High Incidence of Atypical Forms of Coeliac Disease in a Pediatric Case Study

Abstract

In the last ten years, better knowledge of coeliac disease (CD), has permitted the identification, not only of the typical forms of the disease characterized by gastrointestinal symptoms, but the identification of atypical forms, characterized by the absence of diarrhea and the presence, sometimes, of symptoms not referring to a gastrointestinal pathology. In the beginning such atypical forms were considered rather rare and more frequent in older children but we are becoming more and more convinced that there is an increase of the number of such atypical diagnostic forms. This is due above all, either to the greater sensibilization of both pediatric gastroenterologists and pediatricians, or the use of new screening tests for CD like the antigliadin antibodies, that allow us to choose the subjects to present for biopsy. In the last 12 years, at our center in Rome, 352 cases of CD, aged 8 months to 16 years, have been diagnosed by jejunal biopsy. Of these 279 patients, that is 79%, were affected by a typical form, and 73 patients, that is 21%, presented an atypical clinical picture, without the classic symptoms of CD, at the moment of the diagnosis. The percentage of atypical forms diagnosed by our center six years ago was 11% and that percentage increased in the last years to 21%. Half of the atypical forms had had an early beginning within the first 3 years of life, while the other half had a retarded beginning after the first three years (Table I).