Is the clinical pattern of pediatric celiac disease changing? A thirty-years real-life experience of an Italian center

Abstract Objectives Clinical presentation of pediatric celiac disease (CD) is heterogeneous and ever-evolving. Our aim is to highlight its changes throughout the years. Methods Data about clinical presentation of CD in children diagnosed between 1990 and 2020 at the CD Center of Maggiore Hospital, Bologna, were collected. Patients were stratified into groups based on the date [P1 (1990–2011), P2 (2012–2020)] and age [G1 (< 2 years), G2 (2–5), G3 (6–11), G4 (12–18)] at diagnosis, then investigated by comparing CD clinical presentation in different periods and ages. Results 1081 children were selected. Mean age at diagnosis increases from 5.9 to 6.6 years from P1 to P2. Gastrointestinal Symptoms (GIs) are predominant, with a decline of diarrhea (47%VS30%) and an increase of constipation (4%VS19%) (p < 0.001). Among Extraintestinal symptoms (EIs) a decrease of anemia (76%VS43%, p = 0,001) is observed. Failure to Thrive (FTT) is stable throughout the years (p = 0.03), while screenings show a trend of increment (19%VS23%). GIs’ frequency decline from G1 to G4 (p = 0,001), with reduction of diarrhea (p < 0.001), and rise of recurrent abdominal pain (p = 0,02). EIs are more frequent at older ages, FTT in younger patients. Conclusions Changes in clinical presentation of CD have occurred in the last 30 years. We observe a reduction of severe and classic gastroenterologic symptoms and a rise of atypical ones, together with a growth of serological screenings and higher age at diagnosis. Awareness about CD clinical trends is crucial for a proper approach and early diagnosis.

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Changes in Age at Diagnosis and Nutritional Course of Celiac Disease in the Last Two Decades

Nutrients ◽

10.3390/nu12010156 ◽

2020 ◽

Vol 12 (1) ◽

pp. 156 ◽

Cited By ~ 2

Author(s):

Mónica Villanueva ◽

Amaya Oyarzún ◽

Bárbara Leyton ◽

Mónica González ◽

Elizabeth Navarro ◽

...

Keyword(s):

Celiac Disease ◽

Nutritional Status ◽

Gastrointestinal Symptoms ◽

Failure To Thrive ◽

Age At Diagnosis ◽

Pediatric Hospitals ◽

Geographical Variations ◽

Number Of Patients ◽

Antiendomysial Antibodies

The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994–2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased (p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years (p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years (p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.

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The Use of Antigenic SARS-CoV-2 Point-of-Care Test: The Italian Pediatric Real-Life Experience

Clinical Pediatrics ◽

10.1177/00099228211053916 ◽

2021 ◽

pp. 000992282110539

Author(s):

Federica Ferrari ◽

Fortunata Civitelli ◽

Francesca Ardenti Morini ◽

Federico Angelo Carmelo Buonaiuto ◽

Gianluca Frega ◽

...

Keyword(s):

Life Experience ◽

Close Contact ◽

Point Of Care ◽

Pediatric Population ◽

Real Life ◽

Gastrointestinal Symptoms ◽

Point Of Care Test ◽

Large Numbers ◽

History Of ◽

Acute Rhinitis

In Italy, during the second epidemic wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rapid antigenic (Ag) test at point-of-care (POCT) station were employed to quickly evaluate large numbers of swabs. We collected data of all children who underwent the Ag test in our hospital. All positive patients were recalled to perform reverse transcription polymerase chain reaction. A total of 2133 tests were collected over 1 month. Clinical data of 1941 children (median age = 3.7 years) were analyzed: 1343 (69.2%) patients complained of symptoms, 594 (30.6%) had a history of close contact with SARS-CoV-2-positive individuals. Among symptoms reported, acute rhinitis was the most frequent (67.9%), followed by cough (42.6%) and fever (31.5%). Among all tests, 95.8% resulted negative, 4.2% positive: 37/89 were confirmed. In confirmed cases, fever (56.2% vs 32.2%; P = .041) and gastrointestinal symptoms (18.8% vs 6.25%; P = .041) were significantly more frequent compared with negative children. The use of POCT for Ag test seems appropriate for SARS-CoV-2 screening in the pediatric population. In children, fever and gastrointestinal symptoms may constitute red flags of SARS-CoV-2.

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Growth and sexual retardation in a boy with celiac disease

Problems of Endocrinology ◽

10.14341/probl2017632103-105 ◽

2017 ◽

Vol 63 (2) ◽

pp. 103-105

Author(s):

Lubov B. Brzhezinski ◽

Oleg Yu. Latyshev ◽

Lubov N. Samsonova ◽

Goar F. Okminyan ◽

Elena V. Kiseleva ◽

...

Keyword(s):

Celiac Disease ◽

Chorionic Gonadotropin ◽

Genetic Disorder ◽

Gastrointestinal Symptoms ◽

Reproductive Function ◽

Bone Age ◽

Recurrent Abdominal Pain ◽

Development Stage ◽

Inhibin B ◽

Negative Results

Growth and sexual retardation in boys can be caused by both endocrine and somatogenic causes. One of the somatogenic causes of growth and puberty retardation is celiac disease that is a genetic disorder of the small intestine, which is associated with deficiency of enzymes breaking down the gluten peptide. The clinical picture of celiac disease may be dominated by gastrointestinal manifestations (diarrhea, recurrent abdominal pain, nausea, constipation, appetite disorders) and nonspecific symptoms (irritability, apathy, physical and sexual retardation, impaired reproductive function, anemia, etc.). We present a case of late diagnosis of celiac disease in a 15-year-old boy with physical (height SDS, -4.1; bone age SDS, -8.2) and sexual (Tanner 1) retardation. The negative results of gonadoliberin (max LH, 2 mIU/mL) and chorionic gonadotropin (Δ-testosterone, 2,3 nmol/L) tests indicated the lack of activation of the hypothalamo-pituitary-gonadal system. However, inhibin B (29.9 pg/mL) and anti-Mullerian hormone (43.8 ng/mL) levels indicated preservation of the reserve capabilities of this system. During follow-up, after treatment with a gluten-free diet for 10 months, the patient demonstrated an improved growth rate (2.7 SDS), progression of the sexual development stage (Tanner 2), and positive results of diagnostic diphereline (max LH, 16.8 IU/mL) and chorionic gonadotropin (Δ-testosterone, 11.8 nmol/L) tests. This case demonstrates the need to exclude celiac disease in patients with growth and sexual retardation, especially when these pathologies are combined with protein-energy deficiency, gastrointestinal symptoms, and anemia, as well as the need to use additional indicators of the reproductive system condition in boys, e.g. inhibin B and anti-Mullerian hormone.

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Celiac Disease Presenting as Hemolytic Anemia Mimic: A Case Report

Indian Journal of Clinical Medicine ◽

10.1177/26339447211053438 ◽

2021 ◽

pp. 263394472110534

Author(s):

Anjum Siddiqui ◽

Ruhi Khan

Keyword(s):

Celiac Disease ◽

Hemolytic Anemia ◽

Clinical Presentation ◽

Gastrointestinal Symptoms ◽

Signs And Symptoms ◽

Severe Anemia ◽

Immune Mediated ◽

Systemic Disorder ◽

Variable Combination ◽

Disease Specific

Celiac disease, an immune-mediated enteropathy, results from gluten ingestion in the form of wheat, rye, and barley in genetically susceptible individuals. It is a systemic disorder characterized by a variable combination of gluten-related signs and symptoms, and disease-specific antibodies in addition to enteropathy. The clinical presentation of celiac disease is extremely variable: a small proportion of patients presenting with severe gastrointestinal symptoms and malabsorption, and extraintestinal symptoms, and a large proportion having no symptoms at all. Owing to the varied clinical presentation, diagnosing celiac disease remains a challenge. We present a case of celiac disease presenting with severe anemia and clinical features suggestive of hemolytic anemia, making diagnosis even more difficult.

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Pernio as the clinical presentation of celiac disease: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20940442 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2094044

Author(s):

Alexandre Lemieux ◽

Natasha Emily Sanchez Vivas ◽

Julie Powell ◽

Prévost Jantchou ◽

Marie-Paule Morin

Keyword(s):

Celiac Disease ◽

Case Report ◽

Pharmacological Treatment ◽

Clinical Remission ◽

Clinical Presentation ◽

Gastrointestinal Symptoms ◽

Skin Lesions ◽

Gluten Free Diet ◽

Gluten Free

We present the case of a 12-year-old girl with severe pernio as the sole clinical presentation of celiac disease (CD), without associated gastrointestinal symptoms. Lesions greatly improved once a gluten free diet was initiated. At 5-year follow-up, she remains in clinical remission throughout the year with no pharmacological treatment, without skin lesions flare-up in the winter months.

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Clinical Presentation of Celiac Disease and Diagnosis Accuracy in a Single-Center European Pediatric Cohort over 10 Years

Nutrients ◽

10.3390/nu13114131 ◽

2021 ◽

Vol 13 (11) ◽

pp. 4131

Author(s):

Anna Rita Di Biase ◽

Giovanni Marasco ◽

Federico Ravaioli ◽

Luigi Colecchia ◽

Elton Dajti ◽

...

Keyword(s):

Celiac Disease ◽

Clinical Presentation ◽

Tissue Transglutaminase ◽

Gastrointestinal Symptoms ◽

University Hospital ◽

Pediatric Gastroenterology ◽

Atypical Symptoms ◽

Upper Limit ◽

Diagnosis Accuracy ◽

The University

(1) Background: Changes in the clinical presentation of celiac disease (CD) in children have been reported. The guidelines of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) allow esophagogastroduodenoscopy (EGD) with biopsies to be avoided under specific circumstances. We aimed to assess the clinical picture of pediatric CD patients at diagnosis and to validate ESPGHAN non-biopsy criteria. (2) Methods: Patients with suspected CD or undergoing screening from 2004 to 2014 at the University Hospital in Modena, Italy were enrolled. The accuracy of ESPGHAN non-biopsy criteria and modified versions were assessed. (3) Results: In total, 410 patients were enrolled, of whom 403 were considered for analysis. Of the patients considered, 45 were asymptomatic and diagnosed with CD (11.2%) while 358 patients (88.2%) were symptomatic, of whom 295 were diagnosed with CD. Among symptomatic CD patients, 57 (19.3%) had gastrointestinal symptoms, 98 (33%) had atypical symptoms and 140 (47.4%) had both. No difference was found for the presence of gastrointestinal symptoms at different ages. The non-biopsy ESPGHAN criteria yielded an accuracy of 59.4% with a positive predictive value (PPV) of 100%; 173 out of 308 EGD (56.2%) could have been avoided. The modified 7× and 5× upper limit of normal cut-offs for IgA anti tissue-transglutaminase reached 60.7% and 64.3% of EGD avoided, respectively. (4) Conclusions: Over 10 years, late age at diagnosis and increased rates of atypical CD presentation were found. ESPGHAN non-biopsy criteria are accurate for CD diagnosis and allow half of unneeded EGD to be avoided. Modified versions allowed sparing a greater number of EGD.

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