Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
J Pediatr Gastroenterol Nutr. 2024 Oct;79(4):895-904. doi: 10.1002/jpn3.12321. Epub 2024 Aug 16.
The prevalence of celiac disease (CeD) is increasing, yet it is still underdiagnosed, in part because of its heterogeneous presentation. Diagnostic criteria are evolving and management with strict adherence to a gluten-free diet is challenging for many. We aimed to characterize the clinical presentation of CeD among a large multicenter cohort of pediatric patients and to identify factors associated with gluten-free diet adherence.
Patients with CeD aged 0-18 years were recruited from 11 United States health centers. Parents completed surveys about gluten-free diet adherence and patient electronic health records were reviewed. Logistic regression analyses were performed to identify risk factors associated with gluten exposure.
Charts were reviewed for 460 children with a median age of 6.4 years. Abdominal pain was reported in 57% of the cohort, but diverse symptoms were identified. Parent surveys were completed for 455 participants. Sixty-five (14%) participants were at high risk for gluten exposure based on parental reports of weekly or daily gluten exposure or eating gluten by choice in the past year. Participants under the age of 5 years had a lower risk of gluten exposure, while participants without repeat serology testing 18 months after initial diagnosis were at higher risk of gluten exposure.
In a large, multicenter cohort of pediatric CeD patients, clinical presentation is highly variable, necessitating a high index of suspicion to make a diagnosis. Parent surveys indicate that 14% of patients are at high risk of gluten exposure, with patient age and lack of close follow-up associated with gluten-free diet adherence.
乳糜泻（CeD）的患病率正在上升，但仍未得到充分诊断，部分原因是其表现具有异质性。诊断标准在不断发展，严格遵循无麸质饮食的管理对许多人来说具有挑战性。我们旨在描述大型多中心儿科患者队列中 CeD 的临床表现，并确定与无麸质饮食依从性相关的因素。
从 11 个美国健康中心招募了年龄在 0-18 岁的 CeD 患者。父母完成了关于无麸质饮食依从性的调查，并且审查了患者的电子健康记录。进行了逻辑回归分析，以确定与麸质暴露相关的风险因素。
对 460 名中位年龄为 6.4 岁的儿童的图表进行了审查。该队列中有 57%的患者报告有腹痛，但也发现了各种症状。对 455 名参与者完成了家长调查。根据父母报告的每周或每日麸质暴露或过去一年中选择吃麸质的情况，有 65 名（14%）参与者存在麸质暴露的高风险。年龄小于 5 岁的参与者暴露于麸质的风险较低，而在初次诊断后 18 个月没有重复进行血清学检测的参与者暴露于麸质的风险较高。
在大型多中心儿科 CeD 患者队列中，临床表现高度多样化，需要高度怀疑才能做出诊断。家长调查表明，14%的患者存在麸质暴露的高风险，患者年龄和缺乏密切随访与无麸质饮食依从性相关。
