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Transient gastro-intestinal disorders during infancy and early childhood. A follow-up study with special reference to
Insights
Many children with coeliac disease (CD) were identified through intestinal biopsy, even with minimal symptoms. This highlights the need for biopsies in those with a history of infant gastro-intestinal issues.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Gastroenterology
Background:
- Coeliac disease (CD) diagnosis can be challenging in children, especially those lost to follow-up or initially misdiagnosed.
- A significant number of pediatric patients with a history of gastro-intestinal symptoms may remain undiagnosed.
Purpose of the Study:
- To re-evaluate children and adolescents with a history suggestive of coeliac disease.
- To determine the prevalence of undiagnosed coeliac disease in specific pediatric cohorts.
- To assess the utility of clinical examination and serological markers versus intestinal biopsy for CD diagnosis.
Main Methods:
- A reappraisal study involving 38 children and adolescents.
- Group A: 20 patients with a prior CD diagnosis lost to follow-up.
- Group B: 18 patients hospitalized for gastro-intestinal symptoms without a CD diagnosis.
- Clinical examination, Hb, serum IgA, and folate levels were analyzed.
- Intestinal biopsies were performed for definitive diagnosis.
Main Results:
- Clinical examinations and serological tests (Hb, IgA, folate) were not effective in identifying coeliac disease cases.
- Intestinal biopsy revealed coeliac disease in 8 patients (40%) in Group A and 6 patients (33.3%) in Group B.
- All 14 diagnosed patients had minimal complaints prior to biopsy.
- The prevalence of CD was similar in both groups.
Conclusions:
- Intestinal biopsy is crucial for diagnosing coeliac disease, particularly in children with a history of infant malabsorption-related symptoms.
- Liberal indications for intestinal biopsy should be considered in this patient population.
- Many undiagnosed coeliac disease cases can be identified through this approach.
Abstract:
In a reappraisal study of coeliac disease (CD) 38 children and adolescents were studied: 20 (group A) had a previous diagnosis of CD from early childhood but had been lost to follow-up, 18 (group B) had in infancy or early childhood been hospitalized for more than 1 month for different gastro-intestinal symptoms without receiving a diagnosis of CD. In the present study the patients had a clinical examination and Hb, serum IgA and folate were analysed. These investigations did not prove helpful in selecting coeliac cases. Intestinal biopsy revealed CD in 8 patients in group A and in 6 patients in group B. Thus the frequency of CD was almost the same in the two groups. All 14 patients with CD had very few complaints, when a careful medical history was taken before biopsy. The present study shows the importance of performing intestinal biopsy on liberal indications on patients with an infancy or early childhood history of malabsorption-related symptoms. Among these patients many coeliacs are likely to be found.