{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:02:38Z","timestamp":1780470158644,"version":"3.54.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Celiac disease is among the most common chronic gastrointestinal disorders in childhood and is frequently associated with other autoimmune conditions. The 2020 ESPGHAN guidelines revised pediatric celiac disease diagnosis by allowing non-biopsy confirmation in selected cases. Despite growing global data, evidence from Eastern Europe remains limited, and contemporary regional data describing pediatric celiac disease in routine clinical practice remain scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, single-center study including 58 pediatric patients with confirmed celiac disease followed between 2020 and 2024 at a tertiary pediatric center in North-Eastern Romania. All patients fulfilled the 2020 ESPGHAN criteria and were stratified according to the presence or absence of coexisting immune-mediated conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighteen patients (31.0%) had at least one coexisting immune-mediated condition, most commonly type 1 diabetes mellitus and autoimmune thyroiditis. Female sex predominated in the cohort (female-to-male ratio 3.1:1) and was significantly more common among patients with coexisting immune-mediated conditions. Children with these conditions were diagnosed with celiac disease at an older age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020) and were more often asymptomatic at diagnosis (27.8% vs. 2.5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009). In contrast, children without coexisting immune-mediated conditions were predominantly diagnosed based on symptomatic evaluation, often with mixed gastrointestinal and extraintestinal presentations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings highlight the clinical heterogeneity of pediatric celiac disease according to immune-mediated condition status and suggest that differences in clinical surveillance may influence diagnostic patterns in routine practice. The results support the importance of targeted surveillance and screening strategies in children at increased autoimmune risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1786392","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:07:03Z","timestamp":1780466823000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric celiac disease and coexisting immune-mediated conditions: a five-year single-center study from North-Eastern Romania"],"prefix":"10.3389","volume":"14","author":[{"given":"Laura Otilia","family":"Boca","sequence":"first","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi","place":["Iasi, Romania"]},{"name":"Sfanta Maria Emergency Hospital for Children Iasi","place":["Iasi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Ghiga","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi","place":["Iasi, Romania"]},{"name":"Sfanta Maria Emergency Hospital for Children Iasi","place":["Iasi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"P\u0103duraru","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi","place":["Iasi, Romania"]},{"name":"Sfanta Maria Emergency Hospital for Children Iasi","place":["Iasi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Iulia","family":"Bozomitu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi","place":["Iasi, Romania"]},{"name":"Sfanta Maria Emergency Hospital for Children Iasi","place":["Iasi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoleta","family":"Gimiga","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi","place":["Iasi, Romania"]},{"name":"Sfanta Maria Emergency Hospital for Children Iasi","place":["Iasi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Cojocaru","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi","place":["Iasi, Romania"]},{"name":"Sfanta Maria Emergency Hospital for Children Iasi","place":["Iasi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103t\u0103lina","family":"Lunc\u0103","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi","place":["Iasi, Romania"]},{"name":"Sfanta Maria Emergency Hospital for Children Iasi","place":["Iasi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena Lia","family":"Spoial\u0103","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi","place":["Iasi, Romania"]},{"name":"Sfanta Maria Emergency Hospital for Children Iasi","place":["Iasi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena Mihaela","family":"Manole","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi","place":["Iasi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Mihaela","family":"Trandafir","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi","place":["Iasi, Romania"]},{"name":"Sfanta Maria Emergency Hospital for Children Iasi","place":["Iasi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"357","DOI":"10.3389\/fped.2019.00357","article-title":"Changing pattern of childhood celiac disease epidemiology: contributing factors","volume":"7","author":"Popp","year":"2019","journal-title":"Front Pediatr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.cgh.2017.06.037","article-title":"Global prevalence of celiac disease: systematic review and meta-analysis","volume":"16","author":"Singh","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1650","DOI":"10.3390\/medicina60101650","article-title":"Coeliac disease in children\u2014a clinical review including novel treatment agents","volume":"60","author":"Corlett","year":"2024","journal-title":"Medicina"},{"key":"B4","doi-asserted-by":"publisher","first-page":"320","DOI":"10.3390\/nu11020320","article-title":"Gluten-Induced extra-intestinal manifestations in potential celiac disease-celiac trait","volume":"11","author":"Popp","year":"2019","journal-title":"Nutrients"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2039","DOI":"10.3390\/life13102039","article-title":"The role of intestinal microbiota in celiac disease and further therapeutic perspectives","volume":"13","author":"Belei","year":"2023","journal-title":"Life"},{"key":"B6","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1186\/s12916-019-1380-z","article-title":"Celiac disease: a comprehensive current review","volume":"17","author":"Caio","year":"2019","journal-title":"BMC Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1097\/MPG.0000000000002497","article-title":"European Society paediatric gastroenterology, hepatology and nutrition guidelines for diagnosing coeliac disease 2020","volume":"70","author":"Husby","year":"2020","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"507","DOI":"10.14309\/ajg.0000000000000523","article-title":"Incidence of celiac disease is increasing over time: a systematic review and meta-analysis","volume":"115","author":"King","year":"2020","journal-title":"Am J Gastroenterol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"316","DOI":"10.15403\/jgld-5834","article-title":"Prevalence of celiac disease in Romania","volume":"33","author":"Pop","year":"2024","journal-title":"J Gastrointestin Liver Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"30","DOI":"10.37897\/RJP.2023.1.8","article-title":"Diagnostic challenges in children with celiac disease. A five-year retrospective study","volume":"72","author":"Pop","year":"2023","journal-title":"Romanian J Pediatr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"33","DOI":"10.37897\/RJP.2017.1.7","article-title":"Celiac disease case finding strategy in Romanian symptomatic children","volume":"66","author":"Le\u0219anu","year":"2017","journal-title":"Romanian J Pediatr"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1056\/NEJMoa1400697","article-title":"Introduction of gluten, HLA status, and the risk of celiac disease in children","volume":"371","author":"Lionetti","year":"2014","journal-title":"N Engl J Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1542\/peds.2012-3765","article-title":"Usefulness of symptoms to screen for celiac disease","volume":"133","author":"Ros\u00e9n","year":"2014","journal-title":"Pediatrics"},{"key":"B14","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1111\/apt.16337","article-title":"Systematic review and meta-analysis: the incidence and prevalence of paediatric coeliac disease across Europe","volume":"54","author":"Roberts","year":"2021","journal-title":"Aliment Pharmacol Ther"},{"key":"B15","doi-asserted-by":"publisher","first-page":"959","DOI":"10.3390\/foods14060959","article-title":"Celiac disease\u2014narrative review on progress in celiac disease","volume":"14","author":"Kowalski","year":"2025","journal-title":"Foods"},{"key":"B16","doi-asserted-by":"publisher","first-page":"315","DOI":"10.18203\/2320-6012.ijrms20234028","article-title":"Exploring typical and atypical variants of celiac disease: a narrative review","volume":"12","author":"Oza","year":"2023","journal-title":"Int J Res Med Sci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1097\/MPG.0000000000003015","article-title":"Clinical presentation in children with celiac disease in central Europe","volume":"72","author":"Riznik","year":"2021","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1016\/j.autrev.2018.05.013","article-title":"Celiac disease and endocrine autoimmunity\u2014the genetic link","volume":"17","author":"Kahaly","year":"","journal-title":"Autoimmun Rev"},{"key":"B19","doi-asserted-by":"publisher","first-page":"588","DOI":"10.3390\/children10030588","article-title":"Autoimmune polyendocrine syndromes in the pediatric age","volume":"10","author":"Paparella","year":"2023","journal-title":"Children"},{"key":"B20","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1159\/000439586","article-title":"Risk factors for polyautoimmunity among patients with celiac disease: a cross-sectional survey","volume":"92","author":"Demirezer Bolat","year":"2015","journal-title":"Digestion"},{"key":"B21","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1002\/jpr3.70119","article-title":"Autoantibody signatures in children with celiac disease, juvenile idiopathic arthritis, and polyautoimmunity","volume":"7","author":"Du","year":"2025","journal-title":"JPGN Rep"},{"key":"B22","doi-asserted-by":"publisher","first-page":"488","DOI":"10.36691\/RJA16499","article-title":"IgE-mediated food allergy and celiac disease: an updated review","volume":"20","author":"Ait Said","year":"2023","journal-title":"Russian J Allergy"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.3390\/biomedicines12071429","article-title":"Limited clinical impact of genetic associations between celiac disease and type 2 inflammatory diseases: insights from Mendelian randomization","volume":"12","author":"Omar","year":"2024","journal-title":"Biomedicines"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e8094","DOI":"10.7759\/cureus.8094","article-title":"The prevalence of autoimmune disorders in women: a narrative review","volume":"12","author":"Angum","year":"2020","journal-title":"Cureus"},{"key":"B25","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1038\/s41392-024-01952-8","article-title":"Evolving understanding of autoimmune mechanisms and new therapeutic strategies of autoimmune disorders","volume":"9","author":"Song","year":"2024","journal-title":"Signal Transduct Target Therapy"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e97306","DOI":"10.5812\/ijp.97306","article-title":"Prevalence of celiac disease in children with type 1 diabetes Mellitus in the South of Turkey","volume":"30","author":"Sahin","year":"2019","journal-title":"Iran J Pediatr"},{"key":"B27","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/s10620-018-5353-4","article-title":"Celiac disease and celiac antibodies in DM1 patients: when are screening and biopsy recommended?","volume":"64","author":"Slae","year":"2019","journal-title":"Dig Dis Sci"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e170","DOI":"10.1542\/peds.2014-2883","article-title":"Screening for celiac disease in type 1 diabetes: a systematic review","volume":"136","author":"Pham-Short","year":"2015","journal-title":"Pediatrics"},{"key":"B29","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1136\/adc.2003.029603","article-title":"Mass screening for coeliac disease using antihuman transglutaminase antibody assay","volume":"89","author":"Tommasini","year":"2004","journal-title":"Arch Dis Child"},{"key":"B30","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/1824-7288-38-10","article-title":"Celiac disease in type 1 diabetes mellitus","volume":"38","author":"Camarca","year":"2012","journal-title":"Ital J Pediatr"},{"key":"B31","doi-asserted-by":"publisher","first-page":"94","DOI":"10.5114\/aoms.2018.72241","article-title":"Histologic recovery among celiac disease children on gluten free diet. A long-term follow-up single centre experience","volume":"14","author":"Belei","year":"2018","journal-title":"Arch Med Sci"},{"key":"B32","doi-asserted-by":"publisher","first-page":"130","DOI":"10.4239\/wjd.v4.i4.130","article-title":"Type 1 diabetes and celiac disease: the effects of gluten free diet on metabolic control","volume":"4","author":"Scaramuzza","year":"2013","journal-title":"World J Diabetes"},{"key":"B33","doi-asserted-by":"publisher","first-page":"100893","DOI":"10.1016\/j.conctc.2022.100893","article-title":"Does a gluten-free diet lead to better glycemic control in children with type 1 diabetes? Results from a feasibility study and recommendations for future trials","volume":"26","author":"S\u00f6derstr\u00f6m","year":"2022","journal-title":"Contemp Clin Trials Commun"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1786392\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:07:04Z","timestamp":1780466824000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1786392\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":33,"alternative-id":["10.3389\/fped.2026.1786392"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1786392","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]},"article-number":"1786392"}}