Article Text

VARYING PRESENTATION OF COELIAC DISEASE IN CHILDREN
  1. S Loganathan1,
  2. A Asokkumar1,
  3. M Suresh-Babu1
  1. 1Paediatric Department, Lincoln County Hospital, Lincoln, UK

Abstract

Objective To determine the pattern of presentation of CD in children in Lincolnshire.

Methods Retrospective case notes review of children diagnosed with CD during 1999 to 2007 in a large District General Hospital.

Results A total of 72 patients (29 boys; 43 girls) were reviewed. 60 patients had positive biopsy consistent with CD (n = 60). All but 2 patients with positive biopsy had negative serology (3%). 11 serology positive patients had normal biopsy (Latent Coeliac) of which 1 patient on follow up developed positive biopsy. One patient declined biopsy. The median age of diagnosis was 6 years (10 months–16 years) and mean duration of symptoms was 7.8 months (0–60 months). 40 (67%) presented with gastrointestinal (GI) manifestations, 9 (15%) with non GI manifestations and 11 (18%) were asymptomatic. In GI group, classical presentation was seen only in 6 children (15%) who were <24 months old, the rest had mild GI symptoms +/− wt. loss. In the non GI group 12% presented with anemia. In the asymptomatic group 4 had IDDM, 2 have Down’s syndrome, 1 has William’s syndrome, 1 has Turner’s syndrome and 3 were siblings of CD. Nine patients (15%) had first degree relative with CD.

Conclusion This review confirms the extremely polymorphic nature of CD and the change in clinical presentation in a district hospital setting. A high index of suspicion is necessary in all age. Sibling screening should become a routine. General practitioners need to be updated about its changing presentation.

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