Practical considerations for the identification and follow-up of children with celiac disease.

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Celiac disease is an immune-mediated enteropathy affecting 0 .5 % to 1 % of children and is induced by dietary gluten in susceptible individuals carrying the human leukocyte antigen DQ 2 or DQ 8 heterodimer . If serological screening is positive or if a patient displays suggestive symptoms , an endoscopic biopsy of the distal duodenum is required to confirm the diagnosis . Symptoms of celiac disease are often mild or absent . Overt malabsorption occurs in only 2 % to 10 % of children . Individuals with a higher risk of developing celiac disease , including first -degree relatives of affected patients and children with type I diabetes , Turner syndrome , Williams syndrome or Down syndrome , should be offered screening for celiac disease along with a discussion of the implications . If serological testing is negative , a high index of suspicion should remain if malabsorption , iron deficiency or osteopenia is present . Also , immunoglobulin A deficiency should be excluded . At-risk individuals should undergo serial serological screening . Lifelong adherence to a gluten-free diet is the only treatment . If left untreated , symptomatic children with celiac disease carry an increased risk of developing osteoporosis and have a greater lifetime risk of cancer . The long -term outcome of undiagnosed or untreated asymptomatic individuals is less clear .