The Changing Clinical Presentation of Celiac Disease Pediatr Adolesc Med. Basel, Karger, 2008, vol 12, pp 18–22 Lebenthal E. et al. presented by: Nargess Tavakoli Guilan university of medical sciences

have changed considerably over the past 20 years Incidence Age at presentation The features of celiac disease (CD) in children

Incidence

Age at presentation

The features

of celiac disease (CD) in children

Decrease: Cases with GI symptoms at presentation

Cases with GI symptoms at presentation

Increase Cases with non specific & subtle symptoms at presentation Cases diagnosed by screening CD associated autoimmune disease

Cases with non specific & subtle symptoms at presentation

Cases diagnosed by screening

CD associated autoimmune disease

It is apparent most children with CD remain undiagnosed

most children with CD

remain undiagnosed

Currently most patients present With subtle or non-gastrointestinal manifestations at a later age

most patients present

With subtle or non-gastrointestinal manifestations

at a later age

Median age at presentation Has shifted: from 4 to 8 years

Has shifted:

from 4 to 8 years

childhood prevalence =1%

childhood prevalence =1%

The past: primarily a disorder of European and Western populations Currently : more & more reports: a global problem

The past:

primarily a disorder of

European and Western populations

Currently :

more & more reports:

a global problem

A significant protection affect the duration of breastfeeding (exclusive or partial)

the duration of breastfeeding

(exclusive or partial)

The data do not support the influence of age at first dietary gluten exposure

the influence of age at first dietary gluten exposure

children who carried CD HLA_DQ2 & DQ8 Rotavirus infections & incensement in the risk of CD autoimmunity

Rotavirus infections

&

incensement in the risk of CD autoimmunity

delay in diagnosis of 11.7 years. (Canadian Celiac Health survey) anemia (40%) stress (31%) IBS (29%) Osteoporosis & low bone density(35%)

anemia (40%)

stress (31%)

IBS (29%)

Osteoporosis & low bone density(35%)

Gluten withdrawal does not prevent the development of autoimmune diseases Generally

does not prevent the development of autoimmune diseases

Generally

may disappear after starting a gluten-free diet insulin-dependent diabetes thyroid-specific autoantibodies

insulin-dependent diabetes

thyroid-specific autoantibodies

Improvement may occur Cardiomyopathy Thyroiditis Peripheral neuropathy with a gluten-free diet

Cardiomyopathy

Thyroiditis

Peripheral neuropathy

with a gluten-free diet

Conclusion

Conclusion

Only a small number of patients present with the ‘classical’ symptoms

Only a small number of patients present with the ‘classical’ symptoms

marked weight loss Malnutrition steatorrhea

marked weight loss

Malnutrition

steatorrhea

Many manifest: extra-intestinal symptoms & nonspecific findings .

Many manifest:

extra-intestinal symptoms & nonspecific findings

.

growth failure unexplained iron deficiency anemia recurrent abdominal pain osteoporosis Asymptomatic : they have affected family members or with associated diseases

growth failure

unexplained iron deficiency anemia

recurrent abdominal pain

osteoporosis

Asymptomatic : they have affected family members or with associated diseases