What is Celiac Disease?

Celiac disease is also called gluten allergic bowel disease. In the past, it was also called idiopathic malabsorption syndrome because of unknown cause. It has been proven that the disease is caused by the allergy to gluten, which is a protein component, in the consumption of wheat foods, including wheat, barley and rye. There are different opinions on whether oats can cause the disease, at least it is less harmful. This allergic reaction causes extensive lesions in the upper mucosa of the small intestine and clinically manifests malabsorption symptoms such as steatosis, which is a lifelong disease.

Basic Information

nickname: Gluten allergic bowel disease
Visiting department: Pediatrics
Multiple groups: Children

Common locations: Small intestine
Common causes: Consumption of allergies to gluten, which is a protein component, in the consumption of wheat, including wheat, barley and rye
Common symptoms: Chronic diarrhea, fatty diarrhea, poor growth and development, anemia, etc.

Causes of celiac disease in children

Pathogenic factors

Gluten in wheat (commonly known as gluten) is a complex plant protein. It can be broken down into 4 kinds of proteins, namely gluten protein (also known as gliadin), glutenin, albumin and globulin. Among them, gluten is the causative factor of the disease.

2. Relationship with genetics

The prevalence of this disease among first-degree relatives of children is 2% to 3%. For small intestinal mucosal biopsy, some relatives have typical changes in the small intestinal mucosa, which is significantly higher than that of the general population. About 70% of patients with identical twins are affected at the same time. All these indicate that the onset of this disease is genetically related.

Clinical manifestations of celiac disease in children

Gastrointestinal symptoms

Most cases have symptoms of malabsorption such as chronic diarrhea and fatty diarrhea, such as light stools, oily, and malodorous stools, 2 to 3 times a day, but also once a day, but the amount of stool is large, and diarrhea may worsen intermittently and become water Like stool, it is easy to cause dehydration and electrolyte disturbance. However, a small number of children can have no diarrhea or even constipation. Patients often have anorexia, but occasionally increase appetite. Other symptoms include vomiting, abdominal pain, bloating and prolapse.

2. Backward growth

Due to malabsorption, height and weight often lag significantly behind, and the growth rate is slow. Muscle wasting, especially at the proximal end of the limb. Some children may have enamel dysplasia, which can be recovered after gluten is stopped.

3. Other nutritional deficiencies

Nutritional anemia due to malabsorption of iron and folic acid is common, and children are pale. Due to protein malabsorption and protein-losing enteropathy, hypoproteinemia can be caused, and malnutrition edema can be caused in severe cases. Fat malabsorption can cause malabsorption of fat-soluble vitamins, causing the corresponding symptoms of vitamin A, D, E, and K deficiency.

4. Mental symptoms

May have irritability, personality changes, and sleep disturbances. Children often have abnormal laboratory tests of malabsorption syndrome, such as increased stool fat, decreased serum carotene, decreased xylose absorption test, decreased hemoglobin, hypoalbuminemia, and fat-soluble vitamin deficiency. These abnormalities can only prove the existence of malabsorption, and it is not certain that malabsorption is caused by the disease.

Pediatric celiac disease check

Biopsy

Small bowel mucosal biopsy has characteristic pathological changes of celiac disease.

2. Diet therapy check

Diet therapy means that after removing all foods containing gluten from the diet, the symptoms quickly disappear and weight gain begins. It is not advisable to take dietary treatment before obtaining small intestinal mucosa specimens, because once the symptoms improve, it is difficult to determine whether it is natural recovery or the effect of dietary therapy. With the above two items, a preliminary diagnosis of this disease can be made.

3. Induction test

The induction test is positive, that is, after retrying a gluten-containing diet, whether the symptoms recur or not, the small bowel pathological changes reappear, and the diagnosis of the disease can be confirmed. It is still controversial whether a susceptibility test is needed for children over 2 years of age. Generally, it is recommended to be performed under 2 years of age. The induction test should be carried out 2 years after the start of diet therapy and wait for the pathological changes of the small intestine to return to normal. In order to avoid severe symptoms, a small amount of wheat can be given, such as 1 to 2 slices of bread per day. Most children can tolerate it, and it usually takes 2 years or more for the intestinal mucosa to reappear.

In recent years, it has been found that blood C3 complement is low in untreated children, and IgM is reduced in less than half of the children. Serum anti-gliadin IgA antibodies, anti-reticulin antibodies and anti-endomysial antibodies can be positive, sensitive and specific. Higher. Diagnose with small bowel biopsy. These antibodies disappear after diet, and induction tests can reappear.

Celiac disease diagnosis in children

Confirmation is based on:

1. Biopsy: Small bowel mucosal biopsy has characteristic pathological changes of celiac disease.

2. Diet Therapy: After removing all gluten-containing food in the diet, the symptoms quickly disappear and the weight begins to increase. It is not advisable to use diet treatment before obtaining small intestinal mucosa specimens, because once the symptoms improve, it is difficult to be sure that it will naturally recover. It is still the effect of diet therapy, with the above two can be a preliminary diagnosis of this disease.

3. Induction test: The induction test is positive, that is, after retrying a diet containing gluten protein, whether the symptoms recur or not, and the pathological changes in the small intestine reappear, the diagnosis of the disease is confirmed.

Pediatric celiac disease treatment

There is no medicine that can cure gluten allergy. But for gluten allergy cases, the only way to avoid damaging their intestinal villi and related symptoms is to maintain a gluten-free diet. Foods that contain gluten protein need to be restricted for life, including wheat, barley, rye and oats. It s okay to eat rice and corn. One week after food restriction, symptoms can be improved, and severe cases recover slightly later. Height and weight resumed growth. Long-term strict restrictions on wheat diets have no side effects and reduce the risk of gastrointestinal malignancies in adulthood. The lack of nutrients such as fat-soluble vitamins, iron and folic acid should be supplemented early in the treatment. Although the disaccharide enzyme activity of children often decreases, it rarely causes glucose intolerance. Unless symptoms occur, disaccharide can be eaten for a short period of time, and generally there is no restriction.

Prognosis of celiac disease in children

The disease is a permanent condition, but a lifetime restriction of the gluten-protein-containing diet after diagnosis has a good prognosis. A gluten-free diet leads to a normal and healthy life, but cannot be cured.