Celiac Disease – A 13-Year Casuistic in a Tertiary Hospital

Background: Celiac disease (CD), also known as gluten-sensitive enteropathy is an immune-mediated inflammatory disease of the small intestine caused by sensitivity to dietary gluten and related proteins in genetically predisposed individuals. The disorder occurs in 0.5 to 1 percent of the general population in most countries.

Objective: Evaluating the incidence of celiac disease in the pediatric population in a tertiary hospital.

Methods: A retrospective study was carried out through review of clinical process of the pediatric patients with confirmed diagnosis of celiac disease in a tertiary hospital since 2006 to 2018.

Results: 65 cases of celiac disease were diagnosed, with a mean age of onset at 22 months and mean age of diagnosis between 4-5 years old, with no gender predominance. In the clinical presentation, 61 patients had gastrointestinal symptoms (GI), with a deficient weight progression (N = 45); abdominal distension (N = 40) and diarrhea (N = 39). 33 patients also presented non-GI symptoms, where growth retardation (N = 25) and anemia (N = 18) were the most prevalent.

Analytically all patients were positive for IgA/IgG anti-transglutaminase antibodies and/or IgA/IgG anti-gliadin antibodies. All patients, except 3, underwent upper digestive endoscopy with biopsies, whose histopathological analysis was suggestive for celiac disease in 58 patients, being classified according to Marsh criteria. 77% of patients have a positive genetic test for HLA-DQ2.

Conclusion: The diagnosis of CD is complex, especially with atypical manifestations. The diagnosis may be established after clinical correlation between symptoms, positive serology, intestinal biopsy and response to gluten-free diet. In recent years, the prevalence of CD has increased because of the greater degree of suspicion and better accuracy of the serological tests.