Over the last few decades, the clinical presentation of celiac disease (CD) has shifted to nonclassical, oligosymptomatic, and asymptomatic variants. We looked at how CD manifested clinically in children and adolescents in Central Europe. Paediatric gastroenterologists in five countries reported data on their CD patients retrospectively. The clinical presentation was examined, as well as the distinctions between very young and older children and adolescents. The study used data from 653 children and adolescents from Croatia, Germany, Hungary, Italy, and Slovenia. One-fifth of the children had no symptoms. The most prevalent leading symptom in symptomatic children was abdominal pain, followed by growth retardation and diarrhoea. The majority of symptomatic youngsters had several symptoms. Abdominal discomfort was the most prevalent complaint in both polysymptomatic and monosymptomatic children. When we compared the clinical presentation of CD in very young children to older children, we discovered that symptoms and signs of malabsorption were significantly more common in the younger, whereas abdominal pain and asymptomatic presentation were more common in the older.

Abdominal pain has become the most common symptom in children with CD. However, symptoms of malabsorption are still common in younger children. This begs the question of what is causing the observed shift in clinical presentation toward nonclassical presentation and silent disease at a particular age.

Reference: https://journals.lww.com/jpgn/Abstract/2021/04000/Clinical_Presentation_in_Children_With_Coeliac.14.aspx