Short Communication - (2017) Volume 1, Issue 2
Bhaswati C Acharyya1*, MK Goenka2 and Sujoy Khan3
1Department of Paediatric Gastroenterology, AMRI Hospitals, Kolkata, India
2Department of Gastrosciences, Apollo Gleneagles Hospital, Kolkata, India
3Department of Allergy and Immunology, Apollo Gleneagles Hospital, Kolkata, India
*Corresponding Author:
Bhaswati C Acharyya
Department of Paediatric Gastroenterology
AMRI Hospitals, Kolkata, India
Tel: 9836745890
Email: bukuli2@hotmail.com
Received date: February 21, 2017; Accepted date: April 14, 2017; Published date: April 17, 2017
Citation: Acharyya BC, Goenka MK, Khan S. Celiac Disease in Children – A Profile from a Predominantly Rice Eating Population. J Clin Gastroenterol Hepatol 2017, 1:2. doi: 10.21767/2575-7733.1000011
India had entered into the global scenario of celiac disease with Northern India being the celiac belt. But prevalence studies are lacking from the Eastern part of India.
Keywords
Celiac disease; Anti-endomysial antibody; IgAdeficiency; Duodenal biopsies; Chronic abdominal pain
Introduction
India had entered into the global scenario of celiac disease with Northern India being the celiac belt. But prevalence studies are lacking from the Eastern part of India.
Abbreviations
CD: Celiac Disease; Ig: Immunoglbulin; tTG: Tissue Transglutaminase
Methods
A retrospective study was undertaken where the case files of 720 children, who were screened for CD between the years 2011 to 2015, from three tertiary referral centres of Kolkata, were analysed. Blood tests for serum IgA level and anti tTGg- IgA antibody were used at screening. All children found positive for anti tTGg-IgA antibody at screening were subjected to endoscopic duodenal biopsy after informed consent.
Results
A total of 50 children aged 1 – 14 years were found to be anti tTG IgA positive. In 42 children, the anti tTG IgA antibody was positive in a titre more than 6 times of the normal limit (normal < 20 U/ml). Three children were found to have IgA deficiency, and anti endomysial antibody (EMA) IgG showed a high value suggesting the diagnosis of CD (Table 1).
| Age Group | No. of Anti tTG +ve | IgA deficiency and Anti EMA IgG +ve |
|---|---|---|
| 1-4yrs | 10 | 1 |
| 5-10yrs | 21 | 2 |
| 11-14yrs | 11 | - |
Table 1: Distribution of patients according to age group (n=45), (Male=25).
Celiac genetics were done for the three children with IgA deficiency. 2 were HLA DQ2 positive and one was DQ8 positive. All 50 children underwent endoscopic duodenal
Table 2 Different clinical presentations of celiac disease. biopsy (D1 and D2). In 45 children (25 male, 20 female) duodenal biopsies were suggestive of Celiac Disease (Marsh classification II and above), with adjusted prevalence at 5.83%. Prevalence of IgA deficiency was observed to be 0.42% among the children studied, and 6% among children with CD [1-4].
On analysis of clinical profile diarrhea was presenting feature of 8 children (17.78%), diarrhea with failure to thrive was presentatdiarrheaion of 9 (20%). Failure to thrive and anemia (independently as sole manifestation) were observed in 8 (17.78%) and 4 (8.89%) children respectively. Impaired liver function test (n=3), constipation with bloating (n=4), chronic abdominal pain (n=5) and delayed puberty (n=4) were other manifestations (Table 2).
| Age group | Persistent or recurrent diarrhea | Failure to thrive | Failure to thrive with diarroea | Anaemia | Delayed puberty | Constipation & bloating | Abdominal Pain | Impaired LFT |
|---|---|---|---|---|---|---|---|---|
| 1yr-4yrs | 2 | 3 | 2 | |||||
| 5-10yrs | 4 | 4 | 7 | 3 | 2 | 3 | 3 | |
| 11-14yrs | 2 | 1 | 1 | 4 | 2 | 2 | ||
| 8 (17.8%) | 8 (17.8%) | 9 (20%) | 4 (8.9%) | 4 (8.9%) | 4 (8.9%) | 5 (11%) | 3 (6.6%) |
Table 2: Different clinical presentations of celiac disease.
Ethnic origin analyses showed 13 (28.9%) patients were from Uttar Pradesh, 7 (15.5%) from Bihar and Rajasthan each, and the remaining 18 (40%) from native Bengal (Table 3).
| Ethnic Origin | No (Percentage) |
|---|---|
| Bengal | 18 (40%) |
| Uttar Pradesh | 13 (28.9%) |
| Rajasthan | 7 (15.5%) |
| Bihar | 7 (15.5%) |
Table 3: Ethnic origin of patients.
Discussion
The true prevalence of celiac disease in India is not well known. Symptomatic celiac disease is just the tip of the iceberg in India. Because of the widespread availability of the simple and accurate serological tests the hidden celiac disease groups are getting explored.
1. Regional differences are observed depending on genetic, immunological and dietary habits that is the wheat-rice shift from north to the south in India [1]. In various Indian studies, the prevalence of CD in children with malabsorption and chronic diarrhea ranged from 6.8% to 26%
2. The only Indian study on population screening in children for CD gives a prevalence of 1 in 310.
3. Another study from northern India showed the prevalence of CD to be 1% among children aged between 6 months to 12 years of age attending pediatrics department of a tertiary care hospital.
4. Both these studies did not estimate the serum IgA and probably had missed true cases of celiac disease with IgA deficiency.
No study is documented from Eastern India till now and this study is an eye opener. It is not the true prevalence. However, the fact, that 40% of affected children are from Bengali population, warrants further community studies including genetic studies in rice-eating native population.
Conclusion
Our study from children in East India shows a much higher prevalence at 5.83% but do not take into account the racial differences among these children. It is unlikely to be the true prevalence but since about 40% of the CD affected children are from Bengali population, this warrants further community and genetic studies in the rice-eating native population.
