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Michelle asks: “How do we know if my children are coeliacs? I have coeliac disease and it also runs in my husbands family. The kids have never been tested but seem to react to gluten if they do eat gluten by mistake. Can you help me understand the issues?”
I Reply:
To have coeliac disease you need to be on gluten for months (or even years or sometimes decades). Also, you need to have evidence of small bowel damage that can be detected by small bowel biopsy (via upper GI endoscopy). There are blood tests that can indicate tissue damage. These tests (the tTG and the EMA tests) are very useful to sort out the people who are likely to have gut damage. But these blood tests are not diagnostic for coeliac disease. Once a child starts to eat gluten, it can take many years before these blood tests turn positive (all of this time your child might be experiencing gluten symptoms). Also, is useful to have the HLA DQ2/DQ8 test (which gives an indication of genetic susceptibility to coeliac disease). This tells you if you are more likely to develop coeliac disease, but again it is not diagnostic for coeliac disease. The gluten antibody tests (IgG-gliadin and IgA-gliadin) indicate immune response to gluten, and are usually high in those with gluten-sensitivity. They are also raised early in most people who go on to develop coeliac disease. These tests can become positive in months or years after starting gluten. To conclude: Your children are currently gluten-free and have never been given gluten. Therefore, they cannot have coeliac disease at the moment. With the introduction of gluten they may get sick, but would need to be given gluten for months or years before there might be any evidence of coeliac disease. You have two choices 1 – Keep them gluten-free for the next few years (because you recognise that they get symptoms when they eat gluten). 2 – Or challenge them with gluten and measure their blood tests in a few months and see what the response is. If they get too unwell, then stop the challenge. The most important thing is to have happy healthy children. The actual diagnosis (coeliac or gluten-sensitivity) doesn’t really matter. The treatment is same for both conditions: a gluten-free diet. I hope that this helps. Cheers, Dr Rodney Ford |
