Celiac disease in Saudi children. Evaluation of clinical features and diagnosis.
Celiac disease (CD) is a chronic autoimmune disorder in which ingestion of gluten (a group of proteins
in wheat, rye, and barley). propagation of CD is approximately 0.5 to 1% in general population.1 The true propagation of CD in Kingdom of Saudi Arabia (KSA) is not known due to lack of a national epidemiological study, but regional data shows that it is a common disorder in this part of the world.
The purpose of the study was diagnosis including serological tests characterize the clinical presentation and histopathological findings using Marsh grading in children with CD.
All children with a diagnosis of CD from January 2009 to January 2015 at a private tertiary
care hospital, Suleman Al-Habib Medical Group, Riyadh, KSA were studied retrospectively.
The data was collected from electronic records of patients using search terms: celiac disease, gluten sensitive enteropathy ,chronic diarrhea, malabsorption, and small intestinal biopsies. Only children under the age of 18 years were included
Categorical data were summarized as numbers and percentages, whereas continuous data were summarized as mean and standard deviation.

Results :
Of the 318 small intestinal biopsies performed on children for various reasons over a period
of 6 years, 64 (20.1%) had received a diagnosis of CD. Data was missing in 5 patients, so 59 cases were included in the study.
A total of 59 children had confirmed celiac disease. Thirty (50.8%) were male. Median age was 8 years (range 1 to 16 years). The mean duration of symptoms before the diagnosis was 2.3±1.5 years with almost 95% being of Saudi origin.

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Classical symptoms were present in 18 (30.5%), while 41 (69.5%) had non-classical (atypical presentation

Diarrhea is a hallmark of malabsorption and this symptom was primarily used to designate classical CD. Failure to thrive was most common symptom in classical CD. Many also had abdominal distention and abdominal pain. Short stature was most common presentation of non-classical CD.
A significant proportion of children had growth retardation, in both classical and non-classical
CD groups. Clinical pattern of high risk patients with CD (n=19) including those with type-I diabetes, Down syndrome, autoimmune thyroiditis and siblings

Celiac disease is a common disorder in children. Studies from Arab countries has shown
a rising trend
CD used to present at an earlier age with malabsorptive symptoms such as chronic diarrhea, abdominal
distension and failure to thrive.11 On the other hand, non-classical cases are detected during screening for other presentations such as isolated short stature, vomiting, constipation, recurrent abdominal pain and iron deficiency anemia. Malabsorptive picture with diarrhea is seen in classical CD.