Should a child of a person with coeliac disease (celiac disease) be screened for coeliac disease at their current age?

From the Guidelines

Screening for celiac disease in children of affected parents is recommended, and the most recent evidence suggests that this screening should be considered once the child is consuming gluten regularly, typically after 2-3 years of age. The screening process involves blood tests for celiac-specific antibodies, particularly tissue transglutaminase (tTG) IgA and total IgA levels, as recommended by the American College of Gastroenterology 1. If these tests are positive, confirmation with an intestinal biopsy performed by a gastroenterologist is usually necessary, although recent guidelines suggest that biopsy may not be necessary in symptomatic children with high antibody titers 1.

Key Considerations

• The child should be consuming gluten regularly before screening, as removing gluten can lead to false negative results 1.
• Screening is valuable because celiac disease has a strong genetic component, with first-degree relatives having a 10-15% risk of developing the condition.
• Early detection can prevent complications like malnutrition, growth problems, and long-term health issues.
• Even if initial screening is negative, periodic re-screening every 2-5 years may be warranted as celiac disease can develop at any age.
• A gluten-free diet was beneficial in asymptomatic adults with positive antibodies confirmed by biopsy, highlighting the importance of accurate diagnosis 1.

Recommendations

• Consult with a pediatrician or gastroenterologist to determine the appropriate screening schedule for your child's specific situation.
• Follow the most recent guidelines, which suggest that biopsy may not be necessary in symptomatic children with high antibody titers, but may still be recommended in asymptomatic children to confirm the diagnosis of celiac disease 1.

From the Research

Screening for Coeliac Disease in Children

• Coeliac disease is a common but under-diagnosed condition that can lead to serious long-term complications if left untreated 2.
• Screening for coeliac disease in children can be beneficial, especially for those with a strong family history or certain genetic conditions 3, 4.
• The European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines recommend serological screening with anti-tissue transglutaminase titres for children suspected of having coeliac disease 3, 5, 4.
• A diagnosis of coeliac disease can be confirmed by a small bowel biopsy, but recent guidelines also allow for a non-biopsy diagnosis in certain cases 3, 5, 4, 6.

At-Risk Groups

• Children with a strong family history of coeliac disease are at higher risk of developing the condition 3, 4.
• Certain genetic conditions, such as type 1 diabetes, also increase the risk of coeliac disease 3, 4.
• Children with extra-intestinal manifestations, such as iron deficiency anaemia or faltering growth, should also be screened for coeliac disease 3, 4, 6.

Management and Treatment

• Lifelong adherence to a gluten-free diet is necessary to prevent complications and manage coeliac disease 3, 5, 4, 6.
• Healthcare professionals, including nurses and specialist paediatric dietitians, play an important role in recognizing and diagnosing coeliac disease, as well as providing ongoing dietary and clinical support 3, 5, 4.