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Increasing Incidence and Altered Presentation in a Population-based Study of Pediatric Celiac Disease in North
Eyad Almallouhi1, Katherine S King, Bhavisha Patel
1*Division of Pediatric Gastroenterology and Hepatology †Division of Biomedical Statistics and Informatics ‡Division of Allergy, Department of Internal Medicine §Division of Gastroenterology and Hepatology ||Asthma Epidemiology Research Unit, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
Insights
Childhood celiac disease (CD) incidence and prevalence are rising, with more nonclassical and asymptomatic cases emerging. This trend highlights evolving clinical presentations and the need for ongoing surveillance in pediatric populations.
Area of Science:
- Gastroenterology
- Pediatrics
- Epidemiology
Background:
- Celiac disease (CD) is an immune-mediated disorder affecting up to 1% of the population.
- Recent data suggest a plateau in CD incidence in many regions.
- Understanding trends in childhood CD is crucial for public health.
Purpose of the Study:
- To investigate the incidence and changing presentation of celiac disease in children.
- To analyze demographic and clinical data of pediatric CD cases over a 20-year period.
Main Methods:
- Retrospective review of medical records from the Rochester Epidemiology Project (1994-2014).
- Inclusion of patients aged 18 years or younger at diagnosis.
- Calculation of incidence rates standardized to the 2010 US white population.
Main Results:
- Identified 100 pediatric CD cases, with incidence increasing from 8.1 to 21.5 per 100,000 person-years.
- Prevalence rose from 0.10% in 2010 to 0.17% in 2014.
- Nonclassical (43%) and asymptomatic (23%) presentations were common; 36% had complete villous atrophy.
Conclusions:
- Both incidence and prevalence of pediatric celiac disease continue to increase.
- Clinical and pathological presentations are evolving, with more nonclassical and asymptomatic cases.
- These findings underscore the dynamic nature of childhood CD and the importance of continued monitoring.
Objectives:
Celiac disease (CD) is a common immune-mediated disorder that affects up to 1% of the general population. Recent reports suggest that the incidence of CD has reached a plateau in many countries. We aim to study the incidence and altered presentation of childhood CD in a well-defined population.
Methods:
Using the Rochester Epidemiology Project, we retrospectively reviewed Mayo Clinic and Olmsted Medical Center medical records from January 1994 to December 2014. We identified all CD cases of patients ages 18 years or younger at the time of diagnosis. Incidence rates were calculated by adjusting for age, sex, and calendar year and standardizing to the 2010 US white population.
Results:
We identified 100 patients with CD. Incidence of CD has increased from 8.1 per 100,000 person-years (2000-2002) to 21.5 per 100,000 person-years (2011-2014). There was an increase in CD prevalence in children from 2010 (0.10%) to 2014 (0.17%). Thirty-four patients (34%) presented with classical CD symptoms, 43 (43%) had nonclassical CD, and 23 (23%) were diagnosed by screening asymptomatic high-risk patients. Thirty-six patients (36%) had complete villous atrophy, 51 (51%) had partial atrophy, and 11 (11%) had increased intraepithelial lymphocytes. Two patients were diagnosed without biopsy. Most patients (67%) had a normal body mass index, 17% were overweight/obese, and only 9% were underweight.
Conclusions:
Both incidence and prevalence of CD have continued to increase in children during the past 15 years in Olmsted County, Minnesota. Clinical and pathologic presentations of CD are changing over time (more nonclassical and asymptomatic cases are emerging).
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