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Celiac Disease

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Information about Celiac Disease
Health & Medicine

Published on November 2, 2008

Author: NTavakoli

Source: slideshare.net

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Celiac Disease in children clinical practice guidline summary Presented by Nargess Tavakoli Guilan University of Medical sciences

Journal of Pediatric Gastroenterology and Nutrition 40:1–19 January 2005 Lippincott Williams & Wilkins, Philadelphia Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

DEFINITION An immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals

An immune-mediated enteropathy

caused by a permanent sensitivity to

gluten in genetically susceptible

individuals

GASTROINTESTINAL MANIFESTATIONS • Diarrhea with failure to thrive • Abdominal pain • Vomiting • Constipation • Abdominal distension

• Diarrhea with failure to thrive

• Abdominal pain

• Vomiting

• Constipation

• Abdominal distension

Non_gastrointestinal manifestations A)Strong to moderate evidence of an association Dermatitis herpetiformis Dental enamel hypoplasia of permanent teeth Osteopenia and osteoporosis Short stature Delayed puberty Iron-deficient anemia unresponsive to treatment with oral iron (well documented in adults only)

A)Strong to moderate evidence of an association

Dermatitis herpetiformis

Dental enamel hypoplasia of permanent teeth

Osteopenia and osteoporosis

Short stature

Delayed puberty

Iron-deficient anemia unresponsive to treatment

with oral iron (well documented in adults only)

Non_gastrointestinal manifestations Less strong: Hepatitis (elevated liver enzymes) Arthritis Epilepsy with occipital calcifications

Less strong:

Hepatitis (elevated liver enzymes)

Arthritis

Epilepsy with occipital calcifications

Associated with an increased prevalence Type 1 diabetes Autoimmune thyroiditis Down Syndrome Turner Syndrome Williams Syndrome Selective IgA deficiency First degree relatives of celiac patients

Type 1 diabetes

Autoimmune thyroiditis

Down Syndrome

Turner Syndrome

Williams Syndrome

Selective IgA deficiency

First degree relatives of

celiac patients

Who to test? Diarrhea & FTT Persistent GI symptoms NonGI symptoms of strong to mod. evidence for Asymptomatic with conditions of high association

Diarrhea & FTT

Persistent GI symptoms

NonGI symptoms of strong to mod. evidence for

Asymptomatic with conditions of high association

How to test? Definitive Dx : Biopsy of the small intestinal muccosa Screening : serological tests

Definitive Dx : Biopsy of the small intestinal muccosa

Screening : serological tests

Serological (blood) testing TTG IgA : initial test EMA IgA AGA IgA & IgG: no longer recommended inferior accuracy

TTG IgA : initial test

EMA IgA

AGA IgA & IgG:

no longer recommended

inferior accuracy

IgA deficients & CD FIRST: measurement of quantitative serum IgA If low  Check TTG IgG

FIRST: measurement of quantitative

serum IgA

If low  Check TTG IgG

Intestinal biopsy confirmation of Dx . in all cases when the serum TTG is elevated Even if serological tests negative may be useful in symptomatic children (particularly 0 to 2 years old)

confirmation of Dx . in all cases

when the serum TTG is elevated

Even if serological tests negative may be useful in symptomatic children (particularly 0 to 2 years old)

WHO TO TREAT? Symptomatic with Pos. Biopsy Asymptomatic with associated conditions & Pos. Biopsy

Symptomatic with Pos. Biopsy

Asymptomatic with

associated conditions & Pos. Biopsy

BENEFITS OF TREATMENT Resolves persistent diarrhea & poor weight gain Reverses reduced bone mineralization Prevents: osteoporosis abortions low birth weight cancer

Resolves persistent diarrhea & poor weight gain

Reverses reduced bone mineralization

Prevents:

osteoporosis

abortions

low birth weight

cancer

HOW TO TREAT? A gluten-free diet for life Lactose restrictions? not usually necessary

A gluten-free diet for life

Lactose restrictions?

not usually necessary

HOW TO MONITOR? Periodic visits Check TTG : NO symptoms : 6 month after, then once a year Any time if persistent or recurring symptoms

Periodic visits

Check TTG :

NO symptoms : 6 month after, then once a year

Any time if persistent or

recurring symptoms

 

 

 

 

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