Increasing Incidence and Altered Presentation in a Population‐based Study of Pediatric Celiac Disease in North America

Abstract

Background Celiac disease (CD) is a common immune-mediated disorder that affects up to 1% of the general population. Recent reports suggest that the incidence of CD has reached a plateau in many countries. We aim to study the incidence and altered presentation of childhood CD in a well-defined population. Methods Using the Rochester Epidemiology Project, we retrospectively reviewed Mayo Clinic and Olmsted Medical Center medical records from January 1994 to December 2014. We identified all CD cases of patients aged 18 or younger at the time of diagnosis. Incidence rates were calculated by adjusting for age, sex, and calendar year and standardizing to the 2010 US white population. Results We identified 100 patients with CD. Incidence of CD has increased from 8.1 per 100,000 person-years (2000–2002) to 21.5 per 100,000 person-years (2011–2014). There was an increase in CD prevalence in children from 2010 (0.10%) to 2014 (0.17%). Thirty-four patients (34%) presented with classical CD symptoms, 43(43%) had non-classical CD, and 23(23%) were diagnosed by screening asymptomatic high-risk patients. Thirty-six patients (36%) had complete villous atrophy, 51 (51%) had partial atrophy, 11 (11%) had increased intraepithelial lymphocytes. Two patients were diagnosed without biopsy. Most patients (67%) had a normal body mass index, 17% were overweight/obese and only 9% were underweight. Conclusion Both incidence and prevalence of CD have continued to increase in children over the past 15 years in Olmsted County, Minnesota. Clinical and pathologic presentations of CD are changing over time (more non-classical and asymptomatic cases are emerging).

Relationships between Clinical Presentation, Serology, Histology, and Duodenal Deposits of Tissue Transglutaminase Antibodies in Pediatric Celiac Disease

“…The proportion of monosymptomatic to polysymptomatic clinical presentation is in agreement with recent studies that showed an altered clinical picture in the United States and the Netherlands in recent decades [26,27].…”

Heterogeneity of asthma and the risk of celiac disease in children

“…13,14 The inclusion criteria were the following: (1) positive serology markers, such as antitissue transglutaminase immune globulin A; (2) confirmatory small bowel biopsy specimen that showed the characteristic histologic findings (increased intraepithelial lymphocytes, villous atrophy, and crypts hyperplasia); (3) Olmsted County residents at the time of index date (Olmsted County residency was established by the residency at the time of diagnosis); and (4) research authorization for using medical records for research. Exclusion criteria were the following: (1) non-Olmsted County residency at the time of diagnosis; (2) no research authorization for use of medical records for research; (3) patients without confirmatory small bowel biopsy for CD; and (4) other diseases that cause villous atrophy, including autoimmune enteropathy, inflammatory bowel disease, and small bowel bacterial overgrowth.…”

“…This study was approved by the institutional review board at Mayo Clinic and Olmsted Medical Center. In this study, we identified and enrolled eligible children with CD (cases) between 1997 and 2014 who resided in Olmsted County, Minnesota, 13 and these cases were then matched by birth year and sex to obtain their corresponding control subjects. We then compared the frequency of a history of asthma between patients in the cases and the controls.…”

A histomorphometric classification system for normal and inflamed mouse duodenum—Quali‐quantitative approach

“…Irrespective of the presence of a positive serology, intestinal histopathological analysis is still considered a determinant requirement for FPIGD diagnosis . The most serious lesions usually occur in the proximal small intestine and tend to diminish in severity as they approach the large intestine . In the classification system proposed by Marsh, the subclinical stages of FPIGD were classified as Phase 1 (infiltrative type) and Phase 2 (hyperplastic type), while the stage where clinical signs and symptoms are present, Phase 3 (destructive type), was frequently observed.…”

“…13,26 The most serious lesions usually occur in the proximal small intestine and tend to diminish in severity as they approach the large intestine. 27 In the classification system proposed by Marsh, 24 the subclinical stages of FPIGD were classified as Phase 1 (infiltrative type) and Phase 2 (hyperplastic type), while the stage where clinical signs and symptoms are present, Phase 3 (destructive type), was frequently observed. Later, Oberhuber 14,25 proposed a subdivision of Phase 3 into 3a, 3b and 3c, characterized by increasing damage to the mucosa.…”