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. 2017 Oct;65(4):432-437.
doi: 10.1097/MPG.0000000000001532.

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

Eyad Almallouhi  1 , Katherine S King, Bhavisha Patel, Chung Wi, Young J Juhn, Joseph A Murray, Imad Absah
Affiliations

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

Eyad Almallouhi et al. J Pediatr Gastroenterol Nutr. 2017 Oct.

Abstract

Objectives: 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 ages 18 years 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 nonclassical 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, and 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.

Conclusions: Both incidence and prevalence of CD have continued to increase in children during the past 15 years in Olmsted County, Minnesota. Clinical and pathologic presentations of CD are changing over time (more nonclassical and asymptomatic cases are emerging).

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Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest or financial disclosures.

Figures

Figure 1
Figure 1
Loess smooth of incidence of pediatric celiac disease and shaded 95% confidence limits with modeled linear trend as dashed line.
Figure 2
Figure 2
Loess smooth of calendar-year trends of incidence by age groups.
See this image and copyright information in PMC

Comment in

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