Clinical spectrum of Celiac Disease in adults at a tertiary care hospital in Karachi, Pakistan

  • Verda Arshad
  • Maha Inam Aga Khan University Hospital
  • Safia Awan
  • Faisal Wasim Ismail
Keywords: celiac disease, diet, gluten free, autoimmune diseases


Objectives: Celiac Disease (CD) is a disorder that impacts physical, social and emotional health. Requiring life-long treatment, it poses a major economic burden on the healthcare system. Our objective was to study CD in patients from initial presentation to diagnosis and to ascertain the effect of a low resource setting on improvement in disease process.

Methods: This is a retrospective cross-sectional study conducted at a Aga Khan University Hospital (AKUH), a tertiary care center in Karachi, Pakistan. Medical records of patients (≥18 years) from 2008 to 2018 with a diagnosis of CD were reviewed. Data on demographics, presenting complaints, investigations, endoscopy results and follow up visits was collected.

Results: One hundred and twenty-six patients were included (61.6% females, mean age 35.5 years). The most common intestinal and extra-intestinal symptoms were abdominal pain (56.3%) and fatigue (24.6%) respectively. After microcytic anemia (36.5%), increased ALT (27.2%) was the most common laboratory derangement. On endoscopy, visible fissuring (29.4%) and atrophic mucosa (29.4%) were reported. Biopsy findings showed increased intraepithelial lymphocytes (92.9%) and villous atrophy (77.8%). Improvement in at least one of three parameters (symptoms, laboratory values or EGD) was reported by 42.0% of subjects, whereas 48.4% subjects were lost to follow-up.

Conclusion: The most commonly reported symptoms by CD patients were abdominal pain, diarrhea and anemia. Thus, patients presenting with vague abdominal symptoms and anemia should be worked up for CD. A concerning majority of subjects was lost to follow up for reasons such as inability to afford advised GFD and a poor understanding of the disease process.


How to cite this:
Arshad V, Inam M, Awan S, Ismail FW. Clinical spectrum of Celiac Disease in adults at a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci. 2022;38(3):445-449. doi:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Verda Arshad

MBBS, Research Fellow

Department of Medicine, Mayo Clinic

Maha Inam, Aga Khan University Hospital

MBBS, Medical Student

Medical College, Aga Khan University

Safia Awan

MSc Statistics, Senior Instructor

Department of Medicine, Aga Khan University

Faisal Wasim Ismail

FCPS Gastroenterology, Associate Professor

 Department of Medicine, Aga Khan University

How to Cite
Arshad, V., Inam, M., Awan, S., & Ismail, F. W. (2022). Clinical spectrum of Celiac Disease in adults at a tertiary care hospital in Karachi, Pakistan. Pakistan Journal of Medical Sciences, 38(3).