Celiac disease in India.

Celiac disease is well documented especially from northern parts of India. It should be suspected in a child having chronic diarrhoea with growth failure. There are unusual manifestations like refractory anemia, rickets, recurrent abdominal pain and short stature without other gastrointestinal manifestations. Definitive diagnosis still requires undertaking multiple intestinal biopsies, before and after wheat withdrawal from the diet. Additional difficulty in diagnosing celiac in tropical countries like India includes confounding factors of malnutrition and parasitic infestations like giardia. Serological tests like antigliadin antibodies (IgG and IgA), anti-reticulin antibodies and endomysial antibodies have shown some promise in screening and definitive evaluation of the disease. Gluten free diet gives dramatic results.