Clinical Presentation in Children with Coeliac Disease in Central Europe

OBJECTIVES: During the past decades, there has been a shift in the clinical presentation of coeliac disease (CD) to non-classical, oligosymptomatic and asymptomatic forms. We assessed clinical presentation of CD in children and adolescents in Central Europe.

METHODS: Paediatric gastroenterologists in five countries retrospectively reported data of their patients diagnosed with CD. Clinical presentation was analysed and the differences among very young (<3 years) and older children and adolescents were studied.

RESULTS: Data from 653 children and adolescents (median age 7 years 2 months; 63.9% female) from Croatia, Germany, Hungary, Italy and Slovenia was available for the analysis. One fifth (N = 134) of all children were asymptomatic. In symptomatic children, the most common leading symptom was abdominal pain (33.3%), followed by growth retardation (13.7%) and diarrhoea (13.3%). The majority of symptomatic children (47.6%; N = 247) were polysymptomatic. Abdominal pain was the most common symptom in polysymptomatic (66.4%) as well as in monosymptomatic children (29.7%). Comparing clinical presentation of CD in very young children (<3 years) with older children (≥3 years), we found that symptoms and signs of malabsorption were significantly more common in younger (p < 0.001) whereas, abdominal pain and asymptomatic presentation were more common in older children and adolescents (both p < 0.001).

CONCLUSION: In children with CD, abdominal pain has become the most common symptom. However, in younger children, symptoms of malabsorption are still seen very frequently. This raises a question about the underlying mechanism of observed change in clinical presentation in favour of non-classical presentation and asymptomatic disease at certain age.An infographic is available for this article at: http://links.lww.com/MPG/C104.