Changing clinical presentation of pediatric celiac disease over time
Ozlem Kalaycik Sengul1, Petek Bal Gumustas2, Kardelen Celikel2
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey. kalaycikoz@yahoo.com.
Background:
Celiac disease (CD), often associated with malabsorption, presents with a wide spectrum of gastrointestinal and extra-intestinal manifestations. It was aimed to investigate changes in the clinical presentation of CD in children over a 16-year period and to assess whether clinical forms (classical, non-classical and asymptomatic) vary according to age, sex, and histopathological severity.
Methods:
This retrospective study included 216 pediatric patients (aged 1-18 years) diagnosed with biopsy-confirmed CD at a tertiary center between January 2008 and November 2023. Patients were divided into two groups based on the year of diagnosis (group 1 = 2008-2015, group 2 = 2016-2023). Demographics, presenting symptoms, histopathological findings, Oslo-based clinical classifications were analyzed.
Results:
The mean age at diagnosis was 92.0 ± 51.2 months, with female predominance (65%). Classical CD was observed in 53.2% of the patients. Over time, the overall distribution of clinical presentation did not differ significantly between the two periods (p = 0.658), although classical CD decreased numerically and non-classical CD increased numerically. Diarrhea and abdominal distention decreased significantly (p = 0.008 and p = 0.006), while constipation (p = 0.063) and isolated short stature (p = 0.304) showed numerical increases that did not reach statistical significance. Histopathological severity decreased over time, with a significant reduction in total villous atrophy (Marsh 3 C, p < 0.001). Asymptomatic patients were diagnosed at an older age than the other clinical presentation groups (three-group comparison, p = 0.007).
Conclusions:
The clinical profile of pediatric CD appears to be evolving, with a significant decline in classical symptoms - especially chronic diarrhea and abdominal distension, alongside numerical (non-significant) trends toward increased non-classical manifestations such as constipation and isolated short stature. Awareness of these evolving presentations, including non-classical and screen-detected diseases, is essential for early diagnosis and prevention of long-term complications.
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