Clinical Presentation in Children with Coeliac Disease in Central Europe.

OBJECTIVES During the past decades, there has been a shift in the clinical presentation of coeliac disease (CD) to non-classical, oligosymptomatic and asymptomatic forms. We assessed clinical presentation of CD in children and adolescents in Central Europe. METHODS Paediatric gastroenterologists in five countries retrospectively reported data of their patients diagnosed with CD. Clinical presentation was analysed and the differences among very young (<3 years) and older children and adolescents were studied. RESULTS Data from 653 children and adolescents (median age 7 years 2 months; 63.9% female) from Croatia, Germany, Hungary, Italy and Slovenia was available for the analysis. One fifth (N = 134) of all children were asymptomatic. In symptomatic children, the most common leading symptom was abdominal pain (33.3%), followed by growth retardation (13.7%) and diarrhoea (13.3%). The majority of symptomatic children (47.6%; N = 247) were polysymptomatic. Abdominal pain was the most common symptom in polysymptomatic (66.4%) as well as in monosymptomatic children (29.7%). Comparing clinical presentation of CD in very young children (<3 years) with older children (≥3 years), we found that symptoms and signs of malabsorption were significantly more common in younger (p < 0.001) whereas, abdominal pain and asymptomatic presentation were more common in older children and adolescents (both p < 0.001). CONCLUSION In children with CD, abdominal pain has become the most common symptom. However, in younger children, symptoms of malabsorption are still seen very frequently. This raises a question about the underlying mechanism of observed change in clinical presentation in favour of non-classical presentation and asymptomatic disease at certain age.An infographic is available for this article at: http://links.lww.com/MPG/C104.