Celiac Disease in children clinical practice guidline summary

Presented by Nargess Tavakoli

Guilan University of Medical sciences

Journal of Pediatric Gastroenterology and Nutrition40:1–19 January 2005 Lippincott Williams & Wilkins, Philadelphia

• Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

DEFINITION

An immune-mediated enteropathy

caused by a permanent sensitivity to

gluten in genetically susceptible

individuals

GASTROINTESTINAL MANIFESTATIONS

• Diarrhea with failure to thrive

• Abdominal pain

• Vomiting

• Constipation

• Abdominal distension

Non_gastrointestinal manifestations

• A)Strong to moderate evidence of an association• Dermatitis herpetiformis• Dental enamel hypoplasia of permanent teeth• Osteopenia and osteoporosis• Short stature• Delayed puberty• Iron-deficient anemia unresponsive to treatment• with oral iron (well documented in adults only)

Non_gastrointestinal manifestations

Less strong:

• Hepatitis (elevated liver enzymes)

• Arthritis

• Epilepsy with occipital calcifications

Associated with an increased prevalence• Type 1 diabetes• Autoimmune thyroiditis• Down Syndrome• Turner Syndrome• Williams Syndrome• Selective IgA deficiency• First degree relatives of• celiac patients

Who to test?

• Diarrhea & FTT

• Persistent GI symptoms

• NonGI symptoms of strong to mod. evidence for

• Asymptomatic with conditions of high association

How to test?

• Definitive Dx: Biopsy of the small intestinal muccosa

• Screening: serological tests

Serological (blood) testing

• TTG IgA : initial test

• EMA IgA

• AGA IgA & IgG:

no longer recommended

inferior accuracy

IgA deficients & CD

FIRST: measurement of quantitative

serum IgA

If low Check TTG IgG

Intestinal biopsy

confirmation of Dx. in all cases

when the serum TTG is elevated

• Even if serological tests negative may be useful in symptomatic children (particularly 0 to 2 years old)

WHO TO TREAT?

• Symptomatic with Pos. Biopsy

• Asymptomatic with

associated conditions & Pos. Biopsy

BENEFITS OF TREATMENT

• Resolves persistent diarrhea & poor weight gain

• Reverses reduced bone mineralization• Prevents: osteoporosis abortions low birth weight cancer

HOW TO TREAT?

• A gluten-free diet for life

• Lactose restrictions?

not usually necessary

HOW TO MONITOR?

• Periodic visits

• Check TTG:

NO symptoms: 6 month after, then once a year

Any time if persistent or

recurring symptoms