At Gems Medical Specialists, we provide a one-stop clinic for the diagnosis and management of children with coeliac disease. A rapid access clinic is available for children with abnormal coeliac serology (coeliac disease antibody blood test). Please email your referral letter and blood test results to reception@gemsmedic.com, and our reception staff will contact you to schedule an urgent appointment.
Children with suspected coeliac disease will receive an urgent appointment to see Dr Lee. Following the clinical assessment, Dr Lee will discuss with the family whether an endoscopy and small bowel biopsy are necessary to make a diagnosis. The risks and benefits associated with a non-biopsy approach to diagnosing coeliac disease in children will also be discussed. Dr Lee typically schedules a follow-up appointment with the family approximately 2 weeks after the endoscopy to review the biopsy results.
Upon confirming a diagnosis of coeliac disease, the family will be scheduled to meet with Stephanie Gilroy, paediatric dietitian at GEMS, for education on the intricacies of a gluten-free diet.
Coeliac disease FAQ
You may find the following list of frequently asked questions and corresponding answers useful.
What is coeliac disease?
Coeliac disease is a chronic autoimmune disorder where the consumption of gluten, a protein found in wheat, barley, and rye, triggers an immune response. This immune reaction leads to inflammation and damage to the small intestine lining, affecting the absorption of nutrients and causing symptoms in some children.
How common is coeliac disease?
Coeliac disease is common in children. It is estimated to affect approximately 1 in 70 Australians. Genetic factors play a significant role in its development.
What are the symptoms of coeliac disease in children?
Children with coeliac disease may experience a range of symptoms, including recurrent abdominal pain, chronic diarrhea, fatigue, irritability, and stunted growth. However, it is important to note that some children may not display obvious symptoms, making clinical diagnosis challenging.
How is coeliac disease diagnosed in children?
Diagnosing coeliac disease involves a two-step process. Firstly, blood tests are conducted to check for specific antibodies, such as anti-tissue transglutaminase (anti-tTG) and anti-endomysial antibodies. If these tests suggest coeliac disease, a small intestinal biopsy is performed for confirmation.
Can coeliac disease be diagnosed in children without a small biopsy?
For children, a biopsy may not be necessary in every case. Guidelines from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) suggest small intestinal biopsies can be avoided in some children who meet the following criteria:
- tTG-IgA levels more than 10 times upper limit of normal
- A positive endomysial antibody (EMA) on a different blood sample
However, the utility of this approach in Australia is uncertain because of the intra-lab variation and lack of standardisation of the tTG assay. Further validation is warranted. The decision to make a non-biopsy diagnosis should be discussed with a paediatric gastroenterologist.
What is the treatment for coeliac disease in children?
The treatment is a lifelong, strict gluten-free diet. This involves avoiding all sources of gluten, including wheat, barley, and rye. Adherence to this diet is crucial for managing symptoms and promoting healing of the small intestine.
Can coeliac disease affect a child’s growth and development?
Untreated coeliac disease can indeed impact a child’s growth and development. Malabsorption of nutrients due to intestinal damage can lead to nutritional deficiencies, affecting overall health. Early diagnosis and initiation of a gluten-free diet are essential to prevent long-term complications.
Are there long-term implications of coeliac disease in children?
With proper management, most children with coeliac disease can lead healthy lives. However, it requires ongoing vigilance and adherence to a gluten-free diet. Regular follow-ups with healthcare providers are necessary to monitor nutritional status, assess growth, screen for other related autoimmune diseases, and address any emerging concerns.
My child has a positive coeliac serology. Should they be on a gluten-free diet while waiting for an appointment to see a paediatric gastroenterologist?
If your child has tested positive for coeliac serology, your child should continue on a diet containing gluten while waiting for an appointment with a paediatric gastroenterologist. Your child should continue to consume at least 2 pieces of bread per day (or an equivalent of 10g of gluten) until all required tests have been completed. It is strongly recommended not to adopt a gluten-free diet while waiting to see a paediatric gastroenterologist.
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