Extra-Intestinal Manifestations of Celiac Disease in Pediatric Population of a Tertiary Care Hospital in Rawalpindi, Pakistan - an Observational Study

Adnan; Hanif   Ullah; Shamama  Hasan; Ifnan  Shamraiz; Husna  Khan

doi:10.51253/pafmj.v76iSUPPL-1.13670

Authors

Adnan Department of Pediatric Gastroenterology, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Hanif Ullah Department of Pediatric Gastroenterology, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Shamama Hasan Department of Pediatric Gastroenterology, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ifnan Shamraiz Department of Pediatric Gastroenterology, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Husna Khan Department of Pediatric Gastroenterology, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-1.13670

Keywords:

Celiac disease, Extra-intestinal manifestations, Pediatric

Abstract

Objective: To determine the frequency and types of extra-intestinal manifestations (EIMs) in children with celiac disease.

Study Design: Observational study.

Place and Duration of Study: Department of Pediatric Gastroenterology, Combined Military Hospital, Rawalpindi, Pakistan from Jan to Jun 2025.

Methodology: The study included 233 children aged 1–15 years diagnosed with celiac disease based on ESPGHAN guidelines. Children with celiac crisis or other autoimmune/chronic illnesses were excluded. Data were collected through clinical examination and laboratory investigations. EIMs were identified using standard definitions. Statistical associations were analyzed using chi-square or Fisher’s exact test (p<0.05 significant).

Results: The median (IQR) of age was 7(4-11) years; 60.1% were male. Common EIMs included iron deficiency anemia (60.5%), short stature (48.9%), eczema (40.8%), and fatigue. Anemia was more frequent in females (69.9%, p=0.02), whereas males had higher rates of behavioral changes (40.0%, p<0.001), headaches (30.0%, p=0.04), and delayed puberty (7.1%, p=0.01). Dental enamel hypoplasia (39.1%, p<0.001), eczema (p<0.001), and fatigue (62.3% in Marsh 3a, p<0.001) varied with Marsh grade. Anemia was frequent in younger children (72.6%, p<0.001), while older children had more failure to thrive (44.9%, p<0.001) and liver dysfunction (20.3%, p<0.001). Recurrent stomatitis (55.6%), fatigue (100%), and psychiatric disorders (55.6%) significantly associated with normal endoscopic findings (all p<0.001).

Conclusion: Extra-Intestinal manifestations (EIMs) are common in pediatric celiac disease, varying significantly with age, sex, histological stage, and endoscopic appearance. Early recognition of EIMs can facilitate timely diagnosis and management.

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