Presentation and Patterns of Celiac Disease in Indian Subcontinent: A Literature Review
Main Article Content
Abstract
Gluten, in genetically susceptible individuals induces an immune mediated enteropathy called Celiac disease (CD). It is an established cause of malabsorption, with the worldwide prevalence being 1% in the general population. It is found across all age groups, from infants to the elderly with 20% patients being diagnosed in the seventh decade of life. It has varying clinical presentations ranging from silent asymptomatic forms which are diagnosed during screening to life threatening forms with severe malabsorption to atypical presentations, with the symptom spectrum extending beyond the gastrointestinal tract which are more common in adults. High index of suspicion, robust screening and testing, followed by strict adherence to gluten free diet is a must to curb and cure the disease. Patients tend to face difficulties not only during diagnosis, but also with compliance and availability of a gluten free diet, in addition to significant economic and psychosocial burden, which is more predominant in developing countries. Screening of high-risk groups like first-degree relatives of celiac disease, patients with severe malnutrition, other autoimmune diseases, refractory anaemia and irritable bowel syndrome should be done to enhance case detection. In low middle income countries, judicious resource utilisation takes precedence, hence, tackling a multifactorial disease such as celiac disease becomes challenging. Repeated follow ups, awareness among patients and doctors, encouragement, availability of testing and dietary counselling is necessary for management of the disease in such settings. Improving sanitation and feeding practices may also play role in decreasing incidence, considering childhood GI infections are a well-established risk factor. Increased availability of serological tests (IgA/IgG anti-tTG, anti -EMA and anti-DGP), biopsy, genetic testing and other newer modalities under research have improved the diagnostic accuracy. Poor compliance increases the risk of GI malignancy, non-Hodgkin’s lymphoma, Hepatocellular carcinoma and MALToma. Hence adherence is a must to prevent complications. A wide variety of treatment modalities are being evaluated to bring into force alternative strategies for management. Only providing gluten free diet is often not sufficient for improvement of nutritional status in patients with CD. Hence, micronutrient supplementation should also be encouraged to meet the unmet needs.
Article Details
How to Cite
SIDDIQUI, Anjum et al.
Presentation and Patterns of Celiac Disease in Indian Subcontinent: A Literature Review.
Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3402>. Date accessed: 20 apr. 2024.
doi: https://doi.org/10.18103/mra.v10i12.3402.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Turner GD, Dunne MR, Ryan AW. Celiac Disease: Background and historical context. Methods Mol Biol. 2015;1326:3-14. doi:10.1007/978-1-4939-2839-2_1
3. Losowsky MS. A history of coeliac disease. Dig Dis. 2008;26(2):112-120. doi:10.1159/000116768
4. Walia BN, Sidhu JK, Tandon BN, Ghai OP, Bhargava S. Coeliac disease in North Indian children. Br Med J. 1966;2(5524):1233-1234. doi:10.1136/bmj.2.5524.1233
5. Silvester JA, Therrien A, Kelly CP. Celiac disease: Fallacies and facts: Fallacies and facts. Am J Gastroenterol. 2021;116(6):1148-1155. doi:10.14309/ajg.0000000000001218
6. Leonard MM, Sapone A, Catassi C, Fasano A. Celiac disease and nonceliac gluten sensitivity: A review: A review. JAMA. 2017;318(7):647-656. doi:10.1001/jama.2017.9730
7. King JA, Jeong J, Underwood FE, et al. Incidence of celiac disease is increasing over time: A systematic review and meta-analysis: A systematic review and meta-analysis. Am J Gastroenterol. 2020;115(4):507-525. doi:10.14309/ajg.0000000000000523
8. Rajput MS, Chauhan A, Makharia GK. Epidemiology and clinical features of celiac disease in adults. In: Coeliac Disease and Gluten-Related Disorders. Elsevier; 2022:1-23. https://doi.org/10.1016/B978-0-12-821571-5.00012-X
9. Makharia GK, Verma AK, Amarchand R, et al. Prevalence of celiac disease in the northern part of India: a community based study: Celiac disease in India. J Gastroenterol Hepatol. 2011;26(5):894-900. doi:10.1111/j.1440-1746.2010.06606.x
10. Sher KS, Fraser RC, Wicks AC, Mayberry JF. High risk of coeliac disease in Punjabis. Epidemiological study in the south Asian and European populations of Leicestershire. Digestion. 1993;54(3):178-182. doi:10.1159/000201035
11. Ramakrishna BS, Makharia GK, Chetri K, et al. Prevalence of adult celiac disease in India: Regional variations and associations. Am J Gastroenterol. 2016;111(1):115-123. doi:10.1038/ajg.2015.398
12. Ramakrishna BS, Makharia GK, Gupta SD, et al. ICMR Guideline on Diagnosis and Management of Celiac Disease. New Delhi: Division of Non communicable diseases, Indian Council of Medical Research; 2016: 10-19
13. Sood A, Midha V, Sood N, Avasthi G, Sehgal A. Prevalence of celiac disease among school children in Punjab, North India. J Gastroenterol Hepatol. 2006;21(10):1622-1625. doi:10.1111/j.1440-1746.2006.04281.x
14. Makharia GK, Verma AK, Amarchand R, et al. Prevalence of celiac disease in the northern part of India: a community based study: Celiac disease in India. J Gastroenterol Hepatol. 2011;26(5):894-900. doi:10.1111/j.1440-1746.2010.06606.x
15. Sood A, Midha V, Sood N, Malhotra V. Adult celiac disease in northern India. Indian J Gastroenterol. 2003;22(4):124-126. Accessed October 25, 2022. https://pubmed.ncbi.nlm.nih.gov/12962433/
16. Dixit R, Lebwohl B, Ludvigsson JF, Lewis SK, Rizkalla-Reilly N, Green PHR. Celiac disease is diagnosed less frequently in young adult males. Dig Dis Sci. 2014;59(7):1509-1512. doi:10.1007/s10620-014-3025-6
17. Banyal V, Chauhan A, Makharia GK. CD in India. Chettinad Health City Medical Journal. 2020;9(3). doi:10.36503/chcmj9(3)-09
18. Singla S, Kumar P, Singh P, Kaur G, Rohtagi A, Choudhury M. HLA profile of celiac disease among first-degree relatives from a tertiary care center in north India. Indian J Pediatr. 2016;83(11):1248-1252. doi:10.1007/s12098-016-2146-7
19. Gautam A, Jain BK, Midha V, Sood A, Sood N. Prevalence of celiac disease among siblings of celiac disease patients. Indian J Gastroenterol. 2006;25(5):233-235. Accessed October 27, 2022. https://pubmed.ncbi.nlm.nih.gov/17090839/
20. Greco L, Romino R, Coto I, Di Cosmo N, Percopo S, Maglio M, et al. The first large population based twin study of coeliac disease. Gut (2002) 50:624–8. doi: 10.1136/gut.50.5.624
21. Tye-Din JA, Galipeau HJ, Agardh D. Celiac disease: A review of current concepts in pathogenesis, prevention, and novel therapies. Front Pediatr. 2018;6:350. doi:10.3389/fped.2018.00350
22. Sarno M, Discepolo V, Troncone R, Auricchio R. Risk factors for celiac disease. Ital J Pediatr. 2015;41(1):57. doi:10.1186/s13052-015-0166-y
23. Henriksson C, Boström AM, Wiklund IE. What effect does breastfeeding have on coeliac disease? A systematic review update. Evid Based Med. 2013;18(3):98-103. doi:10.1136/eb-2012-100607
24. Sharma M, Singh P, Agnihotri A, et al. Celiac disease: a disease with varied manifestations in adults and adolescents: Celiac disease in Asia. J Dig Dis. 2013;14(10):518-525. doi:10.1111/1751-2980.12078
25. Bhatnagar S, Gupta SD, Mathur M, et al. Celiac disease with mild to moderate histologic changes is a common cause of chronic diarrhea in Indian children. J Pediatr Gastroenterol Nutr. 2005;41(2):204-209. doi:10.1097/01.mpg.0000172261.24115.29
26. Holmes GK, Prior P, Lane MR, et al. Malignancy in coeliac disease—effect of a gluten-free diet. Gut 1989; 30:333-8.
27. Corrao G, Corazza GR, Bagnardi V, et al. Mortality in patients with coeliac disease and their relatives: A cohort study. Lancet 2001; 358:356-61.
28. Catassi C, Fabiani E, Corrao G, et al. Risk of non-Hodgkin lymphoma in celiac disease. JAMA 2002; 287:1413-9.
29. Cosnes J, Nion-Larmurier I. Les complications de la maladie cœliaque. Pathol Biol (Paris). 2013;61(2):e21-6. doi:10.1016/j.patbio.2011.03.004
30. Goddard CJR, Gillett HR. Complications of coeliac disease: are all patients at risk? Postgrad Med J. 2006;82(973):705-712. doi:10.1136/pgmj.2006.048876
31. Leffler D, Saha S, Farrell RJ. Celiac disease. Am J Manag Care. 2003;9(12):825-831; quiz 832-833. Accessed October 31, 2022. https://pubmed.ncbi.nlm.nih.gov/14712759/
32. Husby S, Koletzko S, Korponay-Szabó I, et al. European society paediatric gastroenterology, hepatology and nutrition guidelines for diagnosing coeliac disease 2020. J Pediatr Gastroenterol Nutr. 2020;70(1):141-156. doi:10.1097/MPG.0000000000002497
33. Sahin Y. Celiac disease in children: A review of the literature. World J Clin Pediatr. 2021;10(4):53-71. doi:10.5409/wjcp.v10.i4.53
34. Rashtak S, Murray JA. Celiac disease in the elderly. Gastroenterol Clin North Am. 2009;38(3):433-446. doi:10.1016/j.gtc.2009.06.005
35. Bharadia L, Kanojiya L, Choudhary S, Shivpuri D. Celiac disease - A case series from north India. Indian J Pediatr. 2016;83(1):89. doi:10.1007/s12098-015-1790-7
36. Makharia GK, Baba CS, Khadgawat R, et al. Celiac disease: variations of presentations in adults. Indian J Gastroenterol. 2007;26(4):162-166. Accessed November 1, 2022. https://pubmed.ncbi.nlm.nih.gov/17986741/
37. Balekuduru AB, Reddy V, Subbaraj SB, Kulkarni SV. Celiac disease in adult south Indian patients with diarrhoea dominant irritable bowel syndrome. Tropical Gastroenterology. 2020;40(1):8-13. doi:10.7869/tg.516
38. Kumar P, Mishra K, Singh P, Rai K. Should we screen children with severe acute malnutrition for celiac disease? Indian Pediatr. 2012;49(4):330-331. Accessed October 27, 2022. https://pubmed.ncbi.nlm.nih.gov/22565083/
39. Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA, American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108(5):656-676; quiz 677. doi:10.1038/ajg.2013.79
40. Agarwal A, Chauhan A, Ahuja V, Makharia GK. Opportunities and challenges in the management of celiac disease in Asia. JGH Open. 2020;4(5):795-799. doi:10.1002/jgh3.12381
41. Kelley CP. Celiac Disease. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. Ch107. 10th ed. Philadelphia: Elsevier health sciences; 2016: 1849-1871
42. Chauhan JC, Kumar P, Dutta AK, Basu S, Kumar A. Assessment of dietary compliance to gluten free diet and psychosocial problems in Indian children with celiac disease. Indian J Pediatr. 2010;77(6):649-654. doi:10.1007/s12098-010-0092-3
43. Errichiello S, Esposito O, Di Mase R, et al. Celiac disease: predictors of compliance with a gluten-free diet in adolescents and young adults. J Pediatr Gastroenterol Nutr. 2010;50(1):54-60. doi:10.1097/MPG.0b013e31819de82a
44. Rajpoot P, Sharma A, Harikrishnan S, Baruah BJ, Ahuja V, Makharia GK. Adherence to gluten-free diet and barriers to adherence in patients with celiac disease. Indian J Gastroenterol. 2015;34(5):380-386. doi:10.1007/s12664-015-0607-y
45. Sahin Y. Celiac disease in children: A review of the literature. World J Clin Pediatr. 2021;10(4):53-71. doi:10.5409/wjcp.v10.i4.53
46. Bishop J, Ravikumara M. Coeliac disease in childhood: An overview. J Paediatr Child Health. 2020;56(11):1685-1693. doi:10.1111/jpc.14674
47. Newton KP, Singer SA. Celiac disease in children and adolescents: special considerations. Semin Immunopathol. 2012;34(4):479-496. doi:10.1007/s00281-012-0313-0
48. Lau MS, Mooney PD, White WL, et al. The role of an IgA/IgG-deamidated gliadin peptide point-of-care test in predicting persistent villous atrophy in patients with celiac disease on a gluten-free diet. Am J Gastroenterol. 2017;112(12):1859-1867. doi:10.1038/ajg.2017.357
49. Singh P, Wadhwa N, Chaturvedi MK, et al. Validation of point-of-care testing for coeliac disease in children in a tertiary hospital in north India. Arch Dis Child. 2014;99(11):1004-1008. doi:10.1136/archdischild-2013-305567
50. Mir BA, Majeed T, Singh A, Rajput MS, Kumar A, Chauhan A. Emerging biomarkers for screening and management of celiac disease. Biomed Res Int. 2022;2022:2756242. doi:10.1155/2022/2756242
51. Crenn P, Messing B, Cynober L. Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin Nutr. 2008;27(3):328-339. doi:10.1016/j.clnu.2008.02.005
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