Celiac disease is an autoimmune disorder caused by an intolerance to gluten; gluten is the general name of the proteins found in wheat, rye and barley and other grains. This under-recognized disease, particularly in children, damages the small intestine and affects the body’s ability to absorb nutrients through the digestive tract.
Dr. Ivor Hill, the section chief of gastroenterology and director of the Celiac Disease Center at Nationwide Children’s Hospital, answers questions regarding childhood celiac disease, what it means for the child and what steps parents need to take if they are concerned that their child may be suffering from the condition.
HealthScene Ohio: Has celiac disease always been as common as it is today?
Dr. Ivor Hill: It probably has been as common but was previously under-recognized. There is a greater recognition on the part of health care providers of the variable clinical manifestations that occur in celiac disease. In the past two decades, physicians have become much more aware of the condition and hence test patients more readily for the condition.
HSO: In what ways do the symptoms of celiac disease differ from adult celiac disease?
IH: Young children tend to have more gastrointestinal-type symptoms such as diarrhea, abdominal pain, bloating and weight loss. Older children tend to initially have more non-GI symptoms such as growth failure, fatigue, anemia as is more commonly seen in adults.
HSO: How is celiac disease in children most commonly identified?
IH: It first requires clinical suspicion based on symptoms or having a condition that places the child at increased risk for celiac disease (such as a positive family history or an associated autoimmune condition such as diabetes). Children then undergo a blood test to look for specific antibodies found in celiac disease. If this test is positive then an intestinal biopsy is recommended to confirm the diagnosis.
HSO: What are the initial steps for parents after a child is diagnosed with celiac disease?
IV: Ideally the parents should be referred to a dietitian with specialized knowledge who can then educate the family on how to implement a gluten-free diet. Treatment requires strict adherence to a gluten-free diet for the rest of the patient’s life.
HSO: Is childhood celiac disease curable?
IH: There is no “cure” for celiac disease. However, adherence to a strict gluten-free diet in most cases will result in resolution of the symptoms and complete healing of the intestinal damage that occurs with active celiac disease.
HSO: Is there any long-term damage on the ability for the body to absorb nutrients like fats, proteins and vitamins?
IH: Malabsorption of nutrients can occur with active celiac disease but will resolve when the intestinal mucosa heals on a gluten-free diet.
HSO: What role do genetics play? If a parent has celiac disease, what is the likelihood that their child will develop the condition?
IH: There is a genetic component to celiac disease. Celiac disease occurs in about 1 percent of the general population. When you have a first degree relative with celiac disease (e.g., a parent or sibling) the risk for the condition in other members of the family increases to between 10 to 20 percent.
HSO: Are there certain environmental triggers that will lead to the development of childhood celiac disease or is it purely genetic?
IH: To get celiac disease one has to have the genes that predispose to the condition and in addition, one has to ingest foods that contain gluten (found in wheat, barley and rye).
HSO: Are there resources which parents of positively diagnosed children utilize outside of the medical setting?
IH: There are a number of support groups that are very beneficial as well as some reliable websites such as gikids.org and the Celiac Disease Foundation’s website celiac.org.
Nathan Collins is managing editor. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Ivor Hill, MD, MB, ChB, is Section Chief of Gastroenterology and Director of the Celiac Disease Center at Nationwide Children’s Hospital. He is also professor of Clinical Pediatrics at the Ohio State University College of Medicine. One of the leading clinicians and researchers in childhood celiac disease, Dr. Hill has been instrumental in raising awareness of the disease in the United States. Notably, he was the chair of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) committee that developed the first evidence-based guidelines on diagnosis and treatment of celiac disease in children. This has resulted in many more people with celiac disease now being identified and treated appropriately. He has published more than 110 papers in peer-reviewed scientific journals and 41 chapters in medical books.
