الفهرس 
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Abstract
Celiac disease is an immune mediated enteropathy triggered by
ingestion of gluten in genetically predisposed individuals. It is adigestive
disease that damages the small intestine and interferes with absorption
of nutrients. People who have Celiac disease can not tolerate a protein
called gluten, which is found wheat, rye, barely and possibly Oats.
When people with Celiac disease eat foods containing gluten, their
immune system responds by damaging the villi lining the small intestine
and so decreasing the absorptive surface of intestine, resulting in
malabsorption.
Prevalence of Celiac disease varies in different regions , it is very
common in Europe (l/250 in Italy, l/300 in Ireland). In USA, the
incidence is l/1000 of live births. There is no available data about the
prevalence of Celiac disease in Egypt and Arab regions, however the
incidence of Celiac disease in Arab regions was calculated to be l/2800 of
live births.
Celiac disease is considered an autoimmune disorder that has a
genetic predisposition, meaning that it runs in families. Genetic,
immunological, and environmental factors are necessary for the
expression of the disease. It dose not present until gluten containing
products have been introduced into diet. Typically, the patient presents
between 6 months and 2 years of age with impaired growth and typical
intestinal complaints.
Infants and young children present with diarrhea, abdominal
distention and failure to thrive. However, vomiting, irritability, anorexia
and constipation are also common. Older children often present with
Summary and Conclusions
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extra-intestinal manifestation such as short stature, neurological
symptoms or anaemia.
CD is considered a typical when ever the clinical picture is
characterized by a typical intestinal complaints or present with extraintestinal
manifestations. Atypical presentation usually encountered in
association with late onset of complaints. This may happen later, in older
children or even in adulthood.
Diagnosis of celiac disease may be difficult because its symptoms
are similar to those of other malabsorptive disorders, however, several
antibody tests are now considered good markers for this condition.
The first serological tests, including antigliadin antibodies are were
not reliable, however, the sensitivity and specificity of serum IgA.
endomysial antibody testing have approached 100% (except in IgA.
deficient patients).
Also Abs against tissue transglutaminase antigens are very specific
predictors of CD.
If symptoms, signs and serological tests are proved positive, a small
bowel biopsy is taken which remains the standard for diagnosis.
Definitive diagnosis of CD depends on abnormal small intestinal biopsy
together with clinical response to gluten – free diet.
The only treatment for celiac disease is to follow a life long strict
gluten – free diet. Following this diet, symptoms will improve and the
existing small intestinal lesions will heal.
The objective of this study is to detect the undiagnosed cases of
celiac disease ( e.g. cases of failure to thrive ,abdominal distention and
PEM of un explained origin ) and to identify the high risk groups and
suspected groups for CD .
Summary and Conclusions
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The study will benefit the patients with CD by early detection of the
disease and will help to put a policy for diagnosis of suspected cases.
The study was consisted of 80 children, 20 were healthy volunteer
controls. And 60 were selected cases suspected to have CD. Selected
cases were clinically evaluated and laboratory tested for CD.
The 60 selected cases were presenting by one or more of the
following sings and symptoms that may suggest CD:
- Failure to thrive without obvious cause.
- Chronic diarrhea without obvious cause.
- Chronic abdominal distention without obvious cause.
- Wasting and loss of weight especially with introduction of glutencontaining
foods into diet.
- Neurological manifestation of gluten-containing foods into diet.
22 cases were 1st degree relatives to celiac patients, and 24 cases
have IDDM and were receiving insulin for treatment before enrollment in
the study.
According to the distribution of the main presenting symptoms and
signs among the study cases, chronic diarrhea was the most prominent
(80%), followed by failure to thirve (66.7%), recurrent abdominal pain
(23.3%), abdominal distention (40%), repeated vomiting (33.3%), and
anorexia (33.3%).
For every case of the 60 selected cases, detailed medical history,
physical examination and laboratory investigations were done.
Serum IgA anti-endomysial Ab testing was done for all enrolled
subjects in the study (selected cases and controls) as a screening test for
Summary and Conclusions
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CD. among the 60 selected cases, 4 cases (6.7%) were positive for the
test.
Endoscopy and small intestinal biopsy was done for those with
serum IgA endomysial Ab positive results, to prove the histo-pathological
changes of CD.
The relative frequency of positive cases for CD among cases with
chronic diarrhea was (6.2%), among cases with failure to thrive (7.5%),
among cases with I.D.D.M (8.3%) and among the 1st degree relatives
(9.1%). According to the distribution of main distribution of main
presenting symptoms and signs among the positive cases, failure to thrive
present in 75% of cases, chronic diarrhea present in 75% of cases and
abdominal distention present in 50% of cases.
Among positive cases, type I DM present in 50%, skin
manifestations in 25%, foul bulky stool in 50% and 50% of positive cases
were 1st degree relatives to celiac patients.
The positive cases for celiac disease show marked growth
retardation as there was significant difference between positive and
negative cases as regard weight and height.
It was recommended to conduct a larger study to diagnose celiac
disease among suspected cases, for early detection of the disease among
susceptible groups e.g. Failure to thrive of unexplained origin, chronic
diarrhea, chronic abdominal distention. Type I D.M, 1st degree relatives
to celiac patients.