CLINICAL PROFILE OF NON-DIARRHEAL CELIAC DISEASE: SINGLE CENTRE EXPERIENCE FROM CHILDREN’S HOSPITAL SRINAGAR

Background:  Celiac Disease (CD) is an immune-mediated systemic disorder elicited by gluten in wheat and related prolamines from rye and barley in genetically susceptible individuals and is characterized by the presence of a variable combination of gluten-dependent clinical manifestations, CD–specific antibodies, human leukocyte Antigen (HLA)-DQ2 or DQ8 haplotypes and enteropathy. Aim: To study the clinical profile of non-diarrhoeal coeliac disease in children. Methods: This Observational cross sectional study, was conducted in the Postgraduate Department of Paediatrics, Children Hospital, an associated hospital of Government Medical College Srinagar, which is a referral tertiary care hospital for the children of Kashmir valley. A total of 30 pediatric patients within the age group of 0 to 18 with non classical disease (diagnosed or suspected from 6 months) were enrolled and children from 6 months to 18 years with diagnosed or suspected coeliac disease with diarrhoea as the predominant symptom were excluded. Independent sample t-test was used for comparing the quantitative variables with normal distribution while Mann-Whitney U-test was used for comparing quantitative variables having abnormal distribution. A p-value of less than 0.05 was considered significant. Results:  The most common clinical presentation was anemia 50% (n=15), followed by short stature 23.33% (n=7). 16.67% (n=5) presented with gastrointestinal; bleeding.  Out of 30 patients, 66.67% (n=20) were underweight, 2333% (n=7) were of normal weight and 10% (n=3) were overweight. The most common finding on endoscopy was duodenal scalloping 46.6% (n=14) followed by decreased folds 36.6% (n=11). Duodenitis was seen in 20% 9n=6) patients. Out of 30 patients, 43.33% (n=13) had Marsh-Oberhuber grading 3b, 33.33% (n=10) had Marsh-Oberhuber grading 3a and 23.33% (n=7) had Marsh-Oberhuber grading 3c on histopathology examination of duodenal biopsy.  On correlating age with various variables in terms of gender, HPE findings, other demographic data and clinical features no statistical significance was seen (P >0.05). However, a significant correlation was seen between age and BMI (P<0.05). Conclusion: We concluded that, serologic tests are highly recommended for children with failure to thrive, weight loss, delayed puberty, short stature, amenorrhea, iron deficiency anemia, nausea, vomiting and abnormal liver enzyme elevation.