Clinical features of non-classical celiac disease in children and adolescents

Abstract

Introduction/Objective Nonclassical celiac disease (CD) is characterized by a very heterogeneous and non-specific clinical presentation. The aim of this study was to determine the basic symptoms and clinical signs of this CD subtype in children and adolescents

Methods The study was based on a sample of 58 children and adolescent, 38 female and 20 male, ages 1.75 to 17.75 (10.01 ± 4.62) years with a nonclassical CD diagnosed according to the European Society for Pediatric Gastroenterology, Hepatology and Nutrition criteria from 1990 and 2012.

Results Except four patients who were between the ages of 1.75 to 2.50 years, all others were older than three years. The main clinical symptoms and signs suggestive of non-classical CD were anemia caused by iron deficiency (48.28%), short stature (34.48%), and intermittent abdominal pain (18.97%), anorexia with stagnation or weight loss (13.79%), and chronic constipation (6.9%). Thirty patients had one symptom or sign of the disease, 15 had two and 13 had three. In addition, 12 patients had dental enamel hypoplasia, 18 sideropenia without anemia and five mild isolated hypertransaminasemia. A gluten-free diet, apart from the dental enamel hypoplasia, has resulted in the withdrawal of all indicators of the disease.

Conclusion The main symptoms and clinical signs of nonclassical CD in children and adolescents were iron deficiency anemia, short stature and intermittent abdominal pain, and less frequently anorexia with stagnation or weight loss and chronic constipation. Excluding dental enamel hypoplasia, a gluten-free diet leads to a complete recovery of the patient.

Keywords: nonclassical celiac disease; children and adolescents; symptoms and signs