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Clinical presentation and factors associated with gluten exposure in children with celiac disease
Andrew Krueger1, Lisa Fahey2,3, Qin Sun4
1Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Insights
Celiac disease (CeD) presents variably in children, with 14% at high risk for gluten exposure. Younger age and lack of follow-up impact adherence to a gluten-free diet.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Genetics
Background:
- Celiac disease (CeD) prevalence is rising, yet underdiagnosis persists due to varied symptoms.
- Adherence to a gluten-free diet (GFD) presents significant challenges for affected individuals.
Purpose of the Study:
- To characterize the clinical presentation of CeD in a large pediatric cohort.
- To identify factors influencing GFD adherence in children with CeD.
Main Methods:
- Recruited 460 pediatric CeD patients (0-18 years) from 11 US health centers.
- Collected data via parent surveys on GFD adherence and electronic health record review.
- Utilized logistic regression to identify risk factors for gluten exposure.
Main Results:
- Diverse symptoms were observed, with abdominal pain in 57% of patients.
- 14% of participants were at high risk for gluten exposure.
- Younger children (<5 years) had lower gluten exposure risk; lack of repeat serology was linked to higher risk.
Conclusions:
- Pediatric CeD exhibits highly variable clinical presentations, requiring a high index of suspicion for diagnosis.
- Parental reports indicate 14% of pediatric CeD patients are at high risk for gluten exposure.
- Patient age and infrequent follow-up testing are associated with GFD adherence challenges.
Objectives:
The prevalence of celiac disease (CeD) is increasing, yet it is still underdiagnosed, in part because of its heterogeneous presentation. Diagnostic criteria are evolving and management with strict adherence to a gluten-free diet is challenging for many. We aimed to characterize the clinical presentation of CeD among a large multicenter cohort of pediatric patients and to identify factors associated with gluten-free diet adherence.
Methods:
Patients with CeD aged 0-18 years were recruited from 11 United States health centers. Parents completed surveys about gluten-free diet adherence and patient electronic health records were reviewed. Logistic regression analyses were performed to identify risk factors associated with gluten exposure.
Results:
Charts were reviewed for 460 children with a median age of 6.4 years. Abdominal pain was reported in 57% of the cohort, but diverse symptoms were identified. Parent surveys were completed for 455 participants. Sixty-five (14%) participants were at high risk for gluten exposure based on parental reports of weekly or daily gluten exposure or eating gluten by choice in the past year. Participants under the age of 5 years had a lower risk of gluten exposure, while participants without repeat serology testing 18 months after initial diagnosis were at higher risk of gluten exposure.
Conclusions:
In a large, multicenter cohort of pediatric CeD patients, clinical presentation is highly variable, necessitating a high index of suspicion to make a diagnosis. Parent surveys indicate that 14% of patients are at high risk of gluten exposure, with patient age and lack of close follow-up associated with gluten-free diet adherence.
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