Background: 25% of children with Celiac disease (CD) have coagulopathy at the time of presentation. Diagnosis of CD involves endoscopy and multiple duodenal biopsies. Risk of bleeding with endoscopy and biopsy is more if there is underlying coagulopathy.
Objective: to study the correlation of coagulopathy with grade of histology in CD and to assess the response of a single dose of vitamin K on coagulopathy in children undergoing upper GI endoscopy and duodenal biopsy for CD.
Study design: Non-randomized interventional study.
Settings: Department of Pediatrics, Fortis Escorts Hospital, Jaipur
Method: Children (<18 years) suspected to have CD referred for duodenal biopsies were prospectively recruited in study. During the first 6 months (Group A) Prothrombin time (PT) was tested prior to endoscopy. During the next 6 months (Group B)children were given one dose of Vitamin K (5 mg IM in <10 years and 10 mg IM in > 10 years) 24 hour prior to endoscopy and PT was tested prior to endoscopy as in group A. A cut off of INR of > 1.4 was labeled as abnormal (coagulopathy). Subsequently PT/INR was compared in both the groups and correlated with severity of histology.
Results: Of 133 recruited children, 100 had confirmed CD by histologyand were analyzed subsequently. Both groups (A and B) had 50 subjects in each. The male female ratio in CD was 1.6:1 and the mean age was 5 years and 4 months. Group A and B were identical in terms of degree of demography and histological abnormality. Coagulopathy was seen in 32% of children in group A and 14% of children in group B and the difference was statistically significant. More than 50% of subjects with coagulopathy had advanced (Marsh grade IIIc) histology in both the groups which was significantly higher than those who had no coagulopathy. None had any significant bleeding during the endoscopic procedure in the study population.
Conclusion: CD with coagulopathy at presentation predicts advanced histological Marsh grade on duodenal biopsy. Coagulopathy can be significantly improved by single dose of parenteral vitamin K administration a day prior to endoscopy.
10-year-old girl was brought with complaints of intermittent abdominal pain and fullness in upper abdomen for 1 year along with features of malnutrition such as wasting and poor growth velocity. On investigation, celiac serology was positive along with mild fullness in upper abdomen. Endoscopy showed trichobezoar in stomach, extended to duodenum which was managed surgically along with celiac diet and psychotherapy. During postoperative period she improved with psychotherapy and celiac diet.