[Clinical picture of celiac disease in children]

Abstract

During the last few years we have been observing the decreasing incidence of the symptomatic celiac disease and increasing incidence of mono- and asymptomatic disease. Various atypical symptoms and extraintestinal manifestations were observed in older children (above 7 years) and in adults. Clinical symptoms of celiac disease may appear at any age, in each of the following forms: clinical celiac disease (symptomatic), silent (oligosymptomatic) or latent, with late manifestation, being the effect of stress, pregnancy, infections or excessive dietary gluten provocation.

The aim of the study: The presentation the variety of clinical pictures of celiac disease in children.

Materials and methods: We have evaluated the clinical course of celiac disease in 16 children (13 girls and 3 boys), aged between 12 months to 17 years (mean-7,5 years). The celiac disease was diagnosed on the grounds of clinical symptoms, histopathological examination of the small intestinal endoscopic biopsy and immunological examinations: serum antitransglutaminase antibodies and anti-endomysium antibodies.

Results: Most commonly diagnosed form was the silent, monosymptomatic celiac disease. Four children manifested with growth retardation, one with osteoporosis, and one with iron deficiency anemia resistant to treatment. Two girls (aged 16 and 17 years) presented with symptomatic celiac disease. In 3 patients despite the gastrointestinal symptoms and histopathological changes present (villous atrophy, Marsh's index > 40) we did not find any immunological markers of celiac disease (with normal IgA levels).

Conclusions: School-aged children with celiac disease, in many cases have no evident clinical and functional disorders caused by gluten intake, despite to presence of considerable abnormalities in the histopathological examination.