Persistent symptoms are diverse and associated with health concerns and impaired quality of life in patients with paediatric coeliac disease diagnosis after transition to adulthood.

OBJECTIVE: To investigate the prevalence and associated factors of persistent symptoms despite a strict gluten-free diet in adult patients with coeliac disease diagnosed in childhood. DESIGN: Medical data on 239 currently adult patients with paediatric diagnosis were collected from patient records. Also, patients completed structured study questionnaire. All variables were compared between those with and without persistent symptoms. RESULTS: Altogether 180 patients reported adhering to a strict gluten-free diet. Of these, 18% experienced persistent symptoms, including various gastrointestinal symptoms (73%), arthralgia (39%), fatigue (39%), skin symptoms (12%) and depression (6%). Those reporting persistent symptoms had more often gastrointestinal comorbidities (19% vs 6%, p=0.023), health concerns (30% vs 12%, p=0.006) and experiences of restrictions on daily life (64% vs 43%, p=0.028) than the asymptomatic subjects. The patients with symptoms had poorer general health (median score 13 vs 14, p=0.040) and vitality (15 vs 18, p=0.015) based on a validated Psychological General Well-Being Questionnaire and more severe symptoms on a Gastrointestinal Symptom Rating Scale scale (total score 2.1 vs 1.7, p<0.001). Except for general health, these differences remained significant after adjusting for comorbidities. The groups were comparable in current sociodemographic characteristics. Furthermore, none of the childhood features, including clinical, serological and histological presentation at diagnosis, and adherence and response to the diet after 6-24 months predicted symptom persistence in adulthood. CONCLUSION: Almost one-fifth of adult patients diagnosed in childhood reported persistent symptoms despite a strict gluten-free diet. The ongoing symptoms were associated with health concerns and impaired quality of life.

The use of abdominal imaging studies in children visiting emergency department was variable and unsystematic.

AIM: As imaging is used for various reasons in children with acute gastrointestinal complaints, we evaluated the indications and diagnostic yield of abdominal imaging, particularly ultrasound at emergency department (ED). METHODS: Indications and imaging reports of consecutive children who had undergone abdominal imaging in general, surgical and paediatric EDs in the Tampere University Hospital, Finland, in 2015 were collected. Symptoms, clinical findings, imaging indications and findings were categorised and further analysed. RESULTS: Altogether 394 imaging studies, 310 ultrasounds, 72 X-rays and 12 computed tomographies (CT), for 348 children (55% boys) aged 0-16.9 years, median 7.1 years, were performed. The most common indications for ultrasound were suspected appendicitis or infection (36%) and explanation for symptoms (32%), for X-ray suspected foreign body (39%) and obstruction (39%) and for CT trauma (50%). The cause of the symptoms or a clinically significant finding was established in 23% of ultrasounds, varying from 0% to 50% depending on the indication, symptoms and age. CONCLUSION: There was wide variation in the indications and yield of abdominal imaging. The clinical benefits, particularly those of US, were often questionable, even leading to delayed diagnosis and complications. More uniform imaging guidelines are needed in the paediatric ED.