Varied presentation of celiac disease in pakistani adults

The objective of this retrospective study was to evaluate presentation of celiac disease in adults. It included 77 patients,41 (53.2%) males with median age 26 years and median body mass index of 18 (16 - 22) kg/m2. Typical presentation withgastrointestinal symptoms was seen in 76.6%. Atypical presentation with extra intestinal complaints in 7.8% and silentpresentation in 15.6%. Major symptoms were diarrhea in 64.9%, weight loss 36.4%, abdominal pain 35.1%, vomiting32.5%, pallor 24.7%, and weakness 13%. Iron deficiency was documented in 20.8%, B12 deficiency in 9.1%, folic aciddeficiency in 6.5% and vitamin D deficiency in 10.4%. Half of the patients had haemoglobin less than 11 g/dl. Osteoporosisand osteomalacia, hypothyroidism, diabetes and atrophic gastritis were seen in 2.6% each. Raised alanineaminotransferase was documented in 23.4%. Duodenal biopsy, done in 39 patients, revealed increased intraepitheliallymphocytes in 11, along with crypt hyperplasia in 3, partial villous atrophy in 15 and sub-total villous atrophy in 10. Inconclusion, celiac disease in adults should be looked for in patients with chronic diarrhea or irritable bowel syndrome likesymptoms, underweight, anaemic, or having nutritional deficiencies.