Coeliac disease in children
Siba Prosad Paul Specialty trainee year 8, paediatric gastroenterology, Bristol Royal Hospital for Children, Bristol, England
Emily Natasha Kirkham Fourth-year medical student, University of Bristol, Bristol, England
Sarah Pidgeon Specialist paediatric dietitian, Bristol Royal Hospital for Children, Bristol, England
Sarah Sandmann Clinical nurse specialist in paediatric gastroenterology, Bristol Royal Hospital for Children, Bristol, England
Coeliac disease is an immune-mediated systemic disorder caused by ingestion of gluten. The condition presents classically with gastrointestinal signs including diarrhoea, bloating, weight loss and abdominal pain, but presentations can include extra-intestinal symptoms such as iron-deficiency anaemia, faltering growth, delayed puberty and mouth ulcers. Some children are at higher risk of developing coeliac disease, for example those with a strong family history, certain genetic disorders and other autoimmune conditions. If coeliac disease is suspected, serological screening with anti-tissue transglutaminase titres should be performed and the diagnosis may be confirmed by small bowel biopsy while the child remains on a normal (gluten-containing) diet. Modified European guidelines recommend that symptomatic children with anti-tissue transglutaminase titres more than ten times the upper limit of normal, and positive human leucocyte antigen (HLA)-DQ2 or HLA-DQ8 status, do not require small bowel biopsy for diagnosis of coeliac disease. Management of the disease involves strict adherence to a lifelong gluten-free diet, which should lead to resolution of symptoms and prevention of long-term complications. Healthcare professionals should be aware of the varied presentations of coeliac disease to ensure timely screening and early initiation of a gluten-free diet.
Nursing Standard. 29, 49,36-41. doi: 10.7748/ns.29.49.36.e10022Correspondence
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Received: 02 March 2015
Accepted: 20 March 2015