1. Home>
2. Specialties>
3. Pediatrics and Adolescent Medicine>
4. Summary and Comment

Celiac Disease Is Prevalent but Often Undiagnosed

As many as 1 in 100 children may be susceptible to this nutritional disturbance.

Celiac disease occurs in some genetically susceptible people (those with specific HLA haplotypes) when they are exposed to gluten-containing products, such as wheat or barley. In 2001, Finnish investigators retrospectively tested sera that had been obtained in 1994 from an unselected cohort of 3654 children (age range in 1994, 7 to 16 years) for endomysial and tissue transglutaminase antibodies; HLA typing was also done.

In 1994, no member of the cohort had been diagnosed with celiac disease; by 2001, 10 had a biopsy-confirmed diagnosis. Fifty-six serum samples were positive for one or both of the celiac-associated antibodies. Each antibody-positive subject who had not been diagnosed previously was offered small-bowel biopsy to confirm the presence or absence of celiac disease. Of the 36 subjects who underwent biopsies in 2001, 27 had evidence of celiac disease. Thus, the prevalence of biopsy-proven disease was 1 in 99. All but 2 subjects with celiac disease had a celiac-associated HLA haplotype.

Comment: An editorialist suggests that celiac disease fulfills the World Health Organization criteria for conditions that warrant screening, although he notes that additional studies are necessary. Clinicians should consider testing children and young adults for celiac disease if unexplained weight loss, chronic diarrhea, or abdominal distention is present. Atypical manifestations of this disease include diabetes, anemia, chronic fatigue, and irritable bowel.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 28, 2003

Citation(s):

Mäki M et al. Prevalence of celiac disease among children in Finland. N Engl J Med 2003 Jun 19; 348:2517-24.

• Original article (Subscription may be required)
• Medline abstract (Free)

Fasano A. Celiac disease -- How to handle a clinical chameleon. N Engl J Med 2003 Jun 19; 348:2568-70.

• Original article (Subscription may be required)
• Medline abstract (Free)