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Clinical presentation of celiac disease among pediatric compared to adolescent and adult patients

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Abstract

Background

Celiac disease (CD) is being increasingly recognized in adults though a majority of patients continue to be diagnosed in childhood.

Aim

To compare the clinical presentation and profile of newly diagnosed pediatric and adolescent/adult CD patients.

Materials and Methods

Retrospective analysis of patients diagnosed with CD between year 1997 and 2007 in the pediatric group, and between year 2000 and 2007 in the adolescent/adult group was done for clinical presentation, endoscopic findings and duodenal histology.

Results

A total of 434 children and 298 adults were studied. The mean age of diagnosis was 6.5 ± 2.5 years (1–11 years) in children and 29.3 ± 13.3 years (6–73 years) in adolescent/adults. The mean duration of symptoms before diagnosis was 3.5 ± 2.5 years in children and 4.9 ± 4.6 years in the latter. Diarrhea as the presenting symptom was seen in 74 % of children and 58.7 % of adolescent/adults. Anemia (on investigations) was seen in 84 % of children and 94 % of adolescent/adults.

Conclusions

Pediatric patients of CD present more often with typical features than adults. Atypical presentations are more common in adults and the latent period for diagnosis is also longer in adolescent/adults. There is a need for increasing awareness about CD, both among pediatricians and physicians caring for adult patients.

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References

  1. Maki M, Mustalahti K, Kokkonen J, et al. Prevalence of celiac disease among children in Finland. N Engl J Med. 2003;398:2517–24.

    Article  Google Scholar 

  2. Hoffenberg EJ, Mackenzie T, Barriga KJ, et al. A prospective study of the incidence of childhood celiac disease. J Pediatric. 2003;143:308–14.

    Article  Google Scholar 

  3. Catassi C, Fabiani E, Ratesch IM, et al. The celiac iceberg in Italy. A multicentre antigliadin antibodies screening for celiac disease in school-age school-age subjects. Acta Pediatr Suppl. 1996;412:29–35.

    Article  CAS  Google Scholar 

  4. 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 

  5. Telega G, Bennet TR, Werlin S. Emerging new clinical patterns in the presentation of celiac disease. Arch Pediatr Adolesc Med. 2008;162:164–8.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  7. Barada K, Bitar A, Mokadem MA, Hashash JG, Green P. Celiac disease in middle eastern and north African countries: a new burden. World J Gastroenterol. 2010;28:1449–57.

    Article  Google Scholar 

  8. Marsh MN. Clinical and pathological spectrum of celiac disease. Gut. 1993;34:1740.

    Article  PubMed  CAS  Google Scholar 

  9. Marsh MN, Crowe PT. Morphology of the mucosal lesion in gluten sensitivity. Baillieres Clin Gastroenterol. 1995;9:273–93.

    Article  PubMed  CAS  Google Scholar 

  10. Walker-Smith JA, Guandulini S, Schmitz J, et al. Revised criteria for diagnosis of celiac disease. Arch Dis Child. 1990;65:909–11.

    Article  Google Scholar 

  11. Llorenic-Alonso MJ, Fernandez-Accnero MJ, Sebastian M. Gluten intolerance: six and age-related features. Can J Gastroenterol. 2006;20:719–22.

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

  13. Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357:1731–43.

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  15. Poddar U, Thapa BR, Nain CK, et al. Celiac disease in India: are they true cases of celiac disease? J Pediatr Gastroenterol Nutr. 2002;35:508–12.

    Article  PubMed  CAS  Google Scholar 

  16. Green PHR, Stavropoulos SN, Panagi SG, et al. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol. 2001;96:126–31.

    Article  PubMed  Google Scholar 

  17. Lo W, Sano K, Lebwohl B, Diamond B, Green HRP. Changing presentation of adult celiac disease. Dig Dis Sci. 2003;48:395–98.

    Article  PubMed  Google Scholar 

  18. McGowan KE, Castiglione DA, Butzner JD. The changing face of childhood celiac disease in North America: impact of serological testing. Pediatrics. 2009;124:1572–8.

    Article  PubMed  Google Scholar 

  19. Lurz E, Scheidegger U, Spalinger J, Schoni M, Schibli S. Clinical presentation of celiac disease and the diagnostic accuracy of serologic markers in children. Eur J Pediatr. 2009;168:839–45.

    Article  PubMed  Google Scholar 

  20. Steens RF, Csizmadai CG, George FK, Nimaber MK, Hira Sing RA, Mearin ML. A national prospective study on childhood celiac disease in the Netherlands 1993–2000; an increasing recognition and a changing clinical picture. J Pediatr. 2005;147:239–43.

    Article  PubMed  Google Scholar 

  21. Ravi Kumara M, Tuthill DP, Jenkins HR. The changing clinical presentation of celiac disease. Arch Dis Child. 2006;91:969–71.

    Article  CAS  Google Scholar 

  22. Garampazzi A, Rapa A, Mura S, et al. Clinical pattern of celiac disease is still changing. J Pediatr Gastroenterol Nutr. 2007;45:611–4.

    Article  PubMed  Google Scholar 

  23. Zipser R, Patel S, Vahya KZ, Baisch DW, Monarch E. Presentations of adult celiac disease in a nationwide patient support group. Dig Dis Sci. 2003;48:261–4.

    Article  Google Scholar 

  24. Rampertab SD, Pooran N, Brar P, Singh P. Trends in the presentation of celiac disease. Am J Med. 2007;120:e15.

    Google Scholar 

  25. Kuloglu Z, Kirsachioglu CT, Kansu A, Ensari A, Girigin N. Celiac disease: presentation of 109 children. Yonsci Med J. 2009;50:617–23.

    Article  Google Scholar 

  26. Ludvigsson JF, Ansved P, Falth-Magnusson K, et al. Symptoms and signs have changed in Swedish children with celiac disease. J Pediatr Gastroenterol Nutr. 2004;38:181–6.

    Article  PubMed  Google Scholar 

  27. George EK, Mearin ML, Franken HCM, et al. Twenty years of childhood celiac disease in the Netherlands: a rapidly increasing incidence. Gut. 1997;40:61–6.

    PubMed  CAS  Google Scholar 

  28. Bottaro G, Failla P, Rotolo N, et al. Changes in celiac disease behaviour over the years. Acta Pediatr. 1993;82:566–8.

    Article  CAS  Google Scholar 

  29. Ashabani A, Errabtea H, Shapan A, Tuckova L, Tlaskalova-Hogenova H. Serological markers of untreated celiac disease in Libyan children: antigliadin, antitransglutaminase, antiendomysial and anticalerticulin antibodies. J Pediatr Gastroenterol Nutr. 2001;33:276–82.

    Article  PubMed  CAS  Google Scholar 

  30. Demor H, Yuce A, Kocak N, Ozen H, Gurakan F. Celiac disease Turkish children: presentation of 104 children. Pediatr Int. 2000;42:483–7.

    Article  Google Scholar 

  31. Ascher H, Holm K, Kristiansson B, et al. Different features of celiac disease in two neighbouring countries. Arch Dis Child. 1993;69:375–80.

    Article  PubMed  CAS  Google Scholar 

  32. Barker CC, Mitlon C, Jevon G, et al. Can tissue transglutaminase antibody replace small bowel biopsy to diagnose celiac disease in select pediatric population? Pediatrics. 2005;115:1341–6.

    Article  PubMed  Google Scholar 

  33. Green PHR. The many faces of celiac disease; clinical presentation of celiac disease in the adult population. Gastroenterology. 2005;128:574–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Rakesh Kochhar, Kapil Jain, Babu R. Thapa, Pawan Rawal, Abdul Khaliq, Rashi Kochhar, Usha Dutta, Chander K. Nain, Kaushal K. Prasad & Kartar Singh

  2. Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Sanjay Bhadada

  3. Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Kim Vaiphei

  4. Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Subhash Varma

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  1. Rakesh Kochhar
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  2. Kapil Jain
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  3. Babu R. Thapa
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  6. Rashi Kochhar
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  13. Kartar Singh
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Correspondence to Rakesh Kochhar.

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Kochhar, R., Jain, K., Thapa, B.R. et al. Clinical presentation of celiac disease among pediatric compared to adolescent and adult patients. Indian J Gastroenterol 31, 116–120 (2012). https://doi.org/10.1007/s12664-012-0198-9

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  • DOI: https://doi.org/10.1007/s12664-012-0198-9

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