Coeliac Disease in Children with Hepatic Dysfunction: Clinical, Serological, and Histopathological Correlates in a Tertiary Care Hospital of Bangladesh

Abstract

Coeliac disease (CD) is an immune-mediated enteropathy increasingly recognized with extraintestinal manifestations, including hepatic dysfunction. This study aimed to determine the frequency of CD among children with hepatic dysfunction and to evaluate their demographic, clinical, biochemical, serological, endoscopic, and histopathological characteristics. This cross-sectional study was conducted among children aged 1–18 years presenting with persistent hepatic dysfunction after exclusion of established liver diseases. Of 67 eligible children, 62 were finally included. All underwent serum IgA anti-tissue transglutaminase (anti-tTG) testing, and seropositive children subsequently underwent upper gastrointestinal endoscopy with duodenal biopsy. Histopathological grading was performed according to the Marsh classification. Statistical analyses included chi-square test, Fisher’s exact test, independent-samples t-test, odds ratio (OR), 95% confidence interval (CI), and p-values. Among the 62 children, 22 (35.5%) were anti-tTG positive, while biopsy findings compatible with CD were identified in 19 seropositive children, representing 30.6% of the total study population. The mean age of seropositive children was 10.30 ± 4.10 years; 68.2% were male, 81.8% were urban residents, and 63.6% belonged to middle-income families. Chronic diarrhea was present in all children, whereas abdominal distension was significantly more common among seropositive cases (p=0.002). Failure to thrive, anorexia, pallor, and muscle wasting were more frequent among seropositive children. Mean haemoglobin level was significantly lower in seropositive children (p<0.001), confirming anaemia as a major extraintestinal manifestation. Raised serum glutamic-pyruvic transaminase (SGPT) was observed in 72.7% of seropositive children, with significantly higher mean SGPT levels compared with seronegative children (p=0.024), supporting the association between CD and hepatic dysfunction. Endoscopic abnormalities included scalloping of mucosal folds (36.4%), loss of duodenal folds (13.6%), and mosaic mucosal appearance (4.5%), although 45.5% had normal endoscopic appearances. Histopathology revealed Marsh 3a lesions in 63.2%, Marsh 3b in 21.1%, and Marsh 3c in 15.8% of biopsy-compatible cases. Increasing Marsh severity was associated with lower haemoglobin and albumin levels and higher bilirubin, SGPT, and INR values. More than one-third of children with hepatic dysfunction were anti-tTG positive, and most seropositive children had biopsy-compatible CD. Routine serological screening may help identify a treatable cause of paediatric hepatic dysfunction.

Bangladesh Med J. 2025 Sept; 54(3): 32-39