Small child

Celiac disease - causes, symptoms, diagnosis

Grażyna Konińska, a dietitian and mother of three, answers the questions. He works at the Information Point of the Polish Association of People with Celiac Disease and on a Gluten Free Diet. Celiac disease is a little-known disease ...

Grażyna Konińska: I would not agree with this statement. It is a known disease, but it gives people such different symptoms that often the doctor looks for a long time before he realizes that it may be celiac disease.

Until recently, celiac disease was considered a "rare disease of young children that grows out after a few years of diet". Nothing more wrong! The disease can appear at different ages. Currently, celiac disease is most commonly detected in people aged 30-50. In our association we also have people diagnosed with celiac disease at the age of 80! Interestingly, women are diagnosed with celiac disease twice as often as men. It is said that celiac disease is often diagnosed during pregnancy.

G.K: I will not agree with this statement. It is diagnosed, as I said at different ages, it happens that it appears after pregnancy, but it is not so frequent.

Can the disease be diagnosed in an infant?

G.K: Celiac disease may not appear until the child starts eating gluten. There is no such possibility before. In babies, the symptoms affect the gastrointestinal tract and cannot be missed. Fatty or watery diarrhea, pain, bloating, enlargement of the abdomen, no weight gain, tearfulness. These are the symptoms of so-called overt and classical celiac disease.

So the "dose" of gluten permeating with breast milk cannot give any symptoms of an infant?

G.K: Modern medicine believes that gluten does not pass into breast milk. However, some mothers (those who do not tolerate gluten on their own, but eat it for various reasons) notice that the infant calms down when they withdraw products that they cannot tolerate.

What symptoms should a 2-3-year-old child be worried about?

G.K: As in infants, also in young children symptoms mainly affect the gastrointestinal tract. So diarrhea, less often constipation, pain, bloating, enlargement of the abdominal circumference - the abdomen may be flatulent like a balloon, weight loss, the child stops growing (pronounced breakdown of curves on the centile grid), a visible change in temperament (irritability, hyperactivity or fatigue and apathy).

Is the disease always accompanied by gastric problems, stunted growth, and stomach ache?

G.K: Not always. Sometimes celiac disease is detected accidentally.

Symptoms of the disease can be very different, mainly due to the patient's age. It happens that celiac disease is detected by the dentist, noticing the child's mineralization disorders (in the form of white and / or yellow-brown matte) and tooth enamel hypoplasia (in the form of transverse and / or vertical grooves and enamel defects) or recurrent aphts.

So what should parents pay attention to in the context of possible celiac disease or gluten allergy? Can you sum up what has already been said? Maybe there are some signals that should not be underestimated?

G.K: As I said before, celiac disease can give different symptoms, from different systems, not only digestive. Absorption disorders (weight deficiency, deficiency in body height, recurrent anemia) in older children, mental disorders (irritability, apathy, impatience, decreased self-esteem), neurological disorders, increased risk of autoimmune diseases. Although indeed, gastrointestinal symptoms usually predominate in children. The most important symptom in children is stunting (no weight gain, no growth). It is worth adding that often patients suffer from a general decrease in body immunity.

How is celiac disease diagnosed? And can the disease be detected during ultrasound?

G.K: Usually the antibody concentration is determined:

  • against smooth muscle endomysium (EmA),
  • against tissue transglutaminase (tTG).
  • against "New gliadin" GAF (deamidated gliadin denoted by the symbol DGP or GAF).

AGG anti-gliadin antibodies were once tested. It is now believed that AGA antibodies can be helpful in diagnosing hypersensitivity to gluten. It is not necessary to determine all antibodies. However, it should be remembered that during the diagnosis blood should be taken for a test to assess total IgA concentration. It may happen that in the absence of IgA the test may give a false negative result. In the case of IgA deficiency, IgG antibodies are then evaluated. Antibody testing can also be done on your own in larger laboratories.

The above-mentioned antibodies are specific for celiac disease and their presence in the blood significantly increases the likelihood of illness. However, it should be emphasized that their absence does not exclude celiac disease, especially in very young children. Sometimes, to confirm the existence of celiac disease, you need a biopsy and small bowel specimens.
Ultrasound is not useful when diagnosing celiac disease.

So a parent who suspects celiac disease can order tests themselves. What more costs does it have to take into account?

G.K: Yes, many laboratories offer blood tests for celiac disease. The cost is about PLN 80-100 for testing one antibody in one class.