Changing face and clinical features of celiac disease in children

Gökçe, Selim; Arslantaş, Esra

doi:10.1111/ped.12448

Cited by 30 publications

(35 citation statements)

References 51 publications

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“…The relatively high frequency of underweight children with CD in Iran is similar to that found in other developing countries such as India and Turkey [ 13 , 14 ]. This is in contrast to many developed countries, where the prevalence of undernutrition in children with CD has decreased to 4–5% [ 15 , 16 ], indicating that malnutrition is no longer a common presentation [ 17 , 18 ].…”

Section: Discussionsupporting

confidence: 75%

Frequency of overweight/obesity among a group of children with celiac disease in Iran

Shahraki

Hill

2018

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IntroductionA small number of overweight and obese children with celiac disease (CD) has been reported.AimTo estimate the prevalence of obesity, underweight and normal weight in a group of Iranian pediatric patients.Material and methodsIn a retrospective study from 2007 to 2015, 225 children less than 18 years old with biopsy-proven CD were enrolled. Data collected included demographic characteristics, clinical presentation, antibody titers and severity of small-bowel mucosal damage. Body mass index (BMI) profile of subjects was calculated based on the age and gender percentile at presentation.ResultsThe mean ± standard deviation (SD) for age was 7.4 ±3.8 and 62% of patients were female. Fifty-four percent of patients presented with a normal BMI, 43% were underweight, and the remaining patients (3.5%) were overweight/obese. The mean age of underweight and normal weight patients was higher than that of obese/overweight patients. Mean ± SD of TTG titer was higher in overweight/obese and normal weight children compared to underweight subjects. The majority of patients (195/225) had severe enteropathy compatible with Marsh III on duodenal biopsy. Most of the children had gastrointestinal (GI) and extra-intestinal manifestations on presentation. There was no association between severity of histological disease and BMI for age. Five out of eight cases in the obese/overweight group had an index case with CD in their family.ConclusionsThis study highlights the importance of considering celiac disease in children regardless of their BMI. Failure to diagnose CD in children leads to unnecessary diagnostic delays and long-term adverse health consequences.

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Section: Discussionsupporting

confidence: 75%

Frequency of overweight/obesity among a group of children with celiac disease in Iran

Shahraki

Hill

2018

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“…The other patients diagnosed with celiac disease presented with recurrent abdominal pain, constipation, failure to thrive and one patient with increased liver enzymes. Milder, mono or oligosymptomatic forms became more frequent in our experience too, similar to reports from other European countries (7,8,14).…”

Section: Discussionsupporting

confidence: 91%

“…The first issue remains the identification of cases that require serological screening. Whom to test is yet intensely debated because CD has a heterogenous clinical spectrum and even more, the clinical presentation changed significantly in the last decades: the prevalence of the classical form decreased, while cases with extraintestinal symptoms or less suggestive gastrointestinal symptoms are increasingly more frequent (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Celiac Disease Case Finding Strategy in Romanian Symptomatic Children

Lešanu¹,

Vlad²,

Becheanu³

et al. 2017

Ro J Pediatr.

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Objectives. Pediatricians face various challenges in different stages of celiac disease (CD) diagnosis. Whom to test is intensely debated because of CD's heterogenous clinical spectrum. The main purpose of the study was to identify symptoms or symptom associations that should initiate an active strategy of CD early diagnosis in Romanian children. Material and method. We conducted a prospective study in "Grigore Alexandrescu" Emergency Children's Hospital. From March 2013 until February 2014, 249 children with symptoms/signs at risk of CD were included. Results. CD was diagnosed in 11 (1/21 patients evaluated). One in 12.6; 16; 18; 18.5 and 18.5 children respectively with chronic diarrhea, low stature, growth failure, recurrent abdominal pain and constipation had CD. Certain symptom associations increased the risk: classical symptom associations (chronic diarrhea and weight loss), as well as other associations: recurrent abdominal pain and weight loss, constipation and weight loss, constipation and refractory iron deficiency anemia. Conclusion. Active screening among patients with symptoms and especially symptom associations at risk of CD would improve diagnosis rates in pediatric CD.

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“…Although detailed epidemiological data on IDA in CD are limited, recent studies suggest that IDA may be significant in both CD children [10, 11] and adults [12]. …”

Section: Introductionmentioning

confidence: 99%

The DMT1 IVS4+44C>A polymorphism and the risk of iron deficiency anemia in children with celiac disease

et al. 2017

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BackgroundIron deficiency anemia in celiac disease is related to impaired duodenal mucosal uptake, due to villous atrophy. Iron enters the enterocytes through an apical divalent metal transporter, DMT1. Different DMT1 transcripts have been identified, depending on the presence of an iron-responsive element that allows DMT1 up-regulation during iron starvation. An intronic DMT1 polymorphism, IVS4+44C>A, has been associated with metal toxicity, and the CC-carriers show high iron levels.AimsThis study investigates the association between DMT1 IVS4+44C>A and anemia in a cohort of 387 Italian celiac children, and the functional role of the polymorphism.Methods and resultsBy association analysis, we found that DMT1 IVS4+44-AA genotype confers a four-fold risk of developing anemia, despite of atrophy degree. By analysis of mRNA from gastroesophageal biopsies, we found that total DMT1 is significantly upregulated in presence of mild, but not severe, atrophy, independently from IVS4+44C>A variant, and in normal but not in atrophic CC-biopsies. Moreover, we found that A-allele is associated to preferential expression of the DMT1 transcripts lacking the iron-responsive element, thus limiting the DMT1 overexpression that normally occurs to respond to iron starvation.DiscussionPossibly, the IVS4+44-AA-related dysregulation of the iron-induced changes in DMT1 expression is not able to impair iron absorption in physiological condition. However, if exacerbated by the concomitant massive loss of functional absorbing tissue paralleling worsened stages of villus atrophy, it might be ineffective in counteracting iron deficiency, despite of DMT1 overexpression.ConclusionWe suggest, for the first time, that celiac disease may unmask the contribution of the DMT1 IVS4+44C>A polymorphism to the risk of anemia.

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Changing face and clinical features of celiac disease in children

Abstract: The mode of presentation and clinical features of CD in childhood continue to change. Of note, a substantial percentage of patients were overweight at presentation. MBD is a frequent complication, necessitating routine evaluation.

Cited by 30 publications

References 51 publications

Frequency of overweight/obesity among a group of children with celiac disease in Iran

Frequency of overweight/obesity among a group of children with celiac disease in Iran

Celiac Disease Case Finding Strategy in Romanian Symptomatic Children

The DMT1 IVS4+44C>A polymorphism and the risk of iron deficiency anemia in children with celiac disease

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