Clinical, Serological and Histopathological Characteristics of Patients with Celiac Disease in Yemen: A Multicenter Retrospective Study

<title>Abstract</title> <p> <bold>Background:</bold> Celiac disease (CD) is a chronic immune-mediated enteropathy triggered by gluten ingestion in genetically susceptible individuals, with a global prevalence of approximately 1%. In Yemen, limited epidemiological data exist regarding the clinical presentation, serological profile, and factors associated with histological severity of CD. <bold>Objective:</bold> This multicenter retrospective study aimed to describe the demographic, clinical, serological, and histopathological characteristics of patients with confirmed celiac disease and to identify predictors of moderate-to-severe villous atrophy <bold>Methods:</bold> A total of 245 patients with confirmed CD (based on anti-tissue transglutaminase IgA positivity and ESPGHAN 2020 criteria) were included from medical records of University of Science and Technology hospitals and Basmat Hayat Center in Sana'a, Yemen. Demographic, clinical, serological, and histopathological data were extracted. Bivariate and multivariable logistic regression analyses were performed to identify independent predictors of positive intestinal biopsy (moderate/severe villous atrophy). <bold>Results:</bold> The cohort was predominantly female (73.5%), with the majority aged 21–40 years (51.4%). Diarrhea (75.1%) and abdominal pain (68.2%) were the most common gastrointestinal symptoms, while weight loss (42.4%) and iron deficiency anemia (33.1%) were frequent extra-intestinal manifestations. Anti-tTG IgA was positive in 58.0% of patients, and 60.0% had moderate/severe villous atrophy on biopsy. Multivariable analysis revealed that age &gt;40 years was inversely associated with positive biopsy (aOR = 0.055; p &lt; 0.001), while bloating or gas emerged as a significant positive predictor (aOR = 2.666; p = 0.030). <italic>H. pylori</italic> infection demonstrated an inverse association with positive biopsy (aOR = 0.328; p = 0.022). Anti-tTG IgA positivity exhibited the strongest independent association with positive biopsy (aOR = 29.93; p &lt; 0.001). <bold>Conclusion:</bold> Anti-tissue transglutaminase IgA remains the most reliable predictor of moderate to severe villous atrophy in Yemeni patients with celiac disease. The paradoxical protective effect of age over 40 years and the inverse association with Helicobacter pylori infection warrant further investigation, while underscoring the necessity of comprehensive diagnostic evaluation combining serological testing with histopathological confirmation. </p>