Research Article of Open Journal of Gastroenterology and Hepatology
Clinical Picture of Celiac disease: Experience from a health care provider in Arabia
Diamond Joy, MD, MSc, FRCP (UK)1, Fuad Y Maufa, MD1, Nassir Al Hayaf, MD1, Martin Diamond2,3, Sayed Z Haji, MD2, Carole A Merriwether4
1Gastroenterology department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. 2Internal Medicine department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. 3Medical Student, Cardiff Medical School, United Kingdom.4Population health department. Gastroenterology department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
Background: Most studies describing clinical features and associations of celiac disease come from the studies conducted in the western world. Our aim was to determine the clinical features and associations of Celiac disease from our centre serving a Middle East population in Saudi Arabia.
Methods: This retrospective study was conducted in a health care provider serving the Eastern Province of Saudi Arabia. All patients with biopsy-confirmed celiac disease receiving health care at our centre between April 2002 and December 2018 were identified. Individual case records were reviewed. In addition, the Slicer Dicer function was also used from the Electronic medical health record [EPIC] for analysing the clinical features and associations.
Results: We analyzed the clinical features of 149 patients with Celiac disease. 66% of these were females. There was progressively increased yield of confirmed Celiac disease over the study period. This was paralleled by an increase in TTG antibody tests performed year by year. 77 (51.6%) patients had gastrointestinal symptoms. 26% of patients had iron deficiency anemia. 24 patients (16%) had diabetes, of which 46% were type 2. 18 (12%) patients had osteoporosis or osteopenia, and 28 (19%) had various skin diseases.
Conclusion: In Saudi Arabia, celiac disease is being increasingly recognized, largely because of increased awareness and increasing TTG antibody testing. Many patients present with non-gastrointestinal symptoms. Knowledge about the varied clinical features and the targeted use of celiac serology should lead to even earlier recognition of the disease.
Keywords: Clinical Picture, Celiac disease, Arabia
How to cite this article:
Diamond Joy, Fuad Y Maufa, Nassir Al Hayaf, Martin Diamond, Sayed Z Haji, Carole A. Merriwether. Clinical Picture of Celiac disease: Experience from a health care provider in Arabia. Open Journal of Gastroenterology and Hepatology, 2020, 3:37. DOI: 10.28933/ojgh-2020-05-1305
1. Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018 Jun 1;16(6):823-836.e2.
2. Rampertab SD, Pooran N, Brar P, Singh P, Green PHR. Trends in the presentation of celiac disease. Am J Med. 2006 Apr;119(4).
3. Lebwohl B, Sanders DS, Green PHR. Coeliac disease. Lancet (London, England) [Internet]. 2018 [cited 2019 Oct 27];391(10115):70–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28760445
4. Singh P, Arora S, Singh A, Strand TA, Makharia GK. Prevalence of celiac disease in Asia: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31(6).
5. Aljebreen AM, Almadi MA, Alhammad A, Faleh FZ Al. Seroprevalence of celiac disease among healthy adolescents in Saudi Arabia. World J Gastroenterol [Internet]. 2013 [cited 2018 Dec 2];19(15):2374. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631990/
6. Al Attas RA. How common is celiac disease in Eastern Saudi Arabia? Ann Saudi Med [Internet]. [cited 2019 Apr 28];22(5–6):315–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17146251
7. Abu-Zeid YA, Jasem WS, Lebwohl B, Green PH, ElGhazali G. Seroprevalence of celiac disease among United Arab Emirates healthy adult nationals: a gender disparity. World J Gastroenterol [Internet]. 2014 Nov 14 [cited 2019 Apr 28];20(42):15830–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25400469
8. Al-Hussaini A, Sulaiman N, Al-Zahrani M, Alenizi A, El Haj I. High prevalence of celiac disease among Saudi children with type 1 diabetes: a prospective cross-sectional study. BMC Gastroenterol [Internet]. 2012 Dec 23 [cited 2018 Dec 2];12:180. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23259699
9. Al-Mendalawi MD. Prevalence of celiac disease in Saudi children: Is it underestimated? Saudi J Gastroenterol [Internet]. 2016 [cited 2018 Dec 2];22(1):83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26831616
10. Al Hatlani MM. Prevalence of celiac disease among symptom-free children from the Eastern Province of Saudi Arabia. Saudi J Gastroenterol [Internet]. 2015 [cited 2018 Dec 2];21(6):367–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26655131
11. Saeed A, Assiri A, Assiri H, Ullah A, Rashid M. Celiac disease in Saudi children. Evaluation of clinical features and diagnosis. Saudi Med J [Internet]. 2017 Sep [cited 2018 Dec 2];38(9):895–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28889146
12. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: Time for a standardized report scheme for pathologists. Vol. 11, European Journal of Gastroenterology and Hepatology. Lippincott Williams and Wilkins; 1999. p. 1185–94.
13. Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Vol. 102, Gastroenterology. 1992. p. 330–54.
14. Ford E, Kim J, Kharrazi • Hadi, Gleason K, Gumas D, Decamp L, et al. A Guide to Using Data from EPIC, MyChart, and Cogito for Behavioral, Social and Systems Science Research. 2018.
15. Eisen M. Epic Systems: Epic Tale. Isthmus [Internet]. 2008 Jun 20 [cited 2019 Nov 13]; Available from: http://www. thedailypage.com/isthmus/article.php?article=22980
16. King JA, Jeong J, Underwood F, Quan J, Panaccione N, Windsor JW, et al. A261 INCIDENCE OF CELIAC DISEASE IS INCREASING OVER TIME: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Can Assoc Gastroenterol. 2019 Mar 15;2(Supplement_2):512–4.
17. Bottaro G, Cataldo F, Rotolo N, Spina M, Corazza GR. The clinical pattern of subclinical/silent celiac disease: An analysis on 1026 consecutive cases. Am J Gastroenterol. 1999;Mar 94(3):691-6.
18. Corazza GR, Valentini RA, Andreani ML, D’anchino M, Leva MT, Ginaldi L, et al. Subclinical coeliac disease is a frequent cause of iron-deficiency anaemia. Scand J Gastroenterol. 1995;Feb 30(2):53-6.
19. World Gastroenterology Organisation Global Guidelines on Celiac Disease [Internet]. 2016 [cited 2019 Nov 17]. Available from: https://www. worldgastroenterology.org/UserFiles/file/guidelines/celiac-disease-english-2016.pdf
20. Hill ID, Fasano A, Guandalini S, Hoffenberg E, Levy J, Reilly N, et al. NASPGHAN Clinical Report on the Diagnosis and Treatment of Gluten-related Disorders. J Pediatr Gastroenterol Nutr [Internet]. 2016 Jul [cited 2019 Nov 17];63(1):156–65. Available from: http://insights.ovid.com/crossref?an=00005176-201607000-00028
21. Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United Eur Gastroenterol J [Internet]. 2019 Jun [cited 2019 Nov 17];7(5):583–613. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31210940
22. Goddard AF, James MW, McIntyre AS, Scott BB. British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia. Gut. 2011;Oct;60(10):1309-16.
23. James MW, Scott BB. Coeliac disease: the cause of the various associated disorders? European Journal of Gastroenterology and Hepatology. 2001. p. Sep;13(9):1119-21.
24. Kaur N, Bhadada SK, Minz RW, Dayal D, Kochhar R. Interplay between Type 1 Diabetes Mellitus and Celiac Disease: Implications in Treatment. Dig Dis [Internet]. 2018 [cited 2019 Nov 17];36(6):399–408. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30045024
25. Freeman HJ. Endocrine manifestations in celiac disease. World J Gastroenterol [Internet]. 2016 Oct 14 [cited 2019 Nov 17];22(38):8472. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27784959
26. Goodwin G. Type 1 Diabetes Mellitus and Celiac Disease: Distinct Autoimmune Disorders That Share Common Pathogenic Mechanisms. Horm Res Paediatr [Internet]. 2019 Oct 8 [cited 2019 Nov 17];1–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31593953
27. Abdulaziz Al Dawish M, Alwin Robert A, Braham R, Abdallah Al Hayek A, Al Saeed A, Ahmed Ahmed R, et al. Diabetes Mellitus in Saudi Arabia: A Review of the Recent Literature. Curr Diabetes Rev. 2016;12(4):359–68.
28. Alotaibi A, Perry L, Gholizadeh L, Al-Ganmi A. Incidence and prevalence rates of diabetes mellitus in Saudi Arabia: An overview. Journal of Epidemiology and Global Health. 2017. p. Volume 7, Issue 4, Pages 211-218.
29. Kizilgul M, Ozcelik O, Beysel S, Akinci H, Kan S, Ucan B, et al. Screening for celiac disease in poorly controlled type 2 diabetes mellitus: worth it or not? BMC Endocr Disord [Internet]. 2017 Dec 6 [cited 2019 Nov 17];17(1):62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28985731
30. Mostowy J, Montén C, Gudjonsdottir AH, Arnell H, Browaldh L, Nilsson S, et al. Shared genetic factors involved in celiac disease, type 2 diabetes and anorexia nervosa suggest common molecular pathways for chronic diseases. PLoS One. 2016;Aug 2(11):8.
31. Lewis NR, Scott BB. Guidelines for osteoporosis in inflammatory bowel disease and coeliac disease. BSG Guidel Gastroenterol. 2007;
32. Scott BB, Young S, Rajah SM, Marks J, Losowsky MS. Coeliac disease and dermatitis herpetiformis: further studies of their relationship. Gut. 1976;Oct 17(10):759–62.
33. Bai JC, Ciacci C, Melberg J. World Gastroenterology Organisation Global Guidelines: Celiac Disease February 2017. J Clin Gastroenterol. 2017;51(9):755–68.
34. Lewis NR, Scott BB. Meta-analysis: deamidated gliadin peptide antibody and tissue transglutaminase antibody compared as screening tests for coeliac disease. Aliment Pharmacol Ther [Internet]. 2010 Jan [cited 2019 Nov 14];31(1):73–81. Available from: http://doi.wiley.com/10.1111/j.1365-2036.2009.04110.x
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