Pediatr Gastroenterol Hepatol Nutr.  2017 Dec;20(4):222-226. 10.5223/pghn.2017.20.4.222.

Celiac Disease in South Jordan

Affiliations
  • 1Department of Pediatrics, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. emaltamimi@just.edu.jo

Abstract

PURPOSE
Celiac disease, an autoimmune enteropathy triggered by exposure to gluten, is not uncommon in South Jordan. However, its prevalence is underestimated due to lack of physician awareness of the diversity of disease presentation. The clinical spectrum includes classic gastrointestinal manifestations, as well as rickets, iron-deficiency anemia, short stature, elevated liver enzymes, and edema. Our goal was to evaluate celiac disease presentation in clinically diagnosed children.
METHODS
Retrospective study included all children diagnosed with celiac disease between September 2009 and September 2015. Hospital charts were reviewed. Demographic data, clinical characteristics, and follow-up were recorded.
RESULTS
Thirty-five children were diagnosed with celiac disease during the study period. Mean age±standard deviation was 6.7±3.8 years (range, 2.0-14 years). There were 17 (48.6%) female patients. The average duration between onset of symptoms and diagnosis was 16.3±18.7 months. Fifteen (42.9%) patients presented with classic malabsorption symptoms, whereas 7 (20.0%) patients presented with short stature. Positive tissue transglutaminase antibodies (tTg)-immunoglobulin A (IgA) was seen in 34 (97.1%) patients. The one patient with negative tTg-IgA had IgA deficiency. Although tTG-IgA values were not available for objective documentation of compliance, clinical data (resolution of presenting abnormalities and growth improvement) assured acceptable compliance in 22 (62.9%) patients.
CONCLUSION
CD in children may present with diverse picture. Although of the small number, the non-classical presentations are not uncommon in our rural community. Gluten-free diet is the main strategy for treatment and associated with usually correction of laboratory abnormalities and improvement of growth.

Keyword

Celiac disease; Pediatrics; Gluten free diet; Malabsorption

MeSH Terms

Anemia, Iron-Deficiency
Antibodies
Celiac Disease*
Child
Compliance
Diagnosis
Diet, Gluten-Free
Edema
Female
Follow-Up Studies
Glutens
Humans
IgA Deficiency
Jordan*
Liver
Pediatrics
Prevalence
Retrospective Studies
Rickets
Rural Population
Antibodies
Glutens

Reference

1. Biesiekierski JR. What is gluten? J Gastroenterol Hepatol. 2017; 32:Suppl 1. 78–81.
Article
2. Guandalini S, Assiri A. Celiac disease: a review. JAMA Pediatr. 2014; 168:272–278.
3. Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013; 62:43–52.
Article
4. Di Sabatino A, Corazza GR. Coeliac disease. Lancet. 2009; 373:1480–1493.
Article
5. Barada K, Bitar A, Mokadem MA, Hashash JG, Green P. Celiac disease in Middle Eastern and North African countries: a new burden? World J Gastroenterol. 2010; 16:1449–1457.
Article
6. Rawashdeh MO, Khalil B, Raweily E. Celiac disease in Arabs. J Pediatr Gastroenterol Nutr. 1996; 23:415–418.
Article
7. Nusier MK, Brodtkorb HK, Rein SE, Odeh A, Radaideh AM, Klungland H. Serological screening for celiac disease in schoolchildren in Jordan. Is height and weight affected when seropositive? Ital J Pediatr. 2010; 36:16.
Article
8. Altamimi E. Celiac disease in South Jordan: the typical and the atypical. Pediat Therapeut. 2012; DOI: 10.4172/2161-0665.1000134.
Article
9. 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; 64:437–441.
10. Savvateeva LV, Erdes SI, Antishin AS, Zamyatnin AA Jr. Overview of celiac disease in Russia: regional data and estimated prevalence. J Immunol Res. 2017; DOI: 10.1155/2017/2314813. [Epub].
Article
11. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, et al. European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012; 54:136–160.
Article
12. Hawamdeh H, Al-Zoubi B, AlSharqi Y, Qasrawi A, Abdelaziz Y, Barbar M. Association of tissue transglutaminase antibody titer with duodenal histological changes in children with celiac disease. Gastroenterol Res Pract. 2016; DOI: 10.1155/2016/6718590. [Epub ahead of print].
Article
13. Vivas S, Ruiz de Morales JG, Riestra S, Arias L, Fuentes D, Alvarez N, et al. Duodenal biopsy may be avoided when high transglutaminase antibody titers are present. World J Gastroenterol. 2009; 15:4775–4780.
Article
14. Mones RL, Atienza KV, Youssef NN, Verga B, Mercer GO, Rosh JR. Celiac crisis in the modern era. J Pediatr Gastroenterol Nutr. 2007; 45:480–483.
Article
15. Salardi S, Volta U, Zucchini S, Fiorini E, Maltoni G, Vaira B, et al. Prevalence of celiac disease in children with type 1 diabetes mellitus increased in the mid-1990 s: an 18-year longitudinal study based on anti-endomysial antibodies. J Pediatr Gastroenterol Nutr. 2008; 46:612–614.
Article
16. Rewers M, Liu E, Simmons J, Redondo MJ, Hoffenberg EJ. Celiac disease associated with type 1 diabetes mellitus. Endocrinol Metab Clin North Am. 2004; 33:197–214. xi
Article
17. Singh P, Arora S, Lal S, Strand TA, Makharia GK. Risk of celiac disease in the first- and second-degree relatives of patients with celiac disease: a systematic review and meta-analysis. Am J Gastroenterol. 2015; 110:1539–1548.
Article
18. Rwalah M, Kamal N, Hijazeen R, Ghanma A, Alzeben Z, D'ajeh R. Hematological findings among Jordanian children with celiac disease at presentation: a retrospective analytical study. J R Nav Med Serv. 2014; 21:6–11.
Article
19. Freeman HJ. Dietary compliance in celiac disease. World J Gastroenterol. 2017; 23:2635–2639.
Article
20. Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005; 40:1–19.
Article
21. Capristo E, Malandrino N, Farnetti S, Mingrone G, Leggio L, Addolorato G, et al. Increased serum high-density lipoprotein-cholesterol concentration in celiac disease after gluten-free diet treatment correlates with body fat stores. J Clin Gastroenterol. 2009; 43:946–949.
Article
Full Text Links
  • PGHN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr