title: The clinical presentation of coeliac disease in 1030 Swedish children: Changing features over the past four decades.
abstract: BACKGROUND
  The features of paediatric coeliac disease have changed in recent decades. We hypothesised that the age at diagnosis might continue to increase, whereas the severity of symptoms should decrease.
  
  
  METHODS
  In the present study, filed data on 1030 paediatric patients diagnosed with coeliac disease between 1973 and 2013 were analysed. The information available covered 99.8% of small bowel biopsies and included information on sex, age and clinical symptoms.
  
  
  RESULTS
  The age at diagnosis increased significantly, from a mean of 2.2 years during the first 10 years to 8.2 years in recent years. The proportion of children with severe symptoms declined from 92.8% to 78%, as did the proportion of biopsies characterised by severe pathology. In recent years, the monosymptomatic form of coeliac disease has been more common, and the number of patients detected at screening has increased. The frequency of patients with gastrointestinal symptoms, extra-intestinal symptoms, and failure to thrive and/or short stature at presentation decreased.
  
  
  CONCLUSIONS
  The mean age of newly diagnosed patients has increased over the last 15 years. Currently, coeliac disease shows a less severe picture in terms of symptoms and intestinal pathology. Younger children suffer primarily from gastrointestinal symptoms and growth failure, and adolescents from extra-intestinal manifestations.
authors.affiliation: Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Electronic address: dimta624@student.liu.se.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tapsas
authors.affiliation: Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Hollén
authors.affiliation: Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Pediatrics, Linköping University, Norrköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Stenhammar
authors.affiliation: Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Pediatrics, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Fälth-Magnusson
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D058070:Asymptomatic Diseases; D001827:Body Height; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D058872:Epidemics; D005183:Failure to Thrive / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D012720:Severity of Illness Index; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology
keywords: Coeliac disease onset; Disease severity; Long-term follow-up