Presentation of Pediatric Celiac Disease in the United States: Prominent Effect of Breastfeeding

Abstract

Childhood celiac disease (CD) is considered rare in the United States. Consequently there are few data concerning its clinical presentation. A validated questionnaire was distributed to families of children with CD. One hundred forty-one children with biopsy-proven CD were included in the study. We found significant differences in the clinical spectrum of children based on their infant feeding history. Exclusively breastfed children were significantly less likely to report failure to thrive (69% vs 88%, p<0.05) and short stature (37% vs 62%, p<0.05), and had a higher rate of "atypical'' symptoms (p<0.01). Breastfeeding alters the presentation and contributes to atypical presentations of CD and diagnostic delay. Pediatricians need to be aware of the diverse manifestations of celiac disease to reduce diagnostic delay.

Celiac disease in the Red Sea state of Sudan

“…18 About one third of children with CD in Western countries develop short stature. 19 Anemia was noted in 10.9 % of the patients, and it was mainly due to iron deficiency in most of the cases. Worldwide prevalence of CD among patients with iron deficiency anemia is 2.8-8.7% and may be as high as 15%.…”

Clinical Features of Celiac Disease: A Prospective Birth Cohort

“…In older children the clinical picture is often not specific, with abdominal pain or extraintestinal manifestations, growth retardation, isolated anemia, and behavioral symptoms. [2][3][4] Because the clinical features of CD may not always be evident, a substantial proportion of patients will not be identified through symptom-based case finding. 5,6 The cornerstones of CD diagnosis include presence of clinical signs and symptoms, seropositivity for endomysial or tissue transglutaminase autoantibodies (tTGA), carrying any of the HLA risk haplotypes DR3-DQ2 or DR4-DQ8, and showing typical histologic features in intestinal biopsies, characterized by villous atrophy and crypt hyperplasia with elevated intraepithelial lymphocytes.…”

Influence of Early Feeding Practices on Celiac Disease in Infants

“…According to the latest guidelines, gluten should be introduced into the diet of infants 4-6 months old, but no particular quantity is recommended. Studies have claimed that infant feeding practices, especially breastfeeding and timing of gluten introduction, may delay the onset of the disease or modify its symptoms (5)(6)(7)(8)(9)(10). In addition, they have suggested that breastfeeding at the time of gluten introduction can protect against celiac disease.…”