Diagnosis of a celiac child

Diagnosis of a celiac child

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An untreated celiac child may be listless (disinterested or down) with irritability and easy crying. It has recently been proven that celiacs are 4 times more likely to develop hypothyroidism, 3 times more than having hyperthyroidism and 3.6 times more than having thyroiditis. The only treatment today for celiac disease is the total and strict absence of gluten in the diet.

The diagnosis of a celiac child is based on clinical suspicion through symptoms, serology and intestinal biopsy. None of the tests alone confirm the diagnosis of celiac disease or celiac disease in both children and adults.

Serology in celiac children consists of giving the child a simple blood test. Through this test, the level of antibodies that react to gluten can be measured. People with celiac disease have higher than normal levels of certain antibodies in the blood. These antibodies are produced by the immune system in response to substances such as gluten, which the body receives and detects as threatening. To do this analysis, the child must be consuming gluten.

Through the biopsyIn other words, by removing a tiny portion of the tissue from the small intestine, it is possible to check if there is any damage to the villi that line the intestinal canal. And if there is any damage, evaluate the degree of the disease. To do the biopsy, the medical team uses a long, thin tube called an endoscope, which is inserted through the mouth and stomach into the small intestine. It's annoying, but it doesn't hurt. Next, a small sample of the tissue is taken, using the instruments that are passed through the endoscope.

The intestinal mucosa of an untreated celiac child is different from that of a healthy child. With the microscope, it is observed that the villi are atrophied, that is, flattened. When compared to the mucous membrane from a normal individual the difference is clearly appreciable. In adequately treated celiac disease, the mucosa becomes normal, making it indistinguishable from a healthy individual.

In 1969, the ESPGHAN (European Society of Pediatric Gastroenterology, Hepatology And Nutrition) set the diagnostic criteria for celiac disease, recommending 3 intestinal biopsies for the diagnosis of celiac disease:

1. The first, when the child comes for the first time with suspicious symptoms of the disease. It will be verified that there is severe atrophy of the villi and gluten will be eliminated from the diet.

2. The second, when the child has been on a gluten-free diet for at least two years and the symptoms have disappeared. It will be verified that the suppression of gluten has achieved the normalization of the villi. If this has been the case, the next step is to reintroduce gluten to see if this will reproduce the intestinal alteration. This reintroduction should not be done before 6 years of age (It could damage the enamel of the permanent dentition) or in puberty because it would interfere with the period of rapid growth typical of this age.

3. The third biopsy tries to confirm this relapse. It is usually done 6 months after the reintroduction of gluten or earlier if symptoms reappear or laboratory abnormalities occur. The longer the period of the gluten-free diet has been, the more often relapse is delayed, so that the biopsy at 6 months may be "normal."

Marisol New. Editor of our site

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