Celiac

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Celiac

  1. 1. 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
  2. 2. have changed considerably over the past 20 years <ul><li>Incidence </li></ul><ul><li>Age at presentation </li></ul><ul><li>The features </li></ul><ul><li>of celiac disease (CD) in children </li></ul>
  3. 3. Decrease: <ul><li>Cases with GI symptoms at presentation </li></ul>
  4. 4. Increase <ul><li>Cases with non specific & subtle symptoms at presentation </li></ul><ul><li>Cases diagnosed by screening </li></ul><ul><li>CD associated autoimmune disease </li></ul>
  5. 5. It is apparent <ul><li>most children with CD </li></ul><ul><li>remain undiagnosed </li></ul>
  6. 6. Currently <ul><li>most patients present </li></ul><ul><li>With subtle or non-gastrointestinal manifestations </li></ul><ul><li>at a later age </li></ul>
  7. 7. Median age at presentation <ul><li>Has shifted: </li></ul><ul><li>from 4 to 8 years </li></ul>
  8. 8. <ul><li>childhood prevalence =1% </li></ul>
  9. 9. <ul><li>The past: </li></ul><ul><li>primarily a disorder of </li></ul><ul><li>European and Western populations </li></ul><ul><li>Currently : </li></ul><ul><li>more & more reports: </li></ul><ul><li>a global problem </li></ul>
  10. 10. A significant protection affect <ul><li>the duration of breastfeeding </li></ul><ul><li>(exclusive or partial) </li></ul>
  11. 11. The data do not support <ul><li>the influence of age at first dietary gluten exposure </li></ul>
  12. 12. children who carried CD HLA_DQ2 & DQ8 <ul><li>Rotavirus infections </li></ul><ul><li>& </li></ul><ul><li>incensement in the risk of CD autoimmunity </li></ul>
  13. 13. delay in diagnosis of 11.7 years. (Canadian Celiac Health survey) <ul><li>anemia (40%) </li></ul><ul><li>stress (31%) </li></ul><ul><li>IBS (29%) </li></ul><ul><li>Osteoporosis & low bone density(35%) </li></ul>
  14. 14. Gluten withdrawal <ul><li>does not prevent the development of autoimmune diseases </li></ul><ul><li>Generally </li></ul>
  15. 15. may disappear after starting a gluten-free diet <ul><li>insulin-dependent diabetes </li></ul><ul><li>thyroid-specific autoantibodies </li></ul>
  16. 16. Improvement may occur <ul><li>Cardiomyopathy </li></ul><ul><li>Thyroiditis </li></ul><ul><li>Peripheral neuropathy </li></ul><ul><li>with a gluten-free diet </li></ul>
  17. 17. <ul><li>Conclusion </li></ul>
  18. 18. <ul><li>Only a small number of patients present with the ‘classical’ symptoms </li></ul>
  19. 19. <ul><li>marked weight loss </li></ul><ul><li>Malnutrition </li></ul><ul><li>steatorrhea </li></ul>
  20. 20. <ul><li>Many manifest: </li></ul><ul><li>extra-intestinal symptoms & nonspecific findings </li></ul><ul><li>. </li></ul>
  21. 21. <ul><li>growth failure </li></ul><ul><li>unexplained iron deficiency anemia </li></ul><ul><li>recurrent abdominal pain </li></ul><ul><li>osteoporosis </li></ul><ul><li>Asymptomatic : they have affected family members or with associated diseases </li></ul>

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