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Symptoms and Mucosal Changes Stable During Rapid Increase of Pediatric Celiac Disease in Norway

Beitnes, Ann-Christin R.*; Vikskjold, Florin B.; Jóhannesdóttir, Gróa B.; Perminow, Gøri§; Olbjørn, Christine||,¶; Andersen, Solveig N.*,¶; Bentsen, Beint S.§; Rugtveit, Jarle§; Størdal, Ketil#,**

Journal of Pediatric Gastroenterology and Nutrition: April 2017 - Volume 64 - Issue 4 - p 586–591
doi: 10.1097/MPG.0000000000001307
Original Article: Gastroenterology: Celiac Disease

Objectives: We aimed to study whether the incidence of pediatric celiac disease (CD) in South-Eastern Norway changed from 2000 to 2010. We also examined whether there was a change in symptoms and histopathological morphology in the duodenal biopsies during the same period.

Methods: In 3 hospitals in South-Eastern Norway, records from pediatric patients (0–14.9 years) diagnosed with CD during two 3-year periods (2000–2002 and 2008–2010) were reviewed. Only cases with a duodenal biopsy diagnosis of CD classified as Marsh grade 2 and 3a−c were included. Frequencies of symptoms, anthropometric data, and laboratory results were compared, in addition to re-examinations of histological sections from one of the hospitals.

Results: A total of 400 cases were diagnosed with a female to male ratio of 1.5:1. The incidence rate for 2000 to 2002 was 15.9 cases per 100,000 person-years (95% confidence interval 12.8–19.4), compared with 45.5 cases per 100,000 person-years during 2008 to 2010 (95% confidence interval 40.5–50.9), P < 0.001. The relative frequencies of symptoms and the distribution of histopathological changes were similar in the 2 periods, whereas weight z scores and hemoglobin levels were significantly lower in the first period.

Conclusions: We found a 3-fold increase in the incidence rate for CD in the Norwegian pediatric population during the decade 2000 to 2010. Slightly higher weight and hemoglobin levels at diagnosis in the latter period may be due to improved CD awareness. Unaltered relative frequencies of symptoms and histopathological changes in the gut, however, suggest a true increase of CD in Norwegian children.

*Department of Pathology, Akershus University Hospital, Lørenskog

Department of Pediatric and Adolescent Medicine, Vestre Viken Hospital Trust, Drammen, Norway

Department of Pediatrics, Akureyri Hospital, Akureyri, Iceland

§Department of Pediatrics, Oslo University Hospital, Ullevål, Oslo

||Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog

Institute of Clinical Medicine, University of Oslo, Oslo

#Department of Pediatrics, Østfold Hospital Trust, Kalnes

**Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.

Address correspondence and reprint requests to Ann-Christin R. Beitnes, MD, PhD, Department of Pathology, Akershus University Hospital, Lørenskog, Norway (e-mail:

Received 13 March, 2016

Accepted 11 June, 2016

K.S. was supported by an unrestricted grant from Oak Foundation, Geneva, Switzerland.

The authors report no conflicts of interest.

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,