Child’s Symptoms Can Affect Speed of Celiac Disease Diagnosis

Non-Invasive Tests Celiac Disease Diagnosis ChildrenItalian children with less specific symptoms or failure to thrive experience longer diagnostic delays for celiac disease (CD), while those under age 3 years or with a family history are diagnosed sooner.

  • Daniela Ovadia, MD, 1


The study analyzed 3171 pediatric patients diagnosed with CD across 13 Italian tertiary referral centers from 2010 to 2019.

Data collection spanned from January to June 2023, focusing on the diagnostic delay, defined as the time from first symptoms to definitive diagnosis.

Diagnostic delay was further categorized into pre-consultation and post-consultation periods for detailed analysis.

Statistical analysis included uni-variable and multi-variable linear regression models to identify factors associated with diagnostic delays.


  • The median overall diagnostic delay for pediatric CD in Italy was 5 months, with pre-consultation and post-consultation delays of 2 months and 1 month, respectively.
  • Children under the age of 3 years, male patients, or those with a family history of CD experienced shorter diagnostic delays compared with others.
  • Conditions like neurological symptoms, gastro-esophageal reflux, and failure to thrive were associated with longer delays.
  • Mis-diagnoses were more frequent among those with gastro-esophageal reflux.

In Practice

“Failure to thrive could be attributed to diseases other than CD, and milder cases could be overlooked.

Notably, it has already been reported that the presence of a classical malabsorption syndrome in adult patients was associated with a longer delay.

Given the fact that the delay depends mostly on patients, this means that some patients and their families may delay seeking medical care.

It should be stressed that in Italy there is universal coverage of health care expenses, which can also be full coverage in cases of medium to low family income, so pediatric treatments are universally available to anyone,” wrote the authors of the study.


The study was led by Paola Ilaria Bianchi, MD, Marco Vincenzo Lenti, MD, and Antonio Di Sabatino, MD, Clinica Medica 1, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy. It was published online on April 9, 2024, in JAMA Network Open.


The retrospective nature of the study and reliance on patient or caregiver recall may introduce inaccuracies in reporting the onset of symptoms and diagnostic timelines.


The study was supported by research funds from the University of Pavia to Di Sabatino. No other significant disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.