Pediatric 
Celiac Disease

Celiac disease is a common autoimmune disease in children, affecting approximately 1% of children in Europe1

Up to 80% of children with celiac disease are undiagnosed1

Early diagnosis of celiac disease in children ensures optimal growth, development and symptom management1

Common symptoms of celiac disease in children include:1,2

  • Persistent diarrhea or constipation
  • Abdominal pain and vomiting
  • Extreme tiredness and weakness
  • Bloating
  • Slow growth

Testing and diagnosing celiac disease in children

  • If celiac disease is suspected, a child should be tested as soon as possible if gluten is included in their diet
    • Babies shouldn't be tested before they have started eating foods containing gluten3
    • Infants can be tested if gluten has been included in more than one meal every day for at least 6 weeks3
  • The European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommend that HLA-DQ2 and DQ8 typing is not required in patients with positive tTG-IgA if they qualify for coeliac disease diagnosis with biopsies or have high-serum tTG-IgA (≥10x upper limit of normal) and EMA-IgA positivity4
  • It should be advised that parents do not remove gluten from their children’s diet before completing a celiac disease test3
  • If a test is negative, gluten should remain in the diet and the test repeated2

What do the UK guidelines recommend?

Recommended British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) and Celiac UK diagnosis pathway for children with symptoms of celiac disease2

Monitoring and follow-up of children with celiac disease

1 in 6 patients

In a US study of 241 children with biopsy-confirmed celiac disease:5

  • 83% consulted a dietician
  • 31% attended both a dietician-led class and individual visit
  • 25% were lost to follow-up within the first year*
  • 9% had no visits to the gastroenterologist after their diagnostic biopsy

1 in 6 patients did not receive education about a gluten-free diet

*Attended ≥1 follow-up gastroenterology visit >12 months after diagnosis.5

  • BSPGHAN and ESPGHAN recommend that children should have ongoing monitoring with an experienced pediatric dietitian and gastroenterologist2,6
  • The first follow-up visit should be scheduled 3-6 months after diagnosis, with 6 monthly visits until tTG is normalized, and then every 12-24 months6
  • Children should have their height and weight checked to monitor their growth and development6

Physicians and other healthcare professionals are required to obtain patient consents and/or authorizations as mandated by applicable law.

  1. European Society for Paediatric Gastroenterology, Heptology and Nutrition (ESPGHAN). Paediatric coeliac disease. Earlier diagnosis for better lifelong health: a manifesto for change. Available at: https://www.espghan.org/dam/jcr:3e76ffdf-a838-484f-8c8c-056cef2522de/Paediatric_Coeliac_Disease_Manifesto_FINAL_30.04.pdf. Accessed January 2025
  2. Murch S, Jenkins H et al. Joint BSPGHAN and Coeliac UK guidelines for the diagnosis and management of coeliac disease in children. Arch Dis Child 2013;98:806-811
  3. National Institute for Health and Care Excellence (NICE). NICE guideline 20. Coeliac disease: recognition, assessment and management, September 2015. Information for the public. Available at: https://www.nice.org.uk/guidance/ng20/resources/coeliac-disease-recognition-assessment-and-management-pdf-568336659397. Accessed January 2025
  4. European Society for Paediatric Gastroenterology, Heptology and Nutrition (ESPGHAN). 2019 ESPGHAN guidelines for diagnosing coeliac disease. Available at: https://www.espghan.org/knowledge-center/publications/Gastroenterology/2019_ESPGHAN_guidelines_for_diagnosing_coeliac_disease. Accessed January 2025
  5. Blansky B A, Hintze Z J et al. Lack of follow-up of pediatric patients with celiac disease. Clin Gastroenterol Hepatol 2019;17:2603-2604
  6. European Society for Paediatric Gastroenterology, Heptology and Nutrition (ESPGHAN). 2022 ESPGHAN position paper on follow-up and management of coeliac disease. Available at: https://www.espghan.org/knowledge-center/publications/Gastroenterology/ESPGHAN-Position-Paper-on-Follow-up-of-Coeliac-Disease-. Accessed January 2025