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Pediatric and adult celiac disease: similarities and differences

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Abstract

Differences between children and adults in celiac disease (CD) presentation and epidemiology are reviewed here. Clinical manifestations, histological changes, serology, and response to gluten-free diet are similar. Differences exist in epidemiology, type of clinical presentations, coexisting diseases, complications, and association with obesity. CD is two to five times more common in children than in adults. Classical CD with gastrointestinal symptoms is more common in children whereas nonclassical CD dominates in adults. A gene dose phenomenon (double-dose HLA-DQB1*02 allele) is postulated to be responsible for this difference. Coexisting autoimmune diseases like diabetes mellitus type 1, Sjogren’s syndrome, and dermatitis herpetiformis are more common in adults than in children (42 % vs. 5 %). The association of overweight/obesity and CD is stronger in adults than in children (22.5 % vs. 14 %). Besides poor compliance, pancreatic insufficiency, bacterial overgrowth, lactose intolerance, irritable bowel syndrome, lymphocytic colitis, and microscopic colitis are considered responsible for nonresponsive CD in adults but not in children. Complications like refractory sprue and small intestinal neoplasms are seen exclusively in adults. Existing diagnostic criteria (modified ESPGHAN) are not suitable for diagnosing CD in adults as the majority of cases are either nonclassical or subclinical CD.

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References

  1. Hallert C, Gotthard R, Jansson G, Norrby K, Walan A. Similar prevalence of coeliac disease in children and middle-aged adults in a district of Sweden. Gut. 1983;24:389–91.

    Article  PubMed  CAS  Google Scholar 

  2. Lanzini A, Villanacci V, Apillan N, et al. Epidemiological, clinical and histopathological characteristics of celiac disease: results of a case-finding population-based program in an Italian community. Scand J Gastroenterol. 2005;40:950–7.

    Article  PubMed  Google Scholar 

  3. Marine M, Farre C, Alsina M, et al. The prevalence of coeliac disease is significantly higher in children compared with adults. Aliment Pharmacol Ther. 2011;33:477–86.

    Article  PubMed  CAS  Google Scholar 

  4. Pratesi R, Gandolfi L, Garcia SG, et al. Prevalence of celiac disease: unexplained age-related variation in the same population. Scand J Gastroenterol. 2003;38:747–50.

    PubMed  CAS  Google Scholar 

  5. Makharia GK, Verma AK, Amarchand R, et al. Prevalence of celiac disease in the northern part of India: a community based study. J Gastroenterol Hepatol. 2011;26:894–900.

    Article  PubMed  Google Scholar 

  6. Ludvigsson JF, Leffler DA, Bai JC, et al. The Oslo definition for coeliac disease and related terms. Gut. 2013;62:43–52.

    Article  PubMed  Google Scholar 

  7. Bottaro G, Cataldo F, Rotolo N, Spina M, Corazza GR. The clinical pattern of subclinical/silent celiac disease: an analysis on 1026 consecutive cases. Am J Gastroenterol. 1999;94:691–6.

    PubMed  CAS  Google Scholar 

  8. Roma E, Panayiotou J, Karantana H, et al. Changing pattern in the clinical presentation of pediatric celiac disease: a 30 year study. Digestion. 2009;80:185–91.

    Article  PubMed  Google Scholar 

  9. Poddar U, Thapa BR, Nain CK, Prasad A, Singh K. Celiac disease in India: are they true cases of celiac disease? J Pediatr Gastroenterol Nutr. 2002;35:508–12.

    Article  PubMed  CAS  Google Scholar 

  10. Poddar U, Thapa BR, Singh K. Clinical features of celiac disease in Indian children: are they different from the West? J Pediatr Gastroenterol Nutr. 2006;43:313–7.

    Article  PubMed  Google Scholar 

  11. Mohindra S, Yachha SK, Srivastava A, et al. Coeliac disease in Indian children: assessment of clinical, nutritional and pathologic characteristics. J Health Popul Nutr. 2001;19:204–8.

    PubMed  CAS  Google Scholar 

  12. Patwari AK, Anand VK, Kapur G, Narayan S. Clinical and nutritional profile of children with celiac disease. Indian Pediatr. 2003;40:337–42.

    PubMed  CAS  Google Scholar 

  13. Makharia GK, Baba CS, Khadgawat R, et al. Celiac disease: variations of presentations in adults. Indian J Gastroenterol. 2007;26:162–6.

    PubMed  Google Scholar 

  14. Sood A, Midha V, Sood N, Malhotra V. Adult celiac disease in north India. Indian J Gastroenterol. 2003;22:124–6.

    PubMed  Google Scholar 

  15. Collin P, Reunala T, Rasmussen M, et al. High incidence and prevalence of adult coeliac disease: augmented diagnostic approach. Scand J Gastroenterol. 1997;32:1129–33.

    Article  PubMed  CAS  Google Scholar 

  16. Sanders DS, Hurlstone DP, Stokes RO, et al. Changing face of adult coeliac disease: experience of a single university hospital in South Yorkshire. J Postgrad Med. 2002;78:31–3.

    Article  CAS  Google Scholar 

  17. Bonaci-Nikolic B, Andrejevic S, Radlovic N, et al. Serological and clinical comparison of children and adults with anti-endomysial antibodies. J Clin Immunol. 2007;27:163–71.

    Article  PubMed  CAS  Google Scholar 

  18. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents: 1999 to 2010. JAMA. 2012;307:483–90.

    Article  PubMed  Google Scholar 

  19. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307:491–7.

    Article  PubMed  Google Scholar 

  20. Dickey W, Kearney N. Overweight in celiac disease: prevalence, clinical characterisitics and effect of a gluten-free diet. Am J Gastroenterol. 2006;101:2356–9.

    Article  PubMed  CAS  Google Scholar 

  21. Cheng J, Brar PS, Lee AR, Green PHR. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010;44:267–71.

    Article  PubMed  Google Scholar 

  22. West J, Logan RFA, Card TR, Smith C, Hubbard R. Risk of vascular disease in adults with diagnosed coeliac disease: a population-based study. Aliment Pharmacol Ther. 2004;20:73–9.

    Article  PubMed  CAS  Google Scholar 

  23. Murray JA, Van Dyke C, Plevak MF, Dierkhising RA, Zinsmeister AR, Melton LJ. Trends in the identification and clinical features of celiac disease in a north American community, 1950–2001. Clin Gastroenterol Hepatol. 2003;1:19–27.

    Article  PubMed  Google Scholar 

  24. Venkatasubramani N, Telga G, Werlin SL. Obesity in pediatric celiac disease. J Pediatr Gastroenterol Nutr. 2010;51:295–7.

    PubMed  Google Scholar 

  25. Valletta E, Fornaro M, Cipolli M, Conte S, Bissolo F, Danchielli C. Celiac disease and obesity: need for nutritional follow-up after diagnosis (short communication). Eur J Clin Nutr. 2010;64:1371–2.

    Article  PubMed  CAS  Google Scholar 

  26. Reilly NR, Aguilar K, Hassid BG, et al. Celiac disease in children with normal weight and overweight: clinical features and growth outcomes following a gluten-free diet. J Pediatr Gastoenterol Nutr. 2011;53:528–31.

    Google Scholar 

  27. Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BMR, Moayyedi P. Yield of diagnostic tests for celiac disease individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med. 2009;169:651–8.

    Article  PubMed  Google Scholar 

  28. Ford AC, Ching E, Moayyedi P. Meta-analysis: yield of diagnostic tests for coeliac disease in dyspepsia. Aliment Pharmacol Ther. 2009;30:28–36.

    Article  PubMed  CAS  Google Scholar 

  29. Norris JM, Barriga K, Hoffenberg EJ, et al. Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. JAMA. 2005;293:2343–51.

    Article  PubMed  CAS  Google Scholar 

  30. Farrell RJ. Infant gluten and celiac disease: too early, too late, too much, too many options. JAMA. 2005;293:2410–2.

    Article  PubMed  CAS  Google Scholar 

  31. Akobeng AK, Ramanan AV, Buchan I, Heller RF. Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Arch Dis Child. 2006;91:39–43.

    Article  PubMed  CAS  Google Scholar 

  32. Congia M, Cucca F, Lampis R, et al. A gene dosage effect of the DQA1*0501/DQB1*0201 allelic combination influences the clinical heterogeneity of celiac disease. Hum Immunol. 1994;40:138–42.

    Article  PubMed  CAS  Google Scholar 

  33. Zubillaga P, Vidales MC, Zubillaga I, Ormaechea V, Garcia-Urkia N, Vitor JC. HLA-DQA1 and HLA-DQB1 genetic markers and clinical presentation in celiac disease. J Pediatr Gastroenterol Nutr. 2002;34:548–54.

    Article  PubMed  Google Scholar 

  34. Karinen H, Karkkainen P, Pihlajamaki J, et al. Gene dose effect of the DQB1*0201 allele contributes to the severity of coeliac disease. Scand J Gastroenterol. 2006;41:191–9.

    Article  PubMed  CAS  Google Scholar 

  35. Murray JA, Moore SB, Van Dyke CT, et al. HLA DQ gene dosage and risk and severity of celiac disease. Clin Gastroenterol Hepatol. 2007;5:1406–12.

    Article  PubMed  Google Scholar 

  36. Walker-Smith JA, Guandalini S, Schmitz J, et al. Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child. 1990;65:909–11.

    Article  Google Scholar 

  37. Ramakrishna BS. Wanted: diagnostic criteria for adult celiac disease. Indian J Gastroenterol. 2007;26:157–8.

    PubMed  CAS  Google Scholar 

  38. Walker MM, Murray JA, Ronkainen J, et al. Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study. Gastroenterology. 2010;139:112–9.

    Article  PubMed  Google Scholar 

  39. Poddar U, Thapa BR, Nain CK, Singh K. Is tissue transglutaminase autoantibody the best for diagnosing celiac disease in children of developing countries? J Clin Gastroenterol. 2008;42:147–51.

    Article  PubMed  CAS  Google Scholar 

  40. Poddar U. Celiac disease: clinical features and diagnostic criteria. Indian J Pediatr. 1999;66:S21–5.

    Article  PubMed  CAS  Google Scholar 

  41. Sharma A, Poddar U, Yachha SK. Time to recognize atypical celiac disease in Indian children. Indian J Gastroenterol. 2007;26:269–73.

    PubMed  Google Scholar 

  42. Fine KD, Meyer RL, Lee EL. The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet. Gastroenterology. 1997;112:1830–8.

    Article  PubMed  CAS  Google Scholar 

  43. Abdulkarim AS, Burgart LJ, See J, Murray JA. Etiology of nonresponsive celiac disease: results of a systematic approach. Am J Gastroenterol. 2002;97:2016–21.

    Article  PubMed  Google Scholar 

  44. Leffler DA, Dennis M, Hyett B, Kelly E, Schuppan D, Kelly CP. Etiologies and predictors of diagnosis of nonresponsive celiac disease. Clin Gastroenterol Hepatol. 2007;5:445–50.

    Article  PubMed  Google Scholar 

  45. Roshan B, Leffler DA, Jamma S, et al. The incidence and clinical spectrum of refractory celiac disease in a North American referral center. Am J Gastroenterol. 2011;106:923–8.

    Article  PubMed  Google Scholar 

  46. Mubarak A, Oudshoorn JH, Kneepkens CMF, et al. A child with refractory coeliac disease. J Pediatr Gastroenterol Nutr. 2011;53:216–8.

    Article  PubMed  CAS  Google Scholar 

  47. Holmes GKT, Prior P, Lane MR, Pope D, Allan RN. Malignancy in coeliac disease: effect of a gluten-free diet. Gut. 1989;30:333–8.

    Article  PubMed  CAS  Google Scholar 

  48. Catassi C, Bearzi I, Holmes GKT. Association of celiac disease and intestinal lymphomas and other cancers. Gastroenterology. 2005;128:S79–86.

    Article  PubMed  Google Scholar 

  49. Catassi C, Fabiani E, Corrao G, et al. Risk of non-Hodgkin lymphoma in celiac disease. JAMA. 2002;287:1413–9.

    Article  PubMed  Google Scholar 

  50. Card TR, West J, Holmes GKT. Risk of malignancy in diagnosed coeliac disease: a 24-year prospective, population-based cohort study. Aliment Pharmacol Ther. 2004;20:769–75.

    Article  PubMed  CAS  Google Scholar 

  51. Schweizer JJ, Oren A, Mearin ML, et al. Cancer in children with celiac disease: a survey of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2001;33:97–100.

    Article  PubMed  CAS  Google Scholar 

  52. Peters U, Askling J, Gridley G, Ekbom A, Linet M. Cause of death in patients with celiac disease in a population-based Swedish cohort. Arch Intern Med. 2003;163:1566–72.

    Article  PubMed  Google Scholar 

  53. Askling J, Linet M, Gridley G, Halstensen TS, Ekstrom K, Ekbom A. Cancer incidence in a population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis. Gastroenterology. 2002;123:1428–35.

    Article  PubMed  Google Scholar 

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  1. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India

    Ujjal Poddar

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  1. Ujjal Poddar
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Correspondence to Ujjal Poddar.

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Poddar, U. Pediatric and adult celiac disease: similarities and differences. Indian J Gastroenterol 32, 283–288 (2013). https://doi.org/10.1007/s12664-013-0339-9

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