Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2022; 28(12): 1272-1283
Published online Mar 28, 2022. doi: 10.3748/wjg.v28.i12.1272
Epidemiological, clinical, and histological presentation of celiac disease in Northwest China
Man Wang, Wen-Jie Kong, Yan Feng, Jia-Jie Lu, Wen-Jia Hui, Wei-Dong Liu, Zi-Qiong Li, Tian Shi, Mei Cui, Zhen-Zhu Sun, Feng Gao
Man Wang, Wen-Jie Kong, Yan Feng, Jia-Jie Lu, Wen-Jia Hui, Wei-Dong Liu, Zi-Qiong Li, Tian Shi, Feng Gao, Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Mei Cui, Zhen-Zhu Sun, Department of Pathology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Author contributions: Wang M and Gao F designed the study; Wang M, Kong WJ, and Lu JJ acquired the data and drafted the article; Hui WJ and Liu WD analyzed and interpreted the data; Cui M and Sun ZZ made a pathological diagnosis; Feng Y, Li ZQ, Shi T and Gao F revised the article critically for important intellectual content; all the authors approved the version to be published.
Supported by National Natural Science Foundation of China, No. 81760101; and Natural Science Foundation of Xinjiang Uygur Autonomous Region, No. 2021D01C149.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of People’s Hospital of Xinjiang Uygur Autonomous Region.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Gao, PhD, Chairman, Chief Doctor, Director, Professor, Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang Uygur Autonomous Region, China. drxjgf@sina.com
Received: September 12, 2021
Peer-review started: September 12, 2021
First decision: October 16, 2021
Revised: November 16, 2021
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: March 28, 2022
Abstract
BACKGROUND

Research on celiac disease (CD) in northwest China is still in its infancy. At present, large-sample data on the epidemiological, clinical, and pathological characteristics of CD are limited.

AIM

To investigate the epidemiological, clinical, and pathological characteristics of CD in northwest China.

METHODS

The clinical data of 2884 patients with gastrointestinal (GI) symptoms were retrospectively analyzed. Total immunoglobulin A (IgA) and anti-tissue transglutaminase (tTG) IgA levels were examined in all patients. Gastroscopy and colonoscopy were performed in patients with positive anti-tTG IgA and deficient total IgA levels. Atrophy of the duodenal and ileal villi was examined and histopathological examinations were performed. The modified Marsh–Oberhuber classification system was used to grade villous atrophy in the duodenum or distal ileum. The patients’ Helicobacter pylori (H. pylori) infection status was compared in terms of clinical presentation and Marsh grade. Statistical analyses were performed using the t-test or chi-square test.

RESULTS

Among the 2884 patients, 73 were positive for serum anti-tTG IgA, and 50 were diagnosed with CD. The CD detection rate was significantly higher in Kazakhs (4.39%) than in Uyghurs (2.19%), Huis (0.71%), and Hans (0.55%). The main symptoms of CD were chronic diarrhea, anorexia, anemia, fatigue, weight loss, sleep disorders, osteopenia, and osteoporosis. The body mass index of patients with CD was significantly lower than that of patients without CD. A total of 69 patients with positive serum anti-tTG IgA and two patients with deficient total IgA levels underwent GI endoscopy. Endoscopy revealed crypt hyperplasia and/or duodenal villous atrophy, mainly manifested as nodular mucosal atrophy, grooves, and fissures. The difference in H. pylori infection rates was not statistically significant between CD and non-CD patients but was significantly different among CD patients with different Marsh grades.

CONCLUSION

Among the patients with GI symptoms in northwestern China, the prevalence of CD was more in the Uyghur and Kazakh populations. H. pylori infection may be associated with CD severity.

Keywords: Celiac disease, Epidemiology, Gastrointestinal symptoms, Pathology, Helicobacter pylori infection

Core Tip: Celiac disease (CD) is an autoimmune disease caused by the ingestion of gluten in genetically susceptible individuals. The global prevalence of CD is approximately 1.4%. An increase in celiac-specific autoantibody levels can lead to varying degrees of damage to the small intestinal mucosa and consequently to various gastrointestinal and systemic symptoms. This study reports the epidemiological, clinical, and pathological characteristics of CD and its association with Helicobacter pylori infection and aims to provide useful information for the clinical diagnosis and treatment of CD.