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Faecal occult blood in children with coeliac disease
R Shamir1, A Levine, M Yalon-Hacohen
1Institute of Paediatric Gastroenterology and Nutrition, Schneider Children's Medical Centre of Israel, Petah Tikva, Israel.
Insights
In children with coeliac disease, occult blood loss is common, especially in new diagnoses. A gluten-free diet effectively resolves this issue, indicating its importance in managing the condition.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Bleeding
- Celiac Disease Pathophysiology
Background:
- Iron deficiency is a common complication in pediatric celiac disease.
- The role of gastrointestinal blood loss in this iron deficiency is under investigation.
Purpose of the Study:
- To evaluate the incidence of faecal occult blood in children with coeliac disease.
- To determine the relationship between gluten intake, iron deficiency anaemia, and faecal occult blood.
- To assess the impact of a gluten-free diet on faecal occult blood loss.
Main Methods:
- Prospective evaluation of 45 children diagnosed with coeliac disease.
- Assessment of dietary gluten presence, iron deficiency anaemia, and faecal occult blood.
- Comparison with 60 age-matched control children.
Main Results:
- Faecal occult blood was detected in iron-deficient children on a gluten-containing diet (26.7%).
- Occult blood loss resolved in most cases after initiating a gluten-free diet.
- No significant faecal occult blood was found in children on a gluten-free diet or in control groups.
Conclusions:
- Occult gastrointestinal blood loss is prevalent in newly diagnosed pediatric coeliac disease.
- A gluten-free diet is effective in resolving faecal occult blood loss.
- Faecal occult blood testing is not recommended for children without iron deficiency anaemia or those already on a gluten-free diet.
Unlabelled:
It has recently been suggested that in adults with coeliac disease, faecal blood loss may play a role in the development of iron deficiency. A group of 45 children diagnosed with coeliac disease during 1996 and 1997 were therefore prospectively evaluated for the presence of gluten in their diet, iron deficiency anaemia, and faecal occult blood. Sixty children admitted for elective surgery or asthma served as controls. Faecal occult blood was found in four iron deficient children on normal diet, of whom three were newly diagnosed. Occult blood loss disappeared in three of the four children when gluten was removed from their diet. Faecal occult blood was found in 26.7% of children on gluten-containing diet, but not in children on gluten-free diet (P = 0.01), or in control children (P = 0.001).
Conclusion:
Our data suggest that the incidence of occult blood loss in coeliac disease occurs mainly in newly diagnosed cases and responds to a gluten-free diet. Occult blood testing may not be warranted in the absence of iron deficiency anaemia nor in children with iron deficiency anaemia who are on a gluten-free diet.