Seroprevalence of celiac disease among children in Baghdad, Iraq

represents A The present study determines the celiac disease among suspected children. year - 9 year) and with the symptoms more found with weight loss, chronic diarrhea, vomiting.


INTRODUCTION
Celiac disease (CD) represents A unique disorders in which consumption of a food ingredient namely gluten-containing grains (wheat, rye, barley) in combination with genetic susceptibility is fundamental for the development of an guilefully evolving autoimmune reaction in luence the gut and other organs (Szajewska et al., 2016). Over recent decades the prevalence of the disease in developed countries other than gluten increased the points to the role of one or more likely environmental triggers (Lionetti et al., 2014). General population in most parts of the world affects approximately 1-3 % by CD which is a permanent state (Mustalahti et al., 2010;Myléus et al., 2009) Over time, due to global changes in the diet, an increasing descend of CD has been observed in areas that were previously considered CD-free (Catassi et al., 2014). CD is now recognized as a systemic disease may affect persons of any races and any age and ethnic groups (Fasano and Catassi, 2012). The Pathogenesis of celiac disease lastly leading to celiac enteropathy due to gluten, enzymatically changes in intestinal, permeability, innate and adaptive immune responses to gluten peptides including self-antigens (transglutaminase), gluten HLA recognition (Jabri and Sollid, 2009;Schuppan et al., 2009). Hyper plastic cryptae may lead to complete villous atrophy and reduced intestinal villous height, which is the result of duodenal mucosa with Tiggers an in lammatory state (Tonutti and Bizzaro, 2014). For the time being gluten-sensitive enteropathy represents an elevated number of intraepithelial lymphocytes with crypt hyperplasia to complete villous atrophy (Tosco et al., 2011). And the disease is the most predominant in chronic in lammatory conditions for digestive system and is treatable with the exclusion of dietary gluten (Rubio-Tapia et al., 2009). Clinical presentation depends on age, amount of gluten ingested in the diet and sensitive to gluten as well as unknown factors (Dewar and Ciclitira, 2005). The classical de inition of CD included gastrointestinal manifestations (failure to grow, chronic diarrhea, vomiting, abdominal pain, bloating, weight loss, distention and constipation (Rewers, 2005). Typical classic symptoms of diarrhea and failure to thrive present less frequently in patients, often extraintestinal presentations are identi ied in both children and adults commonly (Reilly et al., 2011). In children not have previously received a clinical diagnosis diseases can be identi ied by serology testing and used two serology test endomysium tissue transglutaminase autoantibody tests (Mäki et al., 2003). The only treatment for disease was accepted is adherence to Gluten-Free Diet (GFD) strict which is the normalizes serology and heals small intestinal mucosa (Kurppa et al., 2010). Treatment with GFD involves (a diet with no wheat, rye or barley proteins), the speci ically manufactured for the patient with CD is a wide range of GFD wheat replace. Gluten threshold, which is the lowest amount give of gluten that causes damage to the celiac intestinal mucosa overtime between (10-50) mg per day (Catassi et al., 2007).

MATERIALS AND METHODS
From the special laboratory for Pathogenesis Analyses in Baghdad 100 children s blood samples was collected during the period from 1st march 2018 to 31 th of July 2018. Sheet of questionnaire was used to collect data with regard to [ages from (1days -15 years), sex, symptoms (chronic diarrhea, vomiting, abdominal cramps, weight loss, and anemia)].
After sterilized of skin by using 70 % alcohol venous blood samples 5 ml was collected from each child by professional clinical laboratory tech-nique and added in the normal tube to separate the serum and centrifugation at 3000 rpm for 5 minutes. All the serum samples were kept in laboratory until analysis frozen at -20 º C. Each sample was analyzed by two serological test which were Anti-tissue transglutaminase (tGT) antibodies and Anti-gliadin antibodies for the presence of serum Immunoglobulin A transglutaminase antibodies (IgA tGT), Immunoglobulin G transglutaminase antibodies (IgG tGT), Immunoglobulin A antigliadin antibodies (IgA AGA), Immunoglobulin G anti-gliadin antibodies (IgG AGA) were measured by Enzyme-linked Immunosorbent Assay (ELISA) with the use Diesse Diagnostic manufacturers of commercial kit.

Statistical analysis
Used in order that analyze and assess the results they including:-1. Descriptive statistics: statistical tables contain observed frequencies with their percentages.
2. Inferential statistics: The accept or reject show by used statistical hypotheses, 0.05 level of signi icance represent the Persons Chi-Square test (χ2).
In AGA test the sensitivity and speci icity of IgA was marginally more that IgG but IgG testing is particularly useful in the 1 % to 2 % of patient with CD who have IgA de iciency (Hadzise et al., 2014). Other researchers reported that AGA was more commonly used (Giersiepen et al., 2012).
Commonly Anti-gliadin antibodies test was considered more sensitive and less speci ic than anti-tTG antibodies (Rostom et al., 2006). The distribution of celiac disease according to the sex in Table 2 show the result of males was 18 (32.1 %) more than female 12 (27.3 %) this agreement with (Dehghani and Asadi-Pooya, 2008). The p-value 0.598 in 2sided represent non-signi icant result.

CONCLUSIONS
In this study, obtained positive serological test Trasglutaminase for (IgA, IgG tGT) Antibodies in male between age group (6 year -9 year) and with the symptoms more found with weight loss, chronic diarrhea, vomiting.

ACKNOWLEDGEMENT
The authors extend his appreciation to the staff of Doctor Luay Ibraheem Laboratory for pathogenesis analyses.