"My Tummy Hurts" 2 - Celiac Disease

     The most common cause of recurrent abdominal pain in an otherwise healthy child is constipation. Children can poop everyday and can even have loose, explosive stools and still have constipation (see previous articles on constipation and tummy pain). Sometimes the only way to know is to put the child on a laxative (Miralax), until the child has daily, loose stools without pain or straining. But sometimes this doesn’t work and the child still has recurring abdominal discomfort. That is the time to consider celiac disease.

     Experts don’t consider celiac disease to be an allergy, but the best way for most people to think of it is as “kind-of-an-allergy”. The child’s intestinal wall lining has a reaction to contact with a certain protein and that reaction causes inflammation (like an allergic reaction). However, the child doesn’t develop hives, congestion or itching. There are microscopic finger-like projections on the lining of the gut called villi. These help you to digest your food. The inflammation from celiac disease damages these villi and impairs your gut function.

     The protein that causes the reaction is called gliadin. This is in grains such as wheat, barley and rye. These grains are called “gluten”, so celiac disease is called “gluten intolerance”. It is thought that celiac disease affects up to 1% of the population, which makes it a very common problem. It can start as early as 6 month of age when foods containing gluten are introduced into the diet but it often goes into adulthood without being diagnosed especially when there are only subtle symptoms such as anemia, infertility or slow growth. The intestinal symptoms of celiac disease are abdominal pain, diarrhea, bloating, gas, and vomiting. The child may loose his appetite, become fussy and have poor weight gain.

     There are several blood tests that can be done to make the diagnosis of celiac disease but parents have to be very certain what test was used because the tests have a wide variance of accuracy. It is even harder to get an accurate test in a child under 2 years of age.  A biopsy of the intestinal wall to see the damage to the villi is accurate, but is more difficult than just drawing blood.  

   The only treatment for celiac disease is to avoid glutens for life. This is very difficult, expensive and imposes a real burden on the whole family. It is important that a child (or adult) not be put on a gluten-free diet until after a firm diagnosis of celiac disease has been made because removing gluten from the diet can cause the diagnostic tests to be negative. There are many sources for information about gluten-free diets on-line and in local support groups. After being placed on a gluten-free diet, a child with celiac disease should be followed routinely be a health care professional who is comfortable dealing with the disease.