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Al-Qahtani et al. | Journal of Clinical and Translational Research 2023; 9(4): 282-289 283
with gastrointestinal and/or extraintestinal symptoms; typical Villanaci and Ceppa [13]; Corazza and Villanaci [14]; and/or
celiac disease is characterized by varying degrees of severity Marsh–Oberhuber criteria [15]. These criteria were suggested to
of gastrointestinal symptoms, while atypical presentation of the simplify histopathological reporting and consequently to facilitate
disease is more frequent, and is characterized by an absence of communication between pathologists and clinicians. Celiac
gastrointestinal symptoms [3,4]. disease lesions were divided into two categories according to the
Gastrointestinal findings in typical celiac disease include Corazza and Villanaci criteria, as follows: (1) Grade A non-atrophic
persistent diarrhea, abdominal pain, distension, vomiting, and lesions, characterized by an increased number of intraepithelial
weight loss. The extraintestinal findings are variable and might lymphocytes with intact villi and (2) Grade B trophic lesions
be non-specific, including chronic fatigue, skin inflammatory with further subcategorization into B1, in which villi were still
disorders, joint pain, anemia, migraines, psychiatric disorders, identifiable, and B2, in which villi were totally atrophic [14].
epilepsy, osteoporosis, infertility, frequent fetal loss, short stature, Grade A lesions correspond to Type 1 and Type 2 lesions based
failure to thrive, dental abnormalities, multiple vitamin deficiencies, on the Marsh–Oberhuber classification and are usually identified
and autoimmune disorders [5]. In addition, a latent form of celiac by immunohistochemical staining for cluster of differentiation
disease is characterized by the presence of predisposing genetic (CD) 3, which is specific for T lymphocytes [2]. Grade B1 lesions
factors such as the presence of human leukocyte antigen (HLA)- correspond to Class 3A and 3B lesions according to the Marsh–
DQ2 and/or HLA-DQ8, normal intestinal mucosa, and the usual Oberhuber classification, while Grade B2 lesions of Corazza and
positive profile of celiac serology [6]. Villanaci correspond to Marsh–Oberhuber class 3C [2].
Early diagnosis and treatment of celiac disease are essential Crombie’s items, the appraisal tool for cross-sectional studies,
mainly in the pediatric age group. This is because certain and the Agency for Health-care Research and Quality methodology
complications of celiac disease may be irreversible, such as growth checklist for cross-sectional/prevalence studies (Table S1), were
retardation, abnormal teething, and osteoporosis. Several studies used to assess selection bias [16].
in the literature suggest prolonged breastfeeding and a delayed Data were analyzed using Prism GraphPad 6 for Windows,
gradual introduction of gluten in the 1 year of life to reduce the version 6.07 (CA, USA). Categorical variables were analyzed
st
risk of celiac disease development [7]. The diagnosis of celiac using descriptive statistics, including frequency and percentages.
disease is based on the presence of a predisposing genetic factor, A Chi-square test was used to assess the association between
positive histopathological biopsy, and the presence of serological gender, age, and clinical presentation. P < 0.05 was considered as
antibodies that are released on gluten ingestion [2]. The most significant results.
available and effective treatment for celiac disease patients is a
lifelong gluten-free diet [8]. This generally leads to improvements 3. Results
in patients within weeks, and normal mucosal histology is regained This study included 150 celiac disease patients who were
after several years [9]. However, Vitamin B deficiency may affect diagnosed from June 2015 to May 2020, and no cases have been
patients because of long gluten-free diets, and patients are advised excluded from the study. As shown in Figure 1 regarding case
to take gluten-free multivitamins [10]. In this context, despite distribution during this period, most cases were diagnosed in 2019
a lack of reports which link the consumption of milk and dairy – 2020 (61, 40.7%). In 2018, there were 51 cases (34%), while
products to the progression of celiac disease [11], celiac disease there were 18 cases (12%) in 2016 – 2017. The least number of
patients are advised to avoid such staples because of abnormal diagnosed cases was in 2015 – 2016 (8 cases, 5.3%), followed by
intestinal absorption [12]. 2017 – 2018 (12 cases, 8%).
The current report aims to investigate histopathological findings As detailed in Table 1, this study included 46 males (30.7%)
retrospectively in celiac disease patients enrolled for duodenal and 104 females (69.3%), and most of the patients were between
biopsy in Najran, since this is considered one of the diagnostic 31 and 40 years old (33.3%, 17 males, 33 females). Patients
criteria, along with serology and genetic testing. aged between 20 and 30 years comprised 32% (14 males and

2. Materials and Methods 34 females) of the diagnosed cases, and those aged between
41 and 50 years accounted for 17.3% (9 males and 17 females) of
A retrospective study was conducted after receiving approval cases. There were only 15 patients (10%) under 20 years old (three
from the Local Ethical Committee at the College of Medicine, males and 12 females) and 11 patients over 50 years old (6% aged
Najran University. As mentioned previously, this study aims to 51 – 60 years, and 1.3% aged more than 60 years). There was
investigate histopathological findings in celiac disease patients no significant association between gender and the different age
enrolled for duodenal biopsy. The study included all patients who groups (P = 0.82).
attended the Departments of Pathology/Histopathology at the Regarding the clinical presentation of the patients, the majority
King Khalid Hospital, Najran General Hospital, Maternity and (62%, 28 males, 65 females) presented with gastrointestinal
Child Hospital, and Najran University Hospital from June 2015 to symptoms, including abdominal pain, diarrhea, and abdominal
May 2020, and data were retrieved from the records of confirmed distention. In addition, 20% (10 males and 20 females) of patients
cases. The inclusion criteria comprised all cases that were reported presented with anemia, 12.7% (six males and 13 females) were
by histopathology, and graded and/or classified according to the asymptomatic, and 5.3% presented with a history of failure to
DOI: http://dx.doi.org/10.18053/jctres.09.202304.22-00189