Celiac Disease in Children: Complete Overview
Contents
OVERVIEW:
Celiac disease in children is also known as "gluten-sensitive enteropathy." It is an autoimmune disease in which eating gluten damages the lining of the small intestine. The tiny villi that absorb nutrients become damaged, which leads to malabsorption.
Malabsorption means the body can't properly absorb fats, fat-soluble vitamins, proteins, carbohydrates, minerals and water. Ongoing diarrhea is a classic sign in young children, but many children have other symptoms or few symptoms at all.
Gluten is a protein found in wheat, rye and barley. Celiac disease in children has the same cause as celiac disease in adults: an abnormal immune reaction to gluten.
What Is Pathogenesis For Celiac Disease?
Celiac disease is caused by an immune reaction to gluten, driven by T cells, in people with certain genes. It almost always occurs in people with the gene variants HLA-DQ2 or HLA-DQ8.
The disease can start at any age after a child begins eating gluten. In response to gluten, the small intestinal villi shrink (atrophy) and the crypts between them grow deeper. Immune cells such as lymphocytes collect in the lining of the intestine.
What Are Symptoms For Celiac Disease In Childs?
In young children, symptoms often appear between 6 months and 2 years of age, after foods containing wheat are added to the diet. Classic symptoms include diarrhea, a swollen belly, vomiting, weight loss and poor growth (failure to thrive).
Older children may have other signs, such as iron deficiency anemia, short stature, delayed puberty, tiredness or mood changes. Poor absorption of vitamin D and calcium can weaken bones and cause rickets or low bone density, which raises the risk of osteoporosis later. Muscle wasting can also occur.
Some children have neurological symptoms such as irritability, and rarely seizures. An itchy, blistering rash called dermatitis herpetiformis can appear on the elbows, knees, buttocks, back or scalp, but it is uncommon in children. Very rarely, celiac disease is linked to a lung condition called idiopathic pulmonary hemosiderosis.
How to Diagnose Celiac Disease in Childs?
Diagnosis of celiac disease in children is based on symptoms, blood antibody tests, and usually a biopsy of the small intestine. Your child should keep eating gluten until testing is done, because a gluten-free diet can affect the results.
- Antibodies: The main screening test is the tissue transglutaminase IgA antibody (tTG-IgA). Doctors also measure total IgA, because children with IgA deficiency can have falsely negative results. The anti-endomysial antibody test may also be used. Anti-gliadin antibody tests are not reliable for screening.
- HLA susceptibility: Genetic testing for HLA-DQ2 and HLA-DQ8 can be done with a blood sample or cheek swab. If a child doesn't have these gene variants, celiac disease is very unlikely. Having them does not mean the child has or will get the disease.
- Duodenal histology: A biopsy of the small intestine, taken during an upper endoscopy, has been the standard way to confirm the diagnosis. It can show villous atrophy and crypt hyperplasia. Samples are usually taken from several areas of the duodenum.
- Other laboratory tests: Other findings may include fat in the stool, low blood protein and albumin levels, anemia and low bone density.
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 a strict, lifelong gluten-free diet. This means no wheat, barley or rye. Oats are allowed for most people only if they are labeled gluten-free, because regular oats are often contaminated. In the United States, foods labeled gluten-free must contain less than 20 parts per million of gluten.
- Many people feel better within days to weeks after starting the diet, and the intestine then heals over time. A registered dietitian can help families plan safe, balanced meals.
- Your child's doctor may check for low vitamin and mineral levels and recommend supplements, such as iron, vitamin D or calcium, if needed. Some children may need to limit lactose for a while until the intestine heals.
- Celiac crisis is a rare, severe complication with serious diarrhea and dehydration. It needs hospital care, and doctors sometimes use corticosteroids along with fluids and nutrition support.
What Is Prognosis For Celiac Disease?
With a strict gluten-free diet, most children recover well. Diarrhea usually improves first, along with mood and appetite, and growth often catches up.
Untreated celiac disease can lead to long-term problems, such as weak bones, anemia, and rarely small intestine lymphoma. Following the diet lowers the risk of these complications.
WHEN TO SEEK MEDICAL HELP?
See your child's doctor if your child has ongoing diarrhea, belly pain, poor weight gain or slowed growth. Seek care right away if your child shows signs of dehydration, such as very little urine, a dry mouth or unusual sleepiness.
The doctor will recommend a gluten-free diet for a child whose blood tests and biopsy confirm celiac disease.
If a child has positive antibody tests but normal histopathology, the doctor may recommend close follow-up and repeat testing before deciding on treatment. Don't start a gluten-free diet before testing unless a doctor advises it.
