Changing pattern in the clinical presentation of pediatric celiac disease: a 30-year study.
OBJECTIVE
The incidence of celiac disease (CD) has increased in recent years due to the recognition of atypical forms and the identification of silent cases through serological screening. Our aim was to detect temporal trends in the presentation of pediatric CD in Greece.


METHODS
We reviewed the medical files of all children diagnosed with CD between 1978 and 2007 at a single academic pediatric center. Cases were classified according to the year of diagnosis. We examined demographic data, presenting symptoms, delay to diagnosis, and the prevalence of associated conditions.


RESULTS
During the study period, 284 new cases of CD were diagnosed. The incidence of CD was significantly increased in recent years (p < 0.05). We observed significant trends towards older age at diagnosis (p < 0.001), longer delay to diagnosis (p < 0.05) and decreased frequency of the classical and/or gastrointestinal predominant mode of presentation (p < 0.001). In recent years, diagnosis of CD was significantly more frequent due to testing of asymptomatic children with a positive family history for CD or personal history of associated conditions (p < 0.001).


CONCLUSIONS
We report a changing pattern in the presentation of pediatric CD in Greece. CD is diagnosed more frequently in older children, oftentimes presents with atypical symptoms, and is increasingly detected through serological screening. CD should be considered in the presence of atypical presentations.
First Department of Pediatrics of Athens University, Aghia Sophia Children's Hospital, Athens, Greece. roma2el@otenet.gr
Eleftheria
E
Roma
Joanna
J
Panayiotou
Helen
H
Karantana
Catherin
C
Constantinidou
Spyros I
SI
Siakavellas
Maro
M
Krini
Vassiliki P
VP
Syriopoulou
Giorgos
G
Bamias
D000293:Adolescent; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male