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Age-Dependent Trends in the Celiac Disease: A Tertiary Center Experience
Alexander Krauthammer1,2, Anat Guz-Mark1,2, Noam Zevit1,2
1Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel.
Insights
Younger children with celiac disease (CD) often show malabsorption symptoms and higher antibody levels, but improve faster on a gluten-free diet (GFD). Awareness of these age-dependent patterns is crucial for diagnosis and management.
Area of Science:
- Pediatric Gastroenterology
- Autoimmune Disorders
- Clinical Research
Background:
- Celiac disease (CD) is a common intestinal autoimmune disorder with varied clinical presentations.
- Understanding age-specific patterns in CD is essential for accurate diagnosis and effective management.
Purpose of the Study:
- To investigate age-dependent variations in the presentation, diagnosis, and management of celiac disease in pediatric patients.
- To compare clinical and laboratory features of CD across different pediatric age groups.
Main Methods:
- Retrospective review of electronic medical records for 932 pediatric patients diagnosed with CD.
- Patients were categorized into four age groups at diagnosis: 0-3, 3-6, 6-12, and 12-18 years.
- Demographic, clinical, and laboratory parameters were compared across the age groups.
Main Results:
- Younger children (0-3 years) more frequently exhibited diarrhea, weight loss, vomiting, abdominal distention, lower weight z-scores, hypoalbuminemia, and zinc deficiency.
- Anemia rates were higher in younger age groups (0-3 and 3-6 years).
- Patients aged 0-6 years more often presented with tissue transglutaminase (TTG) levels >10x ULN and normalized CD serologies faster on a gluten-free diet (GFD).
Conclusions:
- Celiac disease presentation and course in children vary significantly with age.
- Younger pediatric patients typically present with more pronounced malabsorptive symptoms and higher TTG levels.
- Faster serological normalization on GFD in younger children suggests distinct disease dynamics that clinicians should recognize.
Objectives:
Celiac disease (CD) is a common intestinal autoimmune disorder with diverse presenting features. We aimed to determine age-dependent patterns in CD presentation, diagnosis and management at a large tertiary referral center.
Methods:
A retrospective review of electronic medical records of pediatric patients diagnosed with CD between January 1999 and December 2018 at Schneider Children's Medical Center of Israel. We compared demographics, clinical and laboratory parameters between four age groups at CD presentation.
Results:
A cohort of 932 children was divided into four groups by age (in years) at diagnosis: 0-3 (17.9%), 3-6 (31.8%), 6-12 (34.5%), 12-18 (15.8%). The youngest age group presented more frequently with diarrhea, weight loss, abdominal distention, vomiting and lower weight z scores, P < 0.01. Hypoalbuminemia and zinc deficiency were also more frequent in this age group, compared to older patients (P < 0.05, each). Rates of anemia were higher in younger age groups (0-3 and 3-6 years), compared to older age groups, P < 0.05. Patients in the younger age groups (0-3 and 3-6 years) presented more frequently with tissue transglutaminase (TTG) levels above 10 times the upper limit of normal (ULN; P < 0.05), and more often normalized their CD serologies by 24 months of gluten-free diets (GFD) compared to older age groups (P < 0.05).
Conclusion:
There is an age-dependent variation in CD presentation during childhood. Younger patients present more often with malabsorptive features, and higher TTG levels, yet normalize TTG while on GFD more rapidly than older patients. Clinicians should be aware of the diversity in CD presentation and course at the various presentation age.
