Objective The study investigates trends in clinical presentation of children diagnosed with celiac disease (CD).

Methods We performed a retrospective study on cases diagnosed with CD at Emergency Children Hospital in a period of 22 years. We compared two groups of patients: Group 1- children diagnosed from 1985 to 1995 and Group 2-children diagnosed from 1996 to 2006. Symptoms at presentation were classified as: typical gastrointestinal symptoms, atypical or milder gastrointestinal symptoms and extraintestinal symptoms.

Results Group 1 consisted of 20 children (mean age 5.9±4.7 years). Group 2 had 152 children (mean age 4.4±3.6 years). Typical gastrointestinal symptoms were encountered in 18 (90%) patients belonging to Group 1 and in 79 (51.9%) patients coming from Group 2 (p<0.002). Atypical or milder gastrointestinal symptoms in Group 1 and Group 2 were reported in 2 (10 %) vs. 49 (32.2%) patients (p<0.05). Extraintestinal symptoms were not reported in Group 1 and were noticed in 20 (13.2%) children in Group 2. Four (2.6%) patients in Group 2 were asymptomatic. Total villous atrophy was found in 15% patients in group 1 vs. 9.9% in group 2, subtotal villous atrophy in 60% vs. 23% and partial villous atrophy in 25% vs. 67.1% patients (p<0,002).

Conclusion There was a significant increase in the number of CD patients diagnosed during the last years. The clinical presentation has changed: prevalence of classic form decreased and we encountered more celiac children with extraintestinal symptoms or less suggestive gastrointestinal symptoms. Prevalence of mild enteropathy with partial villous atrophy increased.