IINCIIDENCE OF COELIIAC DIISEASE IIN HIIGH RIISK SUDANESE CHIILDREN IIN KHARTOUM STATE

This is a prospective hospital-based study which aimed to determine the incidence of celiac disease among Sudanese children with feateatures suggestive of the disease , to study socio-demographic and clinical features of celiac patients and to correlate between the serological markers titres and the degree of villous atrophy. Inclusion criteria were children aged nine month-18years, with two of the following:chronic diarrhea,growth retardation, refractory iron or folate deficiency anaemia, family history of diagnosed celiac disease.Eighty children 46 males and 34 females were enrolled this study. Study tools included: questionnaire, physical examination, anthropometric measurements, laboratory tests, serology for celiac disease using anti-gliadin anti-bodies test(IgA and IgG classes) and endomysium anti-body test and duodenal biopsy. The result revealed that 18 children (22.5%) confirmed CD (with at least two positive markers of CD and duodenal biopsy confirmatory to CD). 26 children (32.5%) were propable CD ( with at least one marker positive and no confirmatory biopsy). 36 children (45.0%) were non-coeliacs ( with negative AgA test both IgA and IgG classes). There were no statistical significant difference between the three groups regarding socio-demographic and clinical features. The mean age of onset of symptoms of celiac patients was six years and ten years at the time of diagnosis. Male to female ratio was 1:1.3.Celiac 127 children were predominantly from middle socioeconomic class, from from tribal origins from northern and central Sudan. 22.2% of them had delayed motor development, half presented with diarrhea while the other half presented with other symptoms. The commonest presenting symptoms were poor appetite, abdominal distension, vomiting and abdominal pain. Most celiac children presented with severe wasting , 65.4% had weight per height below 3rd centile.The commonest clinical signs were pallor, signs of iron deficiency anaemia, muscle wasting and abdominal distension. Haemoglobin level was low in the majority of celiac children 17(94.4%) had haemoglobin level 5-12 mg/dl. 12 celiac children (66.7%) had iron deficiency anaemia, the remaining had combined iron and folate deficiency anaemia. The degree of villous atrophy did not correlate with the duration, severity of diarrhea or severity of anaemia. There was no correlation between the serological titres and the degree of villous atrophy. AGA-IgG was found more sensitive but less specific,AGA-IgA was less sensitive but more specific while EMA test was highly specific. It was recommended that high risk children should be screened for CD. Prevalence of CD in the community should be determined by further studies by using serological tests for the initial screening