The Changing Clinical Presentationof Celiac Disease

Pediatr Adolesc Med. Basel, Karger, 2008, vol 12, pp 18–22Lebenthal E. et al. presented by: Nargess Tavakoli Guilan university of medical sciences

have changed considerably over the past 20 years

IncidenceIncidence Age at presentationAge at presentation The featuresfeatures of celiac disease (CD) in

children

Decrease:

Cases with GI symptoms at presentation

Increase

Cases with non specific & subtle symptoms at presentation

Cases diagnosed by screening

CD associated autoimmune disease

It is apparent

most children with CD

remain undiagnosed

Currently

most patients present

With subtle or non-gastrointestinal manifestations

at a later age

Median age at presentation

Has shifted: from 4 to 8

years

childhood prevalence =1%

The past:

primarily a disorder ofEuropean and Western

populations

Currently :

more & more reports: a global problema global problem

A significant protection affect

the duration of breastfeeding

(exclusive or partial)

The data do not support

the influence of age at first dietary gluten exposure

children who carried CD HLA_DQ2 & DQ8

Rotavirus infectionsRotavirus infections

&

incensement in the risk of CD autoimmunity

delay in diagnosis of 11.7 years.(Canadian Celiac Health survey)

anemia (40%) stress (31%) IBS (29%) Osteoporosis & low bone

density(35%)

Gluten withdrawal

does not prevent the development of autoimmune diseasesautoimmune diseases

GenerallyGenerally

may disappeardisappear after starting a gluten-free diet

insulin-dependent diabetes

thyroid-specific autoantibodies

Improvement may occur

Cardiomyopathy Thyroiditis Peripheral neuropathy

with a gluten-free diet

Conclusion

Only a small number of patients present with the ‘classical’ symptoms

marked weight lossMalnutritionsteatorrhea

Many manifest:

extra-intestinal symptoms & nonspecific findings

.

growth failure unexplained iron deficiency anemia recurrent abdominal pain osteoporosis Asymptomatic: they have affected

family members or with associated diseases