Prevalence and Clinical Profile of Celiac Disease in Yemeni Children: A Five-Year Retrospective Study at Al-Sabeen Hospital.

INTRODUCTION

Celiac disease (CD) is an autoimmune condition triggered by gluten ingestion. Limited data are available on its prevalence and characteristics in Yemen, a region facing socioeconomic challenges intensified by conflict. This study aimed to estimate the prevalence of CD and evaluate the demographic, clinical, and nutritional profiles of affected children.

METHODS

This five-year retrospective study analyzed data from 120 children diagnosed with CD at Al-Sabeen Hospital, Sana'a, Yemen, from January 2018 to December 2023. Children of any age and sex clinically suspected of having CD based on gastrointestinal (e.g., chronic diarrhea) and/or extraintestinal manifestations (e.g., failure to thrive) were included, with non-CD causes excluded via European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)-guided testing. Diagnosis followed the guidelines of the ESPGHAN guidelines, using transglutaminase 2 antibody (tTA-IgA) and endomysial antibody IgA (EMA IgA) levels, with biopsy recommended for tTA-IgA <10× the upper limit of normal. Data on demographics, nutritional status, clinical manifestations, and associations were collected via a structured questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), with chi-square tests assessing significance (p<0.05).

RESULTS

Among 3,570 admissions, CD prevalence was 3.4% (n=120), with a female predominance (58.3%, n=70) and 70% (n=84) diagnosed before the age of one year (mean 12 ± 3.5 months). Malnutrition affected 60.0% of cases, significantly associated with rural residency (p=0.015), low family income (p=0.001), unprotected water sources (p=0.030), and incomplete vaccination (p<0.001). Chronic diarrhea (85.0%) and pallor (81.7%) were the most common manifestations. No significant associations were found for sex (p=0.705) or animal contact (p=0.053).

CONCLUSIONS

CD prevalence in Yemeni children exceeds the global average, with malnutrition being a major comorbidity linked to socioeconomic and environmental factors. Targeted screening, biopsy-confirmed diagnosis for ambiguous cases, and nutritional interventions are critical in conflict-affected settings such as Yemen. Future multicenter studies with genetic testing are recommended to enhance our understanding and management.