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Research letters

Indian Pediatr 2013;50: 1061-1062

Profile of Typical and Atypical Celiac Disease in Serbian Children

 

Boskovic Aleksandra, Kitic Ivana, Stankovic Ivica and Dragan Prokic

Department of Gastroenterology and Hepatology, Mother and Child Health Care Institute,
Medical University of Belgrade, Serbia 11070 New Belgrade, Radoja Dakica 6-8,Serbia.
Email: [email protected]




We compared the clinical, biopsy and serology profile in typical vs atypical celiac disease.Mean TTG value for Marsh 3b/c in typical group was (140.53+/-88.77) and in atypical (140.66+/-73.53) (P=0.622). Seventy seven percent of patients had Marsh 3b/c in typical and 67.5% in atypical group (P=0.400).

Keywords: Celiac disease; Enteropathy; Enterobiopsy; Serological tests.

We conducted this study to identify whether the clinical presentation, mean anti-TTG level and severity of duodenal lession are different in children with typical and atypical celiac diseases, by a retrospective review of clinical charts of patients with celiac disease, diagnosed between 2006 to 2010. Quantitative detection of human IgA class anti tTG antibodies were measured with an enzyme-linked immunosorbent assay kit (Orgentec, GmbH, Mainz-Germany). Biopsies from the distal duodenum (minimum of four forceps biopsies) were obtained by upper gastrointestinal endoscopy. Three pathologist experienced with diagnosis of celiac disease reviewed the histopathological specimens. Confirmation of a Marsh 2 or 3 lesion was required for a diagnosis of celiac disease [1].

The clinical spectrum was categorized as (1) typical or classical, suggested by clinical malabsorption, chronic diarrhea or failure to thrive; and (2) atypical or oligosymptomatic, suggested by abdominal pain, iron deficiency anemia, chronic hypertransaminasemia, growth failure or screening of risk groups, or familial study.

A total of 103 patients fulfilled the diagnostic criteria for celiac disease (mean age: 6.6 years; range: 0-18 years; median : 5 years). Clinical profile, biopsy findings, and TTG values between the two groups are provided in
Table
I
.

TABLE I  Comparison of Clinical, Biopsy and Serology Profile in Typical and Atypical Celiac Disease (N=103)
Typical CD Atypical CD
Clinical features# malabsorption 25 (37) anemia 10 (27)
chronic diarrhea 21 (33) first degree relatives 9 (24.3)
failure to thrive 12 (18) diabetes mellitus 6 (8.1)
other gastrointestinal symptoms 8(12) nanosomia 4 (16.2)
anorexia 3(10.8), urticaria 2 (54%)
others 3 (8.1%)
TTG* Marsh 3b and 3c 140.5 (88.77) 140 (73.53)
Marsh 3a 129 (73.76) 113.1 (89.43)
Marsh 2   96 (12,17) 89 (14.85)
Marsh degree# Marsh 3b and 3c   51 (77)  25 (67.5)
  Marsh 3a 7 (10.6) 4 (10.8)
Marsh 2   8 (12.4)   8 (21.7)
#Number (%), *Mean (SD).

There are several studies that describe the correlation between anti-TTG antibody level and Marsh type [2,3]; however, none of them deals with the difference between typical and atypical group. In our study, the difference in the mean TTG level in both groups was not significant. There was no difference in the clinical presentation and the severity of duodenal lession, indicating that factors other than the degree of villous atrophy must account for typical simptoms in celiac disease.The diagnosis of atypical celiac disease is often made only at an advanced stage because of the lack of gastrointestinal symptoms, and it could be a possible reasons for similar biopsy changes in children with and without typical features.As opposed to our study, Dinler, et al. [4] found that total/subtotal villous atrophy was significantly higher in the typical than in atypical group . The potential drawback of our work is a retrospective data and bias due to hospital setting.

References

1. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, et al. Guidelines for the Diagnosis of Coeliac Disease in Children:Recomendation of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. JPGN. 2012;54:136-60.

2. Hansson T, Dahlbom I, Rogberg S, Dannaeus A, Hopfl P, Gut H, et al. Recombinant human tissue transglutaminase for diagnosis and follow up of childhood celiac disease. Pediatr Res. 2002;51:700-5.

3. Fabiani E, Catassi C; International Working Group on Eu-TG. The serum IgA class anti-tissue transglutaminase antibodies in the diagnosis and follow up of celiac disease: results of an international multi-centre study. Eur J Gastroenterol Hepatol. 2001;13:659-65.

4. Dinler G, Atalay E, Kalayci G. Celiac disease in 87 children with typical and atypical symptoms in Black sea region of Turkey.World J Pediatr. 2009;5: 282-6.

 

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