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Celiac disease in children with diarrhea is more frequent than previously suspected
Farid Imanzadeh1, Ali Akbar Sayyari, Mohammad Yaghoobi
1Department of Pediatric Gastroenterology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Iran.
Insights
Celiac disease (CD) is common in children with chronic diarrhea, with 6.5% diagnosed. A gluten-free diet significantly improved symptoms and histology in these pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Dietary Medicine
Background:
- Celiac disease (CD) is often underdiagnosed in children presenting with chronic diarrhea.
- Delayed diagnosis can impact a child's health and development.
Purpose of the Study:
- To determine the frequency of celiac disease in pediatric patients with chronic diarrhea.
- To evaluate the efficacy of a gluten-free diet in managing symptoms and histologic findings in these patients.
Main Methods:
- A 6-year study included pediatric patients with chronic diarrhea (>6 weeks) and asymptomatic controls.
- Serologic tests (endomysial and antigliadin antibodies) and duodenal biopsies were used for diagnosis.
- Confirmed CD patients were treated with a gluten-free diet and reassessed after 6 months.
Main Results:
- Celiac disease was diagnosed in 6.5% of children with chronic diarrhea, compared to 0.8% in controls.
- 88.8% of CD patients showed symptom improvement on a gluten-free diet, with 76.1% becoming asymptomatic.
- Repeat endoscopy revealed improved histology in 95.2% of treated patients.
Conclusions:
- Celiac disease is a frequent diagnosis in pediatric patients with chronic diarrhea.
- A gluten-free diet is an effective treatment, leading to significant symptom and histologic improvement.
- Routine celiac disease screening is recommended for children evaluated for chronic diarrhea.
Background:
Celiac disease (CD) may be missed or diagnosed late in children with chronic diarrhea. In this study the authors estimated the frequency of CD among pediatric patients with chronic diarrhea based on serologic and pathologic examinations.
Methods:
During a 6-year period, all patients with chronic diarrhea of more than 6 weeks referred to the authors' department were included. For each patient, an asymptomatic control was enrolled from among the patients referred to our clinic for other reasons. Serologic tests for CD including immunoglobulin A endomysial antibody and immunoglobulin A antigliadin antibody were performed in all patients and controls. If positive, duodenal biopsy was performed to confirm the diagnosis. Patients subsequently diagnosed as CD were placed on a gluten-free diet and reevaluated after 6 months.
Results:
825 cases of diarrhea and 825 controls were enrolled. CD was diagnosed in 54 (6.5%) of the diarrhea patients and seven (0.8%) of the controls. After 6 months of gluten-free diet, 48 (88.8%) patients had significant improvement in symptoms and of these 41 (76.1%) were totally asymptomatic. Forty-two patients allowed repeat endoscopy after 6 months of gluten-free diet and 40 (95.2%) showed improvement in histologic findings.
Conclusion:
CD is common among patients labeled as chronic diarrhea. In this subgroup, gluten-free diet may lead to a significant improvement in symptoms. Routine testing for CD may be indicated in all patients being evaluated for chronic diarrhea.
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