Practical considerations for the identification and follow-up of children with celiac disease.
Celiac disease is an immune-mediated enteropathy affecting 0.5% to 1% of children and is induced by dietary gluten in susceptible individuals carrying the human leukocyte antigen DQ2 or DQ8 heterodimer. If serological screening is positive or if a patient displays suggestive symptoms, an endoscopic biopsy of the distal duodenum is required to confirm the diagnosis. Symptoms of celiac disease are often mild or absent. Overt malabsorption occurs in only 2% to 10% of children. Individuals with a higher risk of developing celiac disease, including first-degree relatives of affected patients and children with type I diabetes, Turner syndrome, Williams syndrome or Down syndrome, should be offered screening for celiac disease along with a discussion of the implications. If serological testing is negative, a high index of suspicion should remain if malabsorption, iron deficiency or osteopenia is present. Also, immunoglobulin A deficiency should be excluded. At-risk individuals should undergo serial serological screening. Lifelong adherence to a gluten-free diet is the only treatment. If left untreated, symptomatic children with celiac disease carry an increased risk of developing osteoporosis and have a greater lifetime risk of cancer. The long-term outcome of undiagnosed or untreated asymptomatic individuals is less clear.
Dirks
Martha H
MH
Division of Gastroenterology, Hepatology and Nutrition, Hôpital Sainte-Justine and the University of Montreal, Montreal, Quebec.
Arch Intern Med. 2003 Feb 10;163(3):286-92
12578508
Diabet Med. 1996 May;13(5):464-70
8737029
BMJ. 2004 Feb 7;328(7435):322-3
14764493
J Pediatr Gastroenterol Nutr. 2001 Jul;33(1):97-100
11479418
J Pediatr. 2000 Jun;136(6):841-3
10839888
Pediatrics. 2004 May;113(5):1254-9
15121938
Lancet. 2001 Aug 4;358(9279):356-61
11502314
Can J Gastroenterol. 2000 Dec;14(11):915-8
11125180
Gastroenterology. 2001 May;120(6):1522-5
11313323
Gut. 2004 May;53(5):649-54
15082581
J Pediatr Gastroenterol Nutr. 2004 Mar;38(3):338-42
15076637
J Pediatr Gastroenterol Nutr. 1995 Oct;21(3):308-12
8523215
J Pediatr Gastroenterol Nutr. 2000 Nov;31(5):513-9
11144436
J Pediatr. 2003 Sep;143(3):308-14
14517510
J Pediatr. 2001 Oct;139(4):516-21
11598597
J Pediatr. 2001 Apr;138(4):593-5
11295729
Gut. 1989 Mar;30(3):333-8
2707633
Gastroenterology. 2001 Feb;120(3):636-51
11179241
J Pediatr. 2000 Sep;137(3):356-60
10969260
Gut. 1998 Oct;43(4):490-3
9824575
Bone. 1999 Mar;24(3):249-55
10071918
N Engl J Med. 1995 Oct 19;333(16):1033-7
7675045
Mayo Clin Proc. 2004 Apr;79(4):476-82
15065612
J Pediatr Endocrinol Metab. 1999 May-Jun;12(3):433-42
10821223
Scand J Gastroenterol. 1998 Dec;33(12):1280-3
9930391
J Pediatr Gastroenterol Nutr. 2005 Jan;40(1):1-19
15625418
J Pediatr Gastroenterol Nutr. 2004 Feb;38(2):181-6
14734881
J Pediatr Gastroenterol Nutr. 1995 Jul;21(1):69-72
8576818
Eur J Gastroenterol Hepatol. 2001 Sep;13(9):1123-8
11564968
Arch Dis Child. 1988 Aug;63(8):916-20
3415327
Diabetes Care. 1998 Nov;21(11):1985-9
9802755
Baillieres Clin Gastroenterol. 1995 Jun;9(2):273-93
7549028
Pediatrics. 2004 May;113(5):e418-22
15121983
Lancet. 2000 Mar 4;355(9206):806
10711931
Am J Med Genet. 2001 Jan 1;98(1):70-4
11426458
Clin Diagn Lab Immunol. 2002 Nov;9(6):1295-300
12414763
J Pediatr Gastroenterol Nutr. 2004 Feb;38(2):204-7
14734885
Clin Chem. 2004 Jan;50(1):216-9
14709654
J Pediatr. 2000 Dec;137(6):756-61
11113830
Scand J Gastroenterol. 2004 Jan;39(1):27-31
14992558
J Med Genet. 2001 Nov;38(11):767-8
11694549
Gastroenterology. 2002 Nov;123(5):1428-35
12404215
Ital J Gastroenterol Hepatol. 1997 Aug;29(4):305-10
9476181
Ann Allergy Asthma Immunol. 1996 Oct;77(4):333-6
8885812
Dig Dis Sci. 2000 Feb;45(2):403-6
10711459
Can J Gastroenterol. 2001 May;15(5):297-301
11381296
J Clin Pathol. 2002 Jul;55(7):488-94
12101191
Pediatrics. 2004 Jun;113(6):1672-6
15173490
Clin Diagn Lab Immunol. 2000 Jul;7(4):584-7
10882656
J Pediatr Gastroenterol Nutr. 2002;35 Suppl 2:S78-88
12192175
Pediatrics. 2001 Nov;108(5):E89
11694673
Gut. 1998 Mar;42(3):362-5
9577342