SCREENING FOR CELIAC DISEASE
IN EGYPTIAN CHILDREN
Prof. Dr: Mona Abu Zekry -Professor of Pediatrics
Head Of Pediatric Gastroenterology- Cairo UNI *
Dr : Mohamed Diab Specialist Pediatrics*
Dr: Ghada Fikry
Specialist Pediatrics*
*Gastroenterology Unit - Children's Hospital
Faculty of Medicine – Cairo University
CELIAC Disease

Celiac disease, otherwise known as glutensensitive enteropathy:

Is an immune-mediated condition in which
ingestion of dietary gluten results in small
intestinal mucosal inflammation, crypt hyperplasia,
and villous atrophy in genetically susceptible
individuals.


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The environmental factors are, the gliadin
fraction of wheat gluten and similar alcoholsoluble proteins in other grains (e.g. barely &
rye)
Genetic predisposition is the presence of
HLA alleles DQA1*0501/DQB1*0201in most
of the cases.
Besides, CD is the result of an inappropriate T
cell–mediated immune response against
ingested gluten.
Subjects and Methods

The study was conducted at the Paediatric Gastroenterology
Unit, Children Hospital, Cairo University. The study included
1500 children attending out patient clinic for various non
gastroenterological conditions. All patients were subjected to
the following:
1- Full history taking
2- Careful Clinical Examination
3-Investigations:
a) Complete Blood Picture
b) General biochemical blood
tests
c) Stool analysis, culture and sensitivity
d) Investigations specific for CD: tTG-IgA , EMA, tTG- IgG
e) Total immunoglobulin A (IgA) for suspected deficiency
f) Endoscopy and biopsies were done for anti-tTG and anti-EMA
positive cases
Clinical Picture

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The symptoms of celiac disease are diverse,
and the disease is often asymptomatic.
Typical symptoms are:
 Diarrhea
 Loss of weight
 Abdominal discomfort
 Bloating
 And various types of malabsorption.
AIM OF THE WORK

The aim of this study is to screen for the
prevalence of celiac disease among
Egyptian children. Until recently celiac
disease was considered very rare among
the Egyptian population.

Small bowel biopsies were collected if the
serological screening demonstrated either:
a)
b)
Positive result for both IgA class antitransglutaminase (tTG) and EMA.
Positive result for IgG anti-tTG in
children with IgA deficiency
RESULTS



Out of the total 1500 cases studied, 21 cases
were found to be positive for celiac disease.
This represents prevalence of 1.4%.
Prevalence detected in different serological
studies conducted worldwide ranges from
0.5% - 1.5% (Dubé et.al.,2005).
Results of serology:
1500
Screened tTGIgA
15
TTG-IgA
Positive
9
EMA +
6
EMA -
10
TTG-IgG +ve
6
TTG-IgG -ve
Biopsy
1284
TTG-IgA
Normal
201
TTG-IgA <0.5
5
TTG-IgG -ve
Biopsy
For follow up
191
TTG-IgG -ve
2
Total IgA ±
Stopped
3
TTG-IgG
+ve
1
TTG-IgG +ve
8
Total IgA <70
Biopsy
For follow up
Biopsy
Stopped
Stopped
different prevalence for CD detected
world wide
1.40%
2%
1%
1%
0.94%
0.80%
1%
0.50%
1%
0.20%
0%
Prevalence %
0.75%
Finland
Germany
North Ireland
Italy
Sweden
United Kigdom
United States
Egyptian study
Female patient 14 years old the figure shows height to be
141 cm this is below the 5th percentile for age. Body weight
of this patient = 33.8 kg which is also below 5th percentile
Male patient 5 years old, height as shown in the figure = 98
cm, body weight of this patient was 13.2 kg both height and
weight are below 5th percentile for age.
Celiac Disease among patients with
diarrhea and growth failure

This study included cases with diarrhea and
growth failure to identify celiac disease as an
important cause of this condition in Egyptian
children. To reach this aim the specific
serological marker for CD human recombinant
tissue transglutaminase (anti-tTG) endomyseal
antibody (anti-EMA) and histopathological
examination of small intestinal mucosal
biopsies obtained by upper endoscopy for
serologically positive cases will be performed.
Subjects and Methods
The study was conducted at the Paediatric
Gastroenterology Unit, Children Hospital,
Cairo University. The study included 150
children suffering from acute, chronic
diarrhoea and malnutrition (35 acute diarrhoea,
40 chronic diarrhoea and 75 malnutrition). The
age ranged from 6months – 3years.
Result

From this group of children 11 cases were
diagnosed with CD by serological testing and
intestinal biopsy representing 7.4% of total
cases.
After GFD
Before
Patient before diagnosis and after GFD
for 6 months
Patient at time of diagnosis


9 years old female with
weight and height below
the 3rd percentile
weight 14 kg and height
110 cm
Conclusions

Celiac disease is prevalent among Egyptian
children; incidence of affection is 1.4%.

Main presenting symptom is failure to thrive
anemia and malnutrition.

CD prevalence in this study among Egyptian children
suffering from chronic diarrhea and malnutrition was
1:14(7.3%) which makes it a common presentation of
CD

Screening tests help determine those children with
high probability of the disease from those with low
probability.
Recommendations
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Increase of disease awareness by educational courses for doctors,
nurses, dieticians, school personnel, affected families and the general
population.
Implementation of diagnostic facilities, by teaching doctors and
technicians the diagnostic procedures for CD.
The use of most recent and sensitive serological tests in search for
CD followed by Upper Endoscopy for diagnosis.
Once diagnosed, patient’s data must be listed in a registry by local
personnel that maintain contact with the patient’s family for supplying
gluten-free food in order to prevent serious complications as general
illness, anaemia, osteoporosis, malignant transformation of GIT
(Intestinal lymphoma, Bowel Adenocarcioma)
Founding of Celiac disease association to support patients and their
families.
Celiac Disease in Type I Diabetics

In patients with Type I Diabetes 250 cases
from Pediatric Endocrinology Unit Children's
Hospital Cairo University where studied 16
cases were serologically positive for Celiac
Disease with prevalence rate 6.4%.