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Clinical Presentation in Children With Coeliac Disease in Central Europe
Petra Riznik1, Luigina De Leo2, Jasmina Dolinsek3
1Department of Paediatrics, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, Maribor, Slovenia.
Insights
Coeliac disease (CD) in children now often presents with abdominal pain or no symptoms, especially in older kids. Younger children still frequently show malabsorption signs. This study analyzed CD presentation across Central Europe.
Area of Science:
- Pediatric Gastroenterology
- Clinical Immunology
- Celiac Disease Research
Background:
- Coeliac disease (CD) presentation has shifted towards nonclassical, oligosymptomatic, and asymptomatic forms over decades.
- Understanding these evolving clinical patterns in pediatric populations is crucial for timely diagnosis.
Purpose of the Study:
- To assess the current clinical presentation of coeliac disease (CD) in children and adolescents in Central Europe.
- To identify differences in CD presentation between very young children (<3 years) and older children/adolescents.
Main Methods:
- Retrospective data collection from pediatric gastroenterologists across 5 Central European countries (Croatia, Germany, Hungary, Italy, Slovenia).
- Analysis of clinical presentation in 653 diagnosed pediatric CD patients.
- Comparison of symptoms and disease forms based on age groups.
Main Results:
- 653 pediatric patients diagnosed with CD were analyzed; 20% were asymptomatic.
- Abdominal pain was the most frequent leading symptom (33.3%) in symptomatic children.
- Younger children (<3 years) more commonly exhibited malabsorption signs (P<0.001), while older children/adolescents presented more frequently with abdominal pain and asymptomatic disease (P<0.001).
Conclusions:
- Abdominal pain is now the predominant symptom of coeliac disease in children.
- Malabsorption symptoms remain significant in very young children with CD.
- The shift towards nonclassical and asymptomatic CD presentations warrants further investigation into underlying mechanisms.
Objectives:
During the past decades, there has been a shift in the clinical presentation of coeliac disease (CD) to nonclassical, oligosymptomatic, and asymptomatic forms. We assessed clinical presentation of CD in children and adolescents in Central Europe.
Methods:
Paediatric gastroenterologists in 5 countries retrospectively reported data of their patients diagnosed with CD. Clinical presentation was analyzed and the differences among very young (<3 years) and older children and adolescents were studied.
Results:
Data from 653 children and adolescents (median age 7 years 2 months; 63.9% girls) from Croatia, Germany, Hungary, Italy, and Slovenia were available for the analysis. One fifth (N = 134) of all children were asymptomatic. In symptomatic children, the most common leading symptom was abdominal pain (33.3%), followed by growth retardation (13.7%) and diarrhoea (13.3%). The majority of symptomatic children (47.6%; N = 247) were polysymptomatic. Abdominal pain was the most common symptom in polysymptomatic (66.4%) as well as in monosymptomatic children (29.7%). Comparing clinical presentation of CD in very young children (younger than 3 years) with older children (3 years or older), we found that symptoms and signs of malabsorption were significantly more common in younger (P < 0.001), whereas abdominal pain and asymptomatic presentation were more common in older children and adolescents (both P < 0.001).
Conclusion:
In children with CD, abdominal pain has become the most common symptom. However, in younger children, symptoms of malabsorption are still seen frequently. This raises a question about the underlying mechanism of observed change in clinical presentation in favour of nonclassical presentation and asymptomatic disease at certain age.
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