Recognition and management of coeliac disease in children

Coeliac disease (CD) is an immune-mediated systemic disorder elicited by the ingestion of gluten (found in wheat, rye, and barley) in genetically susceptible individuals. It affects around 1% of children and leads to proximal small bowel enteropathy, although many cases may remain undiagnosed. CD classically presents with gastrointestinal symptoms of diarrhoea, abdominal pain and weight loss, although other symptoms such as iron deficiency anaemia, faltering growth, dental enamel defects, short stature, liver disease, arthropathy, mouth ulcers, etc may be the presenting feature. Breastfeeding is considered to have a beneficial role in preventing CD or at least delays onset. Community practitioners should remain aware of the classical gastrointestinal and other features of CD and make an early referral to medical professionals. Suspicion of CD should lead to antibody screening tests and the diagnosis is confirmed by an intestinal biopsy. A gluten-free diet (GFD) should always be started by paediatric dietitians and they play a vital role in educating and supporting families. Strict adherence to a GFD is essential to maintain good health and to prevent development of long-term complications.