Celiac Disease in Children

Celiac disease is an autoimmune disease affecting both adults and children, caused as a result of intolerance to food substances containing gluten. Gluten is a complex protein found in some food substances like barley, rye and wheat.

Consumption of gluten-containing food damages the small intestine. The nutrients in the digested food get absorbed into the bloodstream through finger-shaped projections called villi on the inner walls of the small intestine. These are very small microscopic structures which are critical in selectively absorbing the nutrients into the body. In a child with celiac disease, the gluten in the food is perceived as a potential invader and the body attacks the villi in the small intestine. This greatly impedes the absorption and starts showing the various symptoms of celiac disease.

What is Paediatric Celiac Disease?

Paediatric celiac disease is the sensitivity of young children to gluten, a complex protein present in certain foods. It can occur at any age of the child, right after the first consumption of gluten-containing food or after a period of time. Identifying a case of celiac disease in children is tricky and many parents lack the awareness about this disease and its symptoms. Malnourishment, poor weight gain, and absence of proper development can occur as a result of celiac disease in children due to lack of essential nutrients. Therefore, its early diagnosis in growing children is very critical.

Causes of Childhood Celiac Disease

Celiac disease is hereditary, it is passed on from the parents to the children. If any of your relatives have the celiac disease, there are 5-10% chances of your child getting the disease too. It can show up anytime during the child’s life. It can occur a few months after birth, during the first instance of gluten food consumption or can show up later after a prolonged period of gluten intake. The exact reason for the variation in the time of disease onset is unknown, but there is established evidence to prove the genetic predisposition to this disease.

Apart from this, children who have the following conditions have a higher risk of having celiac disease,

• Diabetes (type I)
• Autoimmune thyroid disease
• Down’s syndrome
• Turner syndrome
• Williams syndrome
• Dermatitis herpetiformis.

Signs and Symptoms

The symptom of celiac disease varies from one child to the other and often do not get noticed as a serious problem. Some children experience symptoms like bloating, pain in the abdomen and diarrhoea soon after consuming food containing gluten. If these symptoms are mild, they are easy to be ignored and the diagnosis of celiac disease is usually missed. Irritability is also a very common symptom among children with celiac disease.

As per statistics, only 20-30% of children with celiac disease exhibit stomach-related symptoms. These symptoms may last from a few hours to even several days or weeks. There are also children with celiac disease who do not exhibit any symptoms at all. However, consumption of gluten-containing food causes damage to their intestine.

Most children with celiac disease experience one or many of the following symptoms:

• A loss of appetite and a tendency to avoid some food substances that give them a stomach discomfort
• Set back in their physical and mental growth, compared to other children of their age, due to lack of proper nourishment; children with celiac disease usually have short stature and low body weight
• Bloated and swollen belly causing discomfort
• Defects in the enamel of the teeth
• Joint pain
• Seizures
• A recurrent headache and irritability
• Skin rashes and bumps
• General fatigue
• Constipation
• Anxiety and depression
• Anaemia

Children with symptoms of celiac disease indicating malnourishment need to be treated at the earliest with gluten-free food substance rich in all the essential nutrients.

Diagnosis

The diagnosis of celiac disease is usually very tricky and many times it is misdiagnosed. If you or your doctor suspects celiac disease in your child, then you should opt for a blood test to confirm it. These diagnostic tests are also recommended for asymptomatic children with a family history of celiac disease.

The blood tests currently available to test for celiac disease look for elevated levels of certain antibodies in the blood. These antibodies are produced by the body against the gluten. Typically, the antibodies such as IgA (total), IgA-tTG (anti-tissue transglutaminase), IgA-EMA (anti-endomysial antibodies) and IgA-AGA are tested for their levels. The doctor usually tests for the total IgA and then based on the results, tests for the other specific antibodies. This test is usually not done for children less than 3 years of age as there are chances of inaccuracy in the results. If the test turns out to be positive for celiac disease, the doctor may recommend an endoscopic procedure to confirm the diagnosis.

The gastrointestinal endoscopy is a simple, out-patient procedure, for examining the inner walls of the small intestine for any damage. The doctor usually recommends a gluten diet right before the endoscopy procedure, to confirm if the damage is due to gluten. A small piece of tissue is also taken to examine under the microscope for estimating the extent of the damage. Stomach infections, ulcers, and other food allergies are also sometimes identified during this endoscopy procedure. Once, the endoscopy results suggest the diagnosis of celiac disease, the doctor screens for secondary diseases like diabetes, autoimmune disease, thyroid, and osteoporosis.

Genetic testing is another way of checking for the Celiac disease, especially in asymptomatic children. A blood sample or buccal swab is taken from the child to test for the genes associated with the disease. The presence of the genes HLA DQ2 and DQ8 in the DNA indicate a high chance of having or developing the celiac disease. The genetic testing is not a conclusive test and only indicates the genetic predisposition of the child to Celiac disease. Further physical tests are required to confirm the disease.

Risks and Complications of Celiac Disease in Kids

If undiagnosed or untreated, the celiac disease can pose some serious risks to the child in the long run.

• Nutrient deficiencies

Children with celiac disease, who have a damaged villus, do not have a proper nutrient absorption system in place. The nutrients in the food they consume do not reach the blood and hence, in the long run, these children suffer from serious vitamin and mineral deficiencies.

• Intolerance to lactose

The small intestine is pivotal in digesting the lactose present in milk and milk products. When the small intestine is damaged in the children with celiac disease, the lactose doesn’t get digested and leads to lactose intolerance. The symptoms include bloating, abdominal cramp, vomiting, gas formation and loose stools.

• Failure to thrive

Having a slow growth compared to other children of their age is known as ‘failure to thrive’. The lack of essential nutrients can result in short stature, low weight and delayed developmental milestones.

• Osteoporosis and calcium deficiency

This is a condition that occurs due to low levels of calcium in the body, where the bone density is low (osteopenia) and bones are porous. In children with celiac disease, the absorption of vitamin D and calcium is poor and causes the bones to become brittle. These children also typically have problems in the enamel of the teeth.

• Anaemia

Children with celiac disease also suffer from anaemia, either due to poor absorption of iron and/or due to poor absorption of vitamin B12.

• Depression and anxiety

Children with celiac disease are constantly irritated and feel tired throughout the day. These symptoms can lead to anxiety and even depression in them if left untreated. Biologically, gluten intake leads to inflammation and disintegration of the blood-brain barrier. This increased permeability of the barrier leads to depression, fatigue, and anxiety.

• Cancer

Under extreme circumstances, when the disease is undiagnosed for a long period of time, it can even lead to the lymphoma. The constant damage to the walls of the intestine by the autoimmune system of the body can lead to cancer. However, this is rare in children.

Celiac Disease Treatment for Children

Treatment for patients diagnosed with celiac disease is very important as, without proper treatment, these patients may develop further complications like osteoporosis, cancer and other autoimmune diseases.

Unfortunately, medications are available only to address the symptoms caused by celiac disease and not the disease itself. The only cure for celiac disease is to follow a 100% gluten-free diet. This has to be followed throughout their life as consumption of gluten can trigger the symptoms back anytime.

Following a gluten-free diet for children can be very challenging and it is important for all the people associated with the child to be aware of the child’s condition and dietary requirements. Some medications available in the market also contain gluten in them. Pharmaceutical preparations containing wheat, pregelatinized/modified starch, dextrin, dextrate and caramel colouring are likely to have gluten in them and it is very important to talk to your pharmacist or your doctor before consuming them.

The mental challenges associated with the restrictions in food can be overcome by interacting with other people with a similar condition, either in person or through online support groups. Regular follow up with the doctor is necessary to check for the intestinal health and nutritional status of the body.

Effective Home Remedies to Treat Coeliac Disease

Apart from following a strict gluten-free diet, parents can also try the following home remedies to keep the disease under control.

• Yoghurt

Consumption of yoghurt or any other probiotic is good for the gut. It contains a treasure of good bacteria that help in healing the damaged intestine. It also helps in breaking down the complex food nutrients and repairs the intestine for better absorption.

• Enzyme supplements

There are many enzyme supplements in the market that claim to break down the gluten in the body. There is no complete evidence to corroborate this fact and it can be taken as a supplement for better digestion. For patients with celiac disease, these enzymes do not make it safe for people with celiac disease to eat a normal full gluten diet, they only help in digesting very low amounts of gluten in the body.

• Codfish oil

The oil from codfish available as tablets is good for people with celiac disease and it gives a protective layer to the intestine and saves it from any damage. Any inflammation associated with any accidental consumption of gluten can be reduced to an extent by regular intake of fish oil.

• Herbal tea

Tea prepared from a weed called horsetail, has been found to have beneficial effects on the digestive system. In general, it reduces inflammation and the sensitivity to gluten-containing food.

• Consumptions of herbs: Olive leaf extract, Goldenseal and chamomile are some herbs that are gaining popularity as herbal treatments for celiac disease. All these can regulate the immune response of the body. Celiac disease, being an autoimmune disease can be treated effectively with the consumption of these herbs.

• Natural foods: Eating more fresh fruits and vegetables is a very safe way of dealing with the disease. Artificial and processed foods stand a high chance of having gluten in them, compared to naturally available food substances.

Preventive Measures

Since celiac disease is hereditary, it cannot be prevented. However, if you have celiac disease, you can prevent yourself from experiencing any of the symptoms associated with the disease.

• Avoid completely the intake of any gluten-containing food. Be aware of the possible gluten-containing food substances and check thoroughly for the presence of these in your food. Do not hesitate to customize your no –gluten dish when you are eating outside.

• Before consuming any new medicine check with your doctor for any traces of gluten in it.

• Eat fibre containing fruits and vegetables to soothe your gut and also to prevent constipation.

• See your dietician regularly and get advice on the food substances that need to be avoided by you.

• If your child is affected by celiac disease, make sure you inform the school about your child’s condition and also keep track of the food substances that he or she eats during the day.

• Periodically check your weight, height and nutrient balance to see if you are on the right track.

In today’s day and age, celiac disease is easily manageable with the extensive gluten-free diet options available. There is a growing awareness towards gluten sensitivity and the need for supplementing the diet with the right kind of nutrients. With proper diet and monitoring, celiac disease can be managed effectively.