OVERVIEW:
Celiac disease in children is also known as ‘gluten sensitive enteropathy’. It is an autoimmune disease that is characterized by hypersensitivity to gluten and gliadin and results in loss of small intestinal villi and malabsorption. It is one of the malabsorptive syndromes and by malabsorption syndrome, we mean that there is defective absorption of fats and fat soluble vitamins, proteins, carbohydrates, electrolytes, minerals, and water and the mostly the presentation of celiac disease in children is chronic diarrhea. Gluten is alcohol soluble, water insoluble protein, and is a component of wheat, rye, barley, and oats. Celiac disease in children has the same course as celiac disease in adults and is due to autoimmune reaction going on inside the body.
What Is Pathogenesis For Celiac Disease?
Celiac disease in children is characterized by t-cell and IgM mediated response against gluten in genetically susceptible individuals. It has the highest chance of occurrence in infancy. Celiac disease in children has a genetic tendency and is associated with HLA-DQ8 and HLA-DQ2. Intestinal damage is due to T cell mediated response to gluten and gliadin component of the diet and as a result, the small intestinal Villi undergo atrophy and there is hypertrophy of the crypts. There is an infiltration of lymphocytes and plasma cells inside the mucosa.
What Are Symptoms For Celiac Disease In Childs?
The clinical feature of celiac disease in children occur between 6 months 2 years of life. It is the age when the weaning is started to children and diet containing wheat products are given. If the weaning is started late the symptoms of celiac disease in children occur late. The main symptom is diarrhea and it is due to atrophy of Small intestinal mucosa and malabsorption of Nutrients. The child suffers from recurrent vomiting, gross weight loss and failure to thrive. There is Iron deficiency anemia due to Iron absorption the child may suffer from rickets osteoporosis due to decrease malabsorption of Vitamin D and Calcium. There is muscular atrophy as well.
Celiac disease in children leads to a variety of Neurological symptoms which are irritability, calcification in cerebrum, and fits. Due to decrease absorption of Vitamin D and Calcium child suffers various hormonal symptoms which include delay in puberty, constitutional short height, and increased level of parathyroid hormone. The celiac disease leads to dermatological symptoms such as a rash on extensor surfaces of elbows, front of the knee, back, buttocks, thighs, and scalp. There is idiopathic pulmonary hemosiderosis in children suffering from celiac disease.
How to Diagnose Celiac Disease in Childs?
Diagnosis of celiac disease in children is based on a combination of symptoms, antibiotics, Duodenal Histology, and HLA of the child.
- Antibodies: anti tissue transglutaminase antibody, anti endomysial antibody, and IgA antibody are Diagnostic. As IgA levels decrease in celiac disease in children, total serum IgA a level must also be documented. There is the accuracy of these tests in the absence of IgA deficiency and this test has a specificity and sensitivity of more than 95%. anti-gliadin antibodies are not reliable for screening purposes in celiac disease in children.
- HLA susceptibility: this disease is positive in HLA susceptible individuals. HLA susceptible children need a pair of these genes, one from both parents is to acquire the celiac diseases in the later stages of his life when weaning is started.
- Duodenal histology: duodenal Histology is the most reliable test for celiac disease. There are subtotal, total or partial villous atrophy and crypt hyperplasia. The biopsy is performed by endoscopy and the most accurate specimen for an endoscopic biopsy is the second part of duodenum.
- Other laboratory tests: other laboratory findings in celiac disease in children are fecal fat, impaired absorption of carbohydrate, decrease the level of protein, decreased level of albumin, anemia, and osteoporosis.
What Are Differential Diagnosis For Celiac Disease?
The differential diagnosis for celiac disease includes other malabsorptive syndromes like
- tropical sprue
- bacterial overgrowth
- autoimmune enteropathy
- Crohn disease
- cow milk enteropathy
- Eosinophilic gastroenteritis
- protein energy malnutrition
- nongluten food intolerance
- soy protein enteropathy
- primary immunodeficiency
What Is Treatment For Celiac Disease?
- The treatment of celiac disease in children is the provision of a gluten free diet for a lifetime. Gluten free diet for celiac disease is defined as less than 20 PPM and level of gluten less than 50 milligrams per day. This requires no wheat, Barley, Rai, and oats in the diet and the clinical improvement is evident in the child for one to two weeks and the repair of the intestinal mucosa is seen one year later.
- Celiac disease requires the restriction of iron supplementation and lactose for many months to years as the Small intestinal mucosa is damaged and these supplements will cause a burden on the small intestine. So it is restricted so as to let the small intestinal mucosa heal. Normal amounts of rice, bread, vegetables, fruits, milk, and eggs are given when there is celiac disease.
- Celiac disease when show signs and symptoms of the celiac crisis, corticosteroids are indicated. They hasten the improvement of the child and cause the healing of small intestine and reduces complications of celiac disease in children.
What Is Prognosis For Celiac Disease?
When gluten free diet is started, clinical and histological recovery is seen as early as one week and one year respectively. Initially, the diarrheal symptom of the child subsides and there is also improvement of mood and appetite. In long standing cases of celiac disease in children, the lymphoma of small intestine occurs. Other complications of celiac disease may be prevented by dietary treatment.
WHEN TO SEEK MEDICAL HELP?
Disease in children may prove fatal and the most deadly complication of celiac disease in a child is diarrhea. This leads to dehydration and loss of fluid and consequently weight loss and failure to thrive for celiac disease. You should seek medical help as soon as possible. The doctor will advise you gluten free diet for celiac disease in children with positive serology and positive histopathology. If the disease in children has positive serology but normal histopathology, your doctor may ask you for a proper follow-up and gluten free diet is recommended to you for the treatment of your child.
