A national prospective study on childhood celiac disease in the Netherlands 1993-2000: an increasing recognition and a changing clinical picture.

OBJECTIVES To investigate prospectively whether the incidence of diagnosed celiac disease (CD) is increasing in the Netherlands and whether the clinical presentation is changing. STUDY DESIGN All newly diagnosed cases of CD throughout the Netherlands were registered prospectively from 1993 to 2000. The clinical picture was compared with that noted in our former study (1975-1990). RESULTS The overall incidence rate of CD was 0.81/1000 live births, with a linear increase from 1993 to 2000. There was a significant increase in the number of subjects with partial villous atrophy of the small bowel mucosa. The clinical presentation has changed significantly: abdominal distention, chronic diarrhea, and failure to thrive are less common, and more children presented with weight < P10, abdominal pain, and lassitude. The median age at diagnosis also increased. CONCLUSION The recognition of childhood CD in the Netherlands has increased significantly during the last few years, and the clinical picture has changed as well. Our data may indicate an increasing awareness of the Dutch doctors working in Child Public Health, general practitioners, and pediatricians to recognize more subtle expressions of the disease.