HONOLULU — The prevalence of nonresponsive celiac disease is common among pediatric patients, affecting about a quarter of children with the disease, according to data presented at ACG 2015.
“In adults, 7% to 30% of patients have been identified who do not respond to treatment with a gluten-free diet; however, in children, this data is not available and nobody has previously studied nonresponsive celiac disease,” Gopal Veeraraghavan, MD, from Beth Israel Deaconess Medical Center in Boston, said during his presentation. “Our aim … was to characterize nonresponsive celiac disease in children, and to evaluate the prevalence, clinical presentation and etiologies of nonresponsive celiac disease.”
Veeraraghavan and colleagues reviewed the medical records of 754 children with biopsy-proven celiac disease diagnosed at Boston Children’s Hospital from 2008 to 2012. Among them, 23.4% met criteria for nonresponsive celiac disease, defined as having persistent clinical symptoms after 6 months on a gluten-free diet, persistent elevations of celiac antibody levels greater than 50% above the upper limit of normal at 1 year or less than a 20% reduction in levels by 6 months after diagnosis.
They found that the mean age of celiac disease diagnosis was 9 years in the nonresponsive group compared with 11 years in the overall cohort. The most common symptoms in the nonresponsive group included abdominal pain (70%), constipation (30%) and GERD (15%). The most common causes of nonresponsive celiac disease included gluten exposure (40%), constipation (20%), other functional disorders (10%) and lactose intolerance (5%). Among the nonresponsive patients who experienced persistent functional abdominal symptoms, 15% had underlying neuropsychiatric illnesses, including anxiety, panic attacks and autism, and 10% had a slow reduction in celiac antibodies with no underlying etiology.
“In conclusion, nonresponsive celiac disease is [as] common in children as with adults, with a prevalence of approximately 25% in children with celiac disease,” Veeraraghavan said. “Similar to adults, gluten exposure and overlapping functional symptoms are the most common etiologies. Providers caring for pediatric patients with celiac disease should be aware of these common issues.” – by Adam Leitenberger
Veeraraghavan G, et al. Abstract 11. Presented at: ACG; Oct. 19-21, 2015; Honolulu, HI.
Disclosures: The researchers report no relevant financial disclosures.