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Increasing Incidence and Altered Presentation in a Population-based Study of Pediatric Celiac Disease in North America

Almallouhi, Eyad*; King, Katherine S.; Patel, Bhavisha; Wi, Chung||; Juhn, Young J.‡,||; Murray, Joseph A.§; Absah, Imad*,§

Journal of Pediatric Gastroenterology and Nutrition: October 2017 - Volume 65 - Issue 4 - p 432–437
doi: 10.1097/MPG.0000000000001532
Original Article: Gastroenterology: Celiac Disease

Objectives: Celiac disease (CD) is a common immune-mediated disorder that affects up to 1% of the general population. Recent reports suggest that the incidence of CD has reached a plateau in many countries. We aim to study the incidence and altered presentation of childhood CD in a well-defined population.

Methods: Using the Rochester Epidemiology Project, we retrospectively reviewed Mayo Clinic and Olmsted Medical Center medical records from January 1994 to December 2014. We identified all CD cases of patients ages 18 years or younger at the time of diagnosis. Incidence rates were calculated by adjusting for age, sex, and calendar year and standardizing to the 2010 US white population.

Results: We identified 100 patients with CD. Incidence of CD has increased from 8.1 per 100,000 person-years (2000–2002) to 21.5 per 100,000 person-years (2011–2014). There was an increase in CD prevalence in children from 2010 (0.10%) to 2014 (0.17%). Thirty-four patients (34%) presented with classical CD symptoms, 43 (43%) had nonclassical CD, and 23 (23%) were diagnosed by screening asymptomatic high-risk patients. Thirty-six patients (36%) had complete villous atrophy, 51 (51%) had partial atrophy, and 11 (11%) had increased intraepithelial lymphocytes. Two patients were diagnosed without biopsy. Most patients (67%) had a normal body mass index, 17% were overweight/obese, and only 9% were underweight.

Conclusions: Both incidence and prevalence of CD have continued to increase in children during the past 15 years in Olmsted County, Minnesota. Clinical and pathologic presentations of CD are changing over time (more nonclassical and asymptomatic cases are emerging).

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*Division of Pediatric Gastroenterology and Hepatology

Division of Biomedical Statistics and Informatics

Division of Allergy, Department of Internal Medicine

§Division of Gastroenterology and Hepatology

||Asthma Epidemiology Research Unit, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.

Address correspondence and reprint requests to Imad Absah, MD, Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (

Received 04 August, 2016

Accepted 23 January, 2017

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

The authors have no conflicts of interest.

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