[Clinical picture of celiac disease in children].
During the last few years we have been observing the decreasing incidence of the symptomatic celiac disease and increasing incidence of mono- and asymptomatic disease. Various atypical symptoms and extraintestinal manifestations were observed in older children (above 7 years) and in adults. Clinical symptoms of celiac disease may appear at any age, in each of the following forms: clinical celiac disease (symptomatic), silent (oligosymptomatic) or latent, with late manifestation, being the effect of stress, pregnancy, infections or excessive dietary gluten provocation.


OBJECTIVE
The presentation the variety of clinical pictures of celiac disease in children.


METHODS
We have evaluated the clinical course of celiac disease in 16 children (13 girls and 3 boys), aged between 12 months to 17 years (mean-7,5 years). The celiac disease was diagnosed on the grounds of clinical symptoms, histopathological examination of the small intestinal endoscopic biopsy and immunological examinations: serum antitransglutaminase antibodies and anti-endomysium antibodies.


RESULTS
Most commonly diagnosed form was the silent, monosymptomatic celiac disease. Four children manifested with growth retardation, one with osteoporosis, and one with iron deficiency anemia resistant to treatment. Two girls (aged 16 and 17 years) presented with symptomatic celiac disease. In 3 patients despite the gastrointestinal symptoms and histopathological changes present (villous atrophy, Marsh's index > 40) we did not find any immunological markers of celiac disease (with normal IgA levels).


CONCLUSIONS
School-aged children with celiac disease, in many cases have no evident clinical and functional disorders caused by gluten intake, despite to presence of considerable abnormalities in the histopathological examination.
Grzybowska-Chlebowczyk
Urszula
U
Klinika Pediatrii Slaskiej Akademii Medycznej, Górnoślaskie Centrum Zdrowia Dziecka i Matki w Katowicach. klinikapediatrii@ślam.katowice.pl
Woś
Halina
H
Wiecek
Sabina
S
Kajor
Maciej
M
Szymańska
Maria
M
Staszewska-Kwak
Anna
A
Piatkowska
Marzena
M
Gołka
Dariusz
D
D000293:Adolescent; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D012720:Severity of Illness Index