The presenting pattern of celiac disease (CD) at diagnosis in children has changed over time, with a reduction of malabsorption-related phenotypes and an increase in regular or even excessive growth patterns. We retrospectively reviewed the body mass index (BMI) distribution of all patients with a new diagnosis of CD made in a Pediatric Gastroenterology Outpatient Clinic in 1990–2011, compared to those diagnosed in 2012–2022, according to their clinical and serological characteristics. The 1990–2011 and 2012–2022 cohorts included 250 (M:F = 90:160, mean age 7.3 ± 6.1 years) and 243 children (M:F = 81:162, mean age 7.1 ± 3.7 years, NS), respectively. The prevalence of underweight (UW) was higher in the 1990–2011 cohort (61/250, 24.4% in 1990–2011 vs. 31/243, 12.7% in 2012–2022, p = 0.0001), whereas that of overweight (OW) and obese (OB) subjects was significantly higher in 2012–2022 (10/250, 4% in 1990–2011 vs. 24/243, 9.9% in 2012–2022, p = 0.012, and 1/250, 0.4% in 1990–2011 vs. 8/243, 3.3% in 2012–2022, p = 0.018, respectively). In both cohorts, gastrointestinal symptoms were more frequent in OW/OB than in UW children (6/11, 54.5% vs. 5/61, 8.2% in 1990–2011, p < 0.0001, and 24/32, 75% vs. 10/31, 32.3%, p < 0.0001 in 2012–2022), and the extent of anti-transglutaminase antibody increase was similar in OW/OB and UW subjects. The prevalence of children with a normal or even high BMI at CD diagnosis has increased in the past three decades; therefore, CD should be suspected regardless of BMI status.

The presenting pattern of celiac disease (CD) at diagnosis in children has changed over time, with a reduction of malabsorption-related phenotypes and an increase in regular or even excessive growth patterns. We retrospectively reviewed the body mass index (BMI) distribution of all patients with a new diagnosis of CD made in a Pediatric Gastroenterology Outpatient Clinic in 1990-2011, compared to those diagnosed in 2012-2022, according to their clinical and serological characteristics. The 1990-2011 and 2012-2022 cohorts included 250 (M:F=90:160, mean age 7.3±6.1 years) and 243 children (M:F=81:162, mean age 7.1±3.7 years, NS), respectively. The prevalence of underweight (UW) was higher in the 1990-2011 cohort (61/250, 24.4% in 1990-2011 vs. 31/243, 12.7% in 2012-2022, p=0.0001), whereas that of overweight (OW) and obese (OB) subjects was significantly higher in 2012-2022 (10/250, 4% in 1990-2011 vs. 24/243, 9.9% in 2012-2022, p=0.012, and 1/250, 0.4% in 1990-2011 vs 8/243, 3.3% in 2012-2022, p=0.018, respectively). In both cohorts, gastrointestinal symptoms were more frequent in OW/OB than in UW children (6/11, 54.5% vs. 5/61, 8.2% in 1990-2011, p<0.0001, and 24/32, 75% vs. 10/31, 32.3%, p<0.0001 in 2012-2022) and the extent of anti-transglutaminase antibodies increase was similar in OW/OB and UW subjects. The prevalence of children with a normal or even high BMI at CD diagnosis has increased in the past three decades, therefore CD should be suspected regardless of the BMI status.

Background and Clinical Significance: Celiac disease (CD) is a gluten-triggered immune enteropathy that may rarely present as Celiac crisis (CC), a life-threatening condition marked by severe diarrhea, dehydration, metabolic derangements, and acute malnutrition. Pediatric diagnostic criteria are lacking, and despite its reduced incidence in high-income countries, CC remains a critical complication, potentially associated with refeeding syndrome. Case Presentation: We report the case of a 23-month-old girl presenting with chronic diarrhea, weight loss, iron-deficiency anemia, hypoalbuminemia, and coagulation abnormalities. Serology confirmed CD, and a gluten-free diet (GFD) was initiated. However, the patient experienced clinical deterioration consistent with CC. Her course was further complicated by refeeding syndrome, ileo-ileal intussusception, and deep vein thrombosis, requiring corticosteroids, anticoagulation, and multidisciplinary nutritional support. Full clinical recovery was achieved within two months. Conclusions: This case highlights the life-threatening potential of CC and the necessity for early recognition. Timely GFD initiation, correction of metabolic abnormalities, and monitoring for refeeding syndrome are essential. We propose pediatric-adapted diagnostic criteria to facilitate earlier recognition and standardize the management of CC. The proposed framework includes major and minor criteria based on the rapid onset of gastrointestinal symptoms with serological evidence of CD autoimmunity, accompanied by clinical instability requiring hospitalization or intensive support and multiple indicators of systemic compromise.