Supplementary Material for: Celiac disease as a cause of malabsorption: a clinic-pathological series of five cases

Celiac disease (CD) also called gluten sensitive enteropathy, is a non-infectious and an autoimmune cause of malabsorption. It can be difficult to diagnose because of wide range of gastrointestinal and extraintestinal symptoms. Here we present, five cases of celiac disease out of total 160 patients assessed for malabsorption at a tertiary care facility in western Maharashtra between 2022 and 2023. The male-to-female ratio was 1.5:1 and the age of patients ranged from 2 to 60. Chronic diarrhea was the most prevalent symptom, followed by weight loss and stomach pain. In each case, laboratory results showed elevated tissue transglutaminase IgA (tTG-IgA), along with varied levels of calcium and vitamin D deficiency. Two cases had normal endoscopic findings, one had whitish granular mucosa, while two cases had duodenal fold scalloping. Histopathological analysis verified the diagnosis, classifying the cases as Marsh types 3a, 3b, and 3c. There was no relationship between the severity of the histopathology and tTG-IgA levels. This case series of 5 cases takes into account the prevalence of celiac disease as a cause of malabsorption in western India. It also emphasizes the significance of taking CD into account in patients with malabsorption and the necessity of following a multidisciplinary approach encompassing nutritional assessment, clinical evaluation, histopathology, and serology for an accurate diagnosis and course of treatment.