The Spectrum of Differences between Childhood and Adulthood Celiac Disease.
An old saying states that ''children are not little adults" and this certainly holds true for celiac disease, as there are many peculiar aspects regarding its epidemiology, diagnosis, clinical presentations, associated diseases, and response to treatment in pediatric compared to adult populations, to such an extent that it merits a description of its own. In fact, contrary to the past when it was thought that celiac disease was a disorder predominantly affecting childhood and characterized by a malabsorption syndrome, nowadays it is well recognized that it affects also adult and elderly people with an impressive variability of clinical presentation. In general, the clinical guidelines for diagnosis recommend starting with specific serologic testing in all suspected subjects, including those suffering from extraintestinal related conditions, and performing upper endoscopy with appropriate biopsy sampling of duodenal mucosa in case of positivity. The latter may be omitted in young patients showing high titers of anti-transglutaminase antibodies. The subsequent management of a celiac patient differs substantially depending on the age at diagnosis and should be based on the important consideration that this is a lifelong condition.
Rachele Ciccocioppo, Center for the Study and Cure of Celiac Disease, Clinica Medica I, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, 19-27100 Pavia, Italy. rachele.ciccocioppo@unipv.it.
Rachele
R
Ciccocioppo
International Clinical Research Center, St. Anne's University Hospital and Masaryk University, 65691 Brno, Czech Republic. peter.kruzliak@savba.sk.
Peter
P
Kruzliak
Rachele Ciccocioppo, Center for the Study and Cure of Celiac Disease, Clinica Medica I, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, 19-27100 Pavia, Italy. cangemi.giusy@gmail.com.
Giuseppina C
GC
Cangemi
Faculty of Military Health Sciences, University of Defence, Trebešská 1575-500 01 Hradec Kralove, Czech Republic. miroslav.pohanka@gmail.com.|Department of Geology and Pedology, Faculty of Forestry and Wood Technology, Mendel University in Brno, 61300 Brno, Czech Republic. miroslav.pohanka@gmail.com.
Miroslav
M
Pohanka
Rachele Ciccocioppo, Center for the Study and Cure of Celiac Disease, Clinica Medica I, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, 19-27100 Pavia, Italy. elena.betti19@gmail.com.
Elena
E
Betti
Gastroenterology Unit, Hospital Universitario Central de Asturias, 33000 Oviedo, Spain. meugelb@hotmail.com.
Eugenia
E
Lauret
Gastroenterology Unit, Hospital Universitario Central de Asturias, 33000 Oviedo, Spain. lrodrigosaez@gmail.com.
Luis
L
Rodrigo
D000328:Adult; D000367:Age Factors; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D002648:Child; D002985:Clinical Protocols; D006801:Humans
adulthood; associated diseases; childhood; complications.