Observational Study
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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
ARTICLE HIGHLIGHTS
Research background

Celiac disease (CD) is defined as an immune mediated systemic disorder elicited by gluten and related prolamines in genetically susceptible individuals. CD is one of the most common causes of chronic malabsorption. CD results from injury to the small intestine with loss of absorptive surface area, reduction of digestive enzymes, and consequential impaired absorption of micronutrients such as fat-soluble vitamins, iron, and potentially B12 and folic acid. Celiac disease presented with chronic diarrhea, failure to thrive and abdominal distention usually observed within the first 1-2 years of life. At the older age, atypical features such as anemia, short stature, bone disease and liver failure may occur. It should be considered in patients with an appropriate clinical history as well as in patients from high-risk populations. Serological tests are used as initial tests for CD and duodenal biopsies obtained during esophagogastroduodenoscopy (EGD) are considered the standard for diagnosis. The diagnosis of CD is based on the identification of histological lesions accompanied by clinical and serological consistent data. On the basis of the presence of one or more of these elementary lesions the histopathology of CD is subdivided into different diagnostic categories according to Marsh classification.

Research motivation

Many cases of Celiac disease in our country with different clinical presentations motivate us to search for different histopathological examination in the disease sub-types.

Research objectives

To compare the serological, gastrointestinal endoscopic, and histopathologic findings in typical and atypical presentations of pediatric CD at a tertiary referral hospital in the capital city of Egypt; an African low/middle income country. We also aimed to find whether these findings are different from presentations industrialized countries.

Research methods

A hospital-based, cross-sectional observational study was conducted at Cairo University Children Hospital which is the largest pediatric tertiary hospital in the capital city of Egypt and one of the largest in the Middle East and North Africa (MENA) region. Data of the patients diagnosed with CD was collected in the period from 2010 to 2019. The study included 199 patients diagnosed with celiac disease; they were divided into two groups based upon the presenting symptoms: typical or classic CD (Group A) and atypical or non-classic CD patients (Group B).

Research results

Typical CD is more common than atypical, chronic diarrhea was common in typical group with P value < 0.001. sero-positive cases were 106 (typical 58, atypical 48cases). The most common histological finding in typical seropositive cases were March types 3c (27/58, 46.6%), The most common histological finding in atypical seropositive cases were March types 3b (15/48, 31.3%) (P value 0.022).

Research conclusions

CD clinical presentations in low/middle income country are not different from industrialized countries and late diagnosis is more common in atypical cases.

Research perspectives

Follow up of the CD cases and their prognosis, if there is changes in histological picture in future.