Demographic Profile and Clinical Presentation of Celiac Disease in the Pakistani Population: A Systematic Review and Meta-analysis

Background: Celiac disease (CD) is an increasingly recognized autoimmune enteropathy triggered by gluten ingestion.While its global prevalence is well-documented, data from South Asia, particularly Pakistan, remain fragmented.This systematic review and meta-analysis aimed to consolidate available evidence on the demographic characteristics and clinical presentations of CD in the Pakistani population.Materials and methods: A comprehensive literature search of PubMed, Google Scholar, and Cochrane databases was conducted in accordance with PRISMA guidelines.Studies were selected based on predefined PICOS criteria, including biopsy and serology-confirmed CD cases from Pakistan.Data extraction focused on demographics, symptoms, histology, laboratory parameters, and autoimmune associations.Statistical analysis was performed using a random-effects model.Results: Fourteen studies encompassing 1,578 patients were included.The pooled female prevalence was 51.5%, with mean ages of 7.6 years in pediatric and 35.5 years in adult patients.Iron deficiency anemia (65.9%) and diarrhea (64.6%) were the most common clinical presentations.Atypical presentations like bloating, oral ulcers, and psychiatric symptoms were also reported.Histologically, villous atrophy (96.9%) and intraepithelial lymphocytosis (84.5%) were predominant.Celiac disease was associated with autoimmune diseases, notably psoriasis (25%), hypothyroidism (12.6%), and autoimmune hepatitis (12.5%).Family history was reported in 10.6% of cases.Laboratory findings revealed low mean hemoglobin (9.57gm/dL) and albumin (2.88 gm/dL), indicating nutritional compromise.Conclusion: Celiac disease in Pakistan presents with a diverse clinical spectrum and frequent extraintestinal manifestations.Delayed diagnosis, nutritional deficiencies, and autoimmune overlap are common.Enhanced awareness and diagnostic accessibility are urgently needed to improve early recognition and management.