Evidence-Informed Expert Recommendations for the Management of Celiac Disease in Children

Abstract

Although the need for effective long-term follow-up for patients with celiac disease (CD) has been recognized by many expert groups, published practice guidelines have not provided a clear approach for the optimal management of these patients. In an attempt to provide a thoughtful and practical approach for managing these patients, a group of experts in pediatric CD performed a critical review of the available literature in 6 categories associated with CD to develop a set of best practices by using evidencebased data and expert opinion. The 6 categories included the following: bone health, hematologic issues, endocrine problems, liver disease, nutritional issues, and testing. Evidence was assessed by using standardized criteria for evaluating the quality of the data, grade of evidence, and strength of conclusions. Over 600 publications were reviewed, and 172 were chosen for inclusion. The thorough review of the results demonstrated that the quality of the data available was often insufficient to provide unequivocal best practices. However, using the available data and the clinical experience of the panel, a practical framework for the management of children with CD was created. These recommendations were developed by our expert panel and do not necessarily reflect the policy of the American Academy of Pediatrics. The potential usefulness of these best practices is underscored by the fact that consensus, measured by the outcome of anonymous voting, was reached by the panel for 24 of the 25 questions. We hope that these best practices may be useful to the pediatric gastroenterology and larger general pediatric communities.abstract

Nutritional Status, Dietary Intake, and Adherence to the Mediterranean Diet of Children with Celiac Disease on a Gluten-Free Diet: A Case-Control Prospective Study

“…Indeed, apart from maintaining the safe limit of gluten intake (below 10-50 mg/day), a suitable GFD must also be nutritionally balanced and cover all energy and nutrient requirements to prevent deficiencies and ensure a healthy life. In children, the GFD must also allow appropriate growth and pubertal development [4]. A body of evidence has so far suggested that the GFD may be nutritionally unbalanced either because of the need to exclude several cereals or because of the different nutritional composition of GF products as compared to their unrefined analogs [3,[5][6][7][8][9][10][11][12][13][14][15][16].…”

Coeliac disease in infants: antibodies to deamidated gliadin peptide come first!

“…Coeliac disease (CD) is an autoimmune disorder triggered by gluten ingestion in genetically predisposed subjects [ 1 ]. While it is know to affect around 1% of Caucasian schoolchildren, the true prevalence is probably underestimated [ 2 , 3 ]. While coeliac disease can occur at any age following gluten introduction in the diet, the onset of symptoms shortly after weaning is uncommon [ 4 – 6 ].…”

Child with multiple fractures: a rare presentation of a common disease

“…Initiation of GFD rapidly restores bone mass in almost all children and adolescents 8. This fact is supported by the bone disease-free interval during the 3.5-year period of follow-up of the index case.…”

“…Snyder et al 8 recently published recommendations to clarify the need of bone health surveillance in children with CD. According to these guidelines, BMD evaluation should not be performed routinely and must be reserved for the cases with severe malabsorption, prolonged delay in diagnosis or presentations suggestive of bone disease (bone pain, rickets, osteomalacia, tetany or minimal trauma-related fractures).…”