Celiac Disease

This is an immune mediated disease that is due to exposure to gluten protein found in barley, wheat and rye. It can begin at any time from infancy to adulthood. Children commonly begin to have symptoms 6-24 months after the introduction of gluten into their diet and should be considered in the evaluation of any child who has a history of chronic diarrhea and poor weight gain.
Many different signs and symptoms can be associated with celiac disease. These include anemia, diarrhea, bloating and constipation. Some children with celiac disease present with no clear complaints except poor weight gain. Some conditions are associated with an increased risk of celiac disease. These include Down syndrome and type 1 diabetes. If a family member has celiac disease then the risk increases for other family members.
Common evaluation tests include an antibody test to tissue transglutaminase (TTG IgA). This is the best screening test for children. IGA testing is also commonly done since children with an IGA deficiency may have a false negative test. Children under age 3 may also have a false negative test. Although serologic testing is helpful the best diagnosis is made from intestinal samples taken during endoscopy. Multiple sites are sampled and changes are looked for including villous atrophy. These changes can be very non-specific and serologic results and a comprehensive history can help pin down a diagnosis.
Treatment is elimination of gluten through a gluten free diet. This is a lifelong treatment and symptoms and intestinal changes resolve. Diet adherence is the key and is often difficult.  Anyone with celiac disease should eliminate gluten even if they are symptom free. There is an increased risk of other medical problems for untreated celiac disease.
A repeat TTG IgA test after 6 months of diet adherence is usually done.  Repeat testing is also done if symptoms do not stop. If the level is still high then dietary nonadherence is usually the culprit.