A146 TRENDS IN THE CLINICAL PRESENTATION OF CELIAC DISEASE AT DIAGNOSIS IN CHILDREN IN QUEBEC

Abstract Background Celiac disease (CD) is an immune-mediated condition that affects the intestinal mucosa of children at any age. Digestive symptoms include abdominal pain, diarrhea, vomiting and bloating. However, extra-digestive manifestations appear more common nowadays and may be associated with a delay in diagnosis. Aims To describe the current presentation of CD in children in a tertiary hospital in Quebec and compare it to data from a historical Canadian cohort. Methods We identified all cases of CD seen in the gastroenterology unit between January 2015 and September 2017. Data collection was performed using patient medical records. A database was created with Filemaker pro software to collect the age at diagnosis, anthropometric data, clinical symptoms at diagnosis, associated diseases and intestinal biopsy results. A diagnosis of CD was established when the duodenal biopsies displayed a Marsh classification ≥2 {Oberhuber and al. 1999}. Statistical analyzes were carried out with SAS software. Results A total of 323 patients with CD were included (203 girls (63%)). The median age (Interquartile range(IQR)) at diagnosis was 9 (5.60, 12.10) years. The median (IQR) BMI was 16.30 (15.10, 18.20) and the median (IQR) BMI Z score was -0.31 (-1.00, 0.34). The proportion of undernutrition, normal weight, overweight and obesity at diagnosis were respectively : 27 (8%), 264 (82%), 27 (8%) and 5 (2%). A total of 62% of patients had at least one digestive symptom: 204 (63%) had abdominal pain, 87 (27%) had bloating, 91 (28%) had diarrhea, 83 (26%) had constipation, 34 (11%) had anorexia and 35 (11%) had vomiting. At least one isolated extraintestinal manifestation was present in 96 (30%) children: 72 (22%) with fatigue, 43 (13%) with anemia and 25 (8%) with arthralgia. A total of 26 (8%) children had no symptoms. Associated diseases such as diabetes and Down syndrome were present in 11% of the cohort. Conclusions Although abdominal pain remains the most prevalent symptom at diagnosis, its frequency seems lower than historical studies (90% of children had abdominal pain in a 2005 Canadian study) {Rashid and al. Pediatrics 2005}. Diarrhea and constipation were equally found in ¼ of the cohort as compared to 65% and 30% in the 2005 study {Rashid and al. Pediatrics 2005}. The median age at diagnosis in our cohort was higher than in the past study (3 years). Non-digestive symptoms were present in one-third of patients. Hence, primary caregiver must be aware of these