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Eosinophilic esophagitis and ECP: Which correlation?
Abstracts / Digestive and Liver Disease 45 (2013) e263–e311
H < 2%iles vs target values for age) was attested in the same number of CD pts in Group 1 and 2 (33%). Pancreatitis as extraintestinal manifestation at dg was observed in 6 Group 2 pts vs 1 Group 1 patient. The use of steroids for CD was lower in Group 2 (p < 0.5). Among 27 pts treated with Infliximab, 8 (6 Group 1, 2 Group 2) were unresponsive and were shifted to Adalimumab. Discussion and conclusion: In our cohort, CD pts with recent dg presented more often an ileal localisation as well as fistulising phenotype and perianal disease. However, no significant difference in growth delay was attested between Group 1 and 2 CD pts. Group 2 UC pts mostly presented with pancolitis. The increasing number of IBD-U among recent diagnoses may express the evolving and changing molecular and phenotypical patterns within pediatric IBD.
PO18 A STRANGE PANCREATITIS M. Iafusco 1 , P. D’Avino 1 , L. Savanelli 1 , F. Pellegrini 2 , L. Martemucci 1 1 Pediatrics Department, AORN Santobono-Pausilipon, Neaples, Italy 2 Pediatrics Department, Federico II University, Neaples, Italy
P.M. female 2 years 2 mm and transferred from a suburban hospital for vomiting incoercibile and slight increase of pancreatic enzymes. Born at 37 weeks of pregnancy, TC placental aging emergency. Birth weight kg 1.800, hypoglycaemia and jaundice, neonatal, mixed feeding for 10 months then formula, introduction of gluten in 6 months. To 12 months starting post-meal regurgitation treated by treating with Ranitidine and hydrolysed milk with weight that you always kept below 5◦ PC. Gastric symptoms vomiting and abdominal pain persisted until hospitalization in our Department with a weight less than 5◦ PC always. Discrete conditions except for a modest, colorful rosy-dystrophy pale, abdomen negotiable but very sore in the epigastrium. Surveys showed a slight increase of amylase total (112 u/l), pancreatic amylase (35 u/l) and lipase (706 /l) while the remaining routine blood tests, TTG, AGA, HLA for celiac disease, cystic fibrosis genetic and hereditary pancreatitis, TORCH, stool on 3 samples pest and sweat tests were negative. Eco-abdomen was normal. Personal and family history of absolutely negative, no case of pancreatitis in a child or family, no recent abdominal trauma, no recent intake of drugs, no recent infection or diabetes or metabolic disorders or systemic pathology (Kawasaki). Gave just the idea of being an idiopathic pancreatitis, let us remember that account for 25% of pancreatitis. Beginning therapy with: Partial parenteral nutrition, light diet ipolipidica, Meropenem 20 mg/kg dose × 3, Omeprazole 0.7 mg/kg day. After a few days of therapy of pancreatic enzymes values came in (112 total amylase) but with persistent vomiting and lack of appetite. Eco-abdomen always the norm. At day 5 of the small hospital with vomiting expelled a foreign body of cylindrical shape about 5 cm long and 1 cm in diameter blackish-white that the histologist called fibrous materials of vegetable origin. The EGDS, practiced at a later date because it was formerly contraindicated for pancreatitis, it showed a stomach normo-conformed and expandable with standard normoemica mucosa and presence in the antral region, adjacent to the pylorus, broad-based image with bloody not depressed area. Gastric biopsy showed elements of inflammation clinical conditions of the small improved drastically with the complete disappearance of vomiting and increased appetite. Follow-up and found the complete disappearance of vomiting, still feeds fine without problems and presents a significant increase. In conclusion
e287
remain doubts about how a child so small could swallow a foreign object of such size and timing of events based on the early onset of symptoms (reflux, iplv???). Mild pancreatitis was of course due to mechanical obstruction exercised by foreign body on the pancreatic duct.
PO19 PERSISTENT FEVER AS AN ONSET CROHN’S: DESCRIPTION OF A CASE REPORT P. D’Avino 1 , M. Iafusco 1 , A. Palazzi 1 , B. Quarto 1 , F. Pellegrini 2 , L. Martemucci 1 1 Pediatrics Department, AORN Santobono-Pausilipon, Neaples, Italy 2 Pediatrics Department, Federico II University, Neaples, Italy
Child born at term with p.n. wellness up to 2.900 kg two months prior. At the entrance to decent conditions, mild pallor 18.600 kg weight with 3 kg drop, hyperemia of nasal cavities nothing major organs and apparatuses. Laboratory tests and instrumental to the entrance showed: Piastrinosi (727,000), VES, 120 HB 9.8, mild proteinuria VCA IgM IgG EBNA Neg 564 peripheral Smear: anisocytosis with activated lymphocytes rare Started antibiotic therapy Eco Abdomen: attendance of some lymph nodes more obvious in umbilical region with intestinal wall thickening in mesoipogastrio. Were negative or normal IG, Torch, blood culture, Parvovirus B19, HIV throat swab, Widal Wright, ANA, Tumor Antigen stool test, TSG, LDH, PCT, TAS, ADNASI Rx Thorax, Echocardiogram the appearance of canker sores and blisters on the oral cavity associated with the results of some tests (very high IgG EBNA, lymphocyte activation) induced us to begin therapy with Acyclovir. PCR and ESR remained high, the clinical conditions were good, the weight was increased by about 300 g but low-grade fever persisted. Suddenly rettorragia started with anemia that rapidly needed transfusion. Other previously performed tests showed fecal calprotectin 420 g/g at ASCA. New ultrasound showed the control dials right extended medioinferiori intestinal tract markedly thickened walls, hyperechoic masses and ipervascolarizzate with multiple contiguous and hyperechogenic lymph nodes. The clinical picture was clear we carried out then colonoscopy and EGDS showing signs with Crohn’s disease, gastric and colonic ileus confirming the diagnosis. Conclusions: the incidence of M C stands on 4–5/100,000 cases per year, familiarity is present in 26–42%, the main symptoms in order of frequency are: abdominal pain, weight loss, fever, diarrhea, rettorragia is only present in 17% of cases. In our case there was familiarity, lacked the abdominal pain and diarrhea, and symptoms of onset extraintestinal tissue had only low-grade fever and weight loss.
PO20 EOSINOPHILIC ESOPHAGITIS AND ECP: WHICH CORRELATION? S. Iuliano, A. Fugazza, E. Manzali, I. Lapetina, A. Ghiselli, G.L. de’Angelis Endoscopy Unit, University of Parma, Parma, Italy Objective: Eosinophilic esophagitis (EoE) is diagnosed by the presence of dysphagia and intraepitelial eosinophilic infiltration
e288
Abstracts / Digestive and Liver Disease 45 (2013) e263–e311
of =15 per high-power field (HPF). Dosage of serum eosinophilic cationic protein (ECP) reflects its production by eosinophilic cells and seems to play a role in remodeling of the esophagus. Goal of the study was to dose ECP before and after the treatment for EoE and to show clinical linkage between serum levels of the protein and symptoms of the disease. Methods: In this study were included pediatric patients with EoE occured between 2010 and 2012. Upper endoscopy with biopsy was performed. All patients underwent to hemochrome (with eosinophilic count), ECP dosage and a complete allergic evaluation. After 8 weeks, a clinical remission, on the basis of dysphagia or bolus impaction resolution was evaluated. Moreover a histological and laboratoristic assessment was performed. Results: 20 patients (mean age 11 years ± 4.74; 5 female and 15 male) with an histological diagnosis of EoE were analyzed. 17 patients had an altered ECP at diagnosis and 6 of these had a very high level of ECP (=100 g/l) with an altered eosinophilic count. All patients with positivity to inalants or aliments to skin prick test, showed very high levels of ECP. After treatment with fluticasone, PPI and/or elimination diet, ECP normalized in 15 patients and halved in 2 ones while symptoms completely disappeared in all patients. Conclusions: ECP seems to be a clinical marker of disease in pediatric EoE and it’s rather linked with esophageal dysfunction and bolus impaction.
PO21 RECURRENT ABDOMINAL PAIN AND CELIAC DISEASE M. Letizia 1 , C. Tolone 1 , I. Belfiore 1 , V. Pellino 1 , M. Piccirillo 1 , F.O. Rinaldi 1 , V. Sabatino 1 , A.E. Seguella 1 , S. Tolone 2 1
Department of Pediatrics, Second University of Naples, Naples, Italy 2 Department of General Surgery, Second University of Naples, Naples, Italy Objectives: Recurrent abdominal pain (RAP) is very frequent in children and adolescents, and often causes worries for parents and for the little patients, deteriorating quality of life and causing prolonged school absence. In order to exclude organic causes responsible for RAP, many useless diagnostic tests are often advocated, bothering for patients and very expensive for National Health System and for parents. In fact, this causes additional costs beside those spent for pharmacological and dietologic therapy – which often are ineffective. NASPGHAN therefore recommends to carry out diagnostic tests just in presence of so-called alarming signs and symptoms (familial history of IBD, celiac disease and ulcer, persistent vomit, chronic diarrhea, fever of unknown origin, etc.). Our aim was to investigate whether celiac disease may be responsible for RAP. Material and methods: Given that celiac disease prevalence is currently reported to be 1%, and that it has a broad spectrum of onset symptoms, we tested celiac serology in a large cohort of children and adolescents from Campania, presenting with RAP at the Unit of Pediatric Gastroenterology of the Second University of Naples between January 2008 and January 2013. Patients with incorrect dietary habits or constipation whose symptoms ameliorated after one month of healthful diet and resolution of constipation were excluded from evaluation. Furthermore, patients diagnosed with celiac disease were sub-divided into two groups, considering whether patients had RAP with (group A) or without alarming symptoms (group B).
Results: Out of 350 children with RAP enrolled, (4–14 years, mean age 8.9 years, 188 female) 44 patients (12.5%) were diagnosed celiac disease, according to specific serological and histological criteria. Nineteen out of 44 celiac patients did not experience any symptoms other than RAP (group B). After six months of gluten-free diet abdominal pain disappeared in all patients. Conclusions: Irrespective of accompanying symptoms, celiac disease may underlie RAP in up to one patient out of ten presenting with RAP. Our findings support the need of carrying out at least serological tests for celiac disease in pediatric patients with RAP, especially when painful episodes are frequent and quality of life is impaired, even if no additional-alarming symptoms are observed.
PO22 PLASMATIC VITAMIN D LEVELS IN CELIAC CHILDREN RELATED TO: MUCOSAL ATROPHY, AGE, WEIGHT AND SEASONALITY A. De Rosa 1 , M. Letizia 2 , V. Pellino 2 , I. Picone 1 , F.O. Rinaldi 2 , C. Rocco 2 , V. Sabatino 2 , A.E. Seguella 2 , C. Tolone 2 1
Department of Clinical and Molecular Pathology, Second University of Naples, Naples, Italy 2 Department of Pediatrics, Second University of Naples, Naples, Italy Objectives: Plasmatic vitamin D levels <30 ng/ml can be observed in chronic and autoimmune diseases, and in obese patients. Age and seasonality could influence Vit D levels. Aims of our study were to evaluate Vit D levels in celiacs, looking for differences between celiacs at diagnosis (mucosal atrophy) and those on gluten-free diet (GFD) since 6 months; to evaluate Vit D levels in normal weight compared with overweight/obese celiacs; to evaluate Vit D levels according to different ages and seasons. Material and methods: Celiac diagnosis was made according to ESPGHAN criteria. Vit D levels were determined with CLIA methods. Reference limits are defined as follows: deficiency <10 ng/ml; insufficiency 10–30 ng/ml; sufficiency 30–100 ng/ml. Vit D was measured in 201 celiacs (age 1–18 years, 119 female): 14 at diagnosis, 187 on GFD since 6 months and negative serology. Vit D was also measured in 4 overweight/obese celiacs at diagnosis and in 28 celiacs who were normal weight but became overweight/obese after 3 years of GFD. Patients were subdivided in three age groups: 1–8, 9–13, and 14–18 years. Each year was divided into two periods: summer–autumn and winter–spring, considering that in Campania, sunny days last until the end of October. Results: No statistically significant differences were observed when considering either disease characteristics at diagnosis or weight at diagnosis. Twelve out of 14 patients (85.7%) who were celiac at diagnosis and 162 out of 187 (86.6%) who were on GFD had Vit D levels <30 ng/ml. Similarly, 28/32 overweight/obese (87.5%) and 145/169 normal weight (85.8%) celiac had Vit D levels <30 ng/ml. Vit D levels did not differ between the three age groups. Deficiency/insufficiency was observed in 88%, 87%, and 81% in patients aged 1–8, 9–13, and 14–18 years, respectively. Seasons significantly affected Vit D levels: 66/84 patients (78.6%) of summer-autumn and 108/117 (92.8%) of winter–spring group suffered from Vit deficiency/insufficiency, whereas sufficiency was observed in 18/84 patients (21.4%) of summer–autumn and 9/117 (7.7%) of winter–spring group.
H < 2%iles vs target values for age) was attested in the same number of CD pts in Group 1 and 2 (33%). Pancreatitis as extraintestinal manifestation at dg was observed in 6 Group 2 pts vs 1 Group 1 patient. The use of steroids for CD was lower in Group 2 (p < 0.5). Among 27 pts treated with Infliximab, 8 (6 Group 1, 2 Group 2) were unresponsive and were shifted to Adalimumab. Discussion and conclusion: In our cohort, CD pts with recent dg presented more often an ileal localisation as well as fistulising phenotype and perianal disease. However, no significant difference in growth delay was attested between Group 1 and 2 CD pts. Group 2 UC pts mostly presented with pancolitis. The increasing number of IBD-U among recent diagnoses may express the evolving and changing molecular and phenotypical patterns within pediatric IBD.
PO18 A STRANGE PANCREATITIS M. Iafusco 1 , P. D’Avino 1 , L. Savanelli 1 , F. Pellegrini 2 , L. Martemucci 1 1 Pediatrics Department, AORN Santobono-Pausilipon, Neaples, Italy 2 Pediatrics Department, Federico II University, Neaples, Italy
P.M. female 2 years 2 mm and transferred from a suburban hospital for vomiting incoercibile and slight increase of pancreatic enzymes. Born at 37 weeks of pregnancy, TC placental aging emergency. Birth weight kg 1.800, hypoglycaemia and jaundice, neonatal, mixed feeding for 10 months then formula, introduction of gluten in 6 months. To 12 months starting post-meal regurgitation treated by treating with Ranitidine and hydrolysed milk with weight that you always kept below 5◦ PC. Gastric symptoms vomiting and abdominal pain persisted until hospitalization in our Department with a weight less than 5◦ PC always. Discrete conditions except for a modest, colorful rosy-dystrophy pale, abdomen negotiable but very sore in the epigastrium. Surveys showed a slight increase of amylase total (112 u/l), pancreatic amylase (35 u/l) and lipase (706 /l) while the remaining routine blood tests, TTG, AGA, HLA for celiac disease, cystic fibrosis genetic and hereditary pancreatitis, TORCH, stool on 3 samples pest and sweat tests were negative. Eco-abdomen was normal. Personal and family history of absolutely negative, no case of pancreatitis in a child or family, no recent abdominal trauma, no recent intake of drugs, no recent infection or diabetes or metabolic disorders or systemic pathology (Kawasaki). Gave just the idea of being an idiopathic pancreatitis, let us remember that account for 25% of pancreatitis. Beginning therapy with: Partial parenteral nutrition, light diet ipolipidica, Meropenem 20 mg/kg dose × 3, Omeprazole 0.7 mg/kg day. After a few days of therapy of pancreatic enzymes values came in (112 total amylase) but with persistent vomiting and lack of appetite. Eco-abdomen always the norm. At day 5 of the small hospital with vomiting expelled a foreign body of cylindrical shape about 5 cm long and 1 cm in diameter blackish-white that the histologist called fibrous materials of vegetable origin. The EGDS, practiced at a later date because it was formerly contraindicated for pancreatitis, it showed a stomach normo-conformed and expandable with standard normoemica mucosa and presence in the antral region, adjacent to the pylorus, broad-based image with bloody not depressed area. Gastric biopsy showed elements of inflammation clinical conditions of the small improved drastically with the complete disappearance of vomiting and increased appetite. Follow-up and found the complete disappearance of vomiting, still feeds fine without problems and presents a significant increase. In conclusion
e287
remain doubts about how a child so small could swallow a foreign object of such size and timing of events based on the early onset of symptoms (reflux, iplv???). Mild pancreatitis was of course due to mechanical obstruction exercised by foreign body on the pancreatic duct.
PO19 PERSISTENT FEVER AS AN ONSET CROHN’S: DESCRIPTION OF A CASE REPORT P. D’Avino 1 , M. Iafusco 1 , A. Palazzi 1 , B. Quarto 1 , F. Pellegrini 2 , L. Martemucci 1 1 Pediatrics Department, AORN Santobono-Pausilipon, Neaples, Italy 2 Pediatrics Department, Federico II University, Neaples, Italy
Child born at term with p.n. wellness up to 2.900 kg two months prior. At the entrance to decent conditions, mild pallor 18.600 kg weight with 3 kg drop, hyperemia of nasal cavities nothing major organs and apparatuses. Laboratory tests and instrumental to the entrance showed: Piastrinosi (727,000), VES, 120 HB 9.8, mild proteinuria VCA IgM IgG EBNA Neg 564 peripheral Smear: anisocytosis with activated lymphocytes rare Started antibiotic therapy Eco Abdomen: attendance of some lymph nodes more obvious in umbilical region with intestinal wall thickening in mesoipogastrio. Were negative or normal IG, Torch, blood culture, Parvovirus B19, HIV throat swab, Widal Wright, ANA, Tumor Antigen stool test, TSG, LDH, PCT, TAS, ADNASI Rx Thorax, Echocardiogram the appearance of canker sores and blisters on the oral cavity associated with the results of some tests (very high IgG EBNA, lymphocyte activation) induced us to begin therapy with Acyclovir. PCR and ESR remained high, the clinical conditions were good, the weight was increased by about 300 g but low-grade fever persisted. Suddenly rettorragia started with anemia that rapidly needed transfusion. Other previously performed tests showed fecal calprotectin 420 g/g at ASCA. New ultrasound showed the control dials right extended medioinferiori intestinal tract markedly thickened walls, hyperechoic masses and ipervascolarizzate with multiple contiguous and hyperechogenic lymph nodes. The clinical picture was clear we carried out then colonoscopy and EGDS showing signs with Crohn’s disease, gastric and colonic ileus confirming the diagnosis. Conclusions: the incidence of M C stands on 4–5/100,000 cases per year, familiarity is present in 26–42%, the main symptoms in order of frequency are: abdominal pain, weight loss, fever, diarrhea, rettorragia is only present in 17% of cases. In our case there was familiarity, lacked the abdominal pain and diarrhea, and symptoms of onset extraintestinal tissue had only low-grade fever and weight loss.
PO20 EOSINOPHILIC ESOPHAGITIS AND ECP: WHICH CORRELATION? S. Iuliano, A. Fugazza, E. Manzali, I. Lapetina, A. Ghiselli, G.L. de’Angelis Endoscopy Unit, University of Parma, Parma, Italy Objective: Eosinophilic esophagitis (EoE) is diagnosed by the presence of dysphagia and intraepitelial eosinophilic infiltration
e288
Abstracts / Digestive and Liver Disease 45 (2013) e263–e311
of =15 per high-power field (HPF). Dosage of serum eosinophilic cationic protein (ECP) reflects its production by eosinophilic cells and seems to play a role in remodeling of the esophagus. Goal of the study was to dose ECP before and after the treatment for EoE and to show clinical linkage between serum levels of the protein and symptoms of the disease. Methods: In this study were included pediatric patients with EoE occured between 2010 and 2012. Upper endoscopy with biopsy was performed. All patients underwent to hemochrome (with eosinophilic count), ECP dosage and a complete allergic evaluation. After 8 weeks, a clinical remission, on the basis of dysphagia or bolus impaction resolution was evaluated. Moreover a histological and laboratoristic assessment was performed. Results: 20 patients (mean age 11 years ± 4.74; 5 female and 15 male) with an histological diagnosis of EoE were analyzed. 17 patients had an altered ECP at diagnosis and 6 of these had a very high level of ECP (=100 g/l) with an altered eosinophilic count. All patients with positivity to inalants or aliments to skin prick test, showed very high levels of ECP. After treatment with fluticasone, PPI and/or elimination diet, ECP normalized in 15 patients and halved in 2 ones while symptoms completely disappeared in all patients. Conclusions: ECP seems to be a clinical marker of disease in pediatric EoE and it’s rather linked with esophageal dysfunction and bolus impaction.
PO21 RECURRENT ABDOMINAL PAIN AND CELIAC DISEASE M. Letizia 1 , C. Tolone 1 , I. Belfiore 1 , V. Pellino 1 , M. Piccirillo 1 , F.O. Rinaldi 1 , V. Sabatino 1 , A.E. Seguella 1 , S. Tolone 2 1
Department of Pediatrics, Second University of Naples, Naples, Italy 2 Department of General Surgery, Second University of Naples, Naples, Italy Objectives: Recurrent abdominal pain (RAP) is very frequent in children and adolescents, and often causes worries for parents and for the little patients, deteriorating quality of life and causing prolonged school absence. In order to exclude organic causes responsible for RAP, many useless diagnostic tests are often advocated, bothering for patients and very expensive for National Health System and for parents. In fact, this causes additional costs beside those spent for pharmacological and dietologic therapy – which often are ineffective. NASPGHAN therefore recommends to carry out diagnostic tests just in presence of so-called alarming signs and symptoms (familial history of IBD, celiac disease and ulcer, persistent vomit, chronic diarrhea, fever of unknown origin, etc.). Our aim was to investigate whether celiac disease may be responsible for RAP. Material and methods: Given that celiac disease prevalence is currently reported to be 1%, and that it has a broad spectrum of onset symptoms, we tested celiac serology in a large cohort of children and adolescents from Campania, presenting with RAP at the Unit of Pediatric Gastroenterology of the Second University of Naples between January 2008 and January 2013. Patients with incorrect dietary habits or constipation whose symptoms ameliorated after one month of healthful diet and resolution of constipation were excluded from evaluation. Furthermore, patients diagnosed with celiac disease were sub-divided into two groups, considering whether patients had RAP with (group A) or without alarming symptoms (group B).
Results: Out of 350 children with RAP enrolled, (4–14 years, mean age 8.9 years, 188 female) 44 patients (12.5%) were diagnosed celiac disease, according to specific serological and histological criteria. Nineteen out of 44 celiac patients did not experience any symptoms other than RAP (group B). After six months of gluten-free diet abdominal pain disappeared in all patients. Conclusions: Irrespective of accompanying symptoms, celiac disease may underlie RAP in up to one patient out of ten presenting with RAP. Our findings support the need of carrying out at least serological tests for celiac disease in pediatric patients with RAP, especially when painful episodes are frequent and quality of life is impaired, even if no additional-alarming symptoms are observed.
PO22 PLASMATIC VITAMIN D LEVELS IN CELIAC CHILDREN RELATED TO: MUCOSAL ATROPHY, AGE, WEIGHT AND SEASONALITY A. De Rosa 1 , M. Letizia 2 , V. Pellino 2 , I. Picone 1 , F.O. Rinaldi 2 , C. Rocco 2 , V. Sabatino 2 , A.E. Seguella 2 , C. Tolone 2 1
Department of Clinical and Molecular Pathology, Second University of Naples, Naples, Italy 2 Department of Pediatrics, Second University of Naples, Naples, Italy Objectives: Plasmatic vitamin D levels <30 ng/ml can be observed in chronic and autoimmune diseases, and in obese patients. Age and seasonality could influence Vit D levels. Aims of our study were to evaluate Vit D levels in celiacs, looking for differences between celiacs at diagnosis (mucosal atrophy) and those on gluten-free diet (GFD) since 6 months; to evaluate Vit D levels in normal weight compared with overweight/obese celiacs; to evaluate Vit D levels according to different ages and seasons. Material and methods: Celiac diagnosis was made according to ESPGHAN criteria. Vit D levels were determined with CLIA methods. Reference limits are defined as follows: deficiency <10 ng/ml; insufficiency 10–30 ng/ml; sufficiency 30–100 ng/ml. Vit D was measured in 201 celiacs (age 1–18 years, 119 female): 14 at diagnosis, 187 on GFD since 6 months and negative serology. Vit D was also measured in 4 overweight/obese celiacs at diagnosis and in 28 celiacs who were normal weight but became overweight/obese after 3 years of GFD. Patients were subdivided in three age groups: 1–8, 9–13, and 14–18 years. Each year was divided into two periods: summer–autumn and winter–spring, considering that in Campania, sunny days last until the end of October. Results: No statistically significant differences were observed when considering either disease characteristics at diagnosis or weight at diagnosis. Twelve out of 14 patients (85.7%) who were celiac at diagnosis and 162 out of 187 (86.6%) who were on GFD had Vit D levels <30 ng/ml. Similarly, 28/32 overweight/obese (87.5%) and 145/169 normal weight (85.8%) celiac had Vit D levels <30 ng/ml. Vit D levels did not differ between the three age groups. Deficiency/insufficiency was observed in 88%, 87%, and 81% in patients aged 1–8, 9–13, and 14–18 years, respectively. Seasons significantly affected Vit D levels: 66/84 patients (78.6%) of summer-autumn and 108/117 (92.8%) of winter–spring group suffered from Vit deficiency/insufficiency, whereas sufficiency was observed in 18/84 patients (21.4%) of summer–autumn and 9/117 (7.7%) of winter–spring group.