FM DECEMBER 2018 ISSUE - digital edition

or even refractory or non-responsive, and
can be associated with other autoimmune
disease or other conditions, including
diabetes, thyroid disorders, liver disease,
psoriasis, systemic lupus erythematosus and
rheumatoid arthritis.
There is no cure for celiac disease and
management involves a diet that
is completely gluten-free. Gluten is
THE INCIDENCE OF HLA-
DQ 2/8 IS THE SAME IN THE
NORTH INDIAN AND SOUTH
INDIAN POPULATION, BUT THE
INCIDENCE OF CELIAC DISEASE IS
MUCH HIGHER IN NORTH INDIA
A series of tests were done to confirm whether the
child was suffering from celiac disease. Immunoglobulin
studies showed normal total IgG, IgA, IgM and IgE. Tissue
Transglutaminase (tTG) IgA was negative, and tTG IgG was
positive. Gastric fundus biopsy showed mild chronic gastritis.
Duodenum biopsy showed moderate inflammation with
infiltrating lymphocytes, plasma cells and few eosinophils
in the lamina propria, and the majority of the villi were flat
with elongated crypts. These findings are diagnostic of celiac
disease.
The damage to the intestinal villi results in
malabsorption, affecting growth and development in the
child. Consequently, some of the hallmarks of celiac disease
are stunted growth and pot-belly, which this child did not
present with. Other common clinical signs include diarrhoea,
abdominal pain, osteoporosis, neurologic abnormalities,
increased liver enzyme levels, as well as skin disorders. The
haematological manifestations
of celiac disease are iron-deficiency anaemia, folate
and vitamin B12 deficiency, micronutrient deficiencies,
thrombocytopenia, thrombocytosis, leukopenia, neutropenia,
splenic dysfunction and IgA deficiency. In fact, the child
did not present several common clinical signs associated
with celiac disease. Dr. Kanakia stresses that ‘celiac disease
can present in different ways, and it is important to think
of it in cases of chronic anaemia, with or without chronic
diarrhoea or any of the myriad symptoms associated with
celiac disease’. Celiac disease can be atypical, silent, latent
present in wheat, rye and barley, and
these must be completely avoided. The
child was immediately started on a
gluten-free diet and has been doing
well over the past 6 months. His current
haemoglobin levels have increased to 11 g/
dl and he is not troubled with diarrhoea
anymore.
Gluten is present in one of North India’s
key dietary ingredients -- wheat. A recent
study has shown that while the incidence of
HLA-DQ 2/8 is the same in the North Indian
and South Indian population, the incidence
of celiac disease is much higher in North
India (close to 1% of the population) than
in South India (about 0.01%). This is likely
to be due to the predominantly high daily
wheat intake in the North Indian population.
Breads also have a very high gluten
content, and with the advent of fast food
joints, bread intake has considerably
increased, and this is likely to affect the
incidence of celiac disease as well. It will be
important to consider how our lifestyles may
impact the incidence of celiac disease in
the near future. Our lifestyles are changing,
and it remains to be seen if or when celiac
disease joins the infamous club of lifestyle
diseases.
DR SHIVANEE SHAH
48 / FUTURE MEDICINE / DECEMBER 2018