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Pica as a presenting symptom in childhood celiac disease
1Department of Pediatrics, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel.
Insights
Persistent pica in children can signal underlying celiac disease. This study found that iron deficiency from celiac disease caused pica, which resolved with a gluten-free diet, improving growth.
Area of Science:
- Pediatrics
- Gastroenterology
- Nutrition
Background:
- Persistent pica, the compulsive consumption of non-food substances, is often linked to iron deficiency.
- Iron deficiency anemia can stem from various causes, including nutritional deficits and malabsorption syndromes.
Observation:
- Three children presented with long-standing pica, iron-deficiency anemia, short stature, and delayed bone age.
- Jejunal biopsies revealed total villous atrophy, indicative of celiac disease.
- Impaired xylose absorption further suggested malabsorption issues.
Findings:
- Pica in these cases was secondary to iron deficiency caused by malabsorption associated with celiac disease.
- A gluten-free diet led to a significant growth spurt and complete resolution of pica.
- Gastrointestinal symptoms were minimal, highlighting the non-specific presentation.
Implications:
- Celiac disease should be considered in the differential diagnosis of children with persistent pica and growth failure, even with subtle gastrointestinal symptoms.
- Early diagnosis and dietary management of celiac disease can prevent complications like iron deficiency anemia and growth impairment.
- This highlights the importance of a multidisciplinary approach in managing pediatric feeding disorders and associated nutritional deficiencies.
Abstract:
Persistent pica may be either a cause or a result of iron deficiency. Three children are described with long-standing pica and iron-deficiency anemia and in whom total villous atrophy consistent with celiac disease was found on jejunal biopsy. Additional findings included short stature, delayed bone age, and impaired xylose absorption. A dramatic growth spurt and complete resolution of pica were observed after a gluten-free diet. In these cases pica evidently resulted from iron deficiency secondary to malabsorption. Underlying celiac disease should be considered in children with persistent pica and growth failure even if gastrointestinal disturbances are minimal.