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Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Flourtown, PA 19031, USA.
Journal of Pediatric Gastroenterology and Nutrition (Impact Factor: 2.87). 02/2005; 40(1):1-19. DOI: 10.1097/00005176-200501000-00001
Source: PubMed

ABSTRACT Celiac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. It occurs in children and adolescents with gastrointestinal symptoms, dermatitis herpetiformis, dental enamel defects, osteoporosis, short stature, delayed puberty and persistent iron deficiency anemia and in asymptomatic individuals with type 1 diabetes, Down syndrome, Turner syndrome, Williams syndrome, selective immunoglobulin (Ig)A deficiency and first degree relatives of individuals with celiac disease. The Celiac Disease Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has formulated a clinical practice guideline for the diagnosis and treatment of pediatric celiac disease based on an integration of a systematic review of the medical literature combined with expert opinion. The Committee examined the indications for testing, the value of serological tests, human leukocyte antigen (HLA) typing and histopathology and the treatment and monitoring of children with celiac disease. It is recommended that children and adolescents with symptoms of celiac disease or an increased risk for celiac disease have a blood test for antibody to tissue transglutaminase (TTG), that those with an elevated TTG be referred to a pediatric gastroenterologist for an intestinal biopsy and that those with the characteristics of celiac disease on intestinal histopathology be treated with a strict gluten-free diet. This document represents the official recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition on the diagnosis and treatment of celiac disease in children and adolescents.

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    • "Depuis plusieurs années, les cliniciens et les chercheurs travaillent a ` la mise au point de marqueurs non invasifs, simples a ` mettre en oeuvre, peu coûteux et disponibles même dans les pays moins favorisés, pour réduire la lourdeur de la procédure diagnostique actuelle incluant une fibroscopie oesogastroduodénale. 2. Critères historiques du diagnostic En 1990, la Société européenne de gastroentérologie pédiatrique (ESPGAN) a révisé les critères diagnostiques chez l'enfant en soulignant que le diagnostic pouvait e ˆtre e ´tabli a ` partir d'une suspicion ou d'une histoire clinique e ´vocatrice, si le sujet présentait a ` la fois une positivité des auto-anticorps avec une atrophie villositaire intestinale associée a ` une augmentation des lymphocytes intra-e ´pithéliaux et une rémission nette des symptômes après mise au régime sans gluten [3]. Globalement, cette stratégie diagnostique e ´tait universellement reconnue et appliquée [4] [5]. Elle a e ´galement e ´té validée par les sociétés savantes s'occupant de malades adultes. "
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    • "This condition leads the patients to an inflammatory enteropathy, with villous atrophy of the intestinal mucosa, crypt hyperplasia, and an inflammatory infiltrate in the adjacent connective tissue, associated with an increase of intraepithelial lymphocytes [2]. A considerable increase in the prevalence of CD has been recorded, ranging from 1 : 85 to 1 : 300 according to the considered geographic area [3], probably due to the wheatconsuming affluent societies of the western world and to the improved reliability of serological tests (measurement of antitransglutaminase antibodies tTG and antiendomysium antibodies EMA) recorded in the recent decades. "
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    • "Celiac disease is a permanent intolerance to gluten. Celiac disease relates specifically to the composition of the storage proteins present in many common cereals such as wheat, rye, barley and oat, which are harmful for the sensitive consumers (Hill et al., 2005). Unfortunately, the gluten-forming proteins are fundamental for the production of a great variety of foods, including pasta, which is generally made from durum wheat. "
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