Coeliac Disease: aspects in different child populations

Abstract: The true prevalence of coeliac disease includes patients with symptomatic/diagnosed disease, and silent or undiagnosed disease. The incidence of diagnosed coeliac disease increased steeply in Swedish children born after 1982, when a change in infant feeding recommendations was made. This change included a delayed introduction of gluten, but the effect was also an increased consumption. The change in epidemiology was thought to be explained by high gluten intake precipitating symptoms and thus leading to diagnosis at an earlier age. Screening in a cohort of 2.5 year old children, where 0.7% had been diagnosed with coelic disease, we found a further 1.3% to have undiagnosed coeliac disease. Even in a population with a high known prevalence the majority of children with coeliac diseas are undiagnosed. Gluten-free diet to the silent/ undiagnosed children resulted in growth acceleration and resolution of other unrecognised symptoms. The association between diabetes mellitus and coeliac disease is stressed by our finding that 6% of children with newly diagnosed diabetes mellitus had an undiagnosed coeliac disease. Younger children were more at risk to have this combination. In a cohort of 46 children with Down´s syndrome 8 (19%) had undiagnosed coeliac disease. Another chromosomal aberration, Turner´s syndrome, showed a 5% prevalence of undiagnosed coeliac disease. Given the large proportion of undiagnosed coeliac disease is worth concidering in children with diffuse or atypical symptoms. Screening should be considered in risk groups. Intrauterine enteroviral infections could not be shown to increase the risk of coeliac disease in the child.