Doença Celíaca em crianças e adolescentes: apresentação clínica e mudanças ao longo do tempo

Abstract

Celiac disease (CD) is a chronic immune-mediated enteropathy of the small intestine precipitated by dietary exposure to gluten in genetically predisposed people. It has a wide range of clinical presentations, from classical CD with symptoms of malabsorption (diarrhea, weight loss, steatorrhea, and abdominal pain) to completely asymptomatic people, discovered through serological screening. There is also nonclassicalCD, with symptoms such as anemia, constipation, short stature,osteoporosis, liver enzyme abnormalities, among others. In recent decades there was a increasing trend in the prevalence of CD and a increasing number of nonclassical and asymptomatic phenotypes. In this study, we analyzed 38 celiac children and adolescents who had medicalconsultations on pediatric gastroenterology clinic of the Hospital das Clínicas da UFMG in the period of June to October 2015, aiming to assess the symptoms at diagnosis of the disease. Most patients were female (63.2%) with mean age at diagnosis of 5.4 years. The most common symptoms at diagnosis were: abdominal distension (68.4%), diarrhea (63.2%), abdominal pain (60.5%) and weight loss (52.6%). Regarding the classification of CD: 25 (65.8%) were classical, nine (23.7%) were non-classical and four (10.5%) were asymptomatic. When comparing these three groups, a significant difference was found (p = 0.0001) relative to age at diagnosis, which was lower in the classical group. Patients were also divided into subgroups according to the year of diagnosis: 2005 or earlier, from 2006 to 2010 and from 2011 to 2015. When comparing these three subgroups, a significant difference (p = 0.0438) was found relative to the presentation of CD. This difference was due to the increase in non-classical cases in the last five years, which almost equaled the amount of classical cases. The classicalCD was an absolute majority before 2005. The conclusion of this study was that, although the sample was small, it was possible to reproduce the trend of increase in non-classical cases that has been described in the literature