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          While you and your child may feel unlucky to have celiac disease, you should at least feel lucky to know that you have it.  A lot of cases (the great majority) are undiagnosed, and it causes a variety of symptoms, complications, and associated maladies.  Celiac Disease is a common genetic condition, presented as an inability to tolerate gluten, a protein found in wheat, rye, and barley.  The treatment of Celiac disease is a strict avoidance of a food made of or contaminated with any of these three "toxic" products.  Contaminants my be found in medications, cosmetic products, vitamins, toothpaste, etc.  There is also a lot of conflicting information about "gluten sensitivity", gluten allergies, the role of gluten in irritable bowl syndrome, and some other conditions as well. Many studies are trying to answer those questions, but the best piece of adive I may offer at this point is:  Do your home work, build your knowledge using reputable scientific and medical journals, and use your best judgment. The good news is that :             

  •  Strict avoidance of gluten leads to a fast recovery
  •  Certified gluten free products are easy to find, and they are both tasty and healthy.  

Below are some helpful websites, books, and the support groups:

 

  • Korn, Danna:  "Kids with Celiac Disease".  A Family Guide to Raising Happy, Healthy, Gluten-Free Children.                                            Woodbine House.\

  Please, read my recent article.....

 

Gluten-sensitivity: A Growing Problem?

 

         

          There is a significant degree of confusion when it comes to recognizing the difference between three conditions: celiac disease, gluten sensitivity, and wheat allergy.  The basis for all three is a reaction to gluten- a protein component of wheat, rye, and barley.

Gluten sensitivity (GS) may be defined broadly as a spectrum of disorders, which include celiac disease and wheat allergy. In both, gluten has an adverse effect on the body. 

          The symptoms of  GS include, but are not limited to abdominal pain, bloating, diarrhea, weight loss or failure to thrive, joint pain, muscular disturbances, headache, and fatigue. Celiac disease is a more clearly defined condition within the spectrum of GS, where the genetic and immunologic essays for it are well developed. Along with these essays, a biopsy of the intestinal mucosa must be conducted as the ultimate diagnostic test, whenever celiac disease is suspected. 

Non-celiac disease GS can be defined as a combination of symptoms usually shared by celiac disease, wheat allergy, and irritable bowel syndrome, but celiac disease and wheat allergy are eliminated as possible diagnoses, based on an appropriate work up.  This work up may be done through your child’s primary doctor, pediatric gastroenterologist, or a pediatric allergist service.  

          While both celiac disease and wheat allergy represent adaptive immune responses (autoimmune in the case of celiac disease), and may be classified as delayed hypersensitivities by nature, non-celiac GS is an innate response, e.g. a reaction which is congenital (children are born with it), immediate in nature, and lacking an immunologic memory.  Non-celiac GS is less severe in its expression, and does not produce any morphological changes in the gastrointestinal mucosal lining (a feature of celiac disease). Children with non-celiac GS will not test positive for celiac disease with the currently used immunological blood tests, and a mucosal biopsy.

Allergies, particularly those to wheat, are recognized by a positive immunoglobulin serologic essay, and/or a skin prick test usually done by a pediatric allergist.  While all patients with celiac disease and non-celiac GS must restrict their diets of any source of gluten (wheat, ray and barley), those who only have a wheat allergy should avoid wheat only.

          Currently, there is no reliable test to detect non-celiac GS. If the clinical picture reflects that there is possible gluten sensitivity, the only way to prove or disprove this is through a strict gluten elimination diet.  Conditions such as irritable bowl syndrome, chronic headaches, chronic fatigue, and arthralgias can justify a high index of suspicion of GS. 

          A clear differentiation of these three clinical entities within the spectrum of GS is the first, important step in the approach to your child’s health problem, which is possibly related to sensitivity to gluten.  There is a significant growth in the incidence of celiac disease.  At least two recent immunological studies have compared samples obtained 50 years ago from military recruits to a matched group of modern-day young people.  There was a 400-450% increase in prevalence of celiac disease in the latter sample. The cause of this increase is debatable.  Possible triggers include modern changes in the bread-making process, plant breeding, breastfeeding trends, rise in cesarean birth, and the excessive use of antibiotics, which could result in a change of intestinal microflora.

It is also estimated that close to 1% of the US population has celiac disease, but only 10% of those who have it are diagnosed.  On the other hand, because there are no biomarkers for non-celiac GS and wheat allergy, it is impossible to conduct any retrospective study to compare the prevalence of either of these two conditions.

          In conclusion, the three types of GS should be recognized and distinguished based on a clinical presentation and an appropriate work up. A gluten free diet is becoming easier to uphold now due to a wide availability gluten free products and public awareness. 

 

Discuss the possibility of your child having GS with your primary doctor as soon as possible, for a simple solution to your child’s medical condition may be achieved by dietary modifications.

Michael Tyshkov M.D.