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

https://doi.org/10.1016/j.jpeds.2005.04.013Get rights and content

Objectives

To investigate prospectively whether the incidence of diagnosed celiac disease (CD) is increasing in the Netherlands and whether the clinical presentation is changing.

Study design

All newly diagnosed cases of CD throughout the Netherlands were registered prospectively from 1993 to 2000. The clinical picture was compared with that noted in our former study (1975–1990).

Results

The overall incidence rate of CD was 0.81/1000 live births, with a linear increase from 1993 to 2000. There was a significant increase in the number of subjects with partial villous atrophy of the small bowel mucosa. The clinical presentation has changed significantly: abdominal distention, chronic diarrhea, and failure to thrive are less common, and more children presented with weight < P10, abdominal pain, and lassitude. The median age at diagnosis also increased.

Conclusion

The recognition of childhood CD in the Netherlands has increased significantly during the last few years, and the clinical picture has changed as well. Our data may indicate an increasing awareness of the Dutch doctors working in Child Public Health, general practitioners, and pediatricians to recognize more subtle expressions of the disease.

Section snippets

Data Collection

All newly diagnosed cases of childhood CD throughout the Netherlands were registered prospectively from 1993 to 2000 by means of the Dutch Pediatric Surveillance Unit, founded in 1992 under the auspices of the Dutch Society for Pediatrics. The Unit requested all pediatricians working in general hospitals to report each month regardless of whether they had diagnosed children with CD. In the 8 University Medical Centers, a specific contact person was nominated to report. Private pediatric clinics

Response

More than 90% of the contacted Dutch pediatricians returned the monthly card to the Dutch Pediatric Surveillance Unit during the period of 1993–2000, and they reported that 1778 children had newly diagnosed CD.

Ascertainment

From the children reported by the pediatricians, 39% did not fulfill the inclusion criteria: 496 children were reported twice or were diagnosed outside the study period, 93 were diagnosed without small bowel biopsy, or the results of the biopsy were not compatible with CD, 48 children had

Discussion

We have performed a prospective nation-wide study on all newly diagnosed cases of childhood CD in the Netherlands from1993 to 2000. The pediatricians' high response to the Dutch Pediatric Surveillance Unit, as well as the ascertainment of the diagnosis of CD by means of the data of PALGA, strongly indicate that our study population is representative for the average child with newly diagnosed CD in the Netherlands. Eight percent of the children with newly diagnosed CD had at least 1 parent from

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    This study was partially supported by Preventiefonds/ZON, the Netherlands.

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