From the Guidelines
It is not recommended for parents with children who have celiac disease to necessarily get an endoscopy for themselves, but rather for their child if they are showing symptoms of the disease. When considering the diagnosis of celiac disease in children, an endoscopy with small intestinal biopsies is a crucial diagnostic tool, as it provides a definitive diagnosis and helps determine the severity of intestinal damage, which guides treatment decisions 1. The procedure typically involves a gastroenterologist using a thin, flexible tube with a camera to examine the small intestine and take tiny tissue samples to check for damage to the intestinal villi, which is characteristic of celiac disease. Some key points to consider include:
- Before scheduling an endoscopy, blood tests for celiac-specific antibodies (such as tissue transglutaminase antibodies) are usually done first as a screening tool 1.
- It's essential that children remain on a gluten-containing diet before both the blood tests and endoscopy, as removing gluten can lead to false negative results.
- A combination of history and serology should be used to monitor adherence to a gluten-free diet, and monitoring should also include verification that clinical abnormalities detected on initial laboratory investigations have normalized 1.
- If symptoms relapse or if there is no clinical response, upper endoscopy with bowel biopsies is recommended 1. However, for parents, the decision to undergo an endoscopy should be based on their individual risk factors and symptoms, rather than solely on their child's diagnosis. In cases where parents have a family history of celiac disease or are showing signs of malabsorption, a duodenal biopsy should be considered 1. Ultimately, the decision to undergo an endoscopy should be made in consultation with a healthcare professional, taking into account the individual's medical history, symptoms, and risk factors.
From the Research
Diagnosis and Recommendation for Endoscopy
- Children with suspected celiac disease should undergo serological screening with anti-tissue transglutaminase titres 2.
- Diagnosis is traditionally confirmed by a small bowel biopsy while the child remains on a 'normal' diet that does not exclude gluten 2.
- Children with elevated titers of celiac antibodies or strong clinical suspicion for celiac disease should be referred to a gastroenterologist for upper endoscopy and biopsy 3.
- The child should continue on a diet with ingestion of gluten until the procedure is performed 3.
Importance of Endoscopy and Biopsy
- Upper endoscopy and small-bowel biopsy of the distal duodenum are necessary for seropositive patients to confirm the diagnosis of celiac disease 4.
- A small bowel biopsy is essential for confirming the diagnosis of celiac disease, especially in children with typical and atypical symptoms 3.
Parental Involvement and Support
- Parents of children with celiac disease play a crucial role in maintaining a gluten-free diet and preventing long-term complications 2.
- Families should meet with a dietician and participate in celiac support groups to ensure a gluten-free lifestyle for their child 4.
- Gastroenterology nurses can assist parents in identifying necessary lifestyle changes to make their child's life gluten-free 4.