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The Spectrum of Differences between Childhood and Adulthood Celiac Disease
Rachele Ciccocioppo1, Peter Kruzliak2, Giuseppina C Cangemi3
1Rachele Ciccocioppo, Center for the Study and Cure of Celiac Disease, Clinica Medica I, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, 19-27100 Pavia, Italy. rachele.ciccocioppo@unipv.it.
Insights
Celiac disease presents differently in children versus adults, impacting diagnosis and treatment. Management strategies must consider age-specific factors for this lifelong condition.
Area of Science:
- Gastroenterology
- Pediatric Medicine
- Immunology
Background:
- Celiac disease (CD) is increasingly recognized in adults and the elderly, challenging the historical view of it being primarily a childhood disorder.
- Pediatric celiac disease exhibits unique epidemiological, diagnostic, clinical, and therapeutic characteristics compared to adult presentations.
Purpose of the Study:
- To highlight the distinct features of celiac disease in pediatric populations.
- To emphasize the age-dependent variations in celiac disease management.
Main Methods:
- Review of current clinical guidelines for celiac disease diagnosis and management.
- Analysis of age-specific differences in epidemiology, clinical presentation, and treatment response.
Main Results:
- Celiac disease diagnosis involves serologic testing, with upper endoscopy and duodenal biopsy typically required.
- Endoscopic biopsy may be waived in pediatric cases with high anti-transglutaminase antibody titers.
- Management protocols must account for the lifelong nature of celiac disease and age at diagnosis.
Conclusions:
- Celiac disease management requires age-specific considerations due to significant pediatric-adult differences.
- Early diagnosis and tailored, lifelong management are crucial for celiac disease patients.
Abstract:
An old saying states that ''children are not little adults" and this certainly holds true for celiac disease, as there are many peculiar aspects regarding its epidemiology, diagnosis, clinical presentations, associated diseases, and response to treatment in pediatric compared to adult populations, to such an extent that it merits a description of its own. In fact, contrary to the past when it was thought that celiac disease was a disorder predominantly affecting childhood and characterized by a malabsorption syndrome, nowadays it is well recognized that it affects also adult and elderly people with an impressive variability of clinical presentation. In general, the clinical guidelines for diagnosis recommend starting with specific serologic testing in all suspected subjects, including those suffering from extraintestinal related conditions, and performing upper endoscopy with appropriate biopsy sampling of duodenal mucosa in case of positivity. The latter may be omitted in young patients showing high titers of anti-transglutaminase antibodies. The subsequent management of a celiac patient differs substantially depending on the age at diagnosis and should be based on the important consideration that this is a lifelong condition.
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