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Review
, 7 (10), 8733-51

The Spectrum of Differences Between Childhood and Adulthood Celiac Disease

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Review

The Spectrum of Differences Between Childhood and Adulthood Celiac Disease

Rachele Ciccocioppo et al. Nutrients.

Abstract

An old saying states that ''children are not little adults" and this certainly holds true for celiac disease, as there are many peculiar aspects regarding its epidemiology, diagnosis, clinical presentations, associated diseases, and response to treatment in pediatric compared to adult populations, to such an extent that it merits a description of its own. In fact, contrary to the past when it was thought that celiac disease was a disorder predominantly affecting childhood and characterized by a malabsorption syndrome, nowadays it is well recognized that it affects also adult and elderly people with an impressive variability of clinical presentation. In general, the clinical guidelines for diagnosis recommend starting with specific serologic testing in all suspected subjects, including those suffering from extraintestinal related conditions, and performing upper endoscopy with appropriate biopsy sampling of duodenal mucosa in case of positivity. The latter may be omitted in young patients showing high titers of anti-transglutaminase antibodies. The subsequent management of a celiac patient differs substantially depending on the age at diagnosis and should be based on the important consideration that this is a lifelong condition.

Keywords: adulthood; associated diseases; childhood; complications..

Figures

Figure 1
Figure 1
Serologic and histologic findings in childhood and adulthood celiac disease. The prevalence of major and minor intestinal lesions, as defined according to Marsh’s classification, in terms of percentages in both childhood and adult celiac disease is shown. Moreover, the mean values of anti-tissue transglutaminase antibodies (TG2A) is given on the right hand side, with the blue spot indicating childhood age and the red one adult age. The data are presented according to [50].
Figure 2
Figure 2
Associated diseases. The most common associated diseases listed in descending order of frequency for childhood (left) and adulthood (right) celiac disease. The green arrow shows the prevalent role played by genes or immunity in the pathogenesis of these conditions. Abbreviations: GI: gastrointestinal; Ig: immunoglobulin.
Figure 3
Figure 3
Possible causes of refractoriness to a gluten-free diet. A series of conditions responsible for refractoriness to gluten-free diet is presented according to their “true” (inside the yellow circle) or “false” relationship (all the others) with celiac disease, and to their prevalence in adulthood (red circle) or childhood (blue circle). At the bottom, a schematic representation of the duodenal mucosa architecture is given as a continuum (green arrow) from villus atrophy to a normal appearance, going from left to right, thus the place where each pathological condition is inserted in the circles depends on the status of the small intestinal mucosa. Abbreviations: EATL: enteropathy-type-associated T cell lymphoma; IBS: irritable bowel syndrome; RCD: refractory celiac disease; SIBO: small intestinal bacterial overgrowth; UJI: ulcerative jejunoileitis.

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