Celiac Disease in Children with Down Syndrome in Serbia

Abstract

Introduction. To determine the prevalence of celiac disease (CD) in children with Down syndrome (DS) in Serbia and to analyze clinical characteristics and laboratory data of DS patients.

Methods. Ninety one children (50 boys/41 girls, mean age 6.3 years) with DS were examined, and total levels of IgA and IgA transglutaminase (IgA tTG) antibodies were determined, as well as levels of IgG transglutaminase (IgG tTG) and IgG anti-endomysial (IgG EMA) antibodies in cases of IgA immunodeficiency. In cases where values of antibodies were positive, enterobiopsy was performed.

Results. Thirty-eight children had constipation (41.7%), 26 children had vomiting and regurgitation (28.5%), 16 had anemia (17.5%), while two children had intermittent diarrhea (2.2%). DS-specific mean weight percentile was 15.2%±14.5% (range <5-75%). In four out of five children with positive levels of IgA tTG, enterobiopsy showed presence of CD (4.4%, 95% CI, 1.7%-10.7%.). Levels of IgG tTG and IgG EMA were determined in five children with IgA immunodeficiency. In all five children, IgG EMA was negative. Three children showed increased IgG tTG values, so these children underwent enterobiopsy accordingly, which showed presence of normal mucosa. Our analysis shows that signs and symptoms of CD in children with DS have only minor diagnostic value for detection of the disease.

Conclusion. These results suggest the need for systematic screening, considering the overlapping of symptoms that are characteristic for both diseases.