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Coeliac disease in C hinese children

2015; Wiley; Volume: 51; Issue: 5 Linguagem: Inglês

10.1111/jpc.12894

1440-1754

Li‐Zsa Tan, Samson C Kwok, Chee Y. Ooi,

Eosinophilic Esophagitis

We report a 12-year-old girl of Han Chinese background with non-classic coeliac disease (CD). She presented to her paediatrician with short stature. While her weight had increased from the 25th to the 50th percentile in the last 5 months, her height had plateaued at the 100 U/mL). Other serological investigations including thyroid function tests, insulin-like growth factor 1 and fasting blood glucose were within normal limits. A gastroduodenoscopy was performed, and endoscopic and histopathologic changes consistent with CD were observed in the duodenum. Historically, CD is not considered a condition that affects individuals of Chinese descent, largely because of a lack of data on the existence of CD in Chinese populations. The first report of CD in Chinese children was only recently published.1 In this study, Wang et al. diagnosed CD in 11.9% of 118 Chinese children with chronic diarrhoea on gluten-containing diets, suggesting that CD is more common than previously estimated in this population. Since then, human leukocyte antigen (HLA) haplotyping studies have estimated a frequency of 3.4% and 2.1% for HLA-DQ2.5 and HLA-DQ8 haplotypes respectively in mainland China, and a frequency of 3.5% and 3.8% respectively in southern Han Chinese.2 In addition to genetic predisposition, the other factor crucial in the development of CD is gluten consumption. Chinese populations traditionally observe rice as the major dietary staple. Wheat consumption, however, is actually common in the northern regions of China, where historically it was introduced as a crop in 1600 BC.3 In the more urban southern Chinese populations, gluten consumption is on the rise as Western style diets gain prominence. In 2014, the World Gastroenterology Organization and Asian Pacific Association of Gastroenterology issued a consensus calling for greater awareness of CD in the Asia Pacific region,4 predicting an increased incidence as Western diets become incorporated into traditionally non-gluten-consuming cultures. Notably, our patient had observed a ‘Westernised’ diet since weaning. This case serves as a reminder that CD is a worthwhile differential in this demographic. She is further evidence that the traditional blonde and blue eyed image of a child with CD is increasingly irrelevant in today's multicultural society.