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Clinics of coeliac disease in children in the 2000s
E Savilahti1, K-L Kolho, M Westerholm-Ormio
1Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. erkki.savilahti@hus.fi
Insights
Coeliac disease (CD) presentation varies by age, with younger children experiencing chronic diarrhea and older children reporting abdominal pain. Despite increased diagnoses, many pediatric CD cases remain undetected.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Clinical Medicine
Background:
- Coeliac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- Understanding the evolving clinical presentation of pediatric CD is crucial for timely diagnosis and management.
- Previous studies highlight diagnostic challenges and varying prevalence rates in children.
Purpose of the Study:
- To delineate the current clinical spectrum of coeliac disease in children.
- To analyze changes in CD presentation over recent decades.
- To assess the diagnostic yield compared to historical data.
Main Methods:
- Retrospective analysis of clinical data from 197 pediatric coeliac disease patients diagnosed between 2000-2005.
- Data collection from hospital records, including presenting symptoms, growth parameters, and laboratory findings.
- Histopathological examination of duodenal biopsies for intraepithelial lymphocyte analysis.
Main Results:
- The primary symptom in children under 3 was chronic diarrhea (67%), while older children presented with abdominal pain.
- At diagnosis, 6.6% of patients had severe growth retardation; mean height was -0.06 SD.
- Significant improvements in height and weight were observed after 6 months of a gluten-free diet. Anemia and iron deficiency were noted in 25% and 43% of patients, respectively. Pathological intraepithelial T-cell receptor gamma/delta cells were found in all biopsied specimens.
Conclusions:
- Pediatric coeliac disease presentation is age-dependent.
- Despite a sixfold increase in diagnoses compared to 1976-1985, current detection rates suggest many cases remain undiagnosed.
- Early diagnosis and dietary intervention are vital for improving growth outcomes in children with CD.
Objective:
To describe the clinical picture of patients with coeliac disease (CD) and the change in its presentation over the past decades.
Study Design:
Patients with CD were identified and clinical data collected from hospital records over a 6-year period (2000-2005).
Results:
Altogether 197 patients aged 0.6-15.9 (mean 7.2) years were identified. They were found amongst the child population served by the hospital, the mean number of children at age 0.5-16 years was 268 000 during 2000-2005. The presenting symptom amongst the youngest patients (<3 years) was chronic diarrhoea (in 67%), and amongst older patients, abdominal pain. At the time of diagnosis, growth was severely retarded (height <2 SD for age) in 6.6%; mean height was -0.06 SD and weight + 1% for height. After diet treatment for a mean of 6 months, both height and weight increased significantly. Anaemia and iron deficiency were present in 25% and 43% of patients respectively. Intraepithelial T-cell receptor gamma/delta cells were pathologic in all 150 specimens studied.
Conclusions:
The presentation of CD depends on age. Even when we found six times more patients than during years 1976-1985 in the same hospital, published data on the prevalence of CD suggest that we found only a small minority of children with CD.
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