doiSerbia

Celiac disease in children - modern diagnostic approach

Radlović Nedeljko (University Children’s Hospital, Belgrade)

Celiac disease presents a hereditary disorder of gluten tolerance, i.e. of gliadin and related prolamins of wheat, rye and barley. It primarily occurs in Caucasians (1:100-300), while it is considerably or exceptionally rare in colored races. It is particularly frequent in close relatives of the patient, as well as in persons with congenital IgA deficiency and in patients with autoimmune and some chromosomal diseases. The basis of the disease, as well as the key finding in its diagnostics, lies in small bowel inflammation, which withdraws on gluten free diet. Beside clinically manifest or non-manifest enteropathy, changes involving other organs and systems are also frequently seen. The diagnosis of the manifest form of the disease is based on characteristic pathohistological finding detected by the examination of small bowel mucosa in patients on standard diets and their clinical improvement after the introduction of gluten free diet. However, in the diagnosis of the asymptomatic form of the disease, it is necessary to perform enterobiopsy, which confirms the normalization of the appearance of small bowel mucosa in patients on the elimination diet. In children with gluten sensitive enteropathy detected in the first two years of life, as well as in cases in which mucosa samples taken on the first enterobiopsy do not have typical appearance or are inadequate for a reliable interpretation, a definite diagnosis is made based on biopsy finding during the provocation of gluten tolerance. As the quality of permanent teeth can be disturbed, this procedure is not suggested to be done before the completed age of 6 years, and due to adverse effects on the growth and development of the child, it should not be done during puberty. Due to incomplete sensitivity and specificity, the serological indicators of the disease do not have diagnostic value. Therefore, they are primarily used in the disclosure of asymptomatic and atypical forms of celiac disease, as well as in the assessment of the consistency of elimination diet in cases with already verified disease. In addition, the application of these tests makes easier passing the decision to perform pathohistological examination of small bowel mucosa in patients with provoked gluten tolerance, which also gives a more complete understanding into the remission of the disease during the initial phase of treatment.

Keywords: celiac disease, gluten, enteropathy, enterobiopsy, serological tests