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Coeliac Disease in Children-A Clinical Review Including Novel Treatment Agents
Chloe Corlett1, Astor Rodrigues1, Madhur Ravikumara2
1Department of Gastroenterology, Children's Hospital Oxford, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK.
Insights
Coeliac disease (CD) diagnosis is evolving, with a no-biopsy approach now possible for some children. Research is also exploring new treatments beyond the strict gluten-free diet for this common condition.
Area of Science:
- Gastroenterology and Hepatology
- Immunology
Background:
- Coeliac disease (CD) affects nearly 1% of the population, with most cases undiagnosed.
- Traditionally diagnosed via duodenal biopsy, CD diagnosis criteria have evolved.
- Untreated CD is linked to chronic health issues.
Purpose of the Study:
- To review the clinical aspects of coeliac disease.
- To summarize current and emerging treatment strategies for CD.
- To highlight the shift towards a no-biopsy diagnostic approach.
Main Methods:
- Review of European Society of Paediatric Gastroenterology and Nutrition (ESPGHAN) guidelines (2012, 2020).
- Analysis of the current clinical application of the no-biopsy CD diagnosis.
- Summary of ongoing research into novel CD therapeutic agents.
Main Results:
- A select group of children can now receive a CD diagnosis without duodenal biopsies.
- The no-biopsy approach is increasingly adopted in clinical practice.
- Several investigational treatments for CD are in various clinical trial phases.
Conclusions:
- Diagnostic criteria for coeliac disease have been updated, allowing for a no-biopsy approach in specific pediatric cases.
- A strict gluten-free diet remains the primary treatment, but alternative therapies are under development.
- Continued research into CD pathogenesis is driving the search for new treatment options.
Abstract:
Coeliac disease (CD) affects almost of 1% of the population, yet remains undiagnosed in the majority. Though the demonstration of enteropathy in duodenal biopsy was traditionally the essential criterion for the diagnosis of coeliac disease, the guidelines published by the European Society of Paediatric Gastroenterology and Nutrition (ESPGHAN) in 2012, and revised in 2020, paved the way to a no-biopsy approach to diagnosis. In a select group of children meeting certain criteria, a definitive diagnosis of CD can now be made without the need for duodenal biopsies. This is being increasingly applied in clinical practice. It is well established that untreated coeliac disease is associated with several chronic adverse health conditions. At present, a strict gluten-free diet remains the only effective treatment for CD. The advances in our understanding of the pathogenesis of CD have led to a search for alternative treatment agents. Several investigational agents are in various phases of clinical trials at present. In this review, we outline the clinical aspects of coeliac disease and summarise various investigational treatment agents.
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