Celiac disease: Expert answers to common questions

Dr. Aniruddh Setya is a board-certified pediatric gastroenterologist and an assistant professor in the Department of Pediatrics at Saint Louis University School of Medicine. He treats patients from birth to age 21 for a variety of disorders of the digestive system, allowing him to “bring joy, relief, and hope to people when they need it most.”

What are the symptoms of a gluten intolerance/allergy in children?

Children with gluten intolerance or celiac disease can present a variety of symptoms. Common ones include abdominal pain, bloating, diarrhea with weight loss, iron deficiency anemia, and growth delays. Sometimes children present with just constipation or vomiting. Non-GI related symptoms may include headaches, difficulty concentrating or irritability, arthritis, chronic fatigue, pubertal delay, or skin rashes.

At what age do symptoms normally develop? Is it possible to outgrow it?

Celiac disease is most diagnosed in those age 3 and older, although it can appear at any age as long as there has been substantial exposure to dietary gluten (which is a protein found in the wheat plant and some other grains). It can often present in adulthood. Those with close family members who have celiac disease face a 10% risk of developing the illness, as opposed to a 1% risk in the general populace. Unlike some other conditions, celiac disease is a lifelong condition and cannot be outgrown.

Is there a difference between gluten intolerance and celiac disease?

Yes, there's a substantial difference between the two. Celiac disease is an autoimmune condition where ingestion of gluten leads to damage in the small intestine and can result in non-GI related symptoms as well. It can be diagnosed using a blood test and an endoscopy with biopsy.

Gluten intolerance is also called non-celiac gluten sensitivity (NCGS). It has similar gastrointestinal symptoms but lacks the autoimmune intestinal damage seen in celiac disease. There is no definitive test to diagnose NCGS. Symptoms are usually dependent on the level of tolerance and the frequency and amount of gluten consumed.

What are the options in treatment? When should gluten be completely removed from the diet?

The cornerstone of treatment of celiac disease is the elimination of all gluten in the diet. It requires a lifelong, strict gluten-free diet. However, gluten should be removed from the diet only after testing to confirm the diagnosis. Guidelines include:

Three Ways To Avoid Gluten

Eliminage all wheat, barley, and rye from diet.

Choose oats certified as gluten-free.

Check all food labels for additives with gluten.

• Avoid foods with wheat, rye, and barley. Opt for alternatives like soybean flour, rice, and potatoes. Exercise caution with foods made with beers or malt vinegars unless they're certified gluten-free.
• Examine food labels meticulously, focusing on additives like stabilizers and emulsifiers that may contain gluten.
• Be cautious with oats, as they could trigger celiac symptoms depending on their preparation and variety, especially if made in a factory which processes wheat or other grains containing gluten.

When should my child see a specialist?

Individuals over the age of 3 and adults who show signs of celiac disease should undergo diagnostic testing by a gastroenterology specialist. Those with autoimmune diseases or specific conditions such as type 1 diabetes, Down, Turner, or Williams syndromes, and selective IgA deficiency should also be tested.

Dr. Setya sees patients at SSM Health’s Cardinal Glennon Children’s Hospital and Cardinal Glennon Pediatric Specialty Services in Lake Saint Louis. Call 314-577-5647 to schedule or request an appointment.