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Celiac Disease in Children: A 2023 Update

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Abstract

Celiac disease (CeD) is a chronic immune-mediated enteropathy, which occurs in genetically predisposed individuals by the ingestion of gluten proteins present in wheat, barley and rye. The global pooled prevalence of CeD is 0.7% and it has been reported from nations all around the globe and can affect individuals of any age. It has a wide clinical spectrum ranging from being asymptomatic to being symptomatic with severe manifestations. Though initial descriptions of CeD focused on the classical presentation with gastrointestinal manifestations, in recent years it has been found that more patients have non-classical manifestations such as anemia, osteoporosis, increased transaminases, failure to thrive or short stature. The definitive diagnosis of CeD is based on a combination of clinical history, serologic testing with/without examination of duodenal biopsies. The preferred initial serologic test regardless of age for the detection of CeD is the tissue transglutaminase (IgA anti-tTG). Children with a high tTG-IgA (≥10 ULN) AND a positive anti-endomysial IgA antibody (EMA) can be diagnosed to have CeD without the need for duodenal biopsies. The rest should undergo biopsies with at least 4 biopsies from the distal duodenum and at least 1 from the bulb. A correctly orientated biopsy showing increased intraepithelial cells and a villous to crypt ratio of <2 is suggestive of CeD. The management of CeD is a lifelong complete dietary avoidance of gluten. IgA-TGA acts as a surrogate marker for healing of the small-bowel mucosa and should be performed every 6 mo until normalization and then every 12–24 mo thereafter.

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Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children’s Hospital, 501, Stanley Street, South Brisbane, QLD, 4101, Australia

    Rishi Bolia & Nikhil Thapar

  2. School of Medicine, University of Queensland, Brisbane, Australia

    Nikhil Thapar

  3. Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia

    Nikhil Thapar

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  1. Rishi Bolia
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RB: Concept and design, drafting of the article, final approval of the version to be published; NT: Critical revision, final approval of the version to be published. NT will act as the guarantor of this manucript.

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Correspondence to Rishi Bolia.

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Bolia, R., Thapar, N. Celiac Disease in Children: A 2023 Update. Indian J Pediatr 91, 481–489 (2024). https://doi.org/10.1007/s12098-023-04659-w

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