title: The changing face of childhood celiac disease in north america: impact of serological testing.
abstract: OBJECTIVE
  The goal was to evaluate the impact of immunoglobulin A endomysial antibody testing on the incidence and clinical presentation of childhood celiac disease.
  
  
  METHODS
  The incidence and clinical presentation of celiac disease in patients <18 years of age in 1990-1996 (pretesting group) versus 2000-2006 (testing group) were compared.
  
  
  RESULTS
  The median age at diagnosis was 2 years (95% confidence interval: 2-4 years) in the pretesting group (N = 36), compared with 9 years (95% confidence interval: 8-10 years) in the testing group (N = 199; P < .001); the female/male ratios (1.6:1) were similar (P = .982). The incidence of celiac disease increased from 2.0 cases per 100000 children (pretesting group) to 7.3 cases per 100000 children (testing group; P = .0256). The frequency of classic celiac disease presentations decreased from 67% (pretesting group) to 19% (testing group; P < .001), but the incidence of classic celiac disease did not differ (0.8 vs 1.6 cases per 100000; P = .154). In the testing group, 13 previously unrecognized clinical presentations were observed in 98 children, including 35 with family history, 18 with abdominal pain, and 14 with type 1 diabetes mellitus. The frequency of Marsh IIIc lesions decreased from 64% (pretesting group) to 44% (testing group; P = .0403). In the testing group, classic celiac disease remained predominant (67%) in young children (<3 years), whereas atypical gastrointestinal and silent presentations predominated in older children.
  
  
  CONCLUSIONS
  Antibody testing for celiac disease tripled the incidence of celiac disease and quadrupled the median age at diagnosis.
authors: Department of Pediatrics, University of Calgary, Calgary, Canada.
authors: Kelly E
authors: KE
authors: McGowan
authors: Derek A
authors: DA
authors: Castiglione
authors: J Decker
authors: JD
authors: Butzner
mesh_terms: D000367:Age Factors; D000416:Alberta; D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D015994:Incidence; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008403:Mass Screening; D012737:Sex Factors
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A