Today I’d like to cover Celiac Disease (CD), which impacts about 1 in 100 people worldwide. CD is an important consideration when children present with gastrointestinal concerns, and also when they present with many different non-specific complaints, physical exam findings or laboratory abnormalities. A recent article by J Silvester J, titled “A New Diagnostic Paradigm for Celiac Disease” in the Contemporary Pediatrics December 2020 edition provides a nice review of Celiac Disease. Here are some important summary points directly quoted from the article.
Risk Factors
Celiac disease (CD) is more common in children with the following risk factors:
A family member with CD or dermatitis herpetiformis
Type 1 diabetes
Down syndrome or Turner syndrome
Autoimmune thyroid disease
Common Signs And Symptoms
- Chronic or intermittent diarrhea
- Chronic constipation not responding to usual treatment
- Chronic abdominal pain
- Abdominal distention
- Recurrent nausea or vomiting
- Weight loss or failure to thrive
- Stunted growth or short stature
- Delayed puberty
- Iron deficiency anemia
- Irritability and behavioral issues
- Headache
- Arthritis/arthralgia
- Dental enamel defects
- Recurrent aphthous stomatitis
- Elevated aminotransaminases
Timely diagnosis of celiac disease and optimization of nutrition is particularly important in childhood to prevent irreversible complications, such as short stature, osteoporosis, and the development of other autoimmune disorders.
Screening
The most clinically and cost-effective screening method for Celiac Disease is obtaining a total serum IgA in addition to a test for serum anti-tissue transglutaminase IgA antibodies (tTG IgA) as a child continues to consume a gluten-containing diet. Pediatric patients aged younger than 2 to 3 years may have a less robust presence of IgA rendering tTG IgA testing less efficient. In these cases, one should consider testing for IgG deamidated gliadin antibodies (anti-DPG IgG) in addition to the recommended tTG IgA.
Mitigation
At present, the only way to mitigate celiac disease is a gluten-free diet, so implementing this diet is essential. However, prior to celiac disease diagnosis, reduction or avoidance of gluten is not recommended, as it may reduce the sensitivity of both serology and biopsy testing.
The implementation of a gluten-free diet is the only way to heal intestinal mucosa in celiac disease patients. This means not only avoiding wheat, but also rye and barley.
Hope this helps you the next time you see a child come in with signs or symptoms suggestive of possible Celiac Disease. Have questions or topics you’d like me to tackle? Just respond to this email with your suggestions.
Hope this helps!
Best regards,
Dr. Eyal Ben-Isaac, Children’s Hospital Los Angeles
