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Celiac Disease - Ongoing Assessment

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Screening

Though many asymptomatic individuals have positive serologic tests for celiac disease (CD), screening remains controversial. [Catassi: 2008] Consider testing family members, particularly those with suggestive symptoms (see Testing). [Bardella: 2007]

Diagnostic Criteria

Definite diagnosis of CD
History and clinical presentation compatible with CD:
  • Serologic screening compatible with CD: antigliadin antibody (AGA) antiendomysial antibody (AEA), tissue transglutaminase (tTG) antibody
  • Histological findings compatible with CD: villous atrophy
  • Obvious clinical and serological response to a gluten-free diet (GFD)
  • Subject >2 years old
  • Clinical conditions mimicking CD have been ruled out
[Hill: 2005] [Fasano: 2008] and [Fasano: 2001]

History And Examination

Interim History

Ask about diet problems, weight gain and growth, energy, and symptoms of diarrhea.

Physical Exam

Growth Parameters

Look for low weight for age, low height for age, low weight for height, low BMI, and ongoing growth.

Skin

Look for the characteristic rash - dermatitis herpetiformis: symmetric, grouped, small, tense, erythematous, stinging, pruritic papules or vesicles (see Celiac disease: DH pictures).

Abdomen

Look for abdominal distention

Extremities

Look for clubbing, edema

HEENT

Look for enamel hypoplasia.

Testing

Laboratory Testing

As clinically indicated. Individuals who are not maintaining good dietary control may need screening for low albumin or iron deficiency anemia.

Subspecialist Collaborations and Other Resources

Pediatric Gastroenterology (see Services below for relevant providers)

If the child is still having symptoms despite management with the gluten-free diet, a return consultation with gastroenterology may be helpful. Updating nutritional information and guidance may be helpful periodically, particularly with developmental changes in the child's dietary habits and interests.

Nutrition/Dietary (see Services below for relevant providers)

Because maintaining dietary restrictions can be very challenging, expert nutritional guidance can be helpful. Children should be referred at periodic intervals for reassessment.

Resources

Information & Support

For Professionals

Celiac disease (GeneReviews)
Detailed overview of celiac disease, testing, genetics, resources, reviews, and research; hosted by NCBI (National Center for Biotechnology Information).

For Parents and Patients

Support

Celiac Disease Foundation
Provides support, information and assistance to people affected by Celiac Disease/Dermatitis Herpetiformis (CD/DH).

General

Celiac disease (MedLinePlus)
Brief description and links to many reliable sources of information, compiled and maintained by the National Library of Medicine.

Celiac disease (NDDIC)
General information and links to a lot more, from the National Digestive Diseases Information Clearinghouse, National Institutes of Health.

Practice Guidelines

Fasano A, Araya M, Bhatnagar S, Cameron D, Catassi C, Dirks M, Mearin ML, Ortigosa L, Phillips A.
Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition consensus report on celiac disease.
J Pediatr Gastroenterol Nutr. 2008;47(2):214-9. PubMed abstract

Services

Nutrition/Dietary

See all Nutrition/Dietary services providers (46) in our database.

Pediatric Gastroenterology

See all Pediatric Gastroenterology services providers (2) in our database.

For other services related to this condition, browse our Services categories or search our database.

Helpful Articles

PubMed Search on Celiac Disease in children for last 2 years.

McGowan KE, Castiglione DA, Butzner JD.
The changing face of childhood celiac disease in north america: impact of serological testing.
Pediatrics. 2009;124(6):1572-8. PubMed abstract

Authors

Authors: Lynne M Kerr MD, PhD, 3/2009
Daniel Jackson M.D., 7/2008
Content Last Updated: 3/2009

Page Bibliography

Bardella MT, Elli L, Velio P, Fredella C, Prampolini L, Cesana B.
Silent celiac disease is frequent in the siblings of newly diagnosed celiac patients.
Digestion. 2007;75(4):182-7. PubMed abstract

Catassi C, Fasano A.
Is this really celiac disease? Pitfalls in diagnosis.
Curr Gastroenterol Rep. 2008;10(5):466-72. PubMed abstract

Fasano A, Araya M, Bhatnagar S, Cameron D, Catassi C, Dirks M, Mearin ML, Ortigosa L, Phillips A.
Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition consensus report on celiac disease.
J Pediatr Gastroenterol Nutr. 2008;47(2):214-9. PubMed abstract

Fasano A, Catassi C.
Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum.
Gastroenterology. 2001;120(3):636-51. PubMed abstract
Guidelines for diagnosis and treatment of celiac disease.

Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG.
Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.
J Pediatr Gastroenterol Nutr. 2005;40(1):1-19. PubMed abstract / Full Text
Recommendations for the diagnosis and treatment of celiac disease in children from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.