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A National Prospective Study on Childhood Celiac Disease in the Netherlands 1993–2000: An Increasing Recognition and a Changing Clinical Picture

Indianapolis, IN

ABSTRACT

PURPOSE OF THE STUDY.: To investigate whether the incidence of diagnosed celiac disease (CD) is increasing in the Netherlands and whether the clinical presentation is changing.

STUDY POPULATION.: Children between the ages of 0 and 14 years with newly diagnosed cases of CD from 1993–2000.

METHODS.: Diagnosis of CD was based on biopsy of the small intestine. The following data were collected: age, gender, weight, height, and aspects of the presenting clinical picture.

RESULTS.: The overall crude incidence rate for CD from 1993–2000 was 0.81 per 1000 live births. There was a significant linear increase of the crude incidence from 1993–2000. During the period of 1993–2000 there was a significant increase in the diagnosis of CD with partial villous atrophy of the small-bowel mucosa and a relative decrease in the diagnosis with subtotal villous atrophy. Fewer children are presenting with abdominal distention, chronic diarrhea, and failure to thrive, and more children are presenting with weight <10th percentile, abdominal pain, and lassitude.

CONCLUSIONS.: The increase in newly diagnosed cases of CD seems to represent greater awareness of the disease and the availability of serologic tests. The increase in the number of children with CD diagnosed with small-bowel biopsy specimens showing partial villous atrophy suggests increased recognition of milder cases

REVIEWER COMMENTS.: In the United States, CD now seems to affect 0.5 to 1.0% of the population (10 times higher than previous estimates). In the past, diagnosis of CD has taken an average of 10 years. Serologic screening (eg, tissue transglutaminase immunoglobulin A antibodies) should be considered for children with symptoms of diarrhea, abdominal cramping, pain, and distention as well as short stature and delayed puberty; individuals with Down syndrome or type 1 diabetes mellitus; and first-degree relatives of patients with biopsy-proven CD. Positive serologic tests should be followed up by small-bowel biopsy. Increased awareness of CD allows earlier diagnosis and institution of a gluten-free diet.

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