Is the clinical pattern of pediatric celiac disease changing? A thirty-years real-life experience of an Italian center

Celiac Disease on the Bed-Side: Embedding Case Finding and Screening in Hospitalized Children

BACKGROUND

Strategies for diagnosing celiac disease (CD) include case-finding and population-screening programs. Case finding consists of testing individuals at increased risk for the disease due to symptoms or associated conditions. Screening programs are widespread campaigns, which definitely perform better in terms of unveiling CD diagnoses but nowadays are still debatable. The global prevalence of CD is around 1% but it almost doubles when considering screening programs among school children. Within this framework, we aimed to estimate the prevalence of CD among hospitalized children in the Pediatric Department of a Southern Italy University Hospital in the period from January 2018 through December 2021. In addition, we attempted to explore, at the time of diagnosis, the prevalence of leading clinical alerts due to malabsorption/malnutrition such as anemia or failure to thrive or due to systemic inflammation/immune dysfunction as hypertransaminasemia and thyroid dysfunction.

METHODS

Data records of pediatric patients admitted as inpatients and tested by anti-transglutaminase IgA antibodies (TGA-IgA) were retrospectively analyzed. CD was diagnosed according to either 2012 or 2020 ESPGHAN guidelines, depending on the year of diagnosis. CD autoimmunity (CDA) was a wider group defined within our protocol if patients had elevated TGA-IgA on at least one occasion, regardless of anti-endomysial antibodies (EMA-IgA) and without biopsy confirmation.

RESULTS

During the observation period, 3608 pediatric patients were admitted and 1320 were screened for CD (median age 5 years, IQR 2-9 years; CD test rate: 36.6% out of all admissions). The available prevalence of newly diagnosed CD was 1.59% (21 patients diagnosed) and the available prevalence of CDA was 3.86% (51 subjects). Among CD patients, underweight/malnourished children accounted for 28.6% (6 out of 21).

CONCLUSIONS

The estimated prevalence of CD diagnoses within our setting was comparable to the most recent population-screening programs. The estimated prevalence of CDA was even higher. A hospital-admission CD testing during routine blood draws might be a non-invasive, cost-effective and valuable approach to reduce discrepancy of prevalence between case-finding and population-screening programs.

Body Mass Index during Gluten-Free Diet in Patients with Celiac Disease

The association of clinical variables with body mass index (BMI) and changes experienced during a gluten-free diet (GFD) in celiac disease (CD) is not well established. In this retrospective cohort study, we aimed to investigate factors aligned with baseline and a follow-up regarding BMI in CD cases diagnosed at the University of Pécs (Hungary). Data were collected regarding gender, age, clinical presentation, histology, serology, extraintestinal manifestations, and BMI upon diagnosis and during follow-up. To compare variables with baseline BMI and BMI changes in short-, intermediate-, and long-term periods, we applied univariate analyses. A total of 192 CD patients were included. Males had significantly higher mean BMI when compared with females at diagnosis (22.9 ± 4.1 vs. 21.4 ± 4.3 kg/m2, p = 0.041) and during follow-up (p = 0.031, p = 0.029, and p = 0.033 for short-, intermediate-, and long-term follow-ups, respectively). Non-classical CD patients experienced higher mean BMI at diagnosis (22.9 ± 4.0 vs. 20.7 ± 4.4 kg/m2, p < 0.001) and following long-term follow-up (24.5 ± 3.2 vs. 22.6 ± 3.4 kg/m2, p = 0.039) than classical patients. In conclusion, although the mean BMI remained in the normal range, it increased significantly during follow-up, even at the short-term follow-up. This change was characteristic for non-classical cases and males on the long-term follow-ups.

Clinical Presentation Is Dependent on Age and Calendar Year of Diagnosis in Celiac Disease: A Hungarian Cross-Sectional Study

International trends indicate that celiac disease (CeD) is becoming more common, while the clinical presentation of CeD tends to change. We aimed to investigate factors associated with the clinical presentation of CeD. We reviewed all CeD cases diagnosed at our tertiary center, University of Pécs (Hungary), between 1992 and 2019. We collected data of verified CeD patients on clinical presentations (classified by the Oslo Classification), the age at and calendar year of diagnosis, and sex, serology and histology at diagnosis. To assess the associations of baseline variables with clinical presentations, we applied univariate and multivariate (binary logistic regression) statistics. A total of 738 CeD patients were eligible for inclusion. In the univariate analysis, patients with classical CeD were more common in the latest calendar period (p < 0.001) and tended to be older (p = 0.056), but we failed to observe a significant association between the clinical presentation and sex, serology or histology at diagnosis. In the multivariate analysis, only age at diagnosis and calendar year were independently associated with clinical presentations (OR = 1.02, CI: 1.01-1.04 and OR = 0.93, CI: 0.89-0.98, respectively). Our findings confirmed that classical CeD is independently associated with age at diagnosis and calendar year of diagnosis of CeD, whereas other parameters were not significantly associated with clinical presentations.