Pattern of celiac disease in infants and children.

This study involved all children with celiac disease admitted and seen in the Paediatric Gastroenterology Clinic at King Khalid University Hospital (KKUH) over a 10-year period. In the first year, we identified 62 cases with celiac disease. Their mean age at presentation, introduction to cereals in the diet, and onset of symptoms were 6.5, 6 and 6 months, respectively, and most of the children belonged to the indigenous population. There were three Arabia families with more than one affected child and most families were of good social status. The main symptoms noted were diarrhoea in 34 (57%), growth failure in 47 (74.6%), abdominal distension in 21 (33%), and vomiting in 14 patients (14%). The significant physical signs at the time of presentation were short stature, seen in 44 patients (69.8%), pallor in 25 (40.3%) and abdominal distention in 21 (33%). The mean haemoglobin, serum feritin, serum folate, calcium, and serum albumin were 10.25 g/dL, 2.49 g/mL, 0.25 ng/mL, 8.86 mg/dL, and 3.7 g/dL. The mean anti-reticulin IgG, anti-endomyseal IgG, IgA and anti-gliadin IgG, IgA were one in 246, 332, 720, 121 and 300 units. There was total villous atrophy in each patient at the time of initial presentation; repeat small bowel biopsies were done in 12 patients of whom 6, 4 and 2 had normal villi, partial villous atrophy and subtotal villous atrophy, respectively. A third biopsy was performed in 2 patients while on gluten containing diet, which revealed villous atrophy. Most of the children improved on gluten-free diet.