Petra Riznik1, Luigina De Leo2, Jasmina Dolinsek3, Judit Gyimesi4, Martina Klemenak1, Berthold Koletzko5,6, Sibylle Koletzko6,7, Ilma Rita Korponay-Szabó4,8, Tomaz Krencnik1, Tarcisio Not2, Goran Palcevski9, Daniele Sblattero10, Katharina Julia Werkstetter6, Jernej Dolinsek1,11. 1. Department of Paediatrics, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, Maribor, Slovenia. 2. IRCCS Burlo Garofolo Trieste, Institute for Maternal and Child Health, Trieste, Italy. 3. Municipality of Maribor, Project Office, Maribor, Slovenia. 4. Heim Pál National Paediatric Institute, Coeliac Disease Centre, Budapest, Hungary. 5. Stiftung Kindergesundheit (Child Health Foundation), Dr. von Hauner Children's Hospital. 6. Dr. von Hauner Children's Hospital, Clinical Medical Centre, LMU, Munich, Germany. 7. Department of Paediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland. 8. Faculty of Medicine, Department of Paediatrics, University of Debrecen, Debrecen, Hungary. 9. Department for Gastroenterology, Paediatric Clinic, University Hospital Rijeka, Rijeka, Croatia. 10. University of Trieste, Trieste, Italy. 11. Medical Faculty, Department of Paediatrics, University of Maribor, Maribor, Slovenia.
Abstract
OBJECTIVES: During the past decades, there has been a shift in the clinical presentation of coeliac disease (CD) to nonclassical, oligosymptomatic, and asymptomatic forms. We assessed clinical presentation of CD in children and adolescents in Central Europe. METHODS: Paediatric gastroenterologists in 5 countries retrospectively reported data of their patients diagnosed with CD. Clinical presentation was analyzed and the differences among very young (<3 years) and older children and adolescents were studied. RESULTS: Data from 653 children and adolescents (median age 7 years 2 months; 63.9% girls) from Croatia, Germany, Hungary, Italy, and Slovenia were available for the analysis. One fifth (N = 134) of all children were asymptomatic. In symptomatic children, the most common leading symptom was abdominal pain (33.3%), followed by growth retardation (13.7%) and diarrhoea (13.3%). The majority of symptomatic children (47.6%; N = 247) were polysymptomatic. Abdominal pain was the most common symptom in polysymptomatic (66.4%) as well as in monosymptomatic children (29.7%). Comparing clinical presentation of CD in very young children (younger than 3 years) with older children (3 years or older), we found that symptoms and signs of malabsorption were significantly more common in younger (P < 0.001), whereas abdominal pain and asymptomatic presentation were more common in older children and adolescents (both P < 0.001). CONCLUSION: In children with CD, abdominal pain has become the most common symptom. However, in younger children, symptoms of malabsorption are still seen frequently. This raises a question about the underlying mechanism of observed change in clinical presentation in favour of nonclassical presentation and asymptomatic disease at certain age.
OBJECTIVES: During the past decades, there has been a shift in the clinical presentation of coeliac disease (CD) to nonclassical, oligosymptomatic, and asymptomatic forms. We assessed clinical presentation of CD in children and adolescents in Central Europe. METHODS: Paediatric gastroenterologists in 5 countries retrospectively reported data of their patients diagnosed with CD. Clinical presentation was analyzed and the differences among very young (<3 years) and older children and adolescents were studied. RESULTS: Data from 653 children and adolescents (median age 7 years 2 months; 63.9% girls) from Croatia, Germany, Hungary, Italy, and Slovenia were available for the analysis. One fifth (N = 134) of all children were asymptomatic. In symptomatic children, the most common leading symptom was abdominal pain (33.3%), followed by growth retardation (13.7%) and diarrhoea (13.3%). The majority of symptomatic children (47.6%; N = 247) were polysymptomatic. Abdominal pain was the most common symptom in polysymptomatic (66.4%) as well as in monosymptomatic children (29.7%). Comparing clinical presentation of CD in very young children (younger than 3 years) with older children (3 years or older), we found that symptoms and signs of malabsorption were significantly more common in younger (P < 0.001), whereas abdominal pain and asymptomatic presentation were more common in older children and adolescents (both P < 0.001). CONCLUSION: In children with CD, abdominal pain has become the most common symptom. However, in younger children, symptoms of malabsorption are still seen frequently. This raises a question about the underlying mechanism of observed change in clinical presentation in favour of nonclassical presentation and asymptomatic disease at certain age.
Authors: Paraskevi Massara; Carolyn Spiegel-Feld; Jill Hamilton; Jonathon L Maguire; Catherine Birken; Robert Bandsma; Elena M Comelli Journal: BMJ Open Date: 2022-05-09 Impact factor: 3.006
Authors: Resheed Alkhiari; Shahad M Aljameli; Dalal B Almotairi; Ghadah A AlHarbi; Layan ALmufadhi; Fatimah K Almeathem; Ali A Alharbi; Yasser AlObailan Journal: Cureus Date: 2022-01-07