Emerging New Clinical Patterns in the Presentation of Celiac Disease

Telega, Grzegorz; Bennet, Tess Rivera; Werlin, Steven L.

doi:10.1001/archpediatrics.2007.38

Cited by 114 publications

(106 citation statements)

References 22 publications

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“…33 Combined emergency and elective cesarean rates increased by 78% between 1990 and 2010 in Scotland. 35 Rising age at diagnosis has been observed in the United Kingdom since the 1960s, 36 increasing to between 7 and 9 years more recently, 8,9,20 which is evident in the current dataset. Children presenting nonclassically and those identified through targeted screening were significantly older at diagnosis, with these phenotypes becoming more prolific as clinical awareness has improved.…”

Section: Figurementioning

confidence: 58%

“…[6][7][8][9][10] A number of articles also report that a greater proportion of children in more recent years are diagnosed through targeted screening and experience fewer GI symptoms. [7][8][9] However, no report has calculated the incidence of cases diagnosed over time because of a lower threshold to test or on the basis of the well-established classic presentation. Analyses performed on such robust data will help to determine whether a rise in incidence can entirely be attributed to a heightened clinical awareness or whether a true rise is evident.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

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The Rising Incidence of Celiac Disease in Scotland

et al. 2013

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BACKGROUND AND OBJECTIVES: Although the incidence of pediatric celiac disease (CD) is increasing globally, it is uncertain whether this is attributed to improved case ascertainment or signifies a true rise. We aimed to identify all incident cases of childhood CD in southeast Scotland over the period 1990 to 2009 to assess trends in total incidence and cases diagnosed as a result of (1) a classic presentation, (2) a nonclassic presentation, or (3) targeted screening. METHODS: Twenty-year retrospective cohort study of case notes, pathology databases, endoscopy, and patient records for all children (<16 years of age) diagnosed with CD on biopsy in southeast Scotland (at-risk population of 225 000–233 000). Data were age-gender standardized and Poisson regression models used to calculate changes in incidence over time. RESULTS: A total of 266 children were diagnosed from 1990 to 2009 with an increase in incidence from 1.8/100 000 (95% confidence interval [CI] 1.1–2.7) to 11.7/100 000 (95% CI 9.8–13.9) between the epochs 1990 to 1994 and 2005 to 2009, respectively (P < .0001). The incidence of nonclassic presentation (children with a monosymptomatic presentation and those with extraintestinal symptoms) and actively screened cases increased by 1566% (P < .05) and 1170% (P < .001) from 1990 to 1999 to 2000 to 2009, respectively. However, a rise in the incidence of Oslo classic cases from 1.51/100 000 (95% CI 0.91–2.38) in 1990 to 1994 to 5.22/100 000 (95% CI 3.98–6.75) in 2005 to 2009 (P < .01) remained evident. CONCLUSIONS: The incidence of pediatric CD increased 6.4-fold over the 20 years. This study demonstrates that this rise is significant for classic CD, indicating a true rise in the incidence of pediatric CD.

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Section: Figurementioning

confidence: 58%

Section: (Continued On Last Page)mentioning

confidence: 99%

The Rising Incidence of Celiac Disease in Scotland

et al. 2013

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“…40 Earlier studies have yielded inconsistent results on the correlation between clinical picture and histological findings in celiac disease. 20,[41][42][43] Apart from differences in study designs these discrepancies might be at least partly explained by differences in clinical presentation of the disease between countries. During recent decades, studies from many developed countries have reported that the severity of celiac disease is becoming milder even in the subgroup of patients suffering from classical gastrointestinal symptoms, 44,45 which may contribute to the increasing similarity between clinically and screen-detected children.…”

Section: Discussionmentioning

confidence: 99%

At-Risk Screened Children with Celiac Disease are Comparable in Disease Severity and Dietary Adherence to Those Found because of Clinical Suspicion: A Large Cohort Study

Kivelä

Kaukinen

Huhtala

et al. 2017

The Journal of Pediatrics

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“…In a recent study from a North American CD clinic, 71.4% of children with diabetes reported no gastrointestinal symptoms at the time of a positive screen 74 . Some patients are overweight or obese at diagnosis; 11.2% of children with CD had a BMI greater than the 90th percentile in a recent US study 72 .…”

Section: Evaluation For Celiac Disease In Diabetes Mellitus Type 1 Pamentioning

confidence: 97%