Changing clinical presentation of pediatric celiac disease over time

Celiac disease (CD), often associated with malabsorption, presents with a wide spectrum of gastrointestinal and extra-intestinal manifestations. It was aimed to investigate changes in the clinical presentation of CD in children over a 16-year period and to assess whether clinical forms (classical, non-classical and asymptomatic) vary according to age, sex, and histopathological severity. This retrospective study included 216 pediatric patients (aged 1–18 years) diagnosed with biopsy-confirmed CD at a tertiary center between January 2008 and November 2023. Patients were divided into two groups based on the year of diagnosis (group 1 = 2008–2015, group 2 = 2016–2023). Demographics, presenting symptoms, histopathological findings, Oslo-based clinical classifications were analyzed. The mean age at diagnosis was 92.0 ± 51.2 months, with female predominance (65%). Classical CD was observed in 53.2% of the patients. Over time, the overall distribution of clinical presentation did not differ significantly between the two periods ( p = 0.658), although classical CD decreased numerically and non-classical CD increased numerically. Diarrhea and abdominal distention decreased significantly ( p = 0.008 and p = 0.006), while constipation ( p = 0.063) and isolated short stature ( p = 0.304) showed numerical increases that did not reach statistical significance. Histopathological severity decreased over time, with a significant reduction in total villous atrophy (Marsh 3 C, p < 0.001). Asymptomatic patients were diagnosed at an older age than the other clinical presentation groups (three-group comparison, p = 0.007). The clinical profile of pediatric CD appears to be evolving, with a significant decline in classical symptoms — especially chronic diarrhea and abdominal distension, alongside numerical (non-significant) trends toward increased non-classical manifestations such as constipation and isolated short stature. Awareness of these evolving presentations, including non-classical and screen-detected diseases, is essential for early diagnosis and prevention of long-term complications.