Poor Weight Gain Is Clue to Celiac Disease in Children
Surprising as it sounds, the vast majority of patients with non-specific abdominal pain – such as mild diarrhea or lactose intolerance – do not have celiac disease.
Contributor: Kadakkal Radhakrishnan, MD
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Gluten, a term we hear about every day, is a protein found in wheat, barley and rye. When an individual who is prone to celiac disease eats gluten, the body mounts an immune response directed at the small intestine.
The result is inflammation and injury to the villi – extremely tiny, finger-like projections in the lining of the small intestine that increase the surface area and promote absorption of nutrients. The damage to villi affects nutrient absorption and leads to a multitude of symptoms.
It seems like we can’t go to any restaurant or supermarket without seeing or hearing the term gluten-free. The phrase is synonymous now with healthy eating. But who really needs to go gluten-free? Those who have been diagnosed with celiac disease.
Celiac disease has been reported in children of all ethnicities, though the disease is relatively more common in those with Caucasian roots. It is believed about a third of the Caucasian population have genes that increase susceptibility to celiac disease. However, only 3 percent of those develop the condition.
An estimated one out of 100 people have celiac disease in the United States. To develop the condition, one needs to have the genetic susceptibility, exposure to gluten and variations in the immune system that are controlled by other secondary susceptibility genes. In other words, it has to be the “perfect storm” scenario.
Celiac disease also has a hereditary component, which puts children who have first-degree relatives, such as parents or siblings, with celiac disease at higher risk for developing the disease.
Based on symptoms, patients with celiac disease fall into two groups. The first group – also known as the classic group – account for 5 percent of patients, mostly children. These patients have poor weight gain after they begin consuming a gluten-containing diet and also have loose stools or diarrhea.
But most patients with celiac disease have minor symptoms and are incidentally diagnosed when screened for the disease. This group may have non-specific abdominal pain, mild diarrhea, lactose intolerance or have a first-degree relative with the disease.
However, as surprising as it sounds, the vast majority of patients with non-specific abdominal pain – such as mild diarrhea or lactose intolerance – do not have celiac disease.
Another fact about celiac disease that many people do not know is that it increases the risk of developing other autoimmune disorders. These include Type 1 diabetes, rheumatoid arthritis, autoimmune thyroid disease, Crohn’s disease and ulcerative colitis, to name just a few.
Even though the overall risk of developing another autoimmune disorder may be small – 4 percent develop Type 1 diabetes and 7 percent develop thyroid disease, for example – it is likely these disorders share a common genetic component. However, it is unclear whether elimination of gluten-containing foods would lead to a decrease of autoimmune disorders in celiac disease patients.
Any child with unexplained diarrhea and weight loss, as well as patients with other autoimmune disorders and first-degree relatives of patients with celiac disease, should be checked for celiac disease.
To determine if celiac disease is present, patients undergo screening for anti-gluten antibodies, IgA and sometimes IgG. Those patients with elevated antibodies should be seen by a pediatric gastroenterologist and likely may require an upper gastrointestinal endoscopy. This procedure allows the doctor to identify inflammation or damage to the small intestine and confirm a diagnosis of celiac disease.
Some patients with very high levels of antibodies may not require a biopsy, but this decision should be made after talking with the treating physician. Very low elevation of tTG and deamidated gliadin antibodies may be falsely elevated, and these patients may not truly have celiac disease.
For those diagnosed with celiac disease, there is only one treatment, which is complete elimination of gluten-containing foods. Although this might seem extremely restrictive, there are so many delicious food options today that cater to those with gluten intolerance.
To identify gluten-free foods and to help ease the transition, it’s best to consult with a pediatric dietitian.
When it comes to cutting out gluten, the elimination must be strict and should include not sharing cooking utensils and plates. Patients should also see their pediatric gastroenterologist to monitor adherence to the diet and for potential development of autoimmune disorders and vitamin deficiencies, especially vitamin D.
Poorly controlled celiac disease increases the risk of a small bowel cancer, a type of lymphoma, which is why following a strict, gluten-free diet is important – and even more so, imperative.