Aim: To retrospectively review the clinical presentation and serological testing of children diagnosed with coeliac disease at Starship Children's Hospital (Auckland, New Zealand) over a 4-year period between January 1999 and December 2002.
Methods: A review of Starship Hospital medical records of all children diagnosed with coeliac disease by small bowel biopsy between January 1999 and December 2002 was conducted. Patients had anti-gliadin, endomysial, and tissue transglutaminase antibodies performed prior to small bowel biopsy.
Results: There were 48 patients, median age of 6.9 years (range 1.6 to 15.7 years). Comparing symptomatic age groups older and younger than 5 years, the former age group presented significantly more often with abdominal pain (p=0.005) and the latter age group presented significantly more often with failure to thrive (p=0.02). Screening at-risk groups yielded nine children (19%) with asymptomatic disease. Thirty-three of 36 (92%) patients tested positive for the anti-endomysial IgA antibody, and 26 of 27 (96%) patients tested positive with the anti-tissue transglutaminase IgA antibody. Three patients (aged 3, 4, and 6 years of age) were negative for anti-endomysial antibodies (including one also negative for anti-tissue transglutaminase antibody), but all three were positive for anti-gliadin antibody.
Conclusions: Our study found that children with coeliac disease are being diagnosed at an older age. Older children also presented with more abdominal pain while younger children presented with more failure to thrive. At-risk groups for coeliac disease may be asymptomatic and form a significant group of patients diagnosed with coeliac disease. Anti-endomysial and tissue transglutaminase antibodies are reliable tests for coeliac disease. However, in younger patients or if there is a high clinical index of suspicion of coeliac disease, small bowel biopsy should be performed even if the anti-endomysial and tissue transglutaminase antibody tests are negative.