Celiac disease symptomatology in patients with disease onset prior to age five

Celiac disease (CeD) is an autoimmune disease induced by ingestion of gluten. Patients may present with stereotypical gastrointestinal symptoms, including bloating and diarrhea, but can also present with nongastrointestinal symptoms such as migraines or rashes. The clinical presentation is well described in older pediatric and adult populations; however, the clinical picture is less clear for younger, preschool-aged pediatric patients. This retrospective chart review aims to describe the clinical presentation and serological values seen in patients diagnosed with CeD whose symptoms began before 5 years of age.

A retrospective review of a single pediatric CeD institution was conducted, and 82 children diagnosed with CeD with symptom onset before 5 years of age were identified.

Children with symptom onset on or before 24 months of age were significantly more likely to have higher symptom burden (5 vs. 4, p = 0.0120). Most notable are vomiting (52.5% vs. 19%, p = 0.0024), mood changes (40% vs. 7.1%, p = 0.0005), poor weight gain (67.5% vs. 41.5%, p = 0.0164), and poor linear growth (35% vs. 11.9%, p = 0.0182). This subgroup was more likely to be hospitalized within 3 months of diagnosis (12.5% vs. 0, p = 0.0241). Children who had symptom onset after 24 months were more likely to have abdominal pain (30% vs. 59.5%, p = 0.0086) and sparser extraintestinal symptoms (p = 0.0224). No matter the age of symptom onset, there was no difference in the time interval to diagnosis.

This study adds to the literature evidence of the extraintestinal presentation of CeD that is seen in toddler-aged patients, as well as increased incidence of hospitalization at the time of diagnosis in this age group.