Mini review
Celiac disease in children

https://doi.org/10.1016/j.clinre.2015.05.024Get rights and content

Summary

Celiac disease is an autoimmune enteropathy, triggered by ingestion of gluten in genetically predisposed individuals. Since the use of anti-transglutaminase and anti-endomysium antibodies in the early 1990s, two main groups of clinical presentation can be identified: patients with a symptomatic form of the disease, and patients with a pauci (a)-symptomatic form detected during the work-up of another autoimmune disease or due to a family history of celiac disease. The prevalence of both forms of the disease is currently estimated between 1/100 and 1/400. Classical form of the disease is characterized by occurrence of diarrhoea, failure to thrive, and abdominal bloating in young infants in the months following gluten introduction. Serological tests show high level of anti-transglutaminase and anti-endomysium antibodies. Until recently, the diagnosis required duodenal biopsies that show villous atrophy. HLA genotype can help for diagnosis: the absence of the HLA-DQ2 or DQ8 alleles has a high negative predictive value. European guidelines recently proposed to reconsider the need for systematic endoscopy in typical symptomatic forms with high level of anti-transglutaminase and positive anti-endomysium. These recommandations are being assessed now. Currently, the gluten-free diet remains the only effective treatment for celiac disease. Children with celiac disease have to exclude from their diet all products containing wheat, barley and rye. Gluten-free diet causes clinical remission within a few weeks, but normalization of the small bowel mucosa and negativity of anti-transglutaminase antibodies are obtained in several months or even years. Gluten-free diet is useful to obtain clinical assessment, but also to prevent long-term complications of celiac disease, mainly osteoporosis, other autoimmune diseases, decreased fertility and cancers.

Section snippets

Definition

Celiac disease (CD) is an immune-mediated enteropathy, induced by gluten ingestion in genetically predisposed individuals. Gluten is the major protein component of wheat, barley and rye that are widely consumed cereals in most countries of the world. Gluten sensitivity in CD is due to an abnormal cellular immune response responsible of a villous atrophy, which resolves under gluten-free diet.

Historical

Symptoms of CD were first described by a Greek physician, Aretee de Cappadoce, in the first century.

Conclusion

Prevalence of CD has dramatically increased in the last two decades due to the use of serological tests. Only 10% of children having CD are symptomatic. A large part of asymptomatic patients remains undiagnosed, even if screening CD is now recommended in at risk groups, especially children having type 1 diabetes or in a context of a family history of CD. The typical clinical picture of malabsorptive syndrome remains frequent in young infant, but milder intestinal symptoms and extra-digestive

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

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