Abstract
Celiac disease (CD) is a common condition that occurs in genetically predisposed individuals when they ingest products containing wheat, barley, or rye. It produces an autoimmune-mediated enteropathy with characteristic histologic features on small intestinal mucosal biopsy. The clinical manifestations of CD are highly variable and initially may be unrelated to the gastrointestinal system. The condition is also strongly associated with other autoimmune and nonautoimmune conditions. Physicians caring for children and adolescents are challenged with identifying those who might have CD and require referral for definitive testing, recognizing the potential pitfalls in the diagnostic work-up of the pediatric patient, and providing ongoing care for those with a positive diagnosis. Confirmation of the diagnosis mandates that the individual be placed on a strict gluten-free diet (GFD) for life, as this is the only treatment currently available for CD. This article will discuss the immunopathogenesis, epidemiology, and clinical manifestations of CD and will outline a strategy of active case-finding using serological tests to identify those who require an intestinal biopsy for definitive diagnosis. The need for lifelong treatment by means of a GFD and for continued follow-up of children and adolescents after diagnosis is emphasized.
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References and Recommended Reading
Fasano A, Catassi C:Current approaches to the diagnosis and treatment of celiac disease: an evolving spectrum.Gastroenterology 2001,120:636–651.
Sollid LM, Lie BA:Celiac disease genetics: current concepts and practical applications.Clin Gastroenterol Hepatol 2005,3:843–851.
Cerf-Bensussan N, Cellier C, Heyman M, et al.:Coeliac disease: an update on facts and questions based on the 10th International Symposium on coeliac disease.J Pediatr Gastroenterol Nutr 2003,37:412–421.
Picarelli A, Di Tola M, Sabbatella L, et al.:Immunological evidence of no harmful effect of oats in celiac disease.Am J Clin Nutr 2001,74:137–140.
Shan L, Molberg O, Parrot I, et al.:Structural basis for gluten intolerance in celiac sprue.Science 2002,297:2275–2279.
Fasano A, Not T, Wang W, et al.:Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease.Lancet 2000,355:1518–1519.
Dieterich W, Ehnis T, Bauer M, et al.:Identification of tissue transglutaminase as the autoantigen of celiac disease.Nat Med 1997,3:797–801.
Molberg O, Mcadam S, Korner R, et al.:Tissue transglutaminase selectively modifies gliadin peptides that are recognized by gut derived T cells in celiac disease.Nat Med 1998,4:713–717.
Fasano A, Berti I, Gerarduzzi T, et al.:Prevalence of celiac disease in at-risk and not at-risk groups in the United States: a large multicenter study.Arch Intern Med 2003,163:286–292.
Corazza GR, Valentini RA, Andreani MI, et al.:Subclinical coeliac disease is a frequent cause of iron deficient anemia.Scand J Gastroenterol 1995,30:153–156.
Turner L, Hasanoglu H, Aybay C:Endomysium antibodies in the diagnosis of celiac disease in short-statured children with no gastrointestinal symptoms.Pediatr Int 2001,43:71–73.
Reunala T, Collin P:Diseases associated with dermatitis herpetiformis.Br J Dermatol 1997,136:315–318.
Martinelli P, Troncone R, Paparo E, et al.:Coeliac disease and unfavourable outcomes of pregnancy.Gut 2000,46:332–335.
Barera G, Bonfanti R, Viscardi M, et al.:Occurrence of celiac disease after onset of type 1 diabetes: a 6 year prospective longitudinal study.Pediatrics 2002,109:833–838.
Hill ID, Dirks MH, Liptak GS, et al.:Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.J Pediatr Gastroenterol Nutr 2005,40:1–19.
Silverstein J, Klingensmith G, Copeland K, et al.:Care of children and adolescents with type 1 diabetes. A statement of the American Diabetes Association.Diabetes Care 2005,28:186–212.
NIH Consensus Development Conference on Celiac Disease. Available at: http://consensus.nih.gov/2004/ 2004CeliacDiseasell8html.htm. Accessed June 12, 2006.
Zachor DA, Mroczek-Musulman E, Brown P:Prevalence of celiac disease in Down’s syndrome in the United States.J Pediatr Gastroenterol Nutr 2000,31:275–279.
Hill ID:What are the sensitivity and specificity of serologic tests for celiac disease? Do sensitivity and specificity vary in different populations? Gastroenterology 2005,128(Suppl 1):S25-S32.
Burgin-Wolff A, Gaze H, Hadziselimovic E, et al.:Antigliadin and antiendomysium antibody determination for coeliac disease.Arch Dis Child 1991,66:941–947.
Meeuwisse GW:Diagnostic criteria in coeliac disease [in Swedish].Acta Paediatr Scand 1970,59:461–463.
Guandalini S, Ventura A, Ansaldi N, et al.:Diagnosis of coeliac disease: time for a change? Arch Dis Child 1989,64:1320–1324.
Walker-Smith JA, Guandalini S, Schmitz J, et al.:Revised criteria for diagnosis of coeliac disease: report of the Working Group of European Society of Paediatric Gastroenterology and Nutrition.Arch Dis Child 1990,65:909–911.
Marsh MN:Gluten, major histocompatability complex, and the small intestine. A molecular and immunological approach to the spectrum of gluten sensitivity (‘celiac sprue’).Gastroenterology 1992,102:330–354.
Kupper C:Dietary guidelines and implementation for celiac disease.Gastroenterology 2005,128(Suppl 1):S121-S127.
Dietitians of Canada:Manual of Clinical Dietetics, edn 6. Chicago: American Dietetic Association; 2000.
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Hill, I.D. Management of celiac disease in childhood and adolescence: Unique challenges and strategies. Curr Treat Options Gastro 9, 399–408 (2006). https://doi.org/10.1007/BF02738529
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DOI: https://doi.org/10.1007/BF02738529