Published online December 1, 2005
PEDIATRICS Vol. 116 No. 6 December 2005, pp. e754-e759 (doi:10.1542/peds.2005-0904)
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ELECTRONIC ARTICLE

Celiac Disease: Evaluation of the Diagnosis and Dietary Compliance in Canadian Children

Mohsin Rashid, FRCP(C)*,{ddagger}, Ann Cranney, FRCP(C)§,||, Marion Zarkadas, MSc{ddagger}, Ian D. Graham, PhD, Connie Switzer, FRCP(C){ddagger},#, Shelley Case, BSc{ddagger},**, Mavis Molloy, BSc{ddagger}{ddagger}{ddagger}, Ralph E. Warren, FRCP(C){ddagger},§§, Vernon Burrows, PhD{ddagger},|||| and J. Decker Butzner, FRCP(C){ddagger},¶¶

* Division of Gastroenterology and Nutrition, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
§ Department of Medicine and Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
|| Department of Medicine, Queen's University, Kingston, Ontario, Canada
{ddagger} Professional Advisory Board, Canadian Celiac Association, Mississauga, Ontario, Canada
School of Nursing, University of Ottawa, Ottawa Health Research Institute, Ottawa, Ontario, Canada
# Division of Gastroenterology and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
** Regina, Saskatchewan, Canada
{ddagger}{ddagger} Kelowna General Hospital, Kelowna, British Columbia, Canada
§§ Division of Gastroenterology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
|||| Department of Agriculture and Agri-Food, Ottawa, Ontario, Canada
¶¶ Division of Gastroenterology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada

Objectives. We sought to characterize the clinical features at presentation as well as the associated disorders, family history, and evaluation of compliance with a gluten-free diet in children with celiac disease from across Canada.

Study Design. All members (n = 5240) of the Canadian Celiac Association were surveyed with a questionnaire. Of the 2849 respondents with biopsy-confirmed celiac disease, 168 who were <16 years old provided the data reported here.

Results. The mean age when surveyed was 9.1 ± 4.1 years, and 58% were female. Median age at diagnosis was 3.0 years with a range of 1 to 15 years. Presenting symptoms included abdominal pain (90%), weight loss (71%), diarrhea (65%), weakness (64%), nausea/vomiting (53%), anemia (40%), mood swings (37%), and constipation (30%). Almost one third of families consulted ≥2 pediatricians before confirmation of the diagnosis. Before the recognition of celiac disease, other diagnoses received by these children included anemia (15%), irritable bowel syndrome (11%), gastroesophageal reflux (8%), stress (8%), and peptic ulcer disease (4%). A serological test was performed to screen for celiac disease in 70% of those in this population. Eight percent had either type 1 diabetes mellitus or a first-degree relative with celiac disease. Almost all respondents (95%) reported strict adherence to a gluten-free diet, and 89% noted improved health. Reactions after accidental gluten ingestion developed in 54% of the children between 0.5 and 60 hours after ingestion with a median of 2.0 hours. Reactions included abdominal discomfort (87%), diarrhea (64%), bloating (57%), fatigue (37%), headache (24%), and constipation (8%), and most displayed >1 symptom. Although most adjusted well to their disease and diet, 10% to 20% reported major disruptions in lifestyle. Twenty-three percent felt angry all or most of the time about following a gluten-free diet. Only 15% avoided traveling all or most of the time, and during travel, 83% brought gluten-free food with them all of the time. More than half of the families avoided restaurants all or most of the time. Twenty-eight percent of the respondents found it extremely difficult to locate stores with gluten-free foods, and 27% reported extreme difficulty in finding gluten-free foods or determining if foods were free of gluten. Sixty-three percent of the respondents felt that the information supplied by the Canadian Celiac Association was excellent. Gastroenterologists provided excellent information to 44%, dietitians to 36%, and the family physician to 11.5%. When asked to select 2 items that would improve their quality of life, better labeling of gluten-containing ingredients was selected by 63%, more gluten-free foods in the supermarket by 49%, gluten-free choices on restaurant menus by 49%, earlier diagnosis of celiac disease by 34%, and better dietary counseling by 7%.

Conclusions. In Canada, children with celiac disease present at all ages with a variety of symptoms and associated conditions. Delays in diagnosis are common. Most children are compliant with a gluten-free diet. A minority of these children experience difficulties in modifying their lifestyles, and gluten-free foods remain difficult to obtain.

Key Words: celiac • gluten • survey

Abbreviations: IgA, immunoglobulin A • CCA, Canadian Celiac Association

Accepted Jun 21, 2005.