Pediatric Celiac Disease

　　The pathogenic factor of celiac disease in children is gluten in wheat, commonly known as gluten, which is a complex plant protein. It can be decomposed into four proteins, namely gliadin, glutenin, albumin, and globulin. Among them, gliadin is the pathogenic factor of the disease. The prevalence of the disease in first-degree relatives is about 2% to 3%. If intestinal mucosal biopsy is performed, 10% of relatives have typical changes in intestinal mucosa, which is significantly higher than the general population. About 70% of monozygotic twins have the disease at the same time. All this shows that the onset of the disease is related to heredity.

　　Celiac disease in children often leads to malnutrition and growth lag. When diarrhea worsens, it is often accompanied by dehydration and acidosis, and even shock (celiac crisis) may occur. Patients may also have arthritis and chronic hepatitis of unknown etiology.

　　Celiac disease in infants will not occur before they eat wheat food. The disease can occur at any age, but the peak of onset is 1 to 2 years old. Mild cases can be completely asymptomatic, while severe cases may show severe malabsorption of the small intestine, and typical cases are as follows:

　　1. Gastrointestinal symptoms

　　Most patients have symptoms of malabsorption such as chronic diarrhea and steatorrhea, such as pale feces, greasy, and foul-smelling. Patients defecate 2 to 3 times a day, or even once a day, but the amount is large. Diarrhea can be intermittent and worsen, becoming watery stool, easy to cause dehydration and electrolyte disorders. Children often have anorexia, but occasionally there are symptoms of increased appetite. Other symptoms include vomiting, abdominal pain, abdominal distension, and rectal prolapse, etc.

　　2. Growth and development lag

　　Due to malabsorption, children's height and weight are often significantly behind, and the growth rate is slow. Patients have muscle wasting, especially noticeable in the limbs. About 30% of children may have poor enamel development.

　　3. Other nutritional deficiencies

　　Due to poor absorption of iron and folic acid, children may develop nutritional anemia, manifested as pale complexion. Due to poor protein absorption and protein-losing enteropathy, it can lead to hypoalbuminemia. In severe cases, it can lead to malnutrition edema. Poor fat absorption can lead to poor absorption of fat-soluble vitamins, causing symptoms of vitamin A, D, E, and K deficiency.

　　4. Psychiatric symptoms

　　Patients may have symptoms such as irritability, personality changes, and sleep disorders.

　　In the prevention of celiac disease in children, it is necessary to do a good job of genetic counseling. There are different opinions on whether oats can cause the disease, at least it is less harmful, and it is recommended that the best way is to actively prevent the disease and not to eat wheat, barley, and rye.

　　Celiac disease in children at the time of diagnosis, in addition to relying on its clinical manifestations, also needs to be assisted by chemical tests. The main methods of examination include the following several kinds:

　　1. Blood Routine and Biochemical Examination

　　Blood routine examination is often macrocytic anemia, can also be normocytic anemia or mixed anemia. Serum potassium, sodium, calcium, magnesium, phosphorus, etc., can be reduced, plasma albumin, cholesterol, phospholipids, and prothrombin can also be reduced. In severe cases, serum folic acid, carotene, and vitamin B12 can also be reduced.

　　2. Determination of Small Intestinal Malabsorption

　　Fat quantification study is the best method to determine malabsorption of lipids. Since this experiment requires accurate collection of feces, it is sometimes difficult to collect all feces in infants, so its application is limited. Oral xylose test, that is, 1h serum xylose test is often used.

　　3. Small Intestinal Permeability Test

　　The permeability test is a non-invasive test designed based on the permeability of the small intestinal mucosa to sugar. Although this test has a high sensitivity for abnormal jejunal mucosa, its specificity is low.

　　4. Determination of Anti-Glutenin Antibodies

　　The determination of anti-glutenin antibodies in serum can help diagnose the disease, with a high sensitivity of nearly 100%.

　　5. Small Intestinal Mucosal Biopsy

　　Apply small intestinal biopsy tubes to insert into various parts of the small intestine through the mouth to take mucosal specimens for histological examination, or use small intestinal endoscopy to visualize and biopsy the upper part of the jejunum and the distal ileum with total colonoscopy, which is conducive to diagnosis.

　　Children with celiac disease should have a light diet. Pay attention to the proportion of sugar, fat, and protein in food, and pay attention to the content of vitamins and other essential nutrients for the body. Avoid irregular diet and unclean food. Pay attention to food hygiene and do not eat spoiled food. Foods stored in the refrigerator must be cooked thoroughly before eating. If spoilage is found, it must be discarded firmly and prohibited from being eaten. Avoid cold, hot, and hard food.

　　There is still no medication that can cure celiac disease in children, but for children with celiac disease, the only way to avoid damaging their intestinal villi and related symptoms is to maintain a gluten-free diet. Patients need to limit foods containing glutenin for life, including wheat, barley, rye, and oats. It is harmless to eat rice and corn. After one week of limiting food, symptoms can be improved, and height and weight can recover and increase.