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.