• Muhammad Asim Ikram
  • Aisha Sajid
  • Sadia Hameed
  • Kashan Arshad
  • Irshad -ul- Haq


Background: Coeliac disease used to be considered as a disease of European and Western populationbut now it has emerged as a global problem. Objective of this study was to evaluate the frequency andmode of presentation of coeliac disease in children presenting with failure to thrive. Methods: Thiscross-sectional descriptive study was conducted at Paediatrics Department of Madina TeachingHospital in collaboration with Histopathology Department of University Medical and Dental College,Faisalabad over a period from April 2010 to March 2011. A total of 60 children, aged 4–6 yearspresenting as failure to thrive according to their height and weight, were included. Relevantinvestigations were done along with radiological assessment of bone age. The jejunal biopsy was takenin all the patients. Children who were suffering from primary or secondary malnutrition due to otherchronic illnesses and malabsorptive syndromes were excluded from the study. The data was analysedusing SPSS-17. Chi-square test was used and p<0.05 was considered significant. Results: Total 60children, 4–16 years of age were included in the study. Twenty-four (40%) children were diagnosed ascoeliac disease by jejunal biopsy showing Marsh Grade-3. Male/female ration was 1.5:1. The mostfrequent symptom among these coeliac patients was abdominal distension (75%, p=0.041), followed bypallor. (71%, p=0.048). Anaemia (Hb<12 gm/dl) was found in all 24 patients. Conclusion: Coeliacdisease is increasingly being recognised as presenting with atypical presentation like short stature,failure to thrive, unexplained anaemia, rickets, abdominal distension and abdominal pain.Keywords: Coeliac disease, Failure to thrive, Mixed Deficiency Anaemia


Hill ID. Coeliac disease –a never-ending story? J Pediatr


Fasano A. Clinical presentation of coeliac disease in the

paediatric population. Gastroenterology 2005;128:S68–73.

Labenthal E, Branski D. Coeliac disease: an emerging global

problem. J Pediatar Gastroenterol Nutr 2002;35:472–4.

Sood MR. Disorders of malabsorption. In: Kliegman, Behrman,

Jenson BK, Stanton, editors. Nelson’s Text Book of Pediatrics,

th ed. Philadelphia: WB Saunders; 2007.p. 1587–602.

Murray JA. The widening spectrum of coeliac disease. Am J Clin

Nutr 1999;69:354–65.

Kagnoff MF. Coeliac disease: pathogenesis of a model

immunogenetic disease. J Clin Invest 2007;117(1):41–9.

Kumar V, Jarzabek-Chorzelska M, Sulej J, Karnewska K, Farrell

T, Jablonska S. Coeliac disease and immunoglobulin A

deficiency: how effective are the serological methods of

diagnosis? Clin Diagn Lab Immunol 2002;9:1295–300.

American Gastroenterological Association Medical Position

Statement: Coeliac Sprue. Gastroenterology 2001;120:1522–5.

Clinical Guideline 86: Recognition and assessment of coeliac

disease. London: National Institute for Health and Clinical

Excellence; 2009. Available at:


Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano

A, Guandalini S, et al. Guideline for the diagnosis and treatment

of coeliac disease in children: recommendations of the North

American Society for Pediatric Gastroenterology, Hepatology

and Nutrition. J Pediatr Gastroenterol Nutr 2005;40(1):1–19.

Marsh MN. Gluten, major histocompatability complex and the

small intestine. A molecular and immunologic approach to the

spectrum of gluten sensitivity (‘celiac sprue’). Gastroetrology


Fasano A, Catassi C. Current approaches to diagnosis and

treatment of coeliac disease: an evolving spectrum.

Gastroenterology 2001;120:636–51.

Feighery C. Fortnightly review: coeliac disease BMJ


Citritira PJ, King AL, Fraser JS. AGA technical review on celiac

sprue. Am Gastroenterological Assoc. Gastroenterol


Maki M, Colin P. Coeliac disease. Lancet 1997;349:1755–9.

Not T, Horvath K, Hill ID, Partanen J, Hammed A, Magazzu

G, et al. Celiac disease risk in the USA: high prevalence of

antiendomysium antibodies in healthy blood donors. Scand J

Gastroenterol 1998;33:494–8.

Maki M, Mustalahti K, Kokkonen J, Kulmala P, Haapalahti

M, Karttunen T, et al. Prevalence of celiac disease among

children in Finland. N Engl J Med 2003;348:2517–24.

Van Heel DA, West J. Recent advances in celiac disease. Gut


Ravikumara M, Tuthill DP, Jenkins HR. The changing clinical

presentation of celiac disease. Arch Dis Child 2006;91:969–71.

Beattie RM. The changing face of celiac disease. Arch Dis Child


J Ayub Med Coll Abbottabad 2011;23(4) 9

Aziz S, Muzaffar R, Zafar MN, Mehnaz A, Mubarak M, Abbas

Z, et al: Celiac disease in children with persistant diarrhoea and

failure to thrive. J Coll Physicians Surg Pak 2007;17:554–7.

Murray JA, Rubio-Tapia A, Van Dyke CT, Brogan DL,

Knipschield MA, Lahr B, et al. Mucosal atrophy in coeliac

disease: extent of involvement, correlation with clinical

presentation, and response to treatment. Clin Gastroenterol

Hepatol 2008;6:186–193. [quiz 125]

Villanacci V, Bassotti G. Histological aspects of the terminal

ileum: a windows on coeliac disease too? Dig Liver Dis


Meijer JW, Wahab PJ, Mulder CJ. Small intestinal biopsies in

celiac disease: duodenal or jejunal? Virchows Arch


Mahadeva S, Wyatt JI, Howdle PD. Is a raised intraepithelial

lymphocyte count with normal duodenal villous architecture

clinically relevant? J Clin Pathol 2002;55:424–8.

Wahab PJ, Crusius JB, Meijer JW, Mulder CJ. Gluten challenge

in borderline gluten-sensitive enteropathy. Am J Gastroenterol


Ahmad F, Alam S, Shukla I, Sherwani R, Ali SM. Screening

children with severe short stature for coeliac disease using tissue

transglutaminase. Indian J Pediatr 2010;77:387–90.

Dehghani SM, Asadi-Pooya AA. Coeliac disease in children with

short stature. Indian J Pediatr 2008;75:131–3.

Queiroz MS, Nery M, Cançado EL, Gianella-Neto D, Liberman

B. Prevalence of celiac disease in Brazilian children of short

stature. Braz J Med Biol Res 2004;37(1):55–60.

Sián J, Charles D,Nadim YH. Patterns of clinical presentation of

adult celiac disease in a rural setting. Nutr J 2006;2891:5–24.

Ayesha H, Shamoon M, Nazir B, Butt MA, Ahmad M, Baloch

GR. Nutritional status and micronutrients levels of children with

celiac disease before and after gluten free diet. Professional Med

J 2006;13(1):145–50.




Most read articles by the same author(s)