Clinical picture of classical, atypical and silent celiac disease in children and adolescents.

BACKGROUND Celiac disease is a frequent disease of the alimentary tract in children. Clinical presentation of the disease is variable and depends on type of the disease. OBJECTIVES The aim of the study was an analysis of clinical findings, selected laboratory features and coexisting diseases in children and adolescents with celiac disease. MATERIAL AND METHODS Material of the study comprised a series of 78 children aged 8 months - 13 years. Celiac disease was diagnosed basing on clinical symptoms, histological studies of intestinal specimens and positive serologic tests (EmA, TG2). RESULTS Classical celiac disease was diagnosed in 40 children (51.3%), atypical celiac disease in 26 children (33.3%) and silent celiac disease in 12 children (15.4%). The most frequent clinical symptoms of classical form of celiac disease were chronic diarrhea (90.0%), recurrent abdominal pain (70.0%), development retardation (65%), hypocholesterolemia (35.0%) and IgA deficiency (22.5%). In atypical form of the disease dominated the following symptoms: recurrent abdominal pain (76.9%), failure to thrive (38.4%), short stature (42.3%), anemia (15.3%), hypertransaminasemia (11.5%), food allergy (19.2%) and thyroid diseases (11.5%). In silent celiac disease hypercholesterolemia was present in 33.3%, hypertriglycerydemia in 16.6%, type 1 diabetes in 50%, and celiac disease in parents or siblings in 33.3%. CONCLUSIONS Classical celiac disease is the most frequently diagnosed clinical form of the disease. Silent celiac disease occurs frequently in children with type 1 diabetes mellitus whose parents or siblings have celiac disease. Frequent diagnosis of atypical and silent forms of celiac disease is an indication to serological examination in children with unclear clinical picture and genetic predisposition.