Recent advances in pediatric celiac disease.
The incidence of celiac disease (CD) has increased over the last half-century, resulting in rising interest in identifying risk factors for CD. The necessity of duodenal biopsies in the diagnosis of CD has recently been challenged. Areas covered: This review covers the recent literature regarding the role of infant feeding practices, including breastfeeding and timing of gluten introduction, and the microbiota in the development of CD. Additionally, the application of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for a non-biopsy approach to the diagnosis of CD is reviewed. Expert commentary: Recent investigations have not revealed any significant effect of breastfeeding or timing of gluten introduction on the risk of CD in at-risk populations. There are alterations in the microbiota of CD patients. However, the role of the microbiome and whether its manipulation has a clinical effect are unknown. Preliminary data suggests a non-biopsy approach to diagnosis of pediatric CD can be applied to several populations, although additional studies are needed. Prospective investigations are underway to examine the interplay of infant feeding practices and the microbiome and to identify particular CD-specific biomarkers that may aid in the diagnosis and ultimately prevention of CD.
a Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases , C.S. Mott Children's Hospital, University of Michigan , Ann Arbor , MI , USA.
Grace J
GJ
Lee
b Division of Gastroenterology, Department of Internal Medicine , University of Michigan , Ann Arbor , MI , USA.
John Y
JY
Kao
D000293:Adolescent; D017668:Age of Onset; D001706:Biopsy; D001903:Bottle Feeding; D001942:Breast Feeding; D002446:Celiac Disease / Q000453:epidemiology / Q000235:genetics / Q000276:immunology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004059:Diffusion of Innovation; D004386:Duodenum / Q000276:immunology* / Q000382:microbiology / Q000473:pathology; D064806:Dysbiosis; D005762:Gastroenterology / Q000639:trends*; D000069196:Gastrointestinal Microbiome; D020022:Genetic Predisposition to Disease; D005983:Glutens / Q000276:immunology*; D054884:Host-Pathogen Interactions; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
D005983:Glutens
Celiac disease; diagnosis; infant feeding practices; microbiota; risk factors