Overview

• Coeliac Disease → sensitivity to gluten. Children normally present before the age of 3 years, following the introduction of cereals into the diet.
• Lactose Intolerance:
  • Can occur temporarily secondary to gastroenteritis.
  • Due to deficiency in lactose dehydrogenase.

Making Diagnosis

Clinical Features

• Coeliac Disease ⇒
  • Failure to thrive → may be normal growth until age of weaning (6 months), when gluten is introduced into diet.
  • Diarrhoea.
  • Abdominal distension.
  • Dermatitis herpetiformis.

Investigations

• Anti-TTG and Anti-Endomysial antbodies → check for IgA deficiency before testing for antibodies.
• Endoscopy & Intestinal Biopsy → villous atrophy and crypt hyperplasia.
• Exclude gastroenteritis (stool sample) and crohn’s (faecal calprotectin).

Management Plan

• Gluten Free Diet → avoid wheat, rye and barley.
• Annual Review → check height, weight, and BMI. Review symptoms and adherance to diet.

Complications → vitamin deficiency, anaemia, osteoporosis, EATL.

Prognosis →