Mahmud Iqbal, Yasmin Jalaluddin, Muhammad Luqman.
Coeliac disease in Pakistani children.
Pak Armed Forces Med J Jan ;46(2):68-75.

This study was conducted to investigate the frequency of coeliac disease amongst children with persistent diarrhoea and record its relevant features in children in Pakistan. The children with persistent, non-infective diarrhoea were subjected to routine tests like complete blood picture, absolute values, estimation of serum proteins and globulin, stool analysis alongwith culture & sensitivity. All children had jejunal biopsy carried out by crosby capsule. Out of 85 children, 40147%) cases showing flat jejunal mucosa and eliciting favourable response to gluten free diet were labelled as suffering from coeliac disease. These children had mean age of presentation of 5 years and 3 months. The interval between onset of symptoms and introduction of wheat in weaning diet ranged from 1 week to 3.5 years. Majority of children had persistent diarrhoea (85%), abdominal distention (67.5%) and failure to thrive 152.5%). However, a few children had occult disease with rickets (2.5%), iron deficiency anaemia 15%) and short stature (5%). The mean haemoglobin was 7.6 g/dl. The majority of patients had flat jejunal mucosa (62.5%) with evidence of surface epithelial injury (100%) and increased crypt mitoses (100%). In conclusion, due to lack of diagnostic facilities and awareness, coeliac disease has been, hitherto, under-diagnosed in our country. All children with stunted growth, failure to thrive and abdominal distention associated with gastrointestinal symptoms should be investigated for coeliac disease. However, gluten withdrawal should not be undertaken without biopsy confirmation.

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