Demographic and Clinical Profile of Celiac Disease in Kashmiri Children: An Observational Study
Abstract
Introduction: Celiac disease is a common disorder in North India. No study is available regarding its clinicopathological
profile in Kashmiri children. Kashmir valley is abode to three different ethnicities principally constituted by Kashmiris and small
population of Pahari and Gujjar.
Aims and Objective: This study aims to study demographic and clinical profile of celiac disease in Kashmiri children.
Materials and Methods: The current study is hospital-based descriptive observational study conducted over 11/2 year. All patients
in the age group of 6 months–12 years presenting with chronic diarrhea and unexplained failure to thrive were evaluated for
celiac disease. A total of 62 patients were evaluated during the study period and 12 came positive for celiac disease (19%).
Results: Mean age of presentation is 6 years. Regarding principal modes of presentation, chronic diarrhea is observed in
10 (83%), unexplained failure to thrive 2 (16%), short stature 4 (33%), 7 out of 12 with wasting (58%), anemia 6 (50%), electrolyte
disturbance like hypokalemia in 7 (58%), with severe hypokalemia (k+<2) in three patients, and isolated hypertransaminasemia
in 4 (33%). Majority of the patients are Pahari/Gujjar (66%) despite constituting very little of whole population. This means that
a case of chronic diarrhea and unexplained failure to thrive is more likely to be celiac if belonging to this section of society.
Conclusion: Celiac disease is well present in Kashmiri children with case positivity rate among chronic diarrhea and unexplained
failure to thrive comparable to rest of North India and clinical spectrum shows malnutrition, anemia, and dyselectrolytemia in
majority of patients. Its prevalence varies between different ethnic groups being more in Pahari and Gujjar children as compared
to ethnic Kashmiri population.
References
Indian J Pediatr 2017;84:344-8.
2. Farrell RJ, Kelly CP. Celiac Disease, Sleisenger and Fordtran,
Gastrointestinal and Liver Disease. 9th ed. Saunders; 2010.
3. Mohindra S, Yachha SK, Srivastava A, Krishnani N, Aggarwal R,
Ghoshal UC, et al. Coeliac disease in Indian children: Assessment of clinical,
nutritional and pathologic characteristics. J Health Popul Nutr 2001;19:204-8.
4. Rosen A, Sandstrom O, Carlsson A, Hogberg L, Olen O, Stenlund H,
Ivarsson A. Usefulness of symptoms to screen for celiac disease. Pediatr
2014;133:211-8.
5. Bhattacharya M, Dubey AP, Mathur NB. Prevalence of celiac disease in
north Indian children. Indian Pediatr 2009;46:415-7.
6. Gupta R, Reddy DN, Makharia GM. Indian task force for celiac disease.
World J Gastrol 2009;15:6028-33.
7. Yachha SK, Misra S, Malik AK, Nagi B, Mehta S. Spectrum of
malabsorption syndrome in North Indian children. Indian J Gastroenterol
1993;12:120-5.
8. Thakur B, Mishra P, Desai N. Profile of chronic diarrhea in adults in western
India: A hospital based study. Trop Gastroenterol 2006;27:84-6.
9. Crovella S, Brandao L, Guimaraes R, Filho JL, Arraes LC, Ventura A, et al.
Speeding up coeliac disease diagnosis in the developing countries. Dig
Liver Dis 2007;39:900-2.
10. Malekzadeh R, Sachdev A, Fahid Ali A. Coeliac disease in developing
countries: Middle East, India and North Africa. Best Pract Res Clin
Gastroenterol 2005;19:351-8.
11. Yachha SK. Celiac disease: India on the global map. J Gastroenterol
Hepatol 2006;21:1511-3.
12. Rawashdeh MO, Khalil B, Raweily E. Celiac disease in Arabs. J Pediatric
Gastroenterol Nutr 1996;23:415-8.
13. Ferguson A, Arranz E, O’Mahony S. Clinical and pathological spectrum of
coeliac disease-active, silent, latent, potential. Gut 1993;34:150-1.
14. Ascher H, Holm K, Kristiansson B, Mäki M. Different features of coeliac
disease in two neighbouring countries. Arch Dis Child 1993;69:374-80.
15. Bottaro G, Failla P, Rotolo N, Sanfilippo G, Azzaro F, Spina M. Changes in
coeliac disease behaviour over the years. Acta Pediatr 1993;82:566-8.
16. George EK, Jansen TL, Mearin ML, Mulder CJ. Epidemiology of celiac
disease in the Netherlands. J Pediatr Gastroenterol Nutr 1997;24 Suppl 1:
S7-9.
17. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac
disease: Time for a standardized report scheme for pathologists. Eur J
Gastroenterol Hepatol 1999;11:1185-94.
18. Hoffenberg EJ, Haas J, Drescher A. A trial of oats in children with newly
diagnosed celiac disease. J Pediatr 2000;137:361-6.
19. Jamma S, Rubio-Tapia A, Kelly, CP. Celiac crisis is a rare but serious
complication of celiac disease in adults. Clin Gastroenterol Hepatol
2010;8:587-90.
20. Agarwal J, Poddar U, Yachha SK, Srivastava A. Refeeding syndrome
in children in developing countries who have celiac disease. J Pediatr
Gastroenterol Nutr 2012;54:521-4