title: Coeliac disease in children.
abstract: Coeliac disease is an immune-mediated systemic disorder caused by ingestion of gluten. The condition presents classically with gastrointestinal signs including diarrhoea, bloating, weight loss and abdominal pain, but presentations can include extra-intestinal symptoms such as iron-deficiency anaemia, faltering growth, delayed puberty and mouth ulcers. Some children are at higher risk of developing coeliac disease, for example those with a strong family history, certain genetic disorders and other autoimmune conditions. If coeliac disease is suspected, serological screening with anti-tissue transglutaminase titres should be performed and the diagnosis may be confirmed by small bowel biopsy while the child remains on a normal (gluten-containing) diet. Modified European guidelines recommend that symptomatic children with anti-tissue transglutaminase titres more than ten times the upper limit of normal, and positive human leucocyte antigen (HLA)-DQ2 or HLA-DQ8 status, do not require small bowel biopsy for diagnosis of coeliac disease. Management of the disease involves strict adherence to a lifelong gluten-free diet, which should lead to resolution of symptoms and prevention of long-term complications. Healthcare professionals should be aware of the varied presentations of coeliac disease to ensure timely screening and early initiation of a gluten-free diet.
authors.affiliation: Bristol Royal Hospital for Children, Bristol, England.
authors.forename: Siba Prosad
authors.initials: SP
authors.lastname: Paul
authors.affiliation: University of Bristol, Bristol, England.
authors.forename: Emily Natasha
authors.initials: EN
authors.lastname: Kirkham
authors.affiliation: Bristol Royal Hospital for Children, Bristol, England.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pidgeon
authors.affiliation: Bristol Royal Hospital for Children, Bristol, England.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sandmann
mesh_terms: D000293:Adolescent; D002446:Celiac Disease / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D005260:Female; D006683:HLA-DQ Antigens / Q000276:immunology; D006801:Humans; D007421:Intestine, Small / Q000276:immunology*; D008297:Male
chemical_list: D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; C109756:HLA-DQ8 antigen
keywords: Allergy; anaemia; children’s nursing; coeliac disease; dietitian; gluten-free diet; human leucocyte antigen; iron deficiency; paediatrics; small bowel biopsy; vitamin D