Celiac Disease

Dear Lisa,

I brought my daughter to the doctor’s because she was having a lot of stomach aches. She has been having diarrhea and has lost weight. The doctor ordered some tests and told me that she needed to be tested for Celiac Disease. What is Celiac Disease and how do you get it?

“Need to know more about Celiac Disease”,

Dear “Need to know more about Celiac Disease”,

Celiac Disease or gluten-sensitive enteropathy is an autoimmune disease that is brought on by the ingestion of gluten. Gluten is the major protein found in wheat, rye and barley. Celiac Disease is also considered a malabsorption disorder because gluten ingestion causes intestinal inflammation which leads to inadequate absorption of nutrients. Therefore, children with Celiac Disease develop problems when they eat foods with gluten.

The symptoms of Celiac Disease vary from person to person. Celiac Disease can appear any time in life in genetically susceptible individuals. It can be triggered by surgery, a viral infection, severe emotional distress, and childbirth. In children, the symptoms tend to start between 6 months and 2 years old and include diarrhea or constipation, abdominal distention, signs of malnutrition, failure to thrive, lack of appetite, short stature, irritability, lack of energy and developmental delay (1).

The development of symptoms can develop weeks to months after consuming products that contain gluten. Earlier symptoms usually include poor weight gain which eventually leads to weight loss. Older children may present with less typical symptoms which include recurrent abdominal pain, nausea, vomiting, bloating, constipation, short stature, delay in puberty, iron deficiency, dental enamel defects and abnormalities in liver function tests. (2) The long term effects of untreated Celiac Disease include recurrent miscarriages, infertility, osteoporosis, seizures, hair loss, dental abnormalities, anemia and malignancy.(3)

Celiac Disease is thought to be an inherited disorder since 5-15% of first degree relatives- parents, siblings or children of a person who has biopsy-proven Celiac Disease also test positive for the disease (4) People with other autoimmune disorders such as Type 1 diabetes mellitus, thyroid disease, systemic lupus erythematosus, liver disease, collagen vascular diseases and rheumatoid arthritis have an increased risk of developing Celiac Disease. Between 5-10% people with Down’s syndrome will be diagnosed with Celiac Disease. (3)

The treatment for Celiac Disease is a gluten free diet. Eliminating gluten from the diet stops intestinal inflammation, stops tissue damage and allows the lining of the intestines to heal. Once the proper diet is adhered to, the small intestine typically heals within 6 months. (3) Removing gluten from a child’s diet seems like a very simple solution to what can be a very serious health condition, but this diet is sometimes hard to maintain.

Gluten can often be a hidden ingredient of many products such as herbal supplements, vitamins, minerals and as an inactive ingredient in common medications. (5) Besides this, most of the popular children’s food such as cereal, bread, bagels, pasta, cookies, waffles, pizza, hotdog and hamburger rolls and snack bars all contain gluten. Children with Celiac Disease are also not supposed to eat oat even though it does not contain gluten. The problem is cross-contamination, or accidental mixing of oat with wheat, rye and barley in the plants that commercially prepare oats in the United States. (5)

Children with Celiac Disease should maintain a diet including plain meat, fish, rice, potatoes, fruits and vegetables. Potato, rice or soy flour can be substituted for wheat flour in recipes. If your daughter is diagnosed with Celiac Disease, be assured that it is treatable with the proper dietary modifications. A consult with a nutritionist can assist you with meal planning, choosing the appropriate foods and giving you information about the types of foods that tend to have gluten as hidden ingredients.

For more information about Celiac Disease contact The National Institute of Diabetes and Digestive and Kidney Diseases:

http://www.digestive.niddk.nih.gov.

References:
(1)Leffler D, Saha S, Farrell RJ. Celiac Disease. Am J Managed Care. 2003;9:825-831.
(2) Gelfond D, Fasano A. Celiac Disease in the Pediatric Population. Pediatric Annals 35(4):275-279.
(3)Rewers M. Epidemiology of Celica Disease: What are the prevalence, incidence and progression of Celiac Disease? Gastroenterology. 2005;128(suppl):47-55.
(4)National Digestive Disease Information Clearinghouse. Celiac Disease. Available @ www.digestive.niddk.nih.gov/ddiseases/pubs/celiac. Accessed July 2006.
(5)Kupper C. Dietary guidelines and implementation for celiac disease. Gastroenterology. 2005;128(suppl):121-127.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Website