Apart gender based differences, in the initial years it was observed that difference of prevalence of celiac disease do exist on the basis of age group. In the early years it was supposed that the disease is found to be more in children in contrast to adults in india but as a matter of fact the disease can develop at any time from infancy to old age
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The nonclassic clinical presentation of celiac disease (CD) becomes increasingly common in physician's daily practice, which requires an awareness of its many clinical faces with atypical, silent, and latent forms. Besides the common genetic background (HLA DQ2/DQ8) of the disease, other non-HLA genes are now notably reported with a probable association to atypical forms. The availability of high-sensitive and specific serologic tests such as antitissue transglutuminase, antiendomysium, and more recent antideamidated, gliadin peptide antibodies permits to efficiently uncover a large portion of the submerged CD iceberg, including individuals having conditions associated with a high risk of developing CD (type 1 diabetes, autoimmune diseases, Down syndrome, family history of CD, etc.), biologic abnormalities (iron deficiency anemia, abnormal transaminase levels, etc.), and extraintestinal symptoms (short stature, neuropsychiatric disorders, alopecia, dental enamel hypoplasia, recurrent aphtous stomatitis, etc.). Despite the therapeutic alternatives currently in developing, the strict adherence to a GFD remains the only effective and safe therapy for CD.
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1. Introduction
Celiac disease (CD) is an intestinal chronic inflammatory and autoimmune disease that develops as a result of interplay between genetic, immunologic, and environmental factors [1]. Until recently, CD was considered to be a rare condition, with the highest incidence (1% to 0.3%) in European countries [2, 3]. The true incidence evaluated by a North American study is about 0.5% to 1%, but many, if not most, of studied patients were asymptomatic members of high-risk groups [3, 4]. Recent epidemiological studies performed in North Africa and Asian areas also showed a high rate of CD: 0.53% in Egypt [5], 0.79% in Libya [6], 0.6% in Tunisia [7], 0.88% in Iran [8], 0.6% in Turkey [9], and 0.7% in India [10]. The classic form of CD typically presents in infancy and manifests as failure to thrive, diarrhea, abdominal distention, developmental delay, and, occasionally, severe malnutrition [11, 12], which can lead to a true medical emergency [11]. Furthermore, serologic studies demonstrate that most celiac patients present with oligosymptomatic, latent, potential, and extraintestinal forms. These nonclassic clinical presentations become increasingly common and might reach about 50% of all diagnosed patients. The undiagnosed CD cases remain untreated, leaving individuals exposed to the risk of long-term complications, such as infertility, osteoporosis, or cancer [13–16].
Our aim is to emphasize the atypical clinical expression of celiac disease and suggest a diagnosis and managing approach.