( positive > 10.0 U / ml ), deamidated gliadin peptide antibodies ( DGP ) ( positive > 30U / ml ), or endomysial antibodies ( EMA ) ( positive or negative ), and confirmatory findings on esophagogastroduodenoscopy ( EGD ) with small bowel biopsy . Lesions consistent with Marsh-Oberhuber criteria — including increased intraepithelial lymphocytes , partial to complete villous atrophy , crypt hyperplasia , and increased lymphocytes in the lamina propria — were deemed diagnostic . 8 In cases with symptomatic CD but no EGD , serological levels of tTG IgA greater than 10 times the upper limit of normal and a positive EMA were diagnostic for CD per European Society Pediatric Gastroenterology , Hepatology , and Nutrition guidelines . 9 Patients were excluded if they were older than 18 years at the time of diagnosis , diagnosed with CD outside the study period , or had negative biopsy results . The study was approved by the CAMC / WV University – Charleston Division Institutional Review Board .
Demographic variables included age , gender , race , body mass index ( BMI ), percentiles for gender and age for BMI , or weight for length percentiles in patients under the age of 24 months . 10 Race was self-reported by the patient or parent via intake forms , and race data was recorded as found in the health record . BMI and weight for length percentiles for gender and age were used to classify weight status as underweight (< 5th ), normal ( 5th to < 85th ), overweight ( 85th to < 95th ), or obese ( ≥95th ). Additionally , clinical presentation and symptoms at presentation , endoscopic and histopathological findings , HLA DQ2 / DQ8 genetic testing results , serological profile at baseline and follow-up , and improvement after the introduction of a GFD were obtained . Results from serological tests were classified as either negative or positive using the respective cutoff level for each assay . Serologic results were characterized as “ improving ” if serological levels decreased at follow-up testing or were below quantification limits .
Age at Diagnosis ( years )
BMI = body mass index
The statistical package SPSS 19.0 was used to analyze data . Basic descriptive statistics were performed on each data element . Categorical data was summarized as numbers and percentages , whereas continuous data was summarized as mean and standard deviation ( SD ) or when appropriate , medians with ranges .
RESULTS
A total of 59 patients met all inclusion criteria . Patient characteristics are presented in Table 1 . The mean age at diagnosis was 10 ± 4.6 years , with three ( 5 %) patients under the age of two years . A total of 36 patients were females ( 61 %) and 97 % of the patients self-identified as white . We found six ( 10 %) patients having documented CD family history . A total of 13 patients ( 22 %) were either overweight or obese , while eight patients ( 14 %) were underweight .
Approximately one-third of patients ( n = 19 , 32 %) were asymptomatic and diagnosed as a part of routine screening of patients with type 1 diabetes mellitus or hypothyroidism . For the 40 patients with symptomatic CD , abdominal pain was the most
TABLE 1 : Patient Characteristics n (%)
Mean ± SD 10.0 ± 4.6 Range 1-18 Gender Male 23 ( 39 %) Female 36 ( 61 %) Race White 57 ( 97 %) Black 2 ( 3 %) BMI Classification Underweight 8 ( 14 %) Normal 38 ( 64 %) Overweight 11 ( 19 %) Obese 2 ( 3 %) Family History of Celiac Disease-Self Reported No history 51 ( 86 %) History 6 ( 10 %) Not documented 2 ( 3 %) Autoimmune Disease Comorbidities Type 1 diabetes mellitus 18 ( 31 %) Hypothyroidism 3 ( 5 %)
common symptom ( 78 %). Table 2 displays the frequencies of CD symptoms . Classic symptoms of CD such as diarrhea , failure to thrive , unexplained weight loss , and abdominal distention were less common . Extraintestinal symptoms were rare .
Out of the included patients , 16 patients did not have EGD records for review . Three of these 16 patients received EGDs at outlying facilities and records were not available . Two patients had EGD after starting a GFD and had normal EGD findings , and 11 patients did not receive EGD . These 11 patients were symptomatic and had positive antibody titers . Due to the family ’ s discretion , EGD was not performed . Thus , 43 patients had reports available for review , and in these patients , duodenitis was the most common gross endoscopic finding ( 49 %). On histopathology review , partial villous atrophy was present in 21 %
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