Evaluation of the Impact of the COVID-19 Pandemic on the Clinical Presentation of Pediatric Celiac Disease

Abstract

Purpose To evaluate the impact of the coronavirus disease (COVID-19) pandemic on the clinical presentation, serological load, and duodenal histopathological damage in pediatric celiac disease (CD) patients compared to the pre-pandemic period. Methods This retrospective cohort study included 114 pediatric patients with biopsy-confirmed CD diagnosed between June 2017 and November 2021. The study population was divided into a Pandemic Group (n=57) and a Pre-Pandemic Control Group (n=57). To ensure histopathological comparability, patients diagnosed without biopsy due to high antibody titers were excluded. Demographic data, clinical symptoms, anti-tissue transglutaminase antibody (anti-tTG) IgA/IgG titers, and Modified Marsh scores were analyzed. Results The median age at diagnosis was significantly higher in the Pandemic Group compared to the Pre-Pandemic Group (p=0.004). Regarding serology, the proportion of patients with anti-tTG IgA levels ≥10 times the upper limit of normal (ULN) was significantly elevated in the Pandemic Group (75.4%) compared to the controls (47.4%) (p=0.011). A significant difference was also noted in anti-tTG IgG levels (p=0.032). However, no statistically significant differences were observed between the periods regarding clinical presentation phenotypes (p=0.084) or the severity of duodenal mucosal damage based on Modified Marsh scores (p=0.076). Conclusion The COVID-19 pandemic resulted in a significant delay in diagnosis age and an increased serological load in pediatric CD cases. However, this increased load did not correspond to a significant worsening in duodenal mucosal damage. These results underscore the critical importance of maintaining diagnostic pathways for chronic conditions during health crises.