New Approaches to the Diagnosis and Management of Celiac Disease in Children - Abstract
Celiac Disease (CD) is a chronic immune-mediated disease that is triggered by
the consumption of gluten present in wheat, barley and rye in genetically predisposed
individuals. The increment in the prevalence and incidence of CD in recent years may
reflect a true increment, rising awareness among physicians or use of highly sensitive
serologic tests. The clinical presentation of pediatric CD has changed in recent years
and a number of patients are presenting with “atypical” and “silent” forms. Physicians
should be aware of these unique presentations and high-risk populations in order to
avoid under-diagnosis of CD. Recent European guidelines suggested that the diagnosis
can be made without biopsy. These new guidelines should be followed with caution as
persistent villous atrophy may be associated with a risk of morbidity and mortality.
Initial screening at the time of diagnosis should include checking for autoimmune
disorders (hepatitis and thyroiditis) and inadequate response to Hepatitis B Virus
(HBV) vaccination. However, evaluation for vitamin deficiencies and low bone mineral
density (BMD) may not be necessary. All first-degree relatives should be screened
by serologic testing owing to the higher risk of CD. Human leukocyte antigens (HLA)-
DQ2 and DQ8 are important but not sufficient to predispose to CD. However, HLA
testing could be utilized in screening infants born to families with CD. Compliance to
gluten free diet (GFD) is particularly difficult for teenagers because of social and
psychological factors. Novel therapeutic strategies which may improve quality of life
for these patients include gluten detoxification, modulation of intestinal permeability
and modulation of aberrant immune response.