Abstract
The study enrolled 590 patients presenting with the following characteristics: age 0–14 years; diagnosis of CD based on ESPGHAN criteria. The symptoms have been divided into types: classic (chronic diarrhea, abdominal distension, weight loss, celiac crisis) and non-classic, further divided into gastrointestinal (irritable bowel syndrome, recurrent abdominal pain, growth delay, vomiting, poor appetite, constipation) and extra-gastrointestinal (puberal delay, dental enamel defects, irritability, hypertransaminasemia, anemia, headache, vertigo, aphtous stomatitis, sideropenia). Results: The study group included 221 males [average age 78±44 (SD) months] and 369 females [average age 70±43 (SD) months], with a M:F ratio of 1:1.7. Based on clinical, immunological and histological features, patients have been classified as follows: 186 cases of CD with classic symptoms (32%); 252 cases of CD with non-classic symptoms (43%); 103 cases of silent CD (17%) and 49 cases of potential CD (8%). By analyzing the percentage of different clinical forms in three periods of time (1985–1993, 1994–2002 and 2003–2013), we have obtained these results: CD with classic symptoms 76% vs 33% vs 30%; CD with non-classic symptoms 18% vs 42% vs 44%; silent CD 6% vs 13% vs 19%. Potential CD cases have had an inconstant trend (0% vs 12% vs 8%). Taking into account the biopsy-confirmed celiac patients, mild villous atrophy (Marsh 3a) came out to be the most represented lesion both in patients with classic symptoms, and in those with non-classic symptoms (43% vs 61%). Conclusions: The clinical presentation of CD in children has changed over the last thirty years, with a predilection for atypical presentations. This means that it is crucial to focus on non-classic symptoms not only in order to identify the highest number of possible CD cases, but also to prevent the long term complications of this pathology (autoimmune diseases and intestinal lymphomas) by commencing a gluten free diet as soon as possible.
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