Coeliac Disease in Children
Dr Joseph Mizzi MD MRCP
What is coeliac disease?
Coeliac disease is a lifelong condition of the small bowel caused by a reaction to gluten. It is an auto-immune disorder because the immune system damages its own body. Gluten is the name of a protein found in wheat, barley and rye.
How does gluten affect the bowel?
Gluten triggers the immune system to produce antibodies that attack the delicate lining of the bowel, which is responsible for absorbing nutrients from food. The damaged bowel is unable to absorb the nutrients, resulting in malnutrition.
Who is at risk?
Coeliac disease can be diagnosed at any age. It may first be diagnosed in babies after weaning, when cereals are first introduced into the diet, or later on in childhood and adulthood. The condition affects up to 1 in 300 people in Europe. Coeliac disease runs in families. An individual has a 10% risk of developing the condition if a parent or sibling suffers from coeliac.
What are the symptoms?
Symptoms do not appear until gluten-containing foods are introduced into the diet. The symptoms are related to malabsorption (diarrhoea and pale, bulky stools), and malnutrition (poor growth, pallor, weakness, irritability, poor appetite, abdominal cramps and swelling, and wasting of the muscles of the arms and legs).
Can coeliac be prevented?
Breastfeeding and delaying the introduction of gluten until after four months may reduce the risk of developing coeliac disease.
How is coeliac disease diagnosed?
A simple blood test (‘anti-transglutaminase’) indicates if a person is likely to suffer from coeliac. Other blood tests are performed to check for anaemia and deficiency of iron, folic acid and calcium. If the blood tests are suggestive of coeliac, a biopsy of the small bowel will give a definitive answer. A tiny sample of the inner lining of the bowel is examined under the microscope. The biopsy is taken during an endoscopy test; the child is sedated during the procedure.
What is the treatment?
The single most important aspect is a gluten-free diet. The doctor may also prescribe vitamin and mineral supplements. A gluten-free diet enables the lining of the bowel to return to normal, allowing the proper absorption of nutrients. However the damage will return as soon as the child takes even a small amount of gluten. Moreover, coeliac disease is a chronic condition, and therefore one must adhere strictly to a gluten-free diet for life.
Which foods should be avoided?
All food products made from wheat, rye and barley, as well as foods containing these cereals must be avoided. These include breads, pastas, breakfast cereals, pizza bases, pastries, cakes and biscuits. Processed foods such as soups, sauces and sausages, may also contain gluten. Take care not to contaminate food with gluten during preparation (e.g. jam can be contaminated with crumbs of bread).
What foods may I give to my child?
Vegetables, fruit, legumes, potatoes, rice, maize, milk, dairy products, and meat, fish and poultry are naturally free from gluten. Be careful to check the labels on food products. Gluten-free substitutes (such as rice and maize flour) are available from supermarkets. The Health Department provides staples of gluten-free products (flour, biscuits, bread and pasta) on prescription.
What are the long term complications?
If left untreated coeliac disease can lead to long term complications like anaemia, osteoporosis and bowel lymphoma. However, if a gluten-free diet is followed, the child can enjoy a good quality of life without symptoms or long-term complications.
Where can I get help and more information?
Adaptation to a gluten-free diet is challenging. It takes time for the parents and child to learn which foods are gluten-free and which foods must be avoided. You can get invaluable practical information and support from the Coeliac Association of Malta.