Spanish national registry of celiac disease: incidence and clinical presentation.

OBJECTIVES: The aim of this study was to assess the incidence and clinical pattern of celiac disease (CD) presently diagnosed in Spanish children. METHODS: A prospective, multicenter, nationwide registry of new cases of CD in children <15 years was conducted from June 1, 2006 to May 31, 2007. The parameters studied were age at diagnosis, sex, clinical symptoms, associated diseases, nutritional status, CD serology, histological lesions, and HLA-DQ2/-DQ8. The crude incidence rate of CD was calculated as new cases per 1000 live births and as new cases per 100,000 person-years <15 years of age. RESULTS: A total of 974 new cases of CD were included. The median age at diagnosis was 2.3 years; 39.5% of CD diagnoses occurred in the first 2 years, 42% between 2 and 6, and 18.4% from 6 to 15. Total number of cases in each age group was 385, 409, and 180, respectively. Regarding clinical presentation 70.9% showed classical symptoms, 21.9% were nonclassical, and 7% were asymptomatic. A total of 95.7% of 931, 94.7% of 611, and 86.7% of 651 children tested positive, respectively, for immunoglobulin A (IgA) anti-transglutaminase type 2 antibodies, IgA endomysial antibodies, and IgA anti-gliadin antibodies. Villous atrophy was observed in 92.4% and increased intraepithelial lymphocytes with crypt hyperplasia in 3.3%. Of the children, 55% had normal growth, and 3.4% were overweight. The HLA phenotype was DQ2: 88.3%, DQ2/DQ8: 8.4%, and DQ8: 2.3%. The incidence rate was 7.9 cases of CD per 1000 live births and 54 cases per 100,000 person-years. CONCLUSIONS: In Spain, the most frequent clinical presentation of CD is the classical form, mainly diagnosed during the first 2 years of life. The observed incidence of CD in Spanish children is much higher than the present CD incidence rates observed in other European countries.

Índex de massa corporal en adolescents: canvis en el curs d’una dècada / Body mass index in adolescents: Changes over the last decade

Introducció. S’ha observat que una patologia nutricionalcreixent durant l’adolescència és l’obesitat, com a conseqüènciad’un ambient «obesogènic» que s’estén a totesles capes socials i que afecta principalment, però no exclusivament,el món desenvolupat.Objectiu. Aquest estudi pretén establir, mitjançantl’índex de massa corporal (IMC), quin és l’estat de nutriciód’adolescents de 14 anys en l’actualitat, i com ha canviataquest índex els últims deu anys.Mètode. S’ha estudiat l’IMC de 416 adolescents de 14anys durant els anys 2003-2004 i s’ha distribuït per percentilssegons l’edat i el sexe mitjançant les taules de la FundacióOrbegozo. També s’han recollit dades retrospectivesde l’IMC de 402 adolescents que els anys 1993 i 1994 tenien14 anys, i s’han comparat amb les actuals. L’estudi s’hafet en un centre d’atenció primària que atén nens i nenesentre 0 i 15 anys.Resultats. Es demostra que el 21.6% de la poblacióde 14 anys estudiada en l’actualitat presenta un IMCsuperior al percentil 97 per l’edat i el sexe, cosa que elsqualifica com a obesos. El 10% del total d’adolescentses troba per sobre del percentil 99, és a dir, en situaciód’obesitat mòrbida.Comparant aquestes dades amb les dels anys 1993i 1994, observem un augment del 7% en la taxa d’adolescentsamb IMC superior al percentil 97 i un increment del’IMC mitjà en 1.2 punts, de manera que el percentatged’obesitat mòrbida s’ha triplicat.Conclusions. L’increment en el percentatge d’adolescentsobesos en només deu anys en el medi estudiat confirmaque l’obesitat es comporta com una epidèmia d’extensiócreixent, capaç de multiplicar per 1.5 el nombred’afectats en aquest temps (AU)

Introduction. Obesity has proven to be a major nutritionalproblem during adolescence. There appears to existan obesity-stimulating environment that affects mainly,but not exclusively, developed countries, and involves allsocial strata.Objective. The aim of this study was to use body massindex (BMI) data to estimate the nutritional status of14-year-old adolescents and to evaluate changes over thelast decade.Methods. We studied the BMI of 416 14-year-old adolescentsduring the years 2003 and 2004 and plotted thedata on the age- and gender-specific standard tables of the Orbegozo Foundation. We then compared the datawith BMI from 402 age-matched adolescents seen in 1993and 1994.Results. In our study, 21.6% of the 14 year-old populationcurrently has a BMI above the 97th percentile, thusqualifying for obesity, and 10% are above the 99th percentile,thus qualifying for morbid obesity. Comparingthese data with the data collected in 1993 and 1994, wedocumented a 7% increase in the prevalence of adolescentswith BMI above 97th percentile, and a median increaseof 1.2 points in BMI, indicating that the percentage ofmorbid obesity has tripled over of the last decade.Conclusions. The increase in the percentage of obeseadolescents in our environment over the last decadeconfirms that obesity can be considered an epidemic ofgrowing proportions (AU)

Evolución de las formas de presentación de la enfermedad celíaca en 429 niños a lo largo de veinte años. Estudio multicéntrico / Different clinical presentations of celiac disease over time. Multicentric study of a cohort of 429 children diagnosed over a 20-year period

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