Spectrum of height in patients with celiac disease

Clinical presentations and outcomes of celiac disease in children and adolescents at a tertiary care center in Lebanon

Introduction

Studies on the clinical presentation of celiac disease and its impact on the growth of children in Lebanon are limited. The aim of this 10-year-retrospective study was to describe the common clinical presentations, diagnostic modalities, and the effect of the gluten-free- diet (GFD) on the growth of children and adolescents with celiac disease.

Methods

This was a retrospective chart review of subjects aged 6 months to 18 years who visited the Pediatric Gastroenterology clinic at the American University of Beirut Medical Center (AUBMC) between January 1, 2013, and June 30, 2023, and who were diagnosed with celiac disease based on serological markers and/or changes on histology of the small intestinal mucosal biopsies for those who underwent upper endoscopy, or HLA typing expressing the HLA-DQ2 or DQ8 gene for few subjects.

Results

The study included 90 patients with celiac disease, of whom 64 were newly diagnosed during the study period. The mean age at diagnosis of celiac disease was 6.93 years. Females represented 60% of the pediatric subjects with celiac disease. The most common symptoms reported were abdominal pain (51.1%), weight loss or failure to thrive (45.6%), and diarrhea (24.4%). There was a significant increase in the mean weight-for-age Z-score (WAZ) and mean body mass index (BMI)-for-age Z-score (BMIZ) 12 months following initiation of GFD; however, the change in height-for-age Z-score (HAZ) at 12 months was not statistically significant. Half of the subjects were in remission at the last clinic follow-up.

Conclusion

The most common symptoms that children with celiac disease in this cohort presented with are diarrhea, abdominal pain and failure to thrive. In this cohort, there was a significant increase in the weight parameters with no significant change in the height at 12 months after initiation of the GFD. The recognition of early manifestations, early diagnosis and strict adherence to the diet are of paramount importance to prevent long term complications.

Celiac disease - a pluripathological model in pediatric practice

Being defined as an autoimmune, chronic pathology, frequently encountered in any age group, but especially in pediatrics, celiac disease (also called gluten enteropathy), is gaining more and more ground in terms of diagnosis, but also interest in research. The data from the literature of the last decades attest the chameleonic way of its presentation, there may be both classic onset symptoms and atypical symptoms. Given the impact played by celiac disease, especially in the optimal growth and development of children, the current narrative review aims to highlight the atypical presentation methods, intended to guide the clinician towards the inclusion of the pathology in the differential diagnosis scheme. To these we add the summary presentation of the general data and therapeutic lines regarding the underlying condition and the existing comorbidities. In order to place the related information up to date, we performed a literature review of the recent articles published in international databases. We bring forward the current theories and approaches regarding both classic celiac disease and its atypical manifestations. Among these we note mainly constitutional, skin or mucous, bone, neuro-psychic, renal, reproductive injuries, but also disorders of biological constants and association with multiple autoimmunities. Knowing and correlating them with celiac disease is the key to optimal management of patients, thus reducing the subsequent burden of the disease.