Celiac disease presenting as rickets in Saudi children

Assiri, Asaad; Saeed, Anjum; Mi, El Mouzan; El‐Matary, Wael

doi:10.5144/0256-4947.2013.49

Cited by 14 publications

(9 citation statements)

References 17 publications

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“…Patients with celiac disease experience metabolic bone diseases, including osteoporosis, osteopenia, and bone fractures (10,(17)(18)(19)(20)(21). There are several factors that affect the development of metabolic bone disease in patients with celiac disease.…”

Section: Discussionmentioning

confidence: 99%

Vitamin and mineral deficiency in children newly diagnosed with celiac disease

Topal¹,

Çatal²,

Acar³

et al. 2015

Turk J Med Sci

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IntroductionCeliac disease is a chronic autoimmune disease that particularly affects the proximal small bowel (1). An autoimmune-mediated mechanism plays a part in the pathophysiology of the disease, and small bowel mucosal injury and malabsorption occur due to the hypersensitivity to gluten in prone individuals. Vitamin and mineral deficiency may also be seen depending upon malabsorption. Consequently, the clinical symptoms of the disease are not limited to the gastrointestinal system and may appear with a heterogeneous clinical spectrum involving the extraintestinal system. The typical symptoms of the disease include chronic diarrhea, abdominal distention, and growth retardation (2,3). However, the disease may also manifest itself with extraintestinal findings related to the hematologic, endocrine, and autoimmune systems. Anemia is the most frequently seen disorder in the hematologic system that often develops due to iron deficiency (4-9). Hypocalcemia and osteopenia may also occur due to vitamin D deficiency (10,11). No extensive study has been conducted regarding the vitamin and mineral deficiencies of pediatric patients diagnosed with celiac disease up to the present. Accordingly, it is the objective of this study to determine the frequency of vitamin A, D, and E deficiency, as well as zinc and mineral deficiencies, in pediatric patients diagnosed with celiac disease at the time of application to our clinic. Materials and methodsThe files of the patients diagnosed with celiac disease and followed in our Pediatric Gastroenterology, Hepatology, and Nutrition Clinic from June 2008 to June 2013 were reviewed retrospectively. Patients with complete file records and vitamin and mineral levels checked at the time of application were enrolled in the study. The demographic characteristics, complaints at the time of application, findings of duodenal biopsy, and serum 25 OH vitamin D, vitamin A, vitamin E, iron, and zinc levels of the patients were taken from the file records. The study was approved by the Ethics Committee of İnönü University (approval number 162/2013).The diagnosis of celiac disease was established in accordance with the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition's guidelines Background/aim: To establish the frequency of vitamin and mineral deficiency in children newly diagnosed with celiac disease. Materials and methods:The files of patients diagnosed with celiac disease in our Pediatric Gastroenterology Clinic from June 2008 to June 2013 were reviewed retrospectively.Results: A total of 52 pediatric patients diagnosed with celiac disease via serology and duodenal biopsy and who fulfilled the study criteria were enrolled in the study. The mean diagnosis age of the patients was 8.5 ± 3.9 years and 33 (63.5%) of the patients were female. Vitamin D, vitamin A, vitamin E, zinc, and iron deficiencies were determined in 27 (51.9%), 4 (7.7%), 7 (13.5%), 35 (67.3%), and 18 (34.6%) patients, respectively, at the time of diagnosis. Vitamin D deficiency was observed more frequent...

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Section: Discussionmentioning

confidence: 99%

Vitamin and mineral deficiency in children newly diagnosed with celiac disease

Topal¹,

Çatal²,

Acar³

et al. 2015

Turk J Med Sci

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“…El raquitismo carencial también puede ser secundario a diversos síndromes que cursan con malabsorción intestinal como la fibrosis quística o la enfermedad celíaca, siendo a veces la forma de debut de ésta última antes de que presente síntomas gastrointestinales acompañantes y su mecanismo se debería a la pérdida de la arquitectura vellositaria del intestino que produce malabsorción del calcio y de la vitamina D, por la liberación de citosinas proinflamatorias, activando los osteoclastos que representa la principal acción local del mecanismo (43) responsable del desarreglo óseo .…”

Section: Discussionunclassified

Raquitismo carencial: a propósito de un caso.

Noceda

2018

Pediatr (Asunción).

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Resumen: El raquitismo es una enfermedad que se caracteriza por una deficiencia en la osificación de los huesos, afectando a las metáfisis y por tanto a los niños en su etapa de crecimiento, con una expresión clínica común aun teniendo varias etiologías, entre ellas la carencia de vitamina D3, siendo ésta causa poco frecuente en nuestro país debido a la acción de los rayos solares UVB por ser un país subtropical. El motivo de la presentación es el caso de un niño de 2 años 3 meses portador de una hipoplasia renal congénita bilateral, que era sometido a diálisis peritoneal ambulatoria por ERC desde los 3 meses de edad. Ingresó al hospital para ser tratado por disfunción de la diálisis peritoneal causada por obstrucción distal del catéter, en el examen al ingreso se constataron hipocrecimiento y retraso del desarrollo motor importante, así como signos clínicos, radiográficos y de laboratorio de raquitismo activo, presentando en la sangre niveles de vitamina D2 muy bajos lo que reveló ser raquitismo carencial, iniciándose tratamiento con Calcitriol a 3.000 UI/día, teniendo una buena respuesta a la medicación, mejorando las lesiones óseas y del desarrollo motor comenzando a ponerse de pie y dando pasos con apoyo. Correspondencia: Luís Alberto Chamorro Noceda Correo: cml.chmrr@gmail.com Conflicto de interés: Los autores declaran no poseer conflicto de interés Recibido: 04/03/2018 Aceptado: 20/06/2018

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“…Screening should be done in patients with typical gastrointestinal symptoms suggestive of malabsorption, such as chronic diarrhea with weight loss, steatorrhea, postprandial abdominal pain and bloating [ 9 ] but should also be considered in patients with failure to thrive and those with metabolic bone disease according to NICE guidelines 2009 [ 10 ]. Several studies in Arab children have shown rickets to be quite common in children with CD [ 6 – 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rare presentations such as fever of unknown origin [ 2 ] and psychosis have been reported [ 3 ]. Osteomalacia [ 4 , 5 ] and rickets [ 4 , 6 – 8 ] may also be the presenting feature of celiac disease. We present a case of rickets in a 13 year old girl from the middle east that came to us with severe deformities in the extremities causing severe disability.…”

Section: Introductionmentioning

confidence: 99%

Severe rickets in a young girl caused by celiac disease: the tragedy of delayed diagnosis: a case report

et al. 2014

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BackgroundCeliac disease is a systemic immune mediated disease which usually presents with gastrointestinal symptoms, but it may present with extra gastrointestinal manifestations such as metabolic bone disease and failure to thrive. This may lead to a delay in the diagnosis.Case presentationWe present a 13 year old female from the middle east with an 8 year history of severe rickets causing multiple bone deformities leaving the child crippled with bowing of both of her arms and legs. The patient was also found to have growth failure, anemia and on further workup she was found to have celiac disease.ConclusionWe are presenting this case because it shows a severe case of rickets after malabsorption for many years. Celiac disease should be kept in mind as a cause of rickets in patients not responding to usual forms of treatment or when associated with other manifestations of malabsorption.Electronic supplementary materialThe online version of this article (doi:10.1186/1756-0500-7-701) contains supplementary material, which is available to authorized users.

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Celiac disease presenting as rickets in Saudi children

Cited by 14 publications

References 17 publications

Vitamin and mineral deficiency in children newly diagnosed with celiac disease

Vitamin and mineral deficiency in children newly diagnosed with celiac disease

Raquitismo carencial: a propósito de un caso.

Severe rickets in a young girl caused by celiac disease: the tragedy of delayed diagnosis: a case report

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