The Spectrum of clinical presentations of celiac disease among children in Ramadi city, west of Iraq

Background: Celiac disease (CD) is an immune-mediated systemic disorder triggered by the ingestion of gluten in genetically predisposed individuals. It is characterized by a broad spectrum of intestinal and extra-intestinal manifestations. Unlike many autoimmune disorders, the cause of CD dietary gluten is well established, and adherence to a gluten-free diet (GFD)  is highly effective in inducing symptom remission and healing the intestinal damage associated with enteropathy. Advances in serologic testing and heightened awareness of the condition have significantly contributed to the increased diagnosis of CD, including cases with atypical or subclinical presentations. This shift highlights a broader clinical spectrum than previously recognized, encompassing a variety of symptoms that extend beyond the classical gastrointestinal manifestations. Aim of the Study:- This study aims to understand the clinical presentations of celiac disease in children from the Al Ramadi province, providing insight into its manifestation patterns and guiding future diagnostic and management strategies. Methods:- This retrospective case series was conducted at the gastroenterology center of AL-Ramadi Teaching Hospital between January 2021 and August 2022. The study included 81 children aged 3-15 years who were referred for suspected celiac disease (CD), malabsorption, or a positive CD test. Results:- This study included male and female participants, with a mean age of  10.52 years (± 3.55) and an age range of 3 to 15 years. Of the 81 participants, 37 were female (45.7%) and 44 were male (54.3%). Celiac disease was highest among participants aged 11 to 15 years, accounting for 45 individuals (55.56%), while the lowest prevalence was observed in the 3 to 5-year age group, involving nine individuals (11.11%). The intermediate age group of 6 to 10 years included 27 participants (33.33%). Anemia and diarrhea were the most commonly reported symptoms, affecting 29 participants (35.8%) and 24 participants (29.6%). Bloating and constipation were each reported by  (3.7%)  of participants. Vomiting was documented in 6.4% of cases, and  9 participants (11.11%) presented with short stature. Conclusions: Celiac disease in children presents with a wide range of symptoms. In this study, the highest prevalence of CD was observed in the 11-15-year-old age group, with boys being slightly more affected than girls. Anemia, particularly iron deficiency anemia  (IDA) and diarrhea, were identified as the most common presenting features.