Celiac Disease

1,390 views

Published on

Published in: Health & Medicine
1 Comment
4 Likes
Statistics
Notes
  • REFERENCING SLIDESHARE GROUP 'HEALT AND MEDICINE'
    This cultural group aims to collect and reference all the slideshows, document, Slidecast, videos, of castles, palaces, temples and the very large houses, prestigious residential, around the world. In all periods, small or large, private or public, in all their splendor or in ruin ... Therefore, it also addresses the feudal society, the feudalism through the centuries, the nobles and knights, the temples and monasteries, etc. We would be honored by your support through your membership. You are invited to join us ! I wish you a nice day. Greetings from France.

    http://www.slideshare.net/group/healt-and-medicine
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
1,390
On SlideShare
0
From Embeds
0
Number of Embeds
12
Actions
Shares
0
Downloads
106
Comments
1
Likes
4
Embeds 0
No embeds

No notes for slide

Celiac Disease

  1. 1. Celiac Disease in children clinical practice guidline summary Presented by Nargess Tavakoli Guilan University of Medical sciences
  2. 2. Journal of Pediatric Gastroenterology and Nutrition 40:1–19 January 2005 Lippincott Williams & Wilkins, Philadelphia <ul><li>Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition </li></ul>
  3. 3. DEFINITION <ul><li>An immune-mediated enteropathy </li></ul><ul><li>caused by a permanent sensitivity to </li></ul><ul><li>gluten in genetically susceptible </li></ul><ul><li>individuals </li></ul>
  4. 4. GASTROINTESTINAL MANIFESTATIONS <ul><li>• Diarrhea with failure to thrive </li></ul><ul><li>• Abdominal pain </li></ul><ul><li>• Vomiting </li></ul><ul><li>• Constipation </li></ul><ul><li>• Abdominal distension </li></ul>
  5. 5. Non_gastrointestinal manifestations <ul><li>A)Strong to moderate evidence of an association </li></ul><ul><li>Dermatitis herpetiformis </li></ul><ul><li>Dental enamel hypoplasia of permanent teeth </li></ul><ul><li>Osteopenia and osteoporosis </li></ul><ul><li>Short stature </li></ul><ul><li>Delayed puberty </li></ul><ul><li>Iron-deficient anemia unresponsive to treatment </li></ul><ul><li>with oral iron (well documented in adults only) </li></ul>
  6. 6. Non_gastrointestinal manifestations <ul><li>Less strong: </li></ul><ul><li>Hepatitis (elevated liver enzymes) </li></ul><ul><li>Arthritis </li></ul><ul><li>Epilepsy with occipital calcifications </li></ul>
  7. 7. Associated with an increased prevalence <ul><li>Type 1 diabetes </li></ul><ul><li>Autoimmune thyroiditis </li></ul><ul><li>Down Syndrome </li></ul><ul><li>Turner Syndrome </li></ul><ul><li>Williams Syndrome </li></ul><ul><li>Selective IgA deficiency </li></ul><ul><li>First degree relatives of </li></ul><ul><li>celiac patients </li></ul>
  8. 8. Who to test? <ul><li>Diarrhea & FTT </li></ul><ul><li>Persistent GI symptoms </li></ul><ul><li>NonGI symptoms of strong to mod. evidence for </li></ul><ul><li>Asymptomatic with conditions of high association </li></ul>
  9. 9. How to test? <ul><li>Definitive Dx : Biopsy of the small intestinal muccosa </li></ul><ul><li>Screening : serological tests </li></ul>
  10. 10. Serological (blood) testing <ul><li>TTG IgA : initial test </li></ul><ul><li>EMA IgA </li></ul><ul><li>AGA IgA & IgG: </li></ul><ul><li>no longer recommended </li></ul><ul><li>inferior accuracy </li></ul>
  11. 11. IgA deficients & CD <ul><li>FIRST: measurement of quantitative </li></ul><ul><li>serum IgA </li></ul><ul><li>If low  Check TTG IgG </li></ul>
  12. 12. Intestinal biopsy <ul><li>confirmation of Dx . in all cases </li></ul><ul><li>when the serum TTG is elevated </li></ul><ul><li>Even if serological tests negative may be useful in symptomatic children (particularly 0 to 2 years old) </li></ul>
  13. 13. WHO TO TREAT? <ul><li>Symptomatic with Pos. Biopsy </li></ul><ul><li>Asymptomatic with </li></ul><ul><li>associated conditions & Pos. Biopsy </li></ul>
  14. 14. BENEFITS OF TREATMENT <ul><li>Resolves persistent diarrhea & poor weight gain </li></ul><ul><li>Reverses reduced bone mineralization </li></ul><ul><li>Prevents: </li></ul><ul><li>osteoporosis </li></ul><ul><li>abortions </li></ul><ul><li>low birth weight </li></ul><ul><li>cancer </li></ul>
  15. 15. HOW TO TREAT? <ul><li>A gluten-free diet for life </li></ul><ul><li>Lactose restrictions? </li></ul><ul><li>not usually necessary </li></ul>
  16. 16. HOW TO MONITOR? <ul><li>Periodic visits </li></ul><ul><li>Check TTG : </li></ul><ul><li>NO symptoms : 6 month after, then once a year </li></ul><ul><li>Any time if persistent or </li></ul><ul><li>recurring symptoms </li></ul>

×