Coeliac Disease in Children

Introduction

Coeliac disease is a disease of the small intestine caused by intolerance to a part of wheat, rye and barley called gluten. These cereals need to be avoided by people with coeliac disease. Coeliac disease used to be though of as a rare disease, but recent studies have shown hat the prevalence is as high as 1 in 100. However, if a member of the family is coeliac, the risk of having the disease is increased to 1 in 10.   Age of onset   The earliest age at which coeliac disease can occur is when the infant is weaned. Until the gut encounters gluten it is entirely healthy and the infant grows normally. There is no upper age limit for coeliac disease to be diagnosed with many adults being diagnosed late in life.  

Symptoms 

The small intestine surface is made up of thousands of “finger” like folds. This increases the area through which food can be absorbed. Gluten destroys these “fingers” so the gut surface becomes smooth and food cannot be absorbed properly. This means that the child cannot absorb enough energy and may fail to thrive.   Typical coeliac disease in infants is characterised by impaired growth, abnormal stools, abdominal distension, muscle wasting, poor appetite and unhappy behaviour. The older child who develops the disease may present more subtly, with a slower growth rate, delayed puberty and iron deficiency anaemia being common symptoms.

Diagnosis

The child develops antibodies during the development of coeliac disease. Testing for these antibodies is very sensitive and can now be used to screen for coeliac disease. The tests that can be used are for gliadin, endomysial and tissue-transglutaminase antibodies. In children under 2 years of age it has been suggested that anti-gliadin tests may be more accurate, but in children over two and adults the other tests are more accurate.   To confirm diagnosis, a jejunal biopsy is carried out following a positive antibody test. Some hospitals may not carry out a biopsy in children, and some parents may not wish their child to have a biopsy. In this case a gluten-challenge may be carried out to diagnose coeliac disease. A jejunal biopsy is taken by endoscopy when a flexible camera tube is passed into the small gut and a small part of the gut surface is snipped off. This piece of gut is examined under the microscope to make the definitive diagnosis.  

Treatment

Treatment is with a gluten-free diet. This cuts out all wheat, rye and barley and products that contain these cereals such as bread, pasta, cakes and biscuits. There is now a wide range of gluten free products available, many of which are available on prescription.  

Monitoring

Once the gluten-free diet is started the gut “fingers” begin to re-grow, food is well absorbed and the child demonstrates “catch-up” growth i.e. grows rapidly to the height and weight they would have achieved without coeliac disease. Retesting for antibodies can be helpful. They should become negative if the child is on and maintains a gluten-free diet.   Research has shown that people with coeliac disease are at an increased risk of certain gut cancers and osteoporosis. Adhering to a strict gluten-free diet reduces the risk of developing these diseases, with the risk of cancer being reduced to the same as the general population.  

Useful contact:

Coeliac UK
PO Box 220
High Wycombe
Bucks
HP11 2HY  
http://www.coeliac.co.uk/
Helpline: 0870 444 8804