Celiac Disease among Outpatient Attendees with Gastrointestinal Complaints at a Tertiary Care Hospital in Sana’a City, Yemen: A Four-Year Retrospective Study

Abstract

Background: Celiac disease (CD) is a chronic autoimmune enteropathy, which is caused by gluten in people with genetic predisposition regardless of age and gender. Its presentations can vary from asymptomatic nature to severe malnutrition. Diagnosis usually depends on serology and intestinal biopsy examination. This study aimed to determine the prevalence of CD and describe its clinical presentations and diagnostic approaches among patients with gastrointestinal complaints in Sana’a City, Yemen. Methods: A retrospective, cross-sectional study was conducted using the medical records of patients diagnosed with CD at the University of Science and Technology Hospital (USTH) from January 2020 to December 2023. Out of 350 records for CD patients diagnosed during the study period, 155 records were complete and were used in describing the clinical presentations and diagnostic methods of CD among Yemeni patients. Data about sociodemographic characteristics, clinical presentations and diagnostic methods were collected using a pre-designed data collection sheet. Descriptive statistics were used to summarize the collected data. Results: Out of 160,000 patients attending the Gastroenterology Outpatient Department at the USTH from 2020 to 2023, 350 were diagnosed with CD, yielding a prevalence of 0.22%. The mean age of CD patients was 26 ± 14.6 years, with a majority being female (71%) and over half (54.8%) falling within the 20-40 age group. Clinically, more than half of the patients presented with abdominal pain (52.9%) and diarrhea (50.3%), followed by abdominal distention (25.8%) and weight loss (21.9%). Less frequent typical symptoms included vomiting (17.4%), anorexia (12.9%), and constipation (7.7%). Among atypical manifestations, fatigue and failure to thrive (9% each) were the most common, followed by anemia (7.7%), while rickets, bruising, and delayed puberty were rare (0.6% each). Diagnostic evaluation revealed that 78.4% of 87 patients tested were positive for anti-tissue transglutaminase antibodies, and 91% of 111 patients who underwent intestinal biopsy showed characteristic mucosal changes consistent with CD. Conclusion: The prevalence of CD among patients with gastrointestinal complaints is low, compared to the global and regional trends of the disease, predominately affecting females. It mostly presents with typical gastrointestinal symptoms, particularly abdominal pain, diarrhea and distension. Although atypical non-gastrointestinal manifestations are infrequent, CD should be considered when dealing with patients having non-gastrointestinal problems. Healthcare providers should be educated about the importance of incorporating both serology and intestinal biopsy examination for the diagnosis of patients with suspected CD.