Coeliac disease and gluten-related disorders in childhood

Abstract

Gluten-related disorders such as coeliac disease, wheat allergy and noncoeliac gluten sensitivity are increasingly being diagnosed in children. Coeliac disease occurs frequently, affecting 1-3% of the Western population. The condition manifests at a very young age, more so in girls, and is related to the HLA genotype. Coeliac disease might be considered a public health problem and, as primary prevention is not possible, the debate on mass screening should be reopened. Wheat proteins, including gluten, are responsible for one of the most common food allergies in children: wheat allergy. Unlike coeliac disease and wheat allergy, noncoeliac gluten sensitivity is an unclear and controversial entity. These three gluten-related disorders are treated with a gluten-free diet. In coeliac disease, the diet should be strictly followed, whereas wheat allergy only requires wheat elimination and in noncoeliac gluten sensitivity occasional trials of gluten reintroduction can be done. A good diagnostic work-up is important for gluten-related disorders in childhood to avoid unnecessary restrictive diets in children. In this Review, we provide an overview of the pathogenesis, diagnosis and management of the most common gluten-related disorders in children.

Celiac disease: From pathophysiology to treatment

“…The overall prevalence of celiac disease ranges from 4.5% among high-risk subjects to 0.75% in not-at-risk subjects[12]. High-risk subjects include the relatives of patients with celiac disease, children or adults with celiac disease-associated symptoms ( i.e ., diarrhea, abdominal pain and constipation) and children or adult subjects with celiac disease-associated disorders ( i.e ., Diabetes Mellitus type-1, Down syndrome, anemia, infertility, osteoporosis)[17]. It has been shown that celiac disease is not exclusive of industrialized countries, but includes North Africa, Middle East and India with an incidence overlapping those of European countries[18-20].…”

Impaired intestinal cholecystokinin secretion, a fascinating but overlooked link between coeliac disease and cholesterol gallstone disease

“…Because the detergency of bile acids is obligatory for intestinal cholesterol uptake through micellar solubilization of the intraluminal sterols, the secretion of concentrated gallbladder bile to the small intestine greatly facilitates the digestion and absorption of dietary lipids. If impaired gallbladder contractility is restored by CCK‐1R agonists or bile acids such as cholic acid is fed, this may improve the symptoms of maldigestion and malabsorption such as diarrhoea, steatorrhoea, weight loss and nutritional deficiencies in coeliac patients . In addition, improving gallbladder kinetics may restore small intestinal motility and reduce contacting time of dietary gluten with the epithelial cells of the small intestine by accelerating its faecal excretion.…”

Lack of endogenous cholecystokinin promotes cholelithogenesis in mice

“…Although strict adherence to a gluten‐free diet (GFD) leads to prompt clinical and subsequent histologic improvement, clinical and histologic relapse often occurs when gluten is reintroduced . Celiac disease demonstrates a wide spectrum of clinical presentations with signs and symptoms of maldigestion and malabsorption such as diarrhea, steatorrhea, weight loss, and nutritional deficiencies . However, recent studies have increasingly characterized celiac patients as having symptoms less typical for classic malabsorption …”

“…3 Celiac disease demonstrates a wide spectrum of clinical presentations with signs and symptoms of maldigestion and malabsorption such as diarrhea, steatorrhea, weight loss, and nutritional deficiencies. [4][5][6][7] However, recent studies have increasingly characterized celiac patients as having symptoms less typical for classic malabsorption. 1,[8][9][10] The neuroendocrine peptide hormone cholecystokinin (CCK) is synthesized and secreted by the I-cells in the mucosal epithelium of the proximal small intestine.…”