title: Presentation of Celiac Disease in Finnish Children Is No Longer Changing: A 50-Year Perspective.
abstract: OBJECTIVE
  To chart trends in the presentation of celiac disease in a large cohort of Finnish children diagnosed over a period of 48 years.
  
  
  METHODS
  Clinical and serologic data, severity of small-bowel mucosal damage, and presence of associated conditions were gathered from 596 children diagnosed with celiac disease in 1966-2013. The children were divided into 4 groups based on the year of diagnosis (before 1980, 1980-1999, 2000-2009, and 2010-2013), and the variables were compared between the periods. The incidence of celiac disease autoimmunity in 2001-2013 was calculated based on the number of new antibody-positive cases in each year.
  
  
  RESULTS
  Age at diagnosis rose from median 4.3 years before 1980 to between 7.6 and 9.0 years in the later periods. The severity of clinical presentation, in general, became milder and poor growth less common during the entire study period of 50 years. Percentages of children with classical gastrointestinal presentation decreased, and those with atypical or subclinical presentation increased after the 1990s, these changes leveling off in 2000-2013. Similarly, the severity of small-bowel mucosal damage was milder after the 1990s. The incidence of celiac disease autoimmunity increased in the early 2000s but then fluctuated without a clear trend. There were no significant secular changes in sex distribution, presence of anemia, levels of celiac antibodies, or celiac disease-associated conditions.
  
  
  CONCLUSIONS
  The clinical and histologic presentation of celiac disease in children became milder, especially in the 1980s and 1990s. However, most of these changes have reached a plateau in recent years.
authors: Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors: Laura
authors: L
authors: Kivelä
authors: Department of Internal Medicine, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland.
authors: Katri
authors: K
authors: Kaukinen
authors: Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors: Marja-Leena
authors: ML
authors: Lähdeaho
authors: Tampere School of Health Sciences, University of Tampere, Tampere, Finland.
authors: Heini
authors: H
authors: Huhtala
authors: Department of Pediatrics, Lappeenranta Central Hospital, Lappeenranta, Finland.
authors: Merja
authors: M
authors: Ashorn
authors: Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
authors: Tarja
authors: T
authors: Ruuska
authors: Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors: Pauliina
authors: P
authors: Hiltunen
authors: Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors: Jarmo
authors: J
authors: Visakorpi
authors: Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors: Markku
authors: M
authors: Mäki
authors: Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland. Electronic address: kalle.kurppa@uta.fi.
authors: Kalle
authors: K
authors: Kurppa
mesh_terms: D000293:Adolescent; D015551:Autoimmunity; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005387:Finland / Q000453:epidemiology; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index