Coeliac disease (CD) is an autoimmune enteropathy which occurs in genetically predisposed individuals on exposure to gluten. The recommended diagnostic approach includes serological screening by Anti-tissue Transglutaminase antibody (anti-tTG) followed by a small intestinal biopsy. As high anti-tTG antibody is expected to be significantly associated with MARSH III histopathological changes in the small intestine, it has now become the basis for a biopsy-free approach to diagnose CD. However, we report cases of giardiasis mimicking CD both clinically and serologically; differentiation demands small intestinal biopsy.
SorellLGarroteJAGalvanJA,et al.Celiac disease diagnosis in patients with giardiasis: high value of antitransglutaminase antibodies. Am J Gastroenterol2004; 99: 1330–1332.
2.
SaurabhKNagVLKheraD,et al.Giardiasis mimicking celiac disease in a patient of common variable immunodeficiency. Trop Parasitol2017; 7: 125–127.
3.
HusbySKoletzkoSKorponay-SzabóI, et al.European Society of paediatric gastroenterology, hepatology and nutrition guidelines for diagnosing coeliac disease 2020. J Pediatr Gastroenterol Nutr2020; 70: 141–156.
4.
SinghPAroraAStrandTA, et al.Global prevalence of celiac disease: systematic review and meta-analysis. Clin. Gastroenterol. Hepatol2018; 16: 823–836.
5.
MakhariaGKVermaAKAmarchandR, et al.Prevalence of celiac disease in the northern part of India: a community based study. J Gastroenterol Hepatol2011; 26: 894–900.
6.
LaishramSKangGAjjampurSS. Giardiasis: a review on assemblage distribution and epidemiology in India. Indian J Gastroenterol2012; 31: 3–12.
7.
PruccaCGRiveroFDLujánHD. Regulation of antigenic variation in giardia lamblia. Annu rev Microbiol2011; 65: 611–630.
8.
DonaldsonMRBookLSLeifermanKM,et al.Strongly positive tissue transglutaminase antibodies are associated with marsh 3 histopathology in adult and pediatric celiac disease. J Clin Gastroenterol2008; 42: 256–260.
9.
GidrewiczDTrevenenCLLyonM,et al.Normalization time of celiac serology in children on a gluten-free diet. J Pediatr Gastroenterol Nutr2017 Mar 1; 64: 362–367.
