By Anca Safta, MD, professor of Pediatric Gastroenterology at Wake Forest Baptist Health Brenner Children’s Hospital, and director of Brenner Children’s Hospital’s Gluten and Allergic Digestive Disorders program

There’s been a recent explosion of gluten-free products on our grocery shelves, which is great news for children with celiac disease, gluten sensitivities, or gluten allergies. As a pediatric gastroenterologist, I see children who have symptoms that may or may not be related to gluten, a protein found in wheat, barley and rye. I call celiac disease ‘the great masquerader’ because symptoms are often misdiagnosed as irritable bowel syndrome, Crohn’s disease, lactose intolerance, or other diseases. If untreated, celiac disease can lead to severe malnutrition, so it’s important to recognize symptoms that may be related to gluten and to undergo screening to identify the root cause of those symptoms.

What are the symptoms of gluten sensitivity and celiac disease?
These conditions can generate up to 300 different symptoms. The most common include diarrhea, bloating, cramping, abdominal pain and constipation. Other symptoms include difficulty concentrating, depression, and fatigue. Celiac disease may also be associated with autoimmune thyroid disease, severe dermatitis, osteoporosis, Type 1 diabetes, Downs and Turner syndromes, liver disease and anemia that is not responsive to iron therapy.

How widespread are gluten issues?
Approximately 15 percent of the population suffers from some form of gluten condition, including celiac disease, gluten sensitivity and gluten allergies. About 1 percent has celiac disease, and about 6 percent or 18 million people have non-celiac gluten sensitivity (NCGS).

Celiac disease has a genetic component, and people are 5 to 10 percent more likely to have celiac disease if other family members have it. For that reason, we recommend screening 1st and 2nd generation family members of those diagnosed with celiac disease.

What is celiac disease?
Eating gluten causes an immune reaction in those with celiac disease that damages microscopic hair-like structures, called villi that line the small intestine. Healthy villi absorb nutrients through the intestinal wall, but when they become damaged, severe malnutrition, weight loss, growth issues and anemia can result.  People diagnosed with celiac disease must eliminate gluten from their diet.

What is NCGS?
Gluten sensitivity is a reaction to eating food that contains gluten. Although the symptoms are often similar to celiac disease, the reaction does not cause long-term damage. People who are sensitive to gluten but test negatively for celiac disease are likely to minimize their symptoms by going gluten-free. Unlike celiac disease and gluten allergies, there is no specific test to provide a definitive diagnosis of NCGS.

What is a gluten allergy?
Gluten allergies are among the more common food allergies that affect children. Those who are allergic to gluten produce antibodies when they ingest gluten that may result in an immediate reaction, ranging from severe breathing problems to skin rashes, joint pain, fatigue, and digestive problems. Some children outgrow their gluten allergy by the time they reach adolescence. A gluten-free diet and/or medications are used to treat this allergy.

How do I tell if my child has issues with gluten and what should I do?
Watch for the most common symptoms—bloating, diarrhea, unexplained changes in weight, eczema and other rashes, achy joints, fatigue and moodiness. If these symptoms persist, see your pediatrician for an evaluation and screening tests. A blood test reveals whether a child is at risk for celiac disease. Gluten allergies can be detected with a simple skin prick test.  Do not begin a gluten-free diet before screening. Your child may have a false negative test if he or she has not been ingesting gluten recently.

Do we need to visit a specialist?
If a blood test indicates your child is at risk for celiac disease, your pediatrician will likely refer you for further testing to a pediatric gastroenterologist or a program devoted to gluten and allergic digestive disorders. Your child will undergo an endoscopy so the doctor can look at the lining of the small intestine and determine if inflammation is present.

Expert advice is important. We do not advise beginning a gluten-free diet without the supervision of health care professionals. There are nutritional as well as health considerations that need to be considered and followed to ensure the best outcome. Also, unless you are diagnosed with a gluten-related condition, a gluten-free diet may not be the healthiest choice. Many gluten-free foods are not enriched with vitamins and nutrients that are essential to good health.

Where can I get comprehensive care?
Brenner Children’s Hospital has a program devoted to the detection and treatment of gluten issues called the Gluten & Allergic Digestive Disorders (GIADD) program. Your pediatrician may refer you to us or you may call us directly (336-713-4500). Our program includes a board-certified pediatric gastroenterologist, a registered dietician and an allergist. GIADD brings our experts together in one place so that families can receive comprehensive and accessible services that include diagnosis, treatment, management and support.

The FDA has clarified gluten-labeling requirements, making it easier to follow a gluten-free diet, but professional guidance is needed when beginning this lifestyle change. The GIADD program dietician can provide help navigating the diet as well as support for families.

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