SCREENING FOR CELIAC DISEASE IN EGYPTIAN CHILDREN Prof. Dr: Mona Abu Zekry -Professor of Pediatrics Head Of Pediatric Gastroenterology- Cairo UNI * Dr : Mohamed Diab Specialist Pediatrics* Dr: Ghada Fikry Specialist

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SCREENING FOR CELIAC DISEASE IN EGYPTIAN
CHILDRENProf. Dr Mona Abu Zekry -Professor of
PediatricsHead Of Pediatric Gastroenterology-
Cairo UNI Dr Mohamed Diab Specialist
PediatricsDr Ghada Fikry Specialist
PediatricsGastroenterology Unit - Children's
HospitalFaculty of Medicine Cairo University
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CELIAC Disease

• Celiac disease, otherwise known as
  gluten-sensitive enteropathy
• Is an immune-mediated condition in which
  ingestion of dietary gluten results in small
  intestinal mucosal inflammation, crypt
  hyperplasia, and villous atrophy in genetically
  susceptible individuals.

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• The environmental factors are, the gliadin
  fraction of wheat gluten and similar
  alcohol-soluble proteins in other grains (e.g.
  barely rye)
• Genetic predisposition is the presence of HLA
  alleles DQA10501/DQB10201in most of the cases.
• Besides, CD is the result of an inappropriate T
  cellmediated immune response against ingested
  gluten.

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Subjects and Methods

• The study was conducted at the Paediatric
  Gastroenterology Unit, Children Hospital, Cairo
  University. The study included 1500 children
  attending out patient clinic for various non
  gastroenterological conditions. All patients were
  subjected to the following
• 1- Full history taking 2- Careful
  Clinical Examination
• 3-Investigations
• a) Complete Blood Picture b) General
  biochemical blood tests
• c) Stool analysis, culture and sensitivity
• d) Investigations specific for CD tTG-IgA ,
  EMA, tTG- IgG
• e) Total immunoglobulin A (IgA) for suspected
  deficiency
• f) Endoscopy and biopsies were done for anti-tTG
  and anti-EMA positive cases

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Clinical Picture

• The symptoms of celiac disease are diverse, and
  the disease is often asymptomatic.
• Typical symptoms are
• Diarrhea
• Loss of weight
• Abdominal discomfort
• Bloating
• And various types of malabsorption.

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AIM OF THE WORK

• The aim of this study is to screen for the
  prevalence of celiac disease among Egyptian
  children. Until recently celiac disease was
  considered very rare among the Egyptian
  population.

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• Small bowel biopsies were collected if the
  serological screening demonstrated either
• Positive result for both IgA class
  anti-transglutaminase (tTG) and EMA.
• Positive result for IgG anti-tTG in children with
  IgA deficiency

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RESULTS

• Out of the total 1500 cases studied, 21 cases
  were found to be positive for celiac disease.
• This represents prevalence of 1.4.
• Prevalence detected in different serological
  studies conducted worldwide ranges from 0.5 -
  1.5 (Dubé et.al.,2005).

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Results of serology
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Female patient 14 years old the figure shows
height to be 141 cm this is below the 5th
percentile for age. Body weight of this patient
33.8 kg which is also below 5th percentile
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Male patient 5 years old, height as shown in the
figure 98 cm, body weight of this patient was
13.2 kg both height and weight are below 5th
percentile for age.
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Celiac Disease among patients with diarrhea and
growth failure

• This study included cases with diarrhea and
  growth failure to identify celiac disease as an
  important cause of this condition in Egyptian
  children. To reach this aim the specific
  serological marker for CD human recombinant
  tissue transglutaminase (anti-tTG) endomyseal
  antibody (anti-EMA) and histopathological
  examination of small intestinal mucosal biopsies
  obtained by upper endoscopy for serologically
  positive cases will be performed.

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Subjects and Methods

• The study was conducted at the Paediatric
  Gastroenterology Unit, Children Hospital, Cairo
  University. The study included 150 children
  suffering from acute, chronic diarrhoea and
  malnutrition (35 acute diarrhoea, 40 chronic
  diarrhoea and 75 malnutrition). The age ranged
  from 6months 3years.

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Result

• From this group of children 11 cases were
  diagnosed with CD by serological testing and
  intestinal biopsy representing 7.4 of total
  cases.

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After GFD Before

• Patient before diagnosis and after GFD for 6
  months

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Patient at time of diagnosis

• 9 years old female with weight and height below
  the 3rd percentile
• weight 14 kg and height 110 cm

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Conclusions

• Celiac disease is prevalent among Egyptian
  children incidence of affection is 1.4.
• Main presenting symptom is failure to thrive
  anemia and malnutrition.
• CD prevalence in this study among Egyptian
  children suffering from chronic diarrhea and
  malnutrition was 114(7.3) which makes it a
  common presentation of CD
• Screening tests help determine those children
  with high probability of the disease from those
  with low probability.

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Recommendations

• Increase of disease awareness by educational
  courses for doctors, nurses, dieticians, school
  personnel, affected families and the general
  population.
• Implementation of diagnostic facilities, by
  teaching doctors and technicians the diagnostic
  procedures for CD.
• The use of most recent and sensitive serological
  tests in search for CD followed by Upper
  Endoscopy for diagnosis.
• Once diagnosed, patients data must be listed in
  a registry by local personnel that maintain
  contact with the patients family for supplying
  gluten-free food in order to prevent serious
  complications as general illness, anaemia,
  osteoporosis, malignant transformation of GIT
  (Intestinal lymphoma, Bowel Adenocarcioma)
• Founding of Celiac disease association to support
  patients and their families.

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Celiac Disease in Type I Diabetics

• In patients with Type I Diabetes 250 cases from
  Pediatric Endocrinology Unit Children's Hospital
  Cairo University where studied 16 cases were
  serologically positive for Celiac Disease with
  prevalence rate 6.4.

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Thank You