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[Changing clinical image of celiac sprue in childhood]
P Frühauf1, Z Lojda, J Fabianová
1Klinika detskeho a dorostového lékarství 1. LF UK a VFN, Praha. fruhauf.pavel@vfn.cz
Insights
Celiac sprue clinical manifestations have shifted over 23 years. Diarrhea was the primary symptom in the past, but now intestinal and extraintestinal symptoms are equally distributed, with "sleeping forms" emerging.
Area of Science:
- Pediatric Gastroenterology
- Autoimmune Diseases
- Chronic Disease Epidemiology
Context:
- Celiac sprue affects approximately 1% of children in North America and Western Europe.
- It is a multifactorial autoimmune disease triggered by wheat gliadin in genetically susceptible individuals (HLA-DQ2/DQ8).
- Understanding evolving clinical presentations is crucial for timely diagnosis and management.
Purpose:
- To investigate changes in the clinical manifestation of celiac sprue in a pediatric cohort over a 23-year period.
- To compare symptom prevalence and disease forms between early (1982-1987) and later (2004-2005) diagnostic periods.
Summary:
- A study of 48 children diagnosed with celiac sprue revealed a significant shift in clinical presentation.
- Historically, diarrhea was the predominant symptom (1982-1987).
- In a recent cohort (2004-2005), intestinal and extraintestinal symptoms were equally prevalent, and asymptomatic or 'sleeping' forms of the disease were observed.
Impact:
- Highlights the changing epidemiology and clinical spectrum of pediatric celiac sprue.
- Suggests a potential delay in diagnosis due to less overt symptoms in contemporary cases.
- Informs clinical awareness and diagnostic strategies for celiac sprue in children.
Background:
Celiac sprue is considered to be the second most common chronic disease in childhood after allergic diseases. At present, the prevalence of this disease is stated as high as approximately 1% in inhabitants of the North America and Western Europe. Aetiology of celiac sprue is multifactorial as it is in other chronic diseases. Pathogenetically, it is an autoimmune disease whose main autoantigene is the tissue transglutaminase. It affects those individuals carrying HLA-DO2 or HLA-DO8 gene and those who were exposed to wheat gliadine or similar amino acids (prolamines) in rye and barley. The purpose of the present study was to find out whether clinical manifestation of celiac sprue changed in our group of patients in course of 23 years.
Methods And Results:
In forty-eight children celiac sprue was diagnosed according to histopathological and histochemical findings in the small intestine mucosa. In the children examined within 5 years in 1982-1987, main clinical symptom of celiac sprue was diarrhoea. In the control group of children examined within 7 months in 2004-2005, intestinal and extraintestinal symptoms in celiac sprue were equally distributed; the so-called sleeping forms occurred too.
Conclusions:
It is discussed what are the trigger mechanisms and the possible danger of celiac sprue manifestations and why celiac sprue is diagnosed in the older children at present time compared with the past years.
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