Indian Pediatrics - Editorial

Letters to the Editor

Indian Pediatrics 2005; 42:1171-1172

Celiac Disease in Chennai

Celiac disease (CD), a permanent gluten intolerance is basically a T lymphocytic mediated small intestinal enteropathy induced by gluten in individuals with a genetic predisposition(1). This has been well documented from North India where wheat is the staple diet(2,3). However, there are no documented reports from Tamilnadu. We are reporting 3 cases seen in Chennai as shown in Table I with characteristics features of CD who responded well to gluten free diet (GFD). An interesting information obtained on history was that though the families of these 3 children were living in Chennai for several generations, their ancestral descent was from other states like Rajasthan and Andhra Pradesh. Travel and migration is now part of our life and one should consider CD especially in the migrant population from North India. Early recognition of this problem and avoiding gluten in these children will definitely help in decreasing the morbidity associated with this disease.

Table I

Clinical Profile of Cases.

	Case 1	Case 2	Case 3
Age & sex Age of onset of symptoms Clinical presentation	6 yrs, Male 4.5 yrs Recurrent diarrhea, growth failure	7 yrs, Male 5 yrs Chronic diarrhea, pallor	11yrs, Male 5 yrs Growth failure, Recurrent respiratory illness, recurrent. diarrhea.
Physical findings Height in cms Weight in kg Pallor	105 (exp113) 15 (exp 20) -	107 (exp119) 16.5 (exp 22) +	110 (exp143) 15 (exp 30) +
Upper GI endoscopy	Normal	Scalloping of duodenal mucosa	Scalloping of duodenal mucosa
HPE- duodenal biopsy Villous atrophy Crypt hyperplasia ↑lamina propria cellularity Parasites	Subtotal + + -	Severe + + -	Severe + + -
Serology EMA AGA tTGA	+ ↑ ↑	+ Not significant ↑	Not done ↑ Not done
Response to Gluten Free Diet
Symptomatic improvement Improvement in Ht and Wt	Marked 3 cm & 2 kg in	Marked 2 cm & 2 kg in	Marked 3 cm & 2 kg in
	5 months	5 months	4 months

EMA—Endomysial ntibody, AGA—Anti Gliadin antibody, tTGA—tissue transglutaminase antibody.

Malathi Sathiyasekeran,
So. Shivbalan*,
Kanchi Kamakoti CHILDS Trust Hospital,
Chennai 600 034 and
*Sri Ramachandra Medical College &
Research Institute (Deemed University),
Porur, Chennai- 600 116.
E-mail: [email protected]

References

1. Shamir R. Advances in celiac disease. Gastroenterol Clin North Am 2003; 32: 931-947.

2. Yachha S K, Misra S, Malik A K, Nagi B, Mehta S K. Spectrum of malabsorption syndrome in north indian children. Indian J Gastroenterol 1993; 12: 120-125.

3. Patwari A K, Anand V K, Kapur G, Narayanan S. Clinical and nutritional profile of children with celiac disease. Indian Pediatr 2003; 40: 337-342.