{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T01:18:20Z","timestamp":1787966300916,"version":"build-2784847793"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T00:00:00Z","timestamp":1723766400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The prevalence of celiac disease (CeD) is increasing, yet it is still underdiagnosed, in part because of its heterogeneous presentation. Diagnostic criteria are evolving and management with strict adherence to a gluten\u2010free diet is challenging for many. We aimed to characterize the clinical presentation of CeD among a large multicenter cohort of pediatric patients and to identify factors associated with gluten\u2010free diet adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with CeD aged 0\u201318 years were recruited from 11 United States health centers. Parents completed surveys about gluten\u2010free diet adherence and patient electronic health records were reviewed. Logistic regression analyses were performed to identify risk factors associated with gluten exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Charts were reviewed for 460 children with a median age of 6.4 years. Abdominal pain was reported in 57% of the cohort, but diverse symptoms were identified. Parent surveys were completed for 455 participants. Sixty\u2010five (14%) participants were at high risk for gluten exposure based on parental reports of weekly or daily gluten exposure or eating gluten by choice in the past year. Participants under the age of 5 years had a lower risk of gluten exposure, while participants without repeat serology testing 18 months after initial diagnosis were at higher risk of gluten exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In a large, multicenter cohort of pediatric CeD patients, clinical presentation is highly variable, necessitating a high index of suspicion to make a diagnosis. Parent surveys indicate that 14% of patients are at high risk of gluten exposure, with patient age and lack of close follow\u2010up associated with gluten\u2010free diet adherence.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpn3.12321","type":"journal-article","created":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T08:55:09Z","timestamp":1723798509000},"page":"895-904","source":"Crossref","is-referenced-by-count":8,"title":["Clinical presentation and factors associated with gluten exposure in children with celiac disease"],"prefix":"10.1002","volume":"79","author":[{"given":"Andrew","family":"Krueger","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Fahey","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition The Children's Hospital of Philadelphia Philadelphia Pennsylvania USA"},{"name":"Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Regis","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition Boston Children's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasim","family":"Khavari","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Celiac Disease Center Stanford University, Lucile Packard Children's Hospital Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Jericho","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Celiac Disease Center Stanford University, Lucile Packard Children's Hospital Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vahe","family":"Badalyan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Children's National Hospital George Washington University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imad","family":"Absah","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology Hepatology and Nutrition, Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition The University of Chicago Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen M.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Harvard Medical School, Division of Pediatric Gastroenterology and Nutrition Mass General Hospital for Children Boston Massachusetts USA"},{"name":"Harvard Medical School, Center for Celiac Research and Treatment Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Weisbrod","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Harvard Medical School, Harvard Celiac Research Program Boston Children's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Temara","family":"Hajjat","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale","family":"Lee","sequence":"additional","affiliation":[{"name":"Seattle Children's Hospital University of Washington School of Medicine Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Shull","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Colorado Center for Celiac Disease, Digestive Health Institute, Children's Hospital Colorado University of Colorado Anschutz Medical Campus Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3615-1666","authenticated-orcid":false,"given":"Jocelyn A.","family":"Silvester","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Harvard Medical School, Harvard Celiac Research Program Boston Children's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4126-9191","authenticated-orcid":false,"given":"Daniel","family":"Mallon","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"RAISE\u2010CD","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.06.037"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.06.098"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-021-00552-z"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640617751253"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-105"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002497"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001216"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1536-4801.2005.tb00917.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/ctg.2012.4"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000000887"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1943"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-021-00511-8"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jhn.12754"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.5409\/wjcp.v10.i4.53"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003015"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-021-01183-5"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.11165"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13441"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15112455"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2021.111249"},{"key":"e_1_2_7_22_1","first-page":"S1542","article-title":"One\u2010year outcomes among children identified with celiac disease through a mass screening program","volume":"13","author":"Stahl MG","year":"2024","journal-title":"Clin Gastroenterol Hepatol"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/pch\/19.6.305"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001705"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-021-03939-x"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2013.54"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.02.014"}],"container-title":["Journal of Pediatric Gastroenterology and Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpn3.12321","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,10]],"date-time":"2024-12-10T13:10:50Z","timestamp":1733836250000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jpn3.12321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,16]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1002\/jpn3.12321"],"URL":"https:\/\/doi.org\/10.1002\/jpn3.12321","archive":["Portico"],"relation":{},"ISSN":["0277-2116","1536-4801"],"issn-type":[{"value":"0277-2116","type":"print"},{"value":"1536-4801","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,16]]}}}