1. SCREENING FOR CELIAC DISEASE IN EGYPTIAN CHILDREN SCREENING FOR CELIAC DISEASE IN EGYPTIAN CHILDREN Prof. Dr: Mona Abu Zekry -Professor of Pediatrics Head Of Pediatric Gastroenterology- Cairo UNI * Dr : Mohamed Diab Specialist Pediatrics* Dr: Ghada Fikry Specialist Pediatrics* *Gastroenterology Unit - Children's Hospital Faculty of Medicine – Cairo University

2. CELIAC Disease Celiac disease, otherwise known as gluten- sensitive enteropathy: Celiac disease, otherwise known as gluten- sensitive enteropathy:  Is an immune-mediated condition in which ingestion of dietary gluten results in small intestinal mucosal inflammation, crypt hyperplasia, and villous atrophy in genetically susceptible individuals.

3. The environmental factors are, the gliadin fraction of wheat gluten and similar alcohol- soluble proteins in other grains (e.g. barely & rye) The environmental factors are, the gliadin fraction of wheat gluten and similar alcohol- soluble proteins in other grains (e.g. barely & rye) Genetic predisposition is the presence of HLA alleles DQA1*0501/DQB1*0201in most of the cases. Genetic predisposition is the presence of HLA alleles DQA1*0501/DQB1*0201in most of the cases. Besides, CD is the result of an inappropriate T cell–mediated immune response against ingested gluten. Besides, CD is the result of an inappropriate T cell–mediated immune response against ingested gluten.

4. Subjects and Methods : The study was conducted at the Paediatric Gastroenterology Unit, Children Hospital, Cairo University. The study included 1500 children attending out patient clinic for various non gastroenterological conditions. All patients were subjected to the following: 1- Full history taking 2- Careful Clinical Examination 3-Investigations: a) Complete Blood Picture b) General biochemical blood tests c) Stool analysis, culture and sensitivity c) Stool analysis, culture and sensitivity d) : tTG-IgA, EMA, tTG- IgG d) Investigations specific for CD: tTG-IgA, EMA, tTG- IgG e) Total immunoglobulin A (IgA) for suspected deficiency e) Total immunoglobulin A (IgA) for suspected deficiency positive cases f) Endoscopy and biopsies were done for anti-tTG and anti-EMA positive cases

5. Clinical Picture The symptoms of celiac disease are diverse, and the disease is often asymptomatic. The symptoms of celiac disease are diverse, and the disease is often asymptomatic. Typical symptoms are: Typical symptoms are:  Diarrhea  Loss of weight  Abdominal discomfort  Bloating  And various types of malabsorption.

7. AIM OF THE WORK The aim of this study is to screen for the prevalence of celiac disease among Egyptian children. Until recently celiac disease was considered very rare among the Egyptian population. The aim of this study is to screen for the prevalence of celiac disease among Egyptian children. Until recently celiac disease was considered very rare among the Egyptian population.

8. Small bowel biopsies were collected if the serological screening demonstrated either: Small bowel biopsies were collected if the serological screening demonstrated either: a) Positive result for both IgA class anti- transglutaminase (tTG) and EMA. b) Positive result for IgG anti-tTG in children with IgA deficiency

9. RESULTS Out of the total 1500 cases studied, 21 cases were found to be positive for celiac disease. Out of the total 1500 cases studied, 21 cases were found to be positive for celiac disease. This represents prevalence of 1.4%. This represents prevalence of 1.4%. Prevalence detected in different serological studies conducted worldwide ranges from 0.5% - 1.5% (Dubé et.al.,2005). Prevalence detected in different serological studies conducted worldwide ranges from 0.5% - 1.5% (Dubé et.al.,2005).

10. Results of serology: 1500 Screened tTG- IgA 15 TTG-IgA Positive 9 EMA + 6 TTG-IgG -ve Biopsy 3 TTG-IgG +ve Biopsy 6 EMA - 5 TTG-IgG -ve Biopsy For follow up 1 TTG-IgG +ve For follow up 201 TTG-IgA <0.5 10 TTG-IgG +ve 2 Total IgA ± Stopped 8 Total IgA <70 Biopsy 191 TTG-IgG -ve Stopped 1284 TTG-IgA Normal Stopped

12. Female patient 14 years old the figure shows height to be 141 cm this is below the 5th percentile for age. Body weight of this patient = 33.8 kg which is also below 5th percentile

13. Male patient 5 years old, height as shown in the figure = 98 cm, body weight of this patient was 13.2 kg both height and weight are below 5th percentile for age.

14. Celiac Disease among patients with diarrhea and growth failure This study included cases with diarrhea and growth failure to identify celiac disease as an important cause of this condition in Egyptian children. To reach this aim the specific serological marker for CD human recombinant tissue transglutaminase (anti-tTG) endomyseal antibody (anti-EMA) and histopathological examination of small intestinal mucosal biopsies obtained by upper endoscopy for serologically positive cases will be performed.

15. Subjects and Methods ). The age ranged from 6months – 3years. The study was conducted at the Paediatric Gastroenterology Unit, Children Hospital, Cairo University. The study included 150 children suffering from acute, chronic diarrhoea and malnutrition (35 acute diarrhoea, 40 chronic diarrhoea and 75 malnutrition). The age ranged from 6months – 3years.

16. Result From this group of children 11 cases were diagnosed with CD by serological testing and intestinal biopsy representing 7.4% of total cases. From this group of children 11 cases were diagnosed with CD by serological testing and intestinal biopsy representing 7.4% of total cases.

17. After GFD Before After GFD Before Patient before diagnosis and after GFD Patient before diagnosis and after GFD for 6 months

18. Patient at time of diagnosis 9 years old female with weight and height below the 3rd percentile weight 14 kg and height 110 cm weight 14 kg and height 110 cm

19. Conclusions Celiac disease is prevalent among Egyptian children; incidence of affection is 1.4%. Celiac disease is prevalent among Egyptian children; incidence of affection is 1.4%. Main presenting symptom is failure to thrive anemia and malnutrition. Main presenting symptom is failure to thrive anemia and malnutrition. CD prevalence in this study among Egyptian children suffering from chronic diarrhea and malnutrition was 1:14(7.3%) which makes it a common presentation of CD Screening tests help determine those children with high probability of the disease from those with low probability.

20. Recommendations Increase of disease awareness by educational courses for doctors, nurses, dieticians, school personnel, affected families and the general population. Implementation of diagnostic facilities, by teaching doctors and technicians the diagnostic procedures for CD. The use of most recent and sensitive serological tests in search for CD followed by Upper Endoscopy for diagnosis. alignant transformation of GIT (Intestinal lymphoma, Bowel Adenocarcioma ) Once diagnosed, patient’s data must be listed in a registry by local personnel that maintain contact with the patient’s family for supplying gluten-free food in order to prevent serious complications as general illness, anaemia, osteoporosis, malignant transformation of GIT (Intestinal lymphoma, Bowel Adenocarcioma ) Founding of Celiac disease association to support patients and their families. Founding of Celiac disease association to support patients and their families.

21. Celiac Disease in Type I Diabetics In patients with Type I Diabetes 250 cases from Pediatric Endocrinology Unit Children's Hospital Cairo University where studied 16 cases were serologically positive for Celiac Disease with prevalence rate 6.4%. In patients with Type I Diabetes 250 cases from Pediatric Endocrinology Unit Children's Hospital Cairo University where studied 16 cases were serologically positive for Celiac Disease with prevalence rate 6.4%.