Response to gluten free diet in sero-positive celiac disease children suffering from severe acute malnutrition in age group 1-5 years

Authors

  • Mahendra Meena Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India
  • Pradeep Meena Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India
  • R. L. Suman Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India
  • Suresh Goyal Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20191440

Keywords:

Celiac disease, Gluten free diet, Tissue trans-glutaminase, Severe acute malnutrition

Abstract

Background: Diagnosis of celiac disease in children suffering from severe acute malnutrition without duodenal biopsy or HLA typing is a dilemma. The objective of this study was to study the response to gluten free diet in sero-positive Celiac Disease children suffering from severe acute malnutrition in age group 1-5 years.

Methods: This prospective, observational, hospital-based study was conducted at MTC of tertiary care medical college hospital of southern Rajasthan from Dec. 2017 to Nov. 2018. Total 110 children with SAM were enrolled and screened for celiac disease on the basis of tissue tTg-IgA/IgG serology. Seropositive cases were kept on gluten free diet for short period of time and observed for the resolution of symptoms and improvement in growth, monitored by anthropometry on discharge and follow up visit.

Results: Mean weight gain (gm/kg/day) on follow up was 3.87±3.49 in seropositive and 1.88±3.79 in seronegative cases (P-value<0.05). Mean weight gain was 6.43±3.28gm/kg/day in only tTg-IgA positive and 3.04±2.95 gm/kg/day in only tTg-IgG positive cases (P-value-<0.05). The mean weight gain in strictly gluten free adherent sero-positive cases was 4.89±2.97 gm/kg/day while in gluten free non-adherent patients it was -0.49±1.70 (P-value <0.001). Mean weight gain in probable (tTg-Ig-A <10 times ULN) and presumptive (tTg-IgA >10 times ULN) Celiac disease were 3.44±3.73 and 5.44±3.78, respectively without statically significant difference (P-value >0.05).

Conclusions: In situations where facility of duodenal biopsy and or HLA DQ2/DQ8 typing is not available, resolution of symptoms and improvement in growth on gluten free diet confirms the diagnosis of celiac disease.

References

Rajpoot P, Makharia GK. Problem and challenges to adaptation of gluten free diet by Indian Patients Celiac Dis. Nutr. 2013; 5:4869-79.

Bhatnagar S, Bhan MK. Serological diagnosis of Celiac Disease. Indian J Pediatr. 1966;66(1); 26-31.

International institute for Population Sciences. National family health survey-4, 2015-16. Mumbai. India: Int Institute Population Sci. 2016; P-1-3.

Sood A, Sood N, Midha V, Avasthi G, Sehgal A. Prevalence of celiac disease among school children in Punjab, North India. J Gastroenterol Hepatol. 2006;21:1622-25.

Bhattacharya M, Dubey AP, Mathur NB. Prevalence of Celiac Disease in North Indian Children. Indian. J Pediat. 2009;46:41-47.

Makharia GK, Verma AK, Amarchand R, Bhatnagar S, Das P, Goswami A et al. Prevalence of celiac disease in northern part of India: A community based study. J Gastroenterol Hepatol. 2011;26:894-900.

Deora NS, Deswal A, Dwivedi M, Mishra HN. Prevalence of coeliac disease in India: A mini review. Int J Latest Res Sci Technol. 2014;3(10):58-60.

Kumar P, Mishra K, Singh P, Rai K. Should we screen children with severe acute malnutrition for celiac disease? Indian Pediat. 2012;49:330-31.

Beniwal N, Ameta G, Chahar CK. Celiac Disease in children with severe acute malnutrition (SAM) a hospital-based study. Indian J Pediat.2017;84 (5):339-43.

Branski D, Troncone R, Fasano A. Celiac disease (gluten-sensitive enteropathy). In: Kliegman RM, Stanton BF, St. Geme III JW,editors.Nelson Textbook of Pediatrics. 20th ed. Philadelphia: Elsevier; 2016:1835-1838.

Aesku. Diagnostics. Aeskulisa- Instruction manual: tTG new generation. Available at: www.aesku.com.

WHO multicentre growth reference study group. WHO child growth standards: methods and development. Growth velocity based on weight, length and head circumference. Geneva: World health organization. 2009.

Bhadada SK, Bhansali A, Kochhar R, Menon AS, Sinha SK, Dutta P et al. Does every short stature child need screening for celiac disease? J Gastroenterol Epatol. 2008;23(8):353-56.

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Published

2019-04-30

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Original Research Articles