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Ulceration of the small intestine in children with coeliac disease
M Eltumi1, M J Brueton, N Francis
1Academic Department of Child Health, Charing Cross and Westminster Medical School, Chelsea and Westminster Hospital, London.
Insights
Small intestinal ulcers in children are rare. This study identifies coeliac disease as a cause in two infants with failure to thrive, with symptoms resolving on a gluten-free diet.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Small intestinal ulceration is an under-recognized condition in pediatric patients.
- Previous literature has not described cases of duodenal ulceration in infants.
Observation:
- Two pediatric patients, aged 12 and 18 months, presented with severe failure to thrive and persistent diarrhea.
- Endoscopic examination revealed multiple duodenal ulcers in both children.
Findings:
- Histological analysis of duodenal biopsies confirmed ulceration and revealed features consistent with celiac disease.
- Clinical improvement, linear growth, and resolution of duodenal ulcers were observed following a gluten-free diet.
- Biopsy-controlled gluten challenge confirmed the diagnosis of celiac disease a year later.
Implications:
- This study highlights a novel presentation of celiac disease in pediatric patients.
- Early diagnosis and dietary management are crucial for resolving intestinal ulceration and ensuring adequate growth in affected children.
- Further research into the pathogenesis and prevalence of small intestinal ulceration in pediatric celiac disease is warranted.
Background:
Ulceration of the small intestine in children has not been previously described.
Patients:
Two children, aged 12 and 18 months, presented with a history of failure to thrive and intractable diarrhoea.
Results And Conclusions:
Upper gastrointestinal endoscopy showed multiple ulcers involving the first and second parts of the duodenum. Histology of biopsy specimens taken from these sites confirmed ulceration and showed other features consistent with a diagnosis of coeliac disease. They both showed pronounced clinical improvement and satisfactory linear growth on a gluten free diet. A year later the diagnosis of coeliac disease was confirmed on a biopsy controlled gluten challenge, and repeat endoscopy showed complete resolution of the intestinal ulceration.
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