Diagnostic challenges in children with celiac disease. A five-year experience with new guidelines in a General Pediatrics Department
Authors:   Third Pediatric Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, Pop Daniela ,   Third Pediatric Department, Emergency Hospital for Children, Cluj-Napoca, Romania, Pop Radu Samuel ,   Third Pediatric Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, Schnell Cristina Nicoleta ,   Third Pediatric Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania,   Third Pediatric Department, Emergency Hospital for Children, Cluj-Napoca, Romania, Tarau-Sas Valentina ,   Third Pediatric Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania,   Third Pediatric Department, Emergency Hospital for Children, Cluj-Napoca, Romania, Ichim Edita Gabriela ,   Third Pediatric Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania,   Third Pediatric Department, Emergency Hospital for Children, Cluj-Napoca, Romania, Chereches-Panta Paraschiva ,   Third Pediatric Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania,   Third Pediatric Department, Emergency Hospital for Children, Cluj-Napoca, Romania, Iacob Daniela ,   Third Pediatric Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania,   Third Pediatric Department, Emergency Hospital for Children, Cluj-Napoca, Romania, Gheban Dan ,   Department of Pathology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, Man Sorin Claudiu ,   Third Pediatric Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania,   Third Pediatric Department, Emergency Hospital for Children, Cluj-Napoca, Romania, Farcau Dorin ,   Third Pediatric Department, Emergency Hospital for Children, Cluj-Napoca, Romania,   Nursing Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
Published: June 2023

Background. The clinical characteristics of patients with celiac disease cover a wide range of signs and symptoms. Our study aimed to describe the main clinical features and investigations performed on our celiac patients diagnosed in the past five years. Material and methods. We collected data from medical records of patients aged 0 to 18 years diagnosed with celiac disease. We included in the analysis patients newly diagnosed with celiac disease, in our department, between January 2017 and August 2022. Results. In this period, 30 children were diagnosed with celiac disease in our general pediatrics department. The mean age at diagnosis ± standard deviation was 6.3±4.2 years (median age=4.3 years). The period between onset of symptoms ranged between 3 months to 5 years (median=6 months). Twenty children (66%) had features of classical celiac disease. Thirteen/30 patients (43.3%) were found to have iron deficiency anemia at diagnosis. In 23/30 (76%) of the children, the values of the IgA-TGA were more than 10 times the upper limit of the normal values. Nineteen children were diagnosed between 2017 and 2019. Fifteen of these 19 patients (79%) were diagnosed based on positive levels of antibodies and duodenal biopsy samples showing Marsh 2 or 3 features, and 4/19 (21%) based on positive IgA-TGA and AEM and a genetic test showing HLA DQ2 and/or DQ8. Conclusions. Classical celiac disease remains the predominant phenotype in our patients. Adherence to new guidelines allowed in the past 2 years a diagnosis without histological examination of biopsy fragments in most of the patients.