Is there a relationship between occult celiac disease and functional dyspepsia?

This is a study to answer the question: Is there a relationship between occult celiac disease and functional dyspepsia? The study was carried out on 400 dyspeptic patients. Upper gastrointestinal tract (GIT) endoscopy was done for all patients and those with non-functional dyspepsia were excluded from the study. Duodenal biopsies with histopathological examination according to the Marsh-Oberhuber criteria were done. Serum tissue transglutaminase IgA antibody (anti-tTG-IgA) was done for patients with histopathological findings suggestive to have celiac disease (subtotal and total villous atrophy). 172 patients with endoscopic findings explaining their dyspeptic symptoms were excluded. Only patients with functional dyspepsia were enrolled in this study (228 patients). Bloating was the most common symptom (46.5%). Normal villous pattern was found in 199 cases (87.2%). Villous atrophy was found in 29 patients, subtotal atrophy in 20 cases (8.7%) and total atrophy in 9 cases (3.9%). Age group of 14-20 years (20/29, 90.9% patients) with villous atrophy was reported to have statistically significant difference (P value =0.000). Serum anti-tTG-IgA level was measured in all cases of abnormal villous pattern. Nine patients (3.9%) were proved to have a celiac disease (total villous atrophy and high serum anti-tTG-IgA) and fourteen dyspeptic patients (6.1%) had subtotal villous atrophy with high anti-tTG-IgA level could be diagnosed as occult celiac disease. Occult celiac disease should be suspected among patients with functional dyspepsia complaining of bloating, especially in age 14 to 20. Subtotal villous atrophy and high anti-tTG-IgA could be considered as occult celiac disease.