Celiac disease, or gluten intolerance in children
Most people with celiac disease are not even aware of their illness. Since the most vulnerable group of “hidden” patients is children, it is important to know the symptoms of the disease in order to recognize it in time, thereby preventing the development of complications.
The content of the article:
- Causes, etiology and pathogenesis of the disease
- How to recognize pathology in time
- Which doctor should I contact with alarming symptoms?
- Complications and risks of celiac disease
- Diagnostics and list of analyzes
Causes of celiac disease, etiology and pathogenesis of the disease
The essence of celiac disease is genetically determined impairment of mucosal immunity… It reacts abnormally to gluten and prolamins found in wheat and other grains.
Cereals contain a number of different proteins, in particular albumins and globulins. Gluten (gluten) is a protein group that includes glutenins and prolamins.
The formation of antibodies responsible for celiac disease is mainly due to the structure of gliadin, wheat prolamin.
Proteins from other cereals (rye, oats) can act similarly.
Video: What is gluten?
Celiac disease has a clear link to a genetic cause. Genetically predisposed individuals have altered genes on chromosome 6. Excessive absorption of gliadin occurs in the intestinal mucosa. Enzyme tissue transglutaminase that breaks down gliadin forms short protein chains. These chains, in combination with genetically erroneous particles, activate special T-lymphocyte leukocytes. Leukocytes trigger an inflammatory response, release inflammatory effects, cytokines.
Uncontrolled inflammation develops, causing damage to the mucous membrane of the colon with atrophy (thinning) of the intestinal villi in the absence of necessary digestive enzymes. After a gluten-free diet, villous atrophy is regulated.
Signs and symptoms of gluten intolerance in children – how to recognize pathology in time?
The symptoms of celiac disease may vary from child to child, but the symptoms of the disease have some common features that require attention.
1. Stomach pain, flatulence, constipation and diarrhea
Children with celiac disease often complain of abdominal pain and flatulence. In alternating cycles, they may be bothered by diarrhea and constipation.
Chronic diarrhea or constipation are common symptoms. Sometimes parents notice the baby’s belly is bloating and bulging.
In order to notice the symptoms of celiac disease in a newborn, as well as other pathologies of the gastrointestinal tract, the mother needs to carefully study the contents of the diaper.
2. Itchy skin rashes
Skin problems in the form of itchy red rashes and blisters are one of the most common symptoms of celiac disease in children.
Vomiting, an accompanying symptom of celiac disease, can be easily confused with a symptom of another health problem.
In some children it occurs immediately after taking gluten, in others it is a delayed reaction to gluten.
In any case, this symptom alone is not enough to make a diagnosis.
Vomiting in a child – possible causes and first aid for vomiting in a baby
4. Slowdown in growth
Parents often register that their child is smaller than his peers.
Being underweight and stunted can be caused by poor absorption of nutrients.
5. Irritability, behavioral problems
Impaired gluten tolerance can also manifest as cognitive impairment. Children with celiac disease are characterized by behavioral changes, irritability, aggressiveness, and changes in taste preferences.
Video: Symptoms of Celiac Disease
What to do when you notice symptoms of celiac disease in a child?
See your pediatrician because the risk of long-term damage and complications without diagnosis and treatment is very high.
In addition to compiling a detailed clinical picture, the doctor will perform basic blood tests, abdominal ultrasound and, if celiac disease is suspected, antibody testing.
In case of positive conclusions, the child is referred to a doctor specializing in diseases and disorders of the gastrointestinal tract – gastroenterologist…
Why celiac disease is dangerous for children – the main complications and risks of celiac disease
Exceptionally with severe protein deficiency, edema of the lower extremities may occur.
The disease is also fraught with celiac crisis – a condition characterized by a complete weakening of the child, a significant decrease in pressure, an increase in heart rate.
If clinical improvement does not occur after 6 months despite adherence to a gluten-free diet, the condition is called refractory celiac disease.
Several situations can be the reason:
- Consciously or unwittingly consuming foods containing gluten.
- Presence of a disease that mimics celiac disease, in which a gluten-free diet cannot improve the condition.
- The need to use drugs that inhibit immunity – corticosteroids or immunosuppressants.
- Glutenic enteropathy complicated by a tumor of the lymphatic system – intestinal T-lymphoma.
Celiac disease is a precancerous condition; even a benign disease can cause carcinoma!
Video: Celiac disease; diet for celiac disease in adults and children
Diagnosis of celiac disease in a child and a list of gluten intolerance tests
As a screening test, the most appropriate test is to detect antibodies to tissue transglutaminase, an enzyme that breaks down gliadin. Antibody testing does not determine the diagnosis, but helps to track the course of the disease, to respond by introducing a dietary regimen.
Antibodies against gliadin itself are also determined. But they are also positive for other intestinal diseases such as Crohn’s disease, parasitic infection, lactose intolerance.
Determination of anti-endomic antibodies is characterized by a higher reliability, their positivity is the basis for the diagnosis of celiac disease.
The disadvantage is the cost, complexity and duration of the study, so it is not used for screening.
Detection of antibodies to tissue transglutaminase – anti-tTG IgA, IgG (atTg):
- Tissue transglutaminase is directly related to the pathogenesis of the disease, it has been described as a chemical substrate for endomysia. Determination of antibodies to tissue transglutaminase (atTG) has a high diagnostic efficiency, similar to anti-endomysial antibodies (sensitivity 87-97%, specificity 88-98%).
- The atTG assay is performed by the classic ELISA method, which is more readily available for routine diagnostics than the determination of immunofluorescence of endomysial (EmA) antibodies. Unlike EmA, atTG antibodies can be detected in the IgA and IgG classes, which is important for patients with selective IgA deficiency. The method originally included the guinea pig antigen used in most older kits. The new kits use tissue transglutaminase isolated from human cells, human erythrocytes or recombinant tTG isolated from E. coli as antigen.
In patients with celiac disease, immunodeficiency in the IgA class is more common than in the other population, which can skew blood test results. In these patients, antibodies in the IgG class are also tested in the laboratory.
Endomial antibodies (EmA) – it is a reliable marker of celiac disease (sensitivity 83-95%, specificity 94-99%), in screening algorithms, their determination is recommended as a 2nd step indicating histological data.
But for laboratory tests, an immunofluorescence microscope is required; the assessment of the test is not easy and requires a lot of experience.
To determine the diagnosis is used endoscopic examinationshowing reduced or missing mucosal hairs, visible choroid plexuses, mosaic mucosal relief.
The advantage of endoscopy is the possibility of targeted sampling of the mucous membrane for microscopic examination (biopsy), which is the most reliable method.
In most children and adults, the disease is diagnosed precisely according to a sample taken from the duodenum during a gastroesophageal examination.
In children under 2 years of age, changes in the mucous membrane of the small intestine can be caused by factors other than celiac disease (for example, milk allergy, viral, bacterial intestinal infections, immunodeficiency conditions) – therefore, in these children, a second biopsy is necessary to finally confirm the diagnosis at a later age.
Rendering techniques – such as abdominal ultrasound, x-ray or CT – are ineffective.
Laboratory results – not specific, they show varying degrees of anemia, blood clotting disorders, decreased levels of proteins, cholesterol, iron, calcium.
Blood tests and biopsies of the intestinal mucosa should be done at a time when gluten is a regular part of the diet.
After a certain period of adherence to a gluten-free diet, the lining of the small intestine heals, the antibodies under study return to normal levels.
All information on the site is for informational purposes only, and is not a guide to action. An accurate diagnosis can only be made by a doctor. We kindly ask you not to self-medicate, but to make an appointment with a specialist!
Health to you and your loved ones!
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