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Diagnosis and management of coeliac disease in children

08 July 2021
7 min read
Volume 30 · Issue 13

Abstract

Coeliac disease (CD) is an autoimmune gluten-dependent condition with a prevalence of 1% in the population, if screened. However, approximately only a third of children with CD are diagnosed. When CD is suspected, serological screening with anti-tissue transglutaminase titres should be performed. Children with a positive result should be referred to a specialist in CD for confirmation of the diagnosis. The European Society for Paediatric Gastroenterology Hepatology and Nutrition revised their diagnostic guidance for CD in 2020 and this article discusses the current diagnostic pathways. Lifelong strict adherence to a gluten-free diet is necessary to prevent complications. Nurses and specialist paediatric dietitians have an important role in recognising and diagnosing CD early, as well as offering ongoing dietary and clinical support.

Coeliac disease (CD) is a systemic, immune-mediated disorder precipitated by the ingestion of gluten. It is known to manifest at any age after weaning, with an estimated lifetime prevalence of around 1% (Fok et al, 2016). CD is a multisystem disorder presenting with specific gastrointestinal (eg indigestion, diarrhoea, abdominal pain, bloating, gassiness, abdominal distension or constipation) and extra-intestinal manifestations (eg fatigue, dermatitis herpetiformis, anaemia unresponsive to treatment, dental enamel defects, weight loss, faltering growth or delayed puberty) (National Institute for Health and Clinical Excellence (NICE), 2015). Once a diagnosis of CD is confirmed, a lifelong gluten-free diet (GFD) is required with regular monitoring and support. Ingestion of gluten causes an autoimmune response in people with CD, and this leads to damage in the lining of the small intestines and villous atrophy. This causes malabsorption of food nutrients and various clinical manifestations seen in children with CD. This article will provide an overview of the updates on the diagnostic pathways for paediatric CD, and the vital roles that nurses and dietitians can play in its early recognition, diagnosis and management.

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