Management of celiac disease in childhood and adolescence: Unique challenges and strategies

Abstract

Celiac disease (CD) is a common condition that occurs in genetically predisposed individuals when they ingest products containing wheat, barley, or rye. It produces an autoimmune-mediated enteropathy with characteristic histologic features on small intestinal mucosal biopsy. The clinical manifestations of CD are highly variable and initially may be unrelated to the gastrointestinal system. The condition is also strongly associated with other autoimmune and nonautoimmune conditions. Physicians caring for children and adolescents are challenged with identifying those who might have CD and require referral for definitive testing, recognizing the potential pitfalls in the diagnostic work-up of the pediatric patient, and providing ongoing care for those with a positive diagnosis. Confirmation of the diagnosis mandates that the individual be placed on a strict gluten-free diet (GFD) for life, as this is the only treatment currently available for CD. This article will discuss the immunopathogenesis, epidemiology, and clinical manifestations of CD and will outline a strategy of active case-finding using serological tests to identify those who require an intestinal biopsy for definitive diagnosis. The need for lifelong treatment by means of a GFD and for continued follow-up of children and adolescents after diagnosis is emphasized.