Gut microbiota predicts the diagnosis of celiac disease in Saudi children

Celiac disease (CD) is a permanent intolerance to dietary gluten that is characterized by immune-mediated inflammatory lesions of the intestinal mucosa.Owing to its variable manifestations and age at onset, CD has emerged as a worldwide public health problem.[1] Although the "classical" malabsorption syndrome that is characterized by diarrhea, steatorrhea, weight loss, and fatigue may occur in severe cases, most patients present with a milder constellation of symptoms, such as abdominal discomfort and bloating that mimic irritable bowel syndrome or non-gastrointestinal symptoms that include anemia and osteoporosis, or no symptoms at all.In most patients with CD, a gluten-free diet assures full recovery.Many patients with milder presentation of CD are diagnosed at a relatively advanced stage of the disease.The prompt diagnosis and treatment of CD are associated with symptomatic improvement, reduction of potential complications (including malignancies), and decreased mortality.[2,3] Therefore, it is necessary to increase the awareness of physicians about the variable manifestations of CD and to emphasize the importance of screening.Till date, only one prevalence study for Saudi healthy adolescents has been reported.The study was performed by Aljabreen et al. [4] in three regions: Aseer, Madinah, and Al-Qaseem.They screened 1167 students aged between 16 and 18 years (out of 65,431 students), and showed the prevalence by region as follows: Aseer 2.1%, Madinah 1.8%, and Al-Qaseem 3.2%.The aims of this study were to determine the prevalence of silent and asymptomatic CD in the young population (i.e., individuals aged 6-18 years), to compare the prevalence of CD among those with and without comorbidities, and to identify significant risk factors for CD in the studied age group.These aims were accomplished using ABSTRACT Background/Aim: Epidemiological studies of celiac disease (CD) among Saudi children have been performed only within some groups who are at a high risk of developing CD.The aim of this study was to determine the prevalence of CD among symptom-free children from the public schools of the military campus of National Guard in the Eastern Province of Saudi Arabia.Patients and Methods: Between 2012 and 2014, serum samples were collected from 1141 students (age 6-18 years) attending nine public schools of the military campus of National Guard in the Eastern Province of Saudi Arabia.Participants were screened for CD by testing for anti-tissue transglutaminase IgA (IgA-tTG) and IgG antibodies (IgG-tTG).Small intestinal biopsy was offered to all participants who tested positive for IgA-tTG [IgA-tTG >20 relative units (RU)/ml].Results: Of the 1141 participants, 32 were IgA-tTG positive.Thus, the estimated serology-positive prevalence was 3%.An intestinal biopsy was performed in 10 of the participants with antibody positivity.The biopsy findings of all 10 children were consistent with CD.Thus, the estimated biopsy-confirmed prevalence was about 1%.Conclusions: The prevalence of CD was estimated to be about 1% among symptom-free children from the public schools of the military campus of National Guard in the Eastern Province of Saudi Arabia.