Abstract
Objective: to determine the clinical presentation of celiac disease and its crisis in Children.
prospective descriptive study. Department of Paediatrics Shaheed Mohtrama Benazir Bhutto Medical University at Ghulam Muhammad Mahar Medical College Sukkur, and Chandka Medical College Larkana, from July 2007 to July 2011. Patients included in this study from out patient department as well as admitted in wards. Seventy children who were clinically suspected and had serological evidence in the form of t TGIgA positive were in rolled in study. After taking consent a separate pro forma was filled for each patient to record demography, family history of illness, feeding and weaning, and data about clinical presentation, anthropometric measurements and laboratory investigations. The diagnosis of celiac disease was made on the basis of the clinical presentation, serological and histological features consistent with celiac disease. Out of 70 children 50 (71.4%) were females and 20 (28.5%) males, age ranging from 1year to 12 years and 50% were in age group of 5-9 years. The SD scoring revealed moderate degree of malnutrition -2 SD in 20 (28.5%) of children, severe malnutrition – 3 SD in 35 (50%) of children and very severe malnutrition -4 SD in 15 (21.4) of children. Majority of parents were cousins and in 10 cases the sisters had celiac disease and two brothers. Sixty five (92.8%) children were exclusive breast feed till 2-4 months of age and later added buffalo milk as supplement. Weaning was started at age of 3-5 month, like biscuit, cereal, piece of rotti (bread). All cases had diarrhea, 25 (35.7%) cases treated for tuberculosis. Sixty (85.7% ) cases have classical sign and symptoms of celiac disease and 14.3% had celiac crisis presentation. All cases positive for serological test were included in the study and biopsy revealed M type 2 histopathology in 45 (64.3%) and 25 (35.7%) M type 3. All cases recovered and improved on follow-up after gluten free diet. Celiac disease presentation with classical symptoms and signs in majority of children and its crisis were characterized by severe diarrhea and dehydration, unable to hold neck, very severe malnutrition – 4 SD, edema, and calcium deficiency signs. Majority of patients were the product of consanguineous marriages and early gluten containing diet introduced.

Key words: Celiac disease in children, unable to hold neck, severe malnutrition, gluten diet.