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A long-term study in children with a recognized gluten intolerance
B Nowowiejska1, M Kaczmarski, E J Dabrowska
1Third Department of Pediatrics, Medical Academy of Białystok.
Insights
Children with gluten intolerance, often diagnosed as coeliac disease, frequently develop non-intestinal symptoms like neurological and growth issues. Adherence to a gluten-free diet is crucial for managing these health problems in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Child Neurology
Background:
- Gluten intolerance, particularly coeliac disease (CD), affects children with diverse clinical presentations.
- The evolution of symptoms over time in pediatric patients with gluten intolerance requires further investigation.
- Understanding the long-term consequences of gluten intolerance in children is essential for effective management.
Purpose of the Study:
- To analyze the clinical evolution and long-term outcomes in children diagnosed with gluten intolerance.
- To identify the prevalence of intestinal versus parenteral symptoms in pediatric patients with gluten intolerance.
- To investigate the impact of gluten intolerance on physical development, neurological status, and pubertal maturation.
Main Methods:
- A retrospective and prospective study involving 54 children diagnosed with gluten intolerance 5-10 years prior.
- Confirmation of coeliac disease in 81.5% of the study cohort.
- Clinical assessment focusing on intestinal and parenteral symptoms, growth parameters, pubertal development, and neurological status.
Main Results:
- Coeliac disease was confirmed in 81.5% of children.
- Intestinal symptoms were prevalent in younger children at diagnosis but decreased in adolescence (33%).
- Parenteral symptoms, including osteoarticular, CNS, skin, and mucous membrane issues, affected 67% of patients at follow-up. Significant growth deficiencies and pubertal delays were observed, alongside neurological disorders in nearly two-thirds of cases. Approximately 5% exhibited mental retardation.
Conclusions:
- Non-adherence to a gluten-free diet and parental cooperation challenges contribute to physical and mental disturbances.
- Effective management of gluten intolerance in children necessitates a multidisciplinary approach.
- Early and consistent dietary management is critical to mitigate long-term health complications in pediatric gluten intolerance.
Abstract:
A retrospective and prospective study was carried out on 54 children with gluten intolerance recognized 5-10 years ago. Coeliac disease (CD) was confirmed in 44 (81.5%) patients. The clinical picture in the observed children showed an evolution during the period of analysis. Intestinal symptoms are rare in adolescence (33%) while they are always present in the youngest children (initial diagnosis). At the time of the follow-up analysis, 67% of the patients demonstrated parenteral symptoms, mainly in the osteoarticular system, CNS, skin, mucous membranes and in only 33% children were the intestinal symptoms present. Over one third of the patients demonstrated body weight and height deficiency, 73% of boys and 39% of girls in age of pubescence had no maturity features. Neurological disorders were present in almost two thirds of the cases and about 5% of the children showed an evident mental retardation. Disruption of the gluten-free diet, frequent dietary errors and ineffective cooperation of the parents are the most probable reasons for physical and mental disturbances in the studied children. The obtained therapeutic results call for the creating of multi-disciplinary active care for children with gluten intolerance.