Because Celiac Disease (CD) can manifest in various ways, it is often difficult to diagnose. In children, this is more often than not the case, especially with very young children who lack the ability to verbalize their symptoms accurately or at all. While the typical gastrointestinal (GI) symptoms, such as bloating, diarrhea or constipation, and abdominal pain may be present, there are times when these symptoms do not exist. Instead, some children will present with slowed or stunted growth, anemia, or weakened tooth enamel, all resultant of nutrient malabsorption due to the damage CD causes to the lining of the small intestine. Further, CD may also elicit neuropsychological anomolies such as irritability, moodiness, and the inability to focus or concentrate. With such a vast array of symptoms, it is easy to understand why misdiagnosis, particularly in children, can occur.
While random testing of every child is not recommended, children with symptoms of CD should be tested. Further, there are certain groups in which testing is recommended regardless of outward symptoms of CD, such as those with a parent or sibling who tests positive for CD and children with certain disorders such as Down Syndrome, Type 1 diabetes, IgA deficiency, Turner syndrome, Williams syndrome, and thyroid issues. Children with any of these health issues are considered to be at a higher than normal risk of having or developing CD.
If a child is to be tested for CD, he or she should continue to remain on a diet that includes gluten in order to achieve testing accuracy. The initial laboratory test is typically a serological panel that measures levels of antibodies in the blood, specifically anti-tTG (transglutaminase), which are typically high in those with CD if they are on a gluten-containing diet. If the child has high tTG levels, then the diagnosis will need to be confirmed with a biopsy (tissue sample) of the small intestine lining. This is done via endoscopy, a procedure where a small flexible tube is entered into the digestive tract orally to allow the doctor to assess the small intestine lining for signs of damage and inflammation. Children are administered either a mild sedative or general anesthesia, depending on their age and size, that will help to abate any discomfort and allow the child to relax and remain still during the procedure. A biopsy (tissue sample) of the small intestine lining is usually taken during the procedure. Specifically, the doctor will be looking for signs of damage to the small finger-like projections (villi) lining the small intestine. These villi are what allows the body to absorb nutrients from the foods we eat, and in those with CD, the villi are flat and unable to absorb nutrients properly.
Fortunately, once a child with CD is diagnosed and adopts a gluten-free diet, the resilient villi heal and nutrients are readily absorbed through the gut; thus, the troubling symptoms of CD dissipate over time. Children tend to experience an overall improvement in one to two weeks after beginning a gluten-free diet.
