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Mouslih A, El Rhazi K, Bahra N, Lakhdar Idrissi M, Hida M. Celiac Disease in Moroccan Children: Diagnostic Characteristics and Determinants of Diagnosis Delay. Cureus 2023; 15:e50800. [PMID: 38125690 PMCID: PMC10731523 DOI: 10.7759/cureus.50800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 12/23/2023] Open
Abstract
Advances in the field of celiac disease have led to a better understanding of the disease, but it remains underdiagnosed and poses a daily challenge to clinicians to make a timely diagnosis. This study aims to analyze and describe diagnosis characteristics, diagnosis delay, and the factors influencing this delay in Moroccan children. Our study included 324 children diagnosed during the study period from January 01, 2010, to December 30, 2019, at the Department of Pediatrics, Hassan II University Hospital in Fez, Morocco. Data were collected using a collection grid and then analyzed using SPSS 26 software (IBM Corp., Armonk, NY). The results showed a female predominance (n=197, 60.8%), with a diagnosis age of 73.8±46.8 months. The mean age onset of symptoms was 51.3±41.2 months, and the diagnosis delay was 22.2±22.6 months, with only 32.7% (n=106) diagnosed less than 12 months after symptom onset. The most common consultation reason was diarrhea (n=149, 46%) and growth delay (n=105, 32.4%) and 50.5% (n=98) of parents consulted a pediatrician first. The three clinical, serologic, and histologic criteria made it possible to agree on the diagnosis, with the clinical profile dominated by the digestive form at 84.9% (n=279), serologic with the presence of IgA transglutaminase antibodies (95.7%; n=310), and histologic with villous atrophy at 91.7% (n=297). Unfortunately, 14.8% (n=48) of the children were diagnosed with a celiac crisis. The multivariate logistic regression analysis showed that as symptoms onset age increased, so did the risk of late diagnosis (OR=0.96, 95% CI: 0.94 to 0.97, p<0.001). Age of diagnosis was also associated with delayed diagnosis (OR=19.68, 95% CI: 8.77 to 44.15, p<0.001). The combination of these variables and the diagnosis delay argues in favor of adopting a diagnosis strategy that includes raising awareness among healthcare professionals of the need to identify typical and atypical cases early in order to reduce the adverse effects of late diagnosis and the complications that can result. This methodology for improving diagnoses may also unearth previously unknown aspects of celiac disease in Moroccan children.
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Affiliation(s)
- Assia Mouslih
- Laboratory of Epidemiology and Health Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, MAR
| | - Karima El Rhazi
- Laboratory of Epidemiology and Health Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, MAR
| | - Nassiba Bahra
- Laboratory of Epidemiology and Health Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, MAR
| | - Mounia Lakhdar Idrissi
- Department of Pediatrics, Faculty of Medicine and Pharmacy/ Epidemiology and Health Science Research Laboratory, Hassan II University Hospital, Fez, MAR
- Laboratory of Epidemiology and Health Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, MAR
| | - Moustapha Hida
- Department of Pediatrics, Faculty of Medicine and Pharmacy/ Epidemiology and Health Science Research Laboratory, Hassan II University Hospital, Fez, MAR
- Laboratory of Epidemiology and Health Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, MAR
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Mauro A, Casini F, Talenti A, Di Mari C, Benincaso AR, Di Nardo G, Bernardo L. Celiac crisis as the life-threatening onset of celiac disease in children: a case report. Front Pediatr 2023; 11:1163765. [PMID: 37252043 PMCID: PMC10213434 DOI: 10.3389/fped.2023.1163765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
Celiac disease (CD) is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. In rare cases, CD may occur with a severe potential life-threatening manifestation known as a celiac crisis (CC). This may be a consequence of a delayed diagnosis and expose patients to possible fatal complications. We report the case of a 22-month-old child admitted to our hospital for a CC characterized by weight loss, vomiting, and diarrhea associated with a malnutrition state. Early identification of symptoms of CC is essential to provide a prompt diagnosis and management.
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Affiliation(s)
- Angela Mauro
- Department of Childhood and Developmental Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Francesca Casini
- Department of Biomedical and Clinical Sciences, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Antonella Talenti
- Department of Childhood and Developmental Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Clelia Di Mari
- Department of Childhood and Developmental Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Anna Rita Benincaso
- Department of Childhood and Developmental Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Giovanni Di Nardo
- Faculty of Medicine and Psychology, Sapienza University of Rome-NESMOS Department, Sant’Andrea University Hospital, Rome, Italy
| | - Luca Bernardo
- Department of Childhood and Developmental Medicine, Fatebenefratelli Hospital, Milan, Italy
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Sharma P, Baloda V, Gahlot GP, Singh A, Mehta R, Vishnubathla S, Kapoor K, Ahuja V, Gupta SD, Makharia GK, Das P. Clinical, endoscopic, and histological differentiation between celiac disease and tropical sprue: A systematic review. J Gastroenterol Hepatol 2019; 34:74-83. [PMID: 30069926 DOI: 10.1111/jgh.14403] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/02/2018] [Accepted: 07/14/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM While the prevalence of celiac disease (CD) is increasing globally, the prevalence of tropical sprue (TS) is declining. Still, there are certain regions in the world where both patients with CD and TS exist and differentiation between them is a challenging task. We conducted a systematic review of the literature to find out differentiating clinical, endoscopic, and histological characteristics between CD and TS. METHODS Medline, PubMed, and EMBASE databases were searched for keywords: celiac disease, coeliac, celiac, tropical sprue, sprue, clinical presentation, endoscopy, and histology. Studies published between August 1960 and January 2018 were reviewed. Out of 1063 articles available, 12 articles were included in the final analysis. RESULTS Between the patients with CD and TS, there was no difference in the prevalence and duration of chronic diarrhea, abdominal distension, weight loss, extent of abnormal fecal fat content, and density of intestinal inflammation. The following features were more common in CD: short stature, vomiting/dyspepsia, endoscopic scalloping/attenuation of duodenal folds, histological high modified Marsh changes, crescendo type of IELosis, surface epithelial denudation, surface mucosal flattening, thickening of subepithelial basement membrane and celiac seropositivity; while those in TS include anemia, abnormal urinary D-xylose test, endoscopic either normal duodenal folds or mild attenuation, histologically decrescendo type of IELosis, low modified Marsh changes, patchy mucosal changes, and mucosal eosinophilia. CONCLUSIONS Both patients with CD and TS have overlapping clinical, endoscopic, and histological characteristics, and there is no single diagnostic feature for differentiating CD from TS except for celiac specific serological tests.
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Affiliation(s)
- Pragya Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vandana Baloda
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Ps Gahlot
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Singh
- Department of Gastroenterology and Human Nutritions, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Mehta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Kulwant Kapoor
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Govind K Makharia
- Department of Gastroenterology and Human Nutritions, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Radlovic N, Lekovic Z, Radlovic V, Simic D, Vuletic B, Ducic S, Stojsic Z. Celiac crisis in children in Serbia. Ital J Pediatr 2016; 42:25. [PMID: 26931303 PMCID: PMC4774094 DOI: 10.1186/s13052-016-0233-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/23/2016] [Indexed: 12/21/2022] Open
Abstract
Background To assess the prevalence and risk factors of celiac crisis (CC) in children with classical celiac disease (CD). Methods This retrospective study comprised 367 children with classical CD diagnosed from 1994 to 2015. The diagnosis of CD was based on the revised ESPGHAN criteria and CC on acute worsening and rapid progression of chronic diarrhea and vomiting followed by severe dehydration, multiple metabolic derangements and a marked decrease of body weight. Results Celiac crisis was confirmed in six (1.63 %) children, five in the first and one in the second year of life. In three patients CC was precipitated by rotavirus and in one by Salmonella enteritidis infection, while in the remaining two, except for a too long-standing disease and severe malnutrition, no additional causes of CC were found. Conclusion Celiac crisis in Serbia is still-present in children exclusively below the second year of life as a spontaneous or intestinal infection precipitated complication of previously unrecognized CD.
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Affiliation(s)
- Nedeljko Radlovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade, 11000, Serbia. .,University Children's Hospital, Tirsova 10, Belgrade, 11000, Serbia. .,Academy of Medical Sciences of the Serbian Medical Society, Dzordza Vasingtona 19, Belgrade, 11000, Serbia.
| | - Zoran Lekovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade, 11000, Serbia. .,University Children's Hospital, Tirsova 10, Belgrade, 11000, Serbia.
| | - Vladimir Radlovic
- University Children's Hospital, Tirsova 10, Belgrade, 11000, Serbia.
| | - Dusica Simic
- Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade, 11000, Serbia. .,University Children's Hospital, Tirsova 10, Belgrade, 11000, Serbia.
| | - Biljana Vuletic
- Pediatric Clinic, Clinical Centre, Zmaj Jovina 30, Kragujevac, 34000, Serbia.
| | - Sinisa Ducic
- Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade, 11000, Serbia. .,University Children's Hospital, Tirsova 10, Belgrade, 11000, Serbia.
| | - Zorica Stojsic
- Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade, 11000, Serbia. .,Institute of Pathology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, Belgrade, 11000, Serbia.
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Kumar P, Badhan A. Hypokalemic paraparesis: Presenting feature of previously undiagnosed celiac disease in celiac crisis. Indian J Crit Care Med 2015; 19:501. [PMID: 26321817 PMCID: PMC4548427 DOI: 10.4103/0972-5229.162478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Toyoshima MTK, Queiroz MS, Silva MER, Corrêa-Giannella MLC, Nery M. Celiac crisis in an adult type 1 diabetes mellitus patient: a rare manifestation of celiac disease. ACTA ACUST UNITED AC 2014; 57:650-2. [PMID: 24343635 DOI: 10.1590/s0004-27302013000800011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 01/20/2013] [Indexed: 12/17/2022]
Abstract
Celiac crisis, an acute severe onset of celiac disease, is a rare and life-threatening manifestation. We report a 30-year-old woman with type 1 diabetes mellitus who arrived at our service with one-month history of severe acute watery diarrhea associated with nausea, vomiting, abdominal pain, and weight loss of 9 kg. The diagnostic hypothesis of celiac crisis was reached based on profuse diarrhea leading to dehydration, severe metabolic and electrolyte abnormalities, and subsequent improvement after introduction of a gluten-free diet.
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Aggarwal V, Kanwal SK, Kumar V, Dhingra B, Kumar P, Chopra A, Kumar S. Acute watery diarrhea: are we missing celiac disease? J Trop Pediatr 2012; 58:329-31. [PMID: 21990108 DOI: 10.1093/tropej/fmr084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Affiliation(s)
- Jane Oba
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
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Kaya A, Dogan M, Yuca SA, Acikgöz M, Doğan SZ, Cesur Y. Celiac Disease with Celiac Crisis. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2010. [DOI: 10.29333/ejgm/82855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Atikou A, Rabhi M, Hidani H, El Alaoui Faris M, Toloune F. [Celiac crisis with quadriplegia due to potassium depletion as presenting feature of celiac disease]. Rev Med Interne 2009; 30:516-8. [PMID: 19249140 DOI: 10.1016/j.revmed.2008.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 11/13/2008] [Accepted: 11/23/2008] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Adult coeliac disease revealed by coeliac crisis and quadriplegia due to potassium depletion is an extremely rare situation. CASE REPORT A 26-year-old woman presented with a suddenly developed weakness of all four limbs and a severe diarrhea. Authors emphasize coeliac crisis, which is a presenting feature of coeliac disease, characterized by acute diarrhea with life-threatening acid base and electrolyte abnormalities. The patient improved with correction of hypokalemia and gluten-free diet. CONCLUSION A severe acute diarrhea with metabolic and systemic complications, the so-called coeliac crisis, is a possible presenting clinical feature of a previously undiagnosed adult celiac disease.
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Affiliation(s)
- A Atikou
- Service de médecine interne, hôpital militaire d'instruction Mohammed V, Rabat, Maroc
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Celiac crisis in an adult on immunosuppressive therapy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2008; 22:574-6. [PMID: 18560637 DOI: 10.1155/2008/453520] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
'Celiac crisis' is a rare presentation of celiac disease with manifestations that include severe diarrhea, and severe metabolic and electrolyte abnormalities. It is most frequently seen in children younger than two years of age and has been rarely described in adults. A case of a 50-year-old woman who presented with diarrhea, severe dehydration, hypokalemia and metabolic acidosis is described. Based on positive serology and small bowel biopsy, she was diagnosed with celiac disease. She also had histological evidence of lymphocytic colitis. Microscopic colitis has not previously been described in association with celiac crisis, but it may have contributed to the presentation of celiac crisis in the current case. The patient was on corticosteroids and azathioprine for autoimmune hepatitis at the time of her presentation. The current case demonstrates that modest immunosuppression does not prevent a celiac crisis, although previous reports have shown that patients may respond rapidly to high-dose corticosteroids.
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Buchanan R, Dennis S, Gendel S, Acheson D, Assimon SA, Beru N, Bolger P, Carlson D, Carvajal R, Copp C, Falci K, Garber E, Harden E, Kane R, Kvenberg J, Luccioli S, Park D, Raybourne R, Troxell T, Vierk K. Approaches to establish thresholds for major food allergens and for gluten in food. J Food Prot 2008; 71:1043-88. [PMID: 18522044 DOI: 10.4315/0362-028x-71.5.1043] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Buchanan
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5100 Paint Branch Parkway, College Park, Maryland 20740-3835, USA
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