Celiac disease causes in Morocco many problems of epidemiological, diagnostic and therapeutic order. Actually, the epidemiological aspects of this disease still remain unclear. The non invasive diagnostic means are not always available, and the most difficult remains the treatment of the gluten-free diet.
Patients and methods: We are reporting a retrospective study describing a series of 90 cases collected at the department of hepatology and gastroenterology of CHU HASSAN II of Fez between January, 2001 and July, 2010. We have analysed the epidemiological aspects, the clinical symptoms of our patients thanks to an operating sheet drown up beforehand. The data analysis has been performed with the software Epi-Info.
Results: The average age of our patients was 33 (15-73 years old). The sex ratio Men/Women was 3. The main clinical symptom was the chronic diarrheas (74% of cases). The other clinic symptoms were less frequent: stomach-aches (44%), deficiency-related syndrome (35.5%), altered general state (44%) and a delayed stature and weight in 7 patients. The biology has found a hypochromic microcytic anemia in 53% of the cases. Serology has been performed in 45 patients (50% of cases) with really variable positivity: the anti-endomysial IgA antibodies were positive in 54% of the cases, and the anti-transglutaminases were positive in (30%) of the cases.
The patients profited from œsogastroduodenal endoscopy which were normal in 61% of the cases, it showed an increasing scarcity of duodenal folds in 17% of the cases, and an antral gastrisis corpus in 5% of the cases. The villous atrophy on duodenal biopsies was found in all the cases: 17% grade V, 23% grade IV and 30% grade III of Marsh classification. An intraepithelial lymphocytosis was found in 53% of the cases. All the patients were put under gluten-free diet. The average fall was of 59 months (3 months and 8 years old). 40% of the cases were regularly reviewed through checking, amongst 90% had a good improvement in gluten-free diet. While 10% of the cases showed a symptomatology aggravation due to a bad therapeutic observance.
Conclusion: Our series reveals the young age of our patients and the prevalence of women. Many problems underlined in our country are principally due to an ignorance of the exact epidemiology of the disease and a difficult follow-up the gluten-free diet for essentially economical reasons. The improvement of our knowledge on celiac disease will necessarily require prospective epidemiologic studies and the creation and the generalization of associations of people carrying that disease.