Coeliac disease: how to recognise it and what foods to avoid

Symptoms of celiac disease in children: what they are and how to recognize them

By Cristiano Antonino On Feb 20, 2023

Celiac disease is a chronic condition that leads to malnutrition and therefore interferes with the weight and growth of children, selective malabsorption of some minerals and vitamins that can lead to disease conditions, therefore it must be rigorously diagnosed before starting a gluten-free diet

What is celiac disease?

Celiac disease is a permanent intolerance to gluten, defined by strict diagnostic criteria, which differentiate it from other forms of poor tolerance, such as allergy to gluten and wheat, and such as non-celiac and non-allergic gluten intolerance.

It has an autoimmune trigger mechanism that involves damage to the intestine that can only be stopped by stopping gluten intake.

Symptoms of celiac disease in children

There are basically 2 ways in which celiac disease manifests itself in children:

celiac disease with gastrointestinal manifestations involving poor growth, distended abdomen, diarrhoea, vomiting, symptoms differently combined with each other with children presenting descending growth patterns in terms of nutritional aspect and weight;
atypical celiac disease with manifestations absent or attributable to other organs other than the intestine with children presenting: poor growth, unjustified iron or folic acid anemia and unresponsive to iron therapy.

A further possibility are the autoimmune manifestations of other districts which, knowing that they may be associated with celiac disease, must be examined: for example, in children with type 1 diabetes it is good practice to proceed with the dosage of antibodies; the same is true for people with thyroiditis or alopecia areata and children with other specific conditions, such as Down or Turner syndrome.

Blood tests for celiac disease and antitransglutaminase antibodies

The diagnosis of celiac disease must be performed rigorously following international protocols through specific blood tests and possibly by gastroscopy with biopsies when necessary.

The dosage of anti-transglutaminase antibodies, specific for celiac disease, when highlighted with a high value, represents the most suitable blood test to be performed for the suspicion of a diagnosis of celiac disease.

This screening must always be associated with the determination of total IGA immunoglobulins for a control and reliability mechanism.

In the pediatric population, if these antibodies are negative, no further tests are carried out, because celiac disease is highly unlikely in children if these values are negative.

Conversely, once the positivity for antibodies has been found, the diagnosis must be perfected in accordance with the value of the antibody titre:

if the value of antitransglutaminase antibodies is > 10 times the upper reference limit, confirmation by means of a second test for the determination of antiendomysial antibodies and for HLA typing aimed at searching for predisposing haplotypes (HLA DQ 2 / DQ8) is sufficient;
in the presence of insufficiently high antitransglutaminase values (˂ 10 times the reference index) it is necessary to perform a gastroscopy to perform multiple biopsies at the duodenal level and allow, in the anatomical-pathological analysis, the search for the characteristic alterations that allow for diagnosis.

Although they may seem complicated and annoying to a parent, these exams are usually well tolerated and accepted by children and guarantee extreme rigor, substantially equal to 100%.

Treatment of celiac disease: the gluten-free diet

The gluten-free diet should only be started following diagnostic confirmation, because eliminating gluten from the child’s diet leads to negative examinations and resolution of symptoms, compromising a subsequent diagnosis of certainty.

In addition to the pediatrician, it is useful for the family to be supported by a dietitian who can help in creating an adequate food plan.

In fact, it is necessary to rigorously avoid gluten arriving on the celiac’s plate in order not to frustrate the efforts.

Normally, in subjects following a strict gluten-free diet, the anti-transglutaminase antibodies are negative with recovery of intestinal and metabolic functions.

Since the autoimmune mechanism that triggers this condition can promote autoimmunity in other parts of the body, even as adults, people with celiac disease will have to pay attention to their health, monitoring the other organs that may be more subject to forms of autoimmunity.

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