title: The role of nurses and dietitians in managing paediatric coeliac disease.
abstract: Coeliac disease (CD) is an immune-mediated genetic condition elicited by the ingestion of gluten, leading to proximal small bowel enteropathy. It affects around 1% of the population, although only a small proportion of cases are actually diagnosed. It is a multisystem disorder presenting with both gastrointestinal and extra-intestinal manifestations such as diarrhoea, abdominal pain, constipation, vomiting, iron deficiency anaemia, faltering growth, dental enamel defects, short stature, liver disease, arthropathy and recurrent aphthous ulcers. Nurses, working in different clinical settings, are best placed for early recognition and diagnosis of CD in children. Suspicion of CD should lead to immunoglobulin A (IgA)-based anti-tissue transglutaminase antibody screening tests and a diagnosis confirmed by an intestinal biopsy. Modification of European (ESPGHAN) guidelines now enables CD to be diagnosed without a small-bowel biopsy in a select group of symptomatic children. A gluten-free diet should preferably be started by paediatric dietitians. Strict adherence to a gluten-free diet is essential to maintain good health and to prevent long-term complications. A case study demonstrating some of the challenges that may be faced in children with CD in clinical practice is described. Specialist nurse-led CD clinics are gaining popularity and have been found to be equally effective in providing continuity of quality care.
authors.affiliation: 4th Year Medical Student, University of Bristol.
authors.forename: Chi-Yee
authors.initials: CY
authors.lastname: Fok
authors.affiliation: Specialist Paediatric Dietitian, Yeovil District Hospital.
authors.forename: Kate Sara
authors.initials: KS
authors.lastname: Holland
authors.affiliation: Clinical Nurse Specialist in Paediatric Gastroenterology, Bristol Royal Hospital for Children.
authors.forename: Elena
authors.initials: E
authors.lastname: Gil-Zaragozano
authors.affiliation: Consultant Paediatrician, Torbay Hospital, Torquay.
authors.forename: Siba Prosad
authors.initials: SP
authors.lastname: Paul
mesh_terms: D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy / Q000451:nursing*; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D042241:Early Diagnosis; D061345:Early Medical Intervention; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D007421:Intestine, Small / Q000473:pathology; D024802:Nurse's Role; D064686:Nutritionists; D057184:Practice Patterns, Nurses'; D024382:Professional Role; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D018570:Risk Assessment; D011503:Transglutaminases / Q000276:immunology
chemical_list: D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Adherence; Asymptomatic disease; Biopsies; Coeliac disease; Gluten-free diet; HLA DQ2/DQ8; Non-biopsy pathway