Intended for healthcare professionals

Practice Easily Missed?

Coeliac disease in children

BMJ 2018; 363 doi: (Published 09 October 2018) Cite this as: BMJ 2018;363:k3932
  1. Philippa C Thomas, paediatric specialty registrar, Wessex School of Quality Improvement QI fellow 2018-191,
  2. Mark P Tighe, consultant paediatrician2,
  3. R Mark Beattie, consultant paediatric gastroenterologist, honorary professor of paediatric gastroenterology and nutrition1
  1. 1Child Health, Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton S016 6YD, UK
  2. 2Department of Paediatrics, Poole Hospital NHS Foundation Trust, Poole, UK
  1. Correspondence to: R M Beattie mark.beattie{at}

What you need to know

  • Consider coeliac disease in children with both classic gastrointestinal symptoms (variable bowel habit, abdominal pain) and non-classic presentations (such as impaired growth, tiredness, anaemia)

  • Have a low threshold for investigation of symptomatic children and screening for those with associated conditions such as type 1 diabetes or Down’s syndrome

  • Initial testing is by serology (total IgA and IgA anti-tTG), and inform parents not to exclude gluten from their children's diet before testing

A 3 year old boy is brought to his general practitioner by his mother. She is worried he is waking at night complaining of abdominal pain. He has smelly stools that float in the toilet, and has a cousin with coeliac disease. His growth has fallen from the 25th to the second centile for height and weight. On examination he has a distended, mildly tender abdomen with wasted buttocks. Laboratory results are strongly positive for coeliac disease with an IgA anti-tissue transglutaminase (anti-tTG) concentration of 134 IU/mL (normal range 0-2.9).

Sources and selection criteria

In creating this article, we initially reviewed the BSPGHAN and ESPGHAN guidance, which formed the basis of the article.

We reviewed articles referred to within the guidance and conducted a PubMed search of papers published after 2000 using the search terms “celiac disease” and “children.” We also reviewed relevant additional references from papers obtained. We then added our personal archives of references to obtain a generalised overview of coeliac disease and issues specific to children. For more specific elements—such as the association of coeliac disease with menses and fertility—we performed specific PubMed searches in order to obtain more recent references.

The article was formatted as per the BMJ guidance, and clinical experience plus evidence collected were used to ensure that common issues which arise within paediatric coeliac disease were addressed.

What is coeliac disease?

Coeliac disease is a systemic, immune-mediated disorder elicited by gluten …

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