A COMPARATIVE STUDY ON THE CELIAC DISEASE AMONG CHILDREN AT SHEIKH ZAYED HOSPITAL RAHIM YAR KHAN

Objective: To find out the clinical features as well as associated investigation of laboratory testing of the patients suffering from celiac disease and the comparison of the Classical Celiac Disease with the Non-Diarrheal Celiac Disease. Methodology: This retrospective research work was carried out at Sheikh Zayed Hospital Rahim Yar Khan from January 2016 to December 2019. The patients which were included in this study was from 1 to 15 years of age from both genders with the confirmed diagnosis of the Celiac Disease according to revised Espghan standard. We considered the samples of biopsy with Grade-2 or higher on MMC (Modified Marsh Classification) as consistent with the celiac disease. The categorization of the patients of celiac disease was carried out into classical celiac disease with chronic diarrhea and non-diarrheal celiac disease with atypical celiac and we recorded the clinical aspects and associated investigation of the laboratory testing of the patients. Results: In this study 66 patients who fulfilled the criteria of this study were the participants of this research, we labeled 59.09% (n: 39) patients as classical celiac disease and 40.91% (n: 27) patients as non-diarrheal celiac disease. Marsh grading, 3a and higher were marked more in classical celiac disease patients in comparison with the patients having non-diarrheal celiac disease. Average titer for the TTG (Tissue Transglutaminase Antibodies) was much high in the patients of classical celiac disease group as compared to the patients of non-diarrheal celiac disease group. Abdominal distension was the most common presentation in the patient of classical celiac disease whereas in the patients of non-diarrheal celiac disease, most common feature was recurring abdominal pain (62.90%). Rate of occurrence of failure to thrive is much higher in the patients of classical celiac disease as 82.05% but the patients present were short stature were more frequent in the group of non-diarrheal celiac disease (33.30%). There was presence of refractory anemia in 66.60% patients with non-diarrheal celiac disease and 41.10% patients in the group of classical celiac disease. In the 74.30% classical celiac disease patients, there was deficiency of Vitamin-D while in 85.0% patients of non-diarrheal celiac disease group, there was deficiency of Vitamin-D (P= 0.030). Conclusion: Non-diarrheal celiac disease is common in our community. Recurring pain in abdomen cavity, thrive failure or patients having short stature and anemia are noticeable features in the patients of non-diarrheal celiac disease group while abdominal distension, recurring pain in abdomen cavity and failure to thrive were important features in the patients of classical celiac disease group. Histopathology of high grade and elevated antibodies titer are classical celiac disease’s hallmark. There was not much difference in the deficiency of Vitamin-D in both groups. KEYWORDS: Classical Celiac Disease, Non-Diarrheal Celiac Disease, Anemia, Histopathology, Abdomen, Thrive, Recurring, Antibodies