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Al-Qahtani et al. | Journal of Clinical and Translational Research 2023; 9(4): 282-289 285
were diagnosed with celiac disease from June 2015 to May 2020. Celiac disease patients present with various signs and
The histopathological grading and classification have clinical symptoms, such as abdominal distention, diarrhea, abdominal
importance for clinical follow-up and indicate whether such pain, weight loss, anemia, and bone disease. Despite the increased
grades reduce in severity, are maintained, or deteriorate [19]. In global prevalence of celiac disease, a significant number of celiac
this report, according to the criteria of Villanaci and Ceppa [13]; disease patients are still undiagnosed [30]. A variety of reasons
Corazza and Villanaci [14]; and Marsh–Oberhuber [15], Grade A for this have been discussed in the literature, including the patchy
lesions were found in 56 patients (37.3%) as the second most appearance of mucosal pathology in celiac disease, insufficient
common histopathological pattern after Grade B1 lesions, which or non-representative biopsy for histopathological assessment,
were found in 71 patients (47.3%; Table 2). Moreover, only variability in histopathology reporting, and the presence of
15.3% of the cases were classified as Grade B2 and Class 3C. asymptomatic patients [31-34]. The last observation is consistent
This indicates that most of the diagnosed celiac disease cases in with the results of this study (Table 1), where the asymptomatic
Najran range between Grades A and B1, with less involvement patient group consisted of 19 cases (12.7%). Although typical
of severe Grade B2 and Class 3C. However, despite the absence celiac disease presenting with gastrointestinal symptoms was less
of any observed associations between gender and age or clinical common than that presenting with extra-intestinal symptoms [2-4],
presentation, contrary to what has been published before [20], the former group comprised 93 cases (62%) in this report, and the
there were significant associations between gender and the most affected age group was 31 – 40 years (33.3%), followed by
histopathological findings, grading, and classification of celiac 21 – 30 years (32%). In this report, the atypical extraintestinal
disease lesions. Male patients were diagnosed to have mainly celiac disease presentation group [35] included 30 cases of anemia
Grades B1 (18 males, 39.1%) and B2 (13 males, 28.3%), (20%) and 8 cases of failure to thrive (5.3%).
while female patients were reported to have mostly Grades A Finally, the pathogenesis of celiac disease has been linked
(41 females, 39.4%) and B1 (53 females, 51%) lesions. to various microbial species, including Helicobacter pylori. In
The prevalence of celiac disease in Western countries this study, only 2% of the patients had any history of H. pylori
ranges from 1% to 2%. In Saudi Arabia, while there is no clear infection (data not shown). This was contrary to several studies
data regarding the prevalence of celiac disease, studies from that found a high prevalence of H. pylori infection in celiac
different cities and regions have estimated a prevalence range of disease patients [36]. However, some studies have reported no
1%–3% [21-23]. A meta-analysis conducted in 2018 concluded relationship or correlation between the presence of H. pylori and
that the prevalence of histopathology-proven celiac disease cases pathogenesis of celiac disease [37,38], which may support the
is about 1.4%, and that seroprevalence is around 2.7% [24]. One observation of this report in this regard.
of the largest studies in Saudi Arabia was performed in 2013, In conclusion, females are affected by celiac disease more than
and included 1167 healthy adolescents for screening in three males and most of the patients are aged between 31 and 40 years.
different regions [25]; this investigation revealed a celiac disease Regarding the clinical presentation of the patients, the majority
seroprevalence rate of 2.2%. A notable mass screening study to (62%) presented with typical celiac disease with gastrointestinal
determine the prevalence of celiac disease in Riyadh reported symptoms, including abdominal pain, diarrhea, and abdominal
a high prevalence of the disease (1.5%) among Saudi children, distention. Most of the diagnosed cases of celiac disease in Najran
which is at least double that in Europe and North America [26]. range between Grades A and B1, with less involvement of the
In this report, the prevalence was not studied in detail and was severe degree Grade B2 and Class 3C, according to Corazza
not one of the objectives. However, during the collection of and Villanaci criteria and the Marsh–Oberhuber classification,
gastrointestinal cases assessed by histopathology in our 5-year respectively. Despite the absence of any association between
study period, the number of celiac disease cases was noted to be gender and age or clinical presentations, there was a significant
150 out of 9406 (1.6%), which is consistent with previous reports association between gender and the histopathological findings,
in other regions of the country. grading, and classification of celiac disease lesions. Finally, the
Regarding celiac disease case distribution through the study presence of asymptomatic patients (12.7%) may indicate the
period (Figure 1), the highest frequency was in 2019, with importance of celiac disease screening.
61 cases diagnosed with celiac disease (40.7%). The second
highest frequency was in 2018, with 51 cases (34%), followed Acknowledgments
by 2016 (18 cases, 12%) and 2017 (12 cases, 8%), and the The authors gratefully acknowledge their colleagues from
lowest in 2015 (8 cases, 5.3%). Regarding gender differences, the different hospitals who facilitated their work during data
males and females are comparable in terms of prevalence and collection.
presentation [27]. However, the number of affected females has
been reported to be higher than that of affected males [28,29], Funding
consistent with the observations of this study (Table 1). Females
comprised more than two-thirds of the cases (104 cases, 69.3%). None.
Conversely, gender is not of clinical significance in follow-up, and Conflicts of Interest
males and females have comparable disease courses after adhering
to a gluten-free diet [20]. The authors declare that there are no conflicts of interest.
DOI: http://dx.doi.org/10.18053/jctres.09.202304.22-00189