The Prevalence of Occult Celiac Disease among Patients with Functional Dyspepsia: A Study from the Western Region of Iran

Abstract

Objective. The prevalence of Celiac Disease (CD) is high in Iran, and evaluation of CD is not part of the routine screening procedure for dyspeptic patients; therefore, cases of occult CD may be missed. This study aimed to investigate the prevalence of occult CD among dyspeptic patients who presented at a gastroenterology clinic in the Western region of Iran. Methods. In this descriptive, cross-sectional prospective study, patients who had a history of at least 12 weeks of upper abdominal discomfort were eligible to participate in the study during a 14-month recruitment period. Patients with a clinical or paraclinical data in favor of organic causes were excluded from the study. Enrolled patients were screened for IgA antiendomysium antibody (EMA) and IgA antitissue transglutaminase antibody (tTG). Those who screened positive for EMA/tTG received a confirmatory diagnostic biopsy for Marsh classification of CD. Results. From 225 potential participants with dyspepsia, 55 patients were excluded due to having explainable organic causes. The study sample included 170 patients with “functional dyspepsia.” Mean age of participants was 31 years and 55.8% were female. Twelve patients (7%) had positive tests (EMA/tTG), of which 10 were female (83.4%). According to Rome II criteria, all twelve patients with positive tests had “dysmotility type dyspepsia.” Based on Marsh classification, six patients were consistent with “Marsh I,” four with “Marsh II,” and two with the “Marsh III” classification. Conclusions. In this study, the prevalence of CD in dyspeptic patients was high. As a result, this study suggests that screening by serology tests (EMA/tTG) is justifiable for the detection of CD among functional dyspeptic patients in the tertiary centers in our country.

Acupuncture and a gluten-free diet relieve urticaria and eczema in a case of undiagnosed dermatitis herpetiformis and atypical or extraintestinal celiac disease: a case report

“…An antibody role against the autonomic nervous system is being suggested as a cause of functional "dysmotility" type dyspepsia-heartburn in which no organic cause can be identified. 17,18 One of this patient's primary presenting complaints was acute heartburn that was not being relieved by esomeprazole. Furthermore, the first indication of accidental gluten contamination in this patient is a return of the urticarial eczema and heartburn.…”

Is there a relationship between occult celiac disease and functional dyspepsia?

“…It is demonstrated that the prevalence of occult CD in patients with dyspepsia is higher than that of the general population in Egypt (Abu-Zekry et al, 2008). Another study from eastern country was conducted on 225 dyspeptic Iranian patients, revealing that about 6% of the selected patients with functional dyspepsia had occult celiac disease (Keshavarz et al, 2010). Also, Nakazawa et al (2014) found that seven of the eleven patients with anti-tTG exhibited villous atrophy and partial infiltration of intraepithelial lymphocyte.…”

“…In comparison with the general population, it was observed that CD had a greater prevalence in dyspeptic patients and that 30 to 40% of CD patients have dyspeptic symptoms. These findings suggested that it would be useful to carry out, in subjects undergoing esophago-gastro-duodenoscopy (EGD), biopsies of the descending duodenum independently of the endoscopic aspect of the mucosa (Keshavarz et al, 2010).…”

Frequency of Celiac Disease in Adult Patients with Typical or Atypical Malabsorption Symptoms in Isfahan, Iran

“…There are some studies with case finding approach that are done in these patients. The frequency of CD is reported from 1.4% [ 17 ] to 7% [ 18 ] in people with dyspeptic complaints and from 0.4% to 11.4% in patients with IBS [ 19 – 21 ]. A meta-analysis showed that biopsy-confirmed CD is 4-fold more prevalent in IBS patients than the general population (Pooled odds ratio = 4.34, CI 95% = 1.78–10.6) [ 22 ].…”