Two decades of pediatric celiac disease in a tertiary referral center: What has changed?
Alexander Krauthammer1, Anat Guz-Mark2, Noam Zevit2
1Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Israel.
Insights
Pediatric celiac disease (CD) presentation has shifted towards milder symptoms and asymptomatic cases. Recent decades show improved gluten-free diet adherence and faster serology normalization in children with CD.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Clinical Medicine
Background:
- Celiac disease (CD) is a prevalent global autoimmune disorder.
- The presentation and management of CD are evolving over time.
Purpose of the Study:
- To analyze shifts in pediatric celiac disease presentation and management over two decades.
- To compare clinical and laboratory findings between early and late study periods.
Main Methods:
- Retrospective chart review of 932 pediatric celiac disease patients (1999-2018).
- Comparison of presentation and follow-up data between two 10-year periods (1999-2008 vs. 2009-2018).
Main Results:
- Patients in the later decade showed lower rates of weight loss and abdominal distention.
- Increased abdominal pain and asymptomatic presentations were noted in the later decade.
- Improved gluten-free diet adherence and faster celiac serology normalization were observed in recent years.
Conclusions:
- Children with celiac disease are increasingly diagnosed with milder symptoms.
- Enhanced adherence to gluten-free diets contributes to better outcomes.
- Earlier normalization of celiac serology is achievable with current management strategies.
Background:
Celiac disease (CD) is common worldwide with increasing prevalence and changing presentation.
Aims:
To evaluate changes in the presentation and management of CD over the last two decades.
Methods:
Retrospective chart review of pediatric patients with CD between 01.1999 to 12.2018 was performed. Comparisons were made between an early (1999 to 2008) and late (2009 to 2018) decade, regarding clinical and laboratory parameters at presentation and follow-up.
Results:
In a cohort of 932 patients (early decade n = 316, late decade n = 616), patients from the late decade presented with lower rates of weight loss and abdominal distention (24.2% vs 34.7% and 6% vs 11%, respectively p < 0.01), and with higher rates of abdominal pain or asymptomatic presentation (41.4% vs 27.4%, p < 0.01, and 18% vs 13%, p < 0.05, respectively). Good adherence to gluten-free diet was reported more often in the late decade (64% vs 50.6%, p < 0.001), and fewer patients were lost to follow-up. During the late decade, significantly higher rates of celiac serology normalization were achieved during the first two years of follow-up.
Conclusion:
In recent years, children with CD were diagnosed with milder symptoms, showed better adherence and demonstrated earlier normalization of celiac serology.
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