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Published on: July 5, 2022
[Diagnosis and clinical presentations of celiac disease: a multicenter study]
Paulina Canales R1, Magdalena Araya Q, Francisco Alliende G
1Servicio de Pediatría, Hospital Exequiel González Cortés, Chile.
Insights
Pediatric celiac disease diagnosis in Chile shows a 2.1-year delay. Digestive symptoms are common in younger children, while older children present with atypical symptoms like short stature. Improved screening and food labeling are crucial.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Clinical Diagnostics
Context:
- Celiac disease epidemiology has shifted due to sensitive serological markers.
- The impact of these changes in Chile remains understudied.
- Current pediatric diagnostic practices for celiac disease require assessment.
Purpose:
- To evaluate diagnostic procedures for celiac disease in Chilean pediatric practice.
- To analyze clinical presentations and follow-up of pediatric celiac disease cases.
- To identify areas for improvement in celiac disease management.
Summary:
- A retrospective study analyzed 74 pediatric celiac disease patients diagnosed between 2000-2005 in Santiago, Chile.
- Diagnosis averaged 2.1 years, with younger children showing digestive symptoms and older children exhibiting atypical signs like short stature.
- Commonly used serological tests (IgA-antiendomysial, IgA-antigliadin) were not always available for follow-up, and dietary transgressions complicated management.
Impact:
- Highlights the diagnostic delay and varied presentations of celiac disease in Chilean children.
- Recommends incorporating antiendomysial and antitransglutaminase antibody testing for routine screening and follow-up.
- Emphasizes the need for improved gluten content labeling on food products to aid patient management.
Background:
Ample use of serological markers of high sensitivity and specificity led to relevant changes in the epidemiology of celiac disease. The impact of these changes in our country is poorly known.
Aim:
To assess the diagnostic procedures, clinical presentations and follow up of celiac disease as conducted in current pediatric practice.
Material And Methods:
A multicentric retrospective study of patients diagnosed between 2000 and 2005 in five pediatric hospitals in Santiago, Chile. Data was obtained from clinical records, recorded in electronic spreadsheets and analyzed by descriptive statistics.
Results:
Seventy four of 83 identified patients fulfilled the inclusion criteria and were analyzed. Mean time to reach the diagnosis was 2.1 years. Cases younger than 10 years presented digestive manifestations such as chronic diarrhea and abdominal distension. Twenty one percent of older patients had atypical presentations (mainly short stature, refractory anaemia). Ten percent of cases were screened because a first degree relative had celiac disease. All patients had significant duodenal/jejunal lesion. IgA-antiendomysial antibodies (n =65) and IgA-antigliadin antibodies (n =23) were the most commonly used screening tests used but often, they were not available for follow up. A second biopsy was planned in all patients but only 26 had it due to repeated dietary transgressions, often due to unnoticed consumption of gluten in poorly labeled products.
Conclusions:
Digestive manifestations were the main presentation form for celiac disease among patients under 10 years of age. Atypical symptoms become relevant in patients older than 10 years. Antiendomysial and antitransglutaminase antibody measurement should be incorporated for routine screening and follow up of celiac disease in public hospitals. To improve food labeling about their gluten content is needed.
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