Celiac disease is a intestinal malabsorption syndrome caused by over-sensitivity to wheat, barley and rye containing food products.  For unknown reasons, the gluten protein in these food types activates the immune system in the small intestines, causing inflammation and damage.  The villi of the small intestine become blunted in celiac disease, leading to diarrhea and poor weight gain in affected children.  A blood test can be helpful in determining if celiac disease is present and an upper gastrointestinal endoscopy with biopsies confirms the diagnosis.  Once the diagnosis is made, avoidance of gluten-containing products eliminates the symptoms. 

  

What causes celiac disease?

Celiac disease is caused by an over-reaction of the immune system to gluten, a protein found in wheat, barley and rye.  Gluten activates white blood cells in the small intestine and these cells release inflammation-causing proteins.  The inflammation damages the small intestinal wall and the microscopic finger-like projections called villi.  It is the villi that provide a large surface area in the small intestines for absorption.  When these villi are shortened, the area available to absorb nutrients and water is greatly reduced.  The excess water in the intestines leads to diarrhea and many nutrients are simply pooped out.

What are the symptoms of celiac disease?

The symptoms of celiac disease can be mild to severe.

• Increased frequency of stools
• Watery, loose stools
• Smelly stools (more smelly than usual)
• Abdominal cramping
• Poor weight gain or weight loss
• Vomiting (sometimes)
• Anemia (due to poor absorption of iron and folate)

Red Flags (seek medical care immediately)

• Severe or persistent diarrhea
• Infants and young children with diarrhea
• Ill-appearing child
• Rash
• High fever
• Not drinking fluids
• Decreased urine output
• Excessive sleepiness, confusion or unusual behavior
• Blood in stools

How is celiac disease diagnosed?

The physical exam of a child with celiac disease is often normal... or the child may show evidence of poor weight gain and small size. 

A blood test is available to measure the level of antibodies that target gluten.  These tests are excellent but should be confirmed by performing an upper gastrointestinal endoscopy with biopsies.  Biopsies of the small intestinal wall will show blunting of the villi and excessive white blood cells if celiac disease is present.  

How is celiac disease treated in children?

Removal of gluten-containing products from the diet will eliminate the symptoms of celiac disease.  A pediatric nutritionist should be involved to help families develop a diet that is both healthy and gluten-free.  Many food items contain unexpected gluten and achieving a perfectly gluten-free diet is challenging.  Even gluten-free foods that are processed in the same area as gluten-containing products can cause recurrence of celiac symptoms when eaten.

I think my child has celiac disease, should I start a gluten-free diet?

It is important for a physician to confirm the diagnosis of celiac disease before your child starts the gluten-free diet.  Blood tests and biopsy samples can be normal in patients with celiac disease if they are avoiding gluten.  Therefore, if a child is on a gluten-free diet, but has not yet been diagnosed with celiac disease, she must be rechallenged with a gluten-containing diet before the diagnosis can be made.

What is a gluten-free diet?

• Avoid all foods that contain wheat, barley and rye
• Read all food labels (especially processed foods)
• Some medications and vitamins contain gluten (ask your pharmacist)
• Many unexpected restaurant foods contain wheat (used as a food thickener and filler).  Some examples are: soups, candies, gravy, sauces, immitation meat and seafood, dressings, sausages, fish sticks.

As you can see, consulting a Pediatric nutritionist is very important.

Gluten-free Diet Guide by NASPGHAN.

A Gluten-Free Guide, GuideToCulinarySchools.com