Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. May 9, 2022; 11(3): 295-306
Published online May 9, 2022. doi: 10.5409/wjcp.v11.i3.295
Serologic, endoscopic and pathologic findings in pediatric celiac disease: A single center experience in a low/middle income country
Hala H Mansour, Nabil A Mohsen, Mortada HF El-Shabrawi, Somia M Awad, Dalia Abd El-Kareem
Hala H Mansour, Nabil A Mohsen, Mortada HF El-Shabrawi, Somia M Awad, Department of Pediatrics, Faculty of Medicine Kasr Al Ainy, Cairo University, Cairo 12411, Egypt
Dalia Abd El-Kareem, Department of Pathology, Cairo University, Cairo 11562, Egypt
Author contributions: El-Shabrawi MH, Mohsen NA, Abd El-Kareem D and Mansour HH contributed to the conception of the study, designed and executed the study, and wrote the final manuscript; El-Shabrawi MH contributed to the writing of the manuscript draft; Awad SM collected data and contributed to the writing of the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the research ethics committee of Cairo university Institutional Review Board [(Approval No. 12-10-2019]).
Informed consent statement: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mortada HF El-Shabrawi, MD, Professor, Department of Pediatrics, Faculty of Medicine Kasr Al Ainy, Cairo University, 3 Nablos Street, Off Shehab Street, Mohandesseen, Cairo 12411, Egypt. melshabrawi@medicine.cu.edu.eg
Received: October 11, 2021
Peer-review started: October 11, 2021
First decision: November 7, 2021
Revised: November 25, 2021
Accepted: April 2, 2022
Article in press: April 2, 2022
Published online: May 9, 2022
Processing time: 208 Days and 6.4 Hours
Abstract
BACKGROUND

Studies in Africa, Asia, and Latin America are needed to provide a comprehensive picture of the global incidence of celiac disease (CD).

AIM

To describe the serology, endoscopic and histological findings in typical and atypical presentations of pediatric CD at a tertiary referral hospital in an African low/middle income country (LMIC).

METHODS

This observational study was conducted on 199 patients with CD from 2010 to 2019. The patients were divided into typical and atypical groups according to the presenting symptoms including 120 and 79 patients respectively. Serology, upper gastrointestinal endoscopy with duodenal biopsy were performed for patients who had symptoms suggestive of CD. The severity of the intestinal damage was graded according to the histo-pathologic Marsh-Oberhuber classification.

RESULTS

Chronic diarrhea was the main intestinal presentation in the typical group. Anemia was the most common extraintestinal symptom in both the typical and atypical group. Marsh-Oberhuber type 3b and 3c was significantly higher in the seropositive patients with a P value of 0.007. A significant correlation was observed between the histological grade of the biopsied duodenal mucosa and the clinical presentation (P < 0.001). Age was significantly higher in the atypical group (P value < 0.001).

CONCLUSION

Although typical CD was observed in 120 patients in this study, the clinical variability of the condition was frequently observed. Age only was a significant predictor for the appearance of atypical CD. Therefore, CD presentations in LMIC are not different from industrialized countries.

Keywords: Typical; Atypical celiac disease; Celiac serology; Marsh-Oberhuber histopathology

Core Tip: This study included 199 patients diagnosed with celiac disease (CD) over a 10-year period from 2010 to 2019 and was conducted at our tertiary hospital. Age, sex, clinical presentation, serological tests, and endoscopic findings were evaluated. We used the Marsh-Oberhuber classification to define the histopathological findings of the duodenal biopsies. The histopathological evaluation of intestinal biopsies revealed a statistically significant correlation between the histological grade of biopsied duodenal mucosa and the clinical presentation (P < 0.001). Those typical and atypical CD are not different from industrialized countries regarding age, clinical presentations, serology and pathology.