RESUMO
Fundamento. La enfermedad celíaca es una enfermedadinducida genéticamente, en la que existe una intoleranciapermanente al gluten, y que provoca una lesión severade la mucosa intestinal. En la actualidad se sabe quesu expresividad clínica puede ser muy variada y que, ademásde la forma clásica (diarrea, pérdida de peso, distensiónabdominal, cambio de carácter, etc.), pueden existirformas atípicas, predominantemente extradigestivas, e inclusoformas asintomáticas o silentes.Objetivo. El objetivo de este estudio es conocer las formasde presentación de la enfermedad celíaca en la actualidady su evolución a lo largo de los últimos años.Método. Para ello se ha realizado un estudio multicéntricodescriptivo y retrospectivo, a través de la revisión delas historias clínicas de los pacientes diagnosticados de enfermedadcelíaca en las unidades de gastroenterología infantilde ocho centros hospitalarios, desde 1984 hasta2003, siendo requisito indispensable para la inclusión en elestudio la constatación de lesión de la mucosa intestinalsegún los criterios de Marsh.Resultados. La forma de presentación más frecuentefue la forma digestiva (60%), seguida de las atípicas(33.5%) (retraso de peso, dolor abdominal, distensión abdominal,estreñimiento, retraso de talla, alteraciones aisladasen la analítica sanguínea o vómitos) y las asintomáticaso silentes (6.5%).Se han establecido cuatro periodos de estudio (1984-1988, 1989-1993, 1994-1998 y 1999-2003), y se ha objetivadoun aumento progresivo de la edad media dediagnóstico a lo largo de los diferentes períodos, que secorresponde con un gradual aumento de las formasatípicas, en detrimento de las digestivas, así como unalenta progresión a lo largo del tiempo de las formas silentes diagnosticadas, pasando de un 81.8% de formas digestivasen el primer quinquenio, a un 55.3% en el último. Elanálisis del peso de los enfermos en el momento del diagnósticoen relación con el año en que se realizó éstedemuestra que ha ido mejorando progresivamente a lolargo de los años, lo que es un índice de menor afectacióngeneral en las formas atípicas.Conclusiones. Se concluye que la utilización de marcadoresserológicos para la detección de enfermedad celíacapermite sospechar el diagnóstico en muchos casos de formasatípicas de presentación anteriormente desconocidas,que posteriormente se confirman mediante biopsia intestinal.A medida que esos conocimientos se divulgan, se amplíael campo de investigación y consecuentemente aumentael número de casos diagnosticados
Background. Celiac disease is a genetically-determinedillness characterized by permanent intolerance to gluten,resulting in a severe damage to the intestinal mucosa. It iswell known that celiac disease has a wide spectrum ofclinical presentations; in addition to the classic form, characterizedby diarrhea, weight loss, and abdominal distension,atypical forms with predominantly extraabdominaldisease, and even asymptomatic or silent forms, exist.Objective. The objective of this study is to describe thedifferent presentation forms diagnosed over time.Method. A multicentric retrospective descriptive studywas performed. The medical records of patients diagnosedwith celiac disease in eight gastroenterology units betweenthe years 1984 and 2003, were reviewed. Documentationof the typical intestinal mucosa changes using theMarsh criteria was required.Results. The digestive form was the most common(60%), followed by the atypical form (poor weight orheight gain, abdominal pain, constipation, abnormal laboratorytests, or vomiting) in 33.5%, and the asymptomaticor silent form in 6.5%.The patient population was divided in four periodsaccording to the date of diagnosis (1984-1988, 1989-1993,1994-1998, and 1999-2003). The median age at diagnosisincreased in successive periods, which correlated with agradual increase in the percentage of the atypical andsilent forms. During the first period, 81.8% of celiacdisease cases were digestive forms, compared with 55.3%during the last period. The weight at the time of diagnosisalso increased over time, as a reflection of the less clinicalseverity of the atypical forms.Conclusions. We conclude that the use of serologicalmarkers for the detection of celiac disease allows for thediagnosis of atypical and silent forms, later confirmed byintestinal biopsy. As this knowledge is disseminated, thefield of research is expanded, and the number of casesdiagnosed increasesBackground. Celiac disease is a genetically-determined illness characterized by permanent intolerance to gluten, resulting in a severe damage to the intestinal mucosa. It is well known that celiac disease has a wide spectrum of clinical presentations; in addition to the classic form, characterized by diarrhea, weight loss, and abdominal distension, atypical forms with predominantly extraabdominal disease, and even asymptomatic or silent forms, exist. Objective. The objective of this study is to describe the different presentation forms diagnosed over time. Method. A multicentric retrospective descriptive study was performed. The medical records of patients diagnosed with celiac disease in eight gastroenterology units between the years 1984 and 2003, were reviewed. Documentation of the typical intestinal mucosa changes using the Marsh criteria was required. Results. The digestive form was the most common (60%), followed by the atypical form (poor weight or height gain, abdominal pain, constipation, abnormal laboratory tests, or vomiting) in 33.5%, and the asymptomatic or silent form in 6.5%. The patient population was divided in four periods according to the date of diagnosis (1984-1988, 1989-1993, 1994-1998, and 1999-2003). The median age at diagnosis increased in successive periods, which correlated with a gradual increase in the percentage of the atypical and silent forms. During the first period, 81.8% of celiac disease cases were digestive forms, compared with 55.3% during the last period. The weight at the time of diagnosis also increased over time, as a reflection of the less clinical severity of the atypical forms. Conclusions. We conclude that the use of serological markers for the detection of celiac disease allows for the diagnosis of atypical and silent forms, later confirmed by intestinal biopsy. As this knowledge is disseminated, the field of research is expanded, and the number of cases diagnosed increasesBackground. Celiac disease is a genetically-determined illness characterized by permanent intolerance to gluten, resulting in a severe damage to the intestinal mucosa. It is well known that celiac disease has a wide spectrum of clinical presentations; in addition to the classic form, characterized by diarrhea, weight loss, and abdominal distension, atypical forms with predominantly extraabdominal disease, and even asymptomatic or silent forms, exist. Objective. The objective of this study is to describe the different presentation forms diagnosed over time. Method. A multicentric retrospective descriptive study was performed. The medical records of patients diagnosed with celiac disease in eight gastroenterology units between the years 1984 and 2003, were reviewed. Documentation of the typical intestinal mucosa changes using the Marsh criteria was required. Results. The digestive form was the most common (60%), followed by the atypical form (poor weight or height gain, abdominal pain, constipation, abnormal laboratory tests, or vomiting) in 33.5%, and the asymptomatic or silent form in 6.5%. The patient population was divided in four periods according to the date of diagnosis (1984-1988, 1989-1993, 1994-1998, and 1999-2003). The median age at diagnosis increased in successive periods, which correlated with a gradual increase in the percentage of the atypical and silent forms. During the first period, 81.8% of celiac disease cases were digestive forms, compared with 55.3% during the last period. The weight at the time of diagnosis also increased over time, as a reflection of the less clinical severity of the atypical forms. Conclusions. We conclude that the use of serological markers for the detection of celiac disease allows for the diagnosis of atypical and silent forms, later confirmed by intestinal biopsy. As this knowledge is disseminated, the field of research is expanded, and the number of cases diagnosed increases
