Intest Res  
A simple phenotypic classification for celiac disease
Ajit Sood1, Vandana Midha2, Govind Makharia3, B. K. Thelma4, Shivalingappa S Halli5, Varun Mehta1, Ramit Mahajan1, Vikram Narang6, Kriti Sood6, Kirandeep Kaur7
Departments of 1Gastroenterology and 2Internal Medicine, Dayanand Medical College, Ludhiana, 3Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 4Department of Genetics, University of Delhi South Campus, New Delhi, India, 5Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada, Departments of 6Pathology and 7Pharmacology, Dayanand Medical College, Ludhiana, India
Correspondence to: Ajit Sood, Department of Gastroenterology, Dayanand Medical College & Hospital, Tagore Nagar, Ludhiana 141001, India. Tel: +91-9815400718, Fax: +91-161-2302620; E-mail: ajitsood10@gmail.com
Received: August 30, 2017; Revised: January 1, 2018; Accepted: January 3, 2018; Published online: January 31, 2018.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: Celiac disease is a global health problem. The presentation of celiac disease has unfolded over years and it is now known that it can manifest at different ages, has varied presentations, and is prone to develop complications, if not managed properly. Although the Oslo definitions provide consensus on the various terminologies used in literature, there is no phenotypic classification providing a composite diagnosis for the disease. Methods: Various variables identified for phenotypic classification included age at diagnosis, age at onset of symptoms, clinical presentation, family history and complications. These were applied to the existing registry of 1,664 patients at Dayanand Medical College and Hospital, Ludhiana, India. In addition, age was evaluated as below 15 and below 18 years. Cross tabulations were used for the verification of the classification using the existing data. Expert opinion was sought from both international and national experts of varying fields. Results: After empirical verification, age at diagnosis was considered appropriate in between A1 (〈18) and A2 (≥18). The disease presentation has been classified into 3 types–P1 (classical), P2 (non-classical) and P3 (asymptomatic). Complications were considered as absent (C0) or present (C1). A single phenotypic classification based on these 3 characteristics, namely age at the diagnosis, clinical presentation, and intestinal complications (APC classification) was derived. Conclusions: APC classification (age at diagnosis, presentation, complications) is a simple disease explanatory classification for patients with celiac disease aimed at providing a composite diagnosis.
Keywords: Celiac disease; Classification; Presentation; Complications


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