease 2020. J Pediatr Gastroenterol Nutr 2020;70(1):141–156. DOI: 10.1097/MPG.0000000000002497.
  7. Therrien A, Kelly CP, Silvester JA. Celiac disease: Extraintestinal manifestations and associated conditions. J Clin Gastroenterol 2020;54(1):8. DOI: 10.1097/MCG.0000000000001267.
  8. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: Time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999;11(10):1185–1194. DOI: 10.1097/00042737-199910000-00019.
  9. Jonas F. The Oslo definitions for coeliac disease and related terms/Jonas F., Daniel A., Leffler, Bai Julio [et al.]. Gut 2013;62(1):43–52. DOI: 10.1136/gutjnl-2011-301346.
  10. Green PH. The many faces of celiac disease: Clinical presentation of celiac disease in the adult population. Gastroenterology 2005;128(4):S74–S78. DOI: 10.1053/j.gastro.2005.02.016.
  11. Paez MA, Gramelspacher AM, Sinacore J, et al. Delay in diagnosis of celiac disease in patients without gastrointestinal complaints. Am J Med 2017;130(11):1318–1323. DOI: 10.1016/j.amjmed.2017.05.027.
  12. Abbas Z, Raza S, Yakoob J, et al. Varied presentation of celiac disease in Pakistani adults. J College Physicians Surgeons Pakistan 2013;23(7):522. PMID: 23823965.
  13. Vivas S, Vaquero L, Rodríguez-Martín L, et al. Age-related differences in celiac disease: Specific characteristics of adult presentation. World J Gastrointest Pharmacol Ther 2015;6(4):207. DOI: 10.4292/wjgpt.v6.i4.207.
  14. Jansson-Knodell CL, Hujoel IA, West CP, et al. Sex difference in celiac disease in undiagnosed populations: A systematic review and meta-analysis. Clinical Gastroenterol Hepatol 2019;17(10):1954–1968. DOI: 10.1016/j.cgh.2018.11.013.
  15. Wang M, Kong WJ, Feng Y, et al. Epidemiological, clinical, and histological presentation of celiac disease in Northwest China. World J Gastroenterol 2022;28(12):1272. DOI: 10.3748/wjg.v28.i12. 1272.
  16. Kotze LM, Kotze LR, Arcie GM, et al. Clinical profile of Brazilian patients aged over 50 years at the diagnosis of celiac disease. Rev Assoc Med Bras 2023;69:e0221332. DOI: 10.1590/1806-9282.202 21332.
  17. Arshad V, Inam M, Awan S, et al. Clinical spectrum of celiac disease in adults at a tertiary care hospital in Karachi, Pakistan. Pakistan J Med Sci 2022;38(3Part-I):445. DOI: 10.12669/pjms.38.3.4446.
  18. Khan MA, Jan H, Khan MO, et al. Prevalence of celiac disease in adult patients with iron deficiency anemia. Pakistan Journal of Medical and Health Sciences 2022;16(5):1006–1008. DOI: 10.53350/pjmhs221651006.
  19. Khan MA, Jan H, Khan MO, et al. Prevalence of celiac disease in adult patients with iron deficiency anemia. Pakistan J Med Health Sci 2022;16(05):1006–1008. DOI: 10.1007/s12664-015-0586-z.
  20. Roldan GA, Goyes D, Villafuerte-Gálvez JA, et al. Anemia etiology and the response to a gluten-free diet in untreated patients with celiac disease: A 2-year follow-up. Am J Gastroenterol 2022;117(10): 1684–1692. DOI: 10.14309/ajg.0000000000001875.
  21. Shahriari M, Honar N, Yousefi A, et al. Association of potential celiac disease and refractory iron deficiency anemia in children and adolescents. Arquivos Gastroenterol 2018;55:78–81. DOI: 10.1590/S0004-2803.201800000-15.
  22. Kotze L, Skare T, Vinholi A, et al. Impact of a gluten-free diet on bone mineral density in celiac patients. Rev Esp Enferm Dig 2016;108(2): 84–88. DOI: 10.17235/reed.2015.3953/2015.
  23. Mosca C, Thorsteinsdottir F, Abrahamsen B, et al. Newly diagnosed celiac disease and bone health in young adults: A systematic literature review. Calcified tissue international 2022;110(6):641–648. DOI: 10.1007/s00223-021-00938-w.
  24. Bommu VJ, Mirza L. Osteoporosis can be the sole presentation in celiac disease. Cureus 2021;13(12). DOI: 10.7759/cureus.20602.
  25. Tejaswini A, Nassar P, Mahejabeen F, et al. Celiac disease and autoimmune thyroid disease: The two peas in a pod. Cureus 2022;14(6). DOI: 10.7759/cureus.26243.
  26. Villanacci V, Ceppa P, Tavani E, et al. Coeliac disease: The histology report. Dig Liver Dis 2011;43:S385–S395. DOI: 10.1016/S1590-8658(11)60594-X.
  27. Moran CJ, Kolman OK, Russell GJ, et al. Neutrophilic infiltration in gluten-sensitive enteropathy is neither uncommon nor insignificant: Assessment of duodenal biopsies from 267 pediatric and adult patients. Am J Surg Pahtol 2012;36(9):1339–1345. DOI: 10.1097/pas.0b013e318254f413.
  28. Martínez-Martinez MI, Alegre-Martínez A, García-Ibánez J, et al. Quality of life in people with coeliac disease: Psychological and socio- economic aspects. Endocr Metab Immune Disord Drug Targets 2019;19(2):116–120. DOI: 10.2174/18715303186661807231 00003.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.