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[Clinical data on celiac disease with an early or late onset]
N Ansaldi1, K Tavassoli, D Dell'Olio
1Cattedra di Pediatria, Università di Torino.
Insights
Celiac disease (CD) onset in children presents with typical gastrointestinal symptoms. However, failure to thrive is more common in early-onset CD, and breastfeeding delays symptom onset.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Clinical Nutrition
Background:
- Celiac disease (CD) symptoms vary with onset age, with typical signs often seen early and atypical signs later.
- Understanding symptom prevalence and influencing factors in early-onset versus late-onset pediatric CD is crucial for timely diagnosis and management.
Purpose of the Study:
- To compare clinical signs and symptoms in children with early-onset (<1 year) versus late-onset (≥1 year) celiac disease.
- To evaluate the impact of breastfeeding and gluten introduction timing on symptom onset in pediatric CD.
Main Methods:
- Retrospective analysis of 135 early-onset and 40 late-onset pediatric CD cases.
- Assessment of symptom types (gastrointestinal vs. extraintestinal), time lapse from gluten introduction to onset, and frequency of individual symptoms.
- Statistical evaluation of breastfeeding duration and age of gluten introduction on symptom onset timing.
Main Results:
- Typical gastrointestinal symptoms (diarrhea, anorexia, abdominal distension) were prevalent in both early and late-onset CD groups.
- Failure to thrive was significantly more frequent in early-onset CD (p < 0.01).
- Prolonged breastfeeding significantly delayed symptom onset (p < 0.001), while age of first gluten ingestion showed no significant influence.
Conclusions:
- While gastrointestinal symptoms are common in both early and late-onset pediatric celiac disease, failure to thrive is a key indicator for early-onset cases.
- Breastfeeding plays a protective role by delaying symptom onset in children with celiac disease.
Abstract:
Typical symptoms in celiac disease (CD) are usually associated with early onset of the disease, whereas an atypical symptomatology has more often a later onset. The aim of this study was to evaluate the prevalence of some clinical signs and symptoms in children whose CD started before one year of age ("early onset" 135 children, M/F 50/85, mean age at onset 6.9 +/- 1.9 months) and in children whose disease started later ("late onset", M/F 14/26, mean age at onset 26.3 +/- 26.7 months). We analyzed: a) time lapse between gluten introduction and onset of symptoms, b) prevalence of patients with gastrointestinal symptoms alone and that of patients with gastrointestinal plus extraintestinal symptoms, c) frequency of each symptom. We then evaluated the influence of breast feeding and age of gluten introduction on time lapse. Our results showed that typical gastrointestinal symptoms, like diarrhea anorexia and abdominal distension prevailed both in children with early and late onset; whereas failure to thrive was significantly more frequent in children with an early onset CD (p < 0.01). Breast feeding delayed onset of symptoms: time lapse was significantly longer in children breast fed for a longer time (p < 0.001). On the contrary, age at first gluten ingestion seemed to have no influence on age at onset, since it was similar in both groups.