Emerging New Clinical Patterns in the Presentation of Celiac Disease

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Abstract
Objective To evaluate changes in the clinical presentation of celiac disease in southeastern Wisconsin. Design Retrospective medical record review. Setting Clinical specialty practice in pediatric gastroenterology. Patients The medical records of all patients diagnosed with celiac disease at the Children's Hospital of Wisconsin between 1986 and 2003 were reviewed. Data extracted from the medical records included year of diagnosis, demographics, indications for endoscopy and biopsy, signs, symptoms, and laboratory data. Biopsy specimens were read by the pediatric pathologist and graded according to the Marsh criteria. Main Exposure Date of initial diagnosis of celiac disease. Main Outcome Measures Presenting symptoms of patients with newly diagnosed celiac disease. Results One hundred forty-three patients were diagnosed with celiac disease. The number of patients diagnosed with celiac disease increased from 1 in 1986 to 93 in 2003. The mean age at diagnosis increased from 5.32 years for patients diagnosed before 1995 to 8.70 years for patients diagnosed after 1995. Gastrointestinal symptoms dominated in children younger than 3 years, whereas in children older than 3 years, the majority presented with nongastrointestinal indications. The percentage of patients presenting with gastrointestinal symptoms alone decreased during the study period; 11.2% of patients diagnosed with celiac disease were overweight (body mass index > 90). Conclusions Our study provides a unique longitudinal follow-up of clinical practice over a 17-year period. Currently, patients with celiac disease usually do not present with classic symptoms; they are more likely to be asymptomatic school-aged children who belong to a high-risk group.