Clinical Spectrum of Celiac Disease in Children in Sistan and Baluchestan Province

BACKGROUND: The clinical manifestations of celiac disease (CD) have changed in the past decades. There are currently little data describing the initial clinical manifestations of CD in children in Iran. This study describes the initial presentation of children with suspected CD from a geographically defined region in Iran. METHOD: Medical records of children seen in 2007 – 2015 from Sistan and Baluchestan province, Iran, with suspected CD were reviewed. After obtaining TTG-IgA and IgA, subjects were divided into three groups according to presenting symptoms: GI, non-GI, and asymptomatic group. Those with elevated TTG-IgA or a strong clinical suspicion for CD underwent endoscopy with duodenal biopsy. Demographic data, symptoms, laboratory, histopathology findings and the presence of any CD related conditions were recorded. RESULTS: from 344 children who underwent upper endoscopy and intestinal biopsy, 105 cases with marsh 0 – 1 were excluded from the study and 239 cases considered as a definite celiac disease (Mean± SD of age was 6.8 ± 3.9 years with 145 females). GI symptoms were predominant in the younger age groups while non-GI symptoms were more common in the older children. The most frequent GI and Non-GI symptoms were abdominal pain (41.4%), distension (36.4%), diarrhea (32.2%), under nutrition (51.4%), anemia (36.4%), and decreased bone age (35%). The most common co-morbidities were hypothyroidism (3.7%) and Type 1 diabetes (2.9%). CONCLUSION: GI complaints in Iranian children are a common feature. Screening of children with suspected CD, especially with GI symptom is highly recommended.