Prevalence of Celiac Disease Among Adults Presenting with Dyspepsia in Tobruk, Libya: A Prospective Cross-Sectional Study

Background: Celiac disease (CD) is a chronic immune-mediated enteropathy triggered by gluten ingestion. Although classically associated with malabsorption, CD may present with atypical gastrointestinal symptoms, including dyspepsia, which may delay diagnosis. This study aimed to determine the prevalence of CD among patients presenting with uninvestigated dyspepsia and to describe their clinical, serological, endoscopic, and histopathological characteristics. Methods: A prospective cross-sectional study was conducted at the Gastroenterology Unit of Tobruk Medical Centre, Libya, between February and October 2024. Patients presenting with uninvestigated dyspepsia underwent clinical assessment, complete blood count, anti-tissue transglutaminase immunoglobulin A (anti-tTG IgA) testing, upper gastrointestinal endoscopy, and duodenal biopsy. Histopathological findings were classified according to the Marsh classification. Results: Eighty patients were included (mean age 34.7 ± 11.4 years; 51.2% male). The most common symptoms were abdominal bloating (58.8%), diarrhoea (37.5%), constipation (36.3%), weight loss (33.7%), and vomiting (31.3%). Anti-tTG IgA was positive in 11 patients (13.8%), and endoscopic findings suggestive of duodenal villous atrophy were identified in 29 (36.3%). Histopathological examination confirmed CD in seven patients, corresponding to a prevalence of 8.8%. All confirmed cases had positive anti-tTG IgA serology and endoscopic findings suggestive of villous atrophy. Anti-tTG IgA demonstrated 100% sensitivity, 94.5% specificity, and 95.0% diagnostic accuracy. Conclusion: Histologically confirmed CD was identified in 8.8% of patients presenting with uninvestigated dyspepsia. These findings support considering CD in the differential diagnosis of unexplained dyspeptic symptoms. Serological testing followed by histopathological confirmation remains important for establishing the diagnosis. Larger multicentre studies are required to confirm these findings