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Clinical spectrum of paediatric coeliac disease: a 10-year single-centre experience

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Abstract

This study was undertaken to gain insight in the clinical spectrum of paediatric coeliac disease (CD) in a Dutch teaching hospital. We retrospectively compared the frequency of CD in children with a wide spectrum of complaints with and without CD antibodies in serum and were interested if certain complaints are more pathognomonic for CD. Furthermore, we expected that over a period of 10-year incidence rates of CD would have increased and shifted towards an atypical presentation with more non-gastrointestinal symptoms with increasing age. A retrospective, single-centre, case-control study was performed. All patients who presented at the Department of Paediatrics, Tergooi Hospital, with symptoms suspected for CD were eligible for inclusion during the study period from 1 January 2007 till 31 December 2016. Children were diagnosed with CD according to the 2005 and 2012 ESPGHAN guideline between 2007 and 2016, respectively. Demographic data, presenting symptoms, prevalence of associated conditions and serology results were examined. A total of 105 new cases of paediatric CD were observed, with an average of 10 new cases each year. The calculated incidence was 21.09 (CI 17.49–25.22)/100,000 under 18 years of age. About 40% were infants and toddlers, predominantly presenting with gastrointestinal symptoms. Primary and high school children had more display of atypical symptoms (p = 0.001, p = 0.017) and non-gastrointestinal symptoms (p = 0.009, p = 0.009) than infants and toddlers. In 8.6% of the CD patients, mostly primary school aged female patients, the serology was repeated at least once in time to become positive. The median time for serology to become positive was 609 days (range 140–1054).

Conclusion: As it is well known, our study supports the increasing notion of a shift in the clinical spectrum of presenting symptoms in paediatric CD towards an atypical presentation, with more non-gastrointestinal symptoms and a diagnosis at a later age in a Dutch population, whereas the number of new cases did not increase over the years.

What is Known:

• The clinical spectrum of paediatric coeliac disease is shifting towards a presentation with more atypical and non-GI symptoms.

• The incidence of paediatric coeliac disease is still increasing as is the age at which it is diagnosed.

What is New:

• An average of 10 paediatric CD cases are diagnosed per year in our general teaching hospital.

• The calculated (gender-specific) incidence rates are higher than previously reported.

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Abbreviations

CD:

Celiac disease

EMA:

Endomysial antibodies

tTG:

Trans tissue glutaminase

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Authors and Affiliations

  1. Department of Paediatrics, Tergooi Hospital, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands

    Michael W. Van Kalleveen & Frans B. Plötz

  2. Department of Paediatric Gastroenterology, VU Medical Centre (VUmc), Amsterdam, The Netherlands

    Tim de Meij

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  1. Michael W. Van Kalleveen
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Contributions

MWK and FBP designed the study. MWK, FBP and TDM helped to draft the manuscript. MWK, FBP and TDM read and approved the final manuscript.

Corresponding author

Correspondence to Michael W. Van Kalleveen.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The approval for the study was obtained by the Scientific Review Committee of Tergooi Hospital. The committee judged that the study did not fall under the Medical Research Involving Human Subjects Act (letter reference kv/17.52) so that informed consent by patients and caregivers was not required. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration its later amendments or comparable standards.

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Informed consent by patients and caregivers was not required.

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Communicated by Peter de Winter

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Van Kalleveen, M.W., de Meij, T. & Plötz, F.B. Clinical spectrum of paediatric coeliac disease: a 10-year single-centre experience. Eur J Pediatr 177, 593–602 (2018). https://doi.org/10.1007/s00431-018-3103-4

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  • DOI: https://doi.org/10.1007/s00431-018-3103-4

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