Introduction: Coeliac disease is an autoimmune mediated enteropathy. It initiatesin genetically susceptible individuals upon ingestion of proline and glutamine proteins, commonly found in wheat, barley and ray. CD is perhaps the only multifactorial autoimmune disease where the antigenic trigger is well known and studied. In our study we have evaluated the clinical, laboratory, histopathology data as well as anthropometric measurements of 112 children diagnosed with CD. Material and Methods: The study included 112 children diagnosed with CD in the department of pediatrics, in “Mother Teresa” University Hospital Center, from 2010 to 2016. Thedata were collected during the first consultation with the patients and from the patient clinical records. The collected data are as follows: dermographic and anthropometric data, main complains of the patients, associated diseases, family history for CD etc. Besides these, data were collected from laboratory testing, hystopathology reports and duodenal biopsies. Results:The study included 112 children diagnosed with coeliac disease, out of which55.4%,(62 children), were females. The median age of disease outbreak was 7.16 ± 4.22 years. In 48.2% of the patients, the disease started at age 0 – 5 years. In 22.3% the disease started at age 6 – 10 years. Approximately ¼ of children diagnosed with coeliac live in the district of Tirana (25.7%), due to the high concentration of the population in this district. The main symptoms manifested by the patients are displayed in Table 7.From all cases we found only one asymptomatic patient. The most common complaints were weight loos/ short stature/ dystrophy, found in 26.8% of children; followed by chronic diarrhea in 13.4% of children. Abdominal pain was a complaint in 9.8%. We found anemia in 6.3 % of patients, vomiting in 5.4% and abdominal distension in 4.5%. 27.7 % of patients manifested a number of atypical, uncommon, symptoms of coeliac disease.51.8% or 58 children, about ¾ of them, had no associated diseases. Among all patients, 23.2% (26 children) had Type 1 Diabetes, 6.3% (7 children) had thyroiditis. Amongst patients with thyroiditis, 5 of them had also Type 1 Diabetes. In 26 children with coeliac disease we found other associated conditions such as epilepsy, autism. In 5.4% (6 children) a delay of expressive language was discovered. Some other uncommon conditions we encountered were gastropathy in 3.6% (4 children), various syndromes in 3.6%, ocular disorders in 1.8%, cardiac disorders in 1.8%, The duodenal biopsy was performed in 60% of the children. According to the histopathology reports in 13.2% of cases the intestinal mucosa resulted normal. 13.2 % resulted with stage M1 of coeliac disease. 20.8% resulted with stage M2, 28.3% resulted with stage M3a, 17% resulted with stage M3b and 7.4% with stage M3c.It is obvious that, in children affected by CD, the indicators of growth are delayed, according to the guidelines of World Health Organization (WHO). Children with CD are -0.8683 standard deviations under the optimal weight for age. They are – 1.3642 standard deviations under the optimal height for age and their BMI is – 0.3475 standard deviations under the optimal BMI for age. With regard to laboratory testing, we found low level of Hemoglobin in 39% of cases, low red cell count in 3.7%, low level of iron in blood in 64.9%, low level of MCV in 71.2%, increased level of AST in 55.1% and increased level of ALT in 14.7% of the children. Conclusion: For many a year coeliac disease was considered a disorder of the pediatric age, characterized by classic clinical manifestations such as steatorrhea and malabsorption. Though it is a frequent disease, CD is often undiagnosed and underestimated because of the variability of symptoms and heterogeneous clinical manifestations. From different studies, CD results under diagnosed in 1 – 3 % of general European population, both in adults and in children.Recognizing and understanding the various clinical presentations of CD allow us to establish an early diagnose, to start a gluten free diet as soon as possible, to achieve a normal growth and developent of the affectet children and to prevent the long term complications of the disease.
