ID-10073499

Non-celiac gluten sensitivity in children

I was thrilled to come across a paper about non-celiac gluten sensitivity in children in the Journal of Pediatrics, one of the main pediatric journals. Many of my pediatrician colleagues read this journal on a regular basis. In this article, a group of Italian researchers have described the symptoms and lab test results in 15 children with gluten sensitivity (GS) compared to 15 children with active celiac disease and 15 controls (children with IBS-type symptoms that have no correlation with gluten intake). None of the children included in the GS group had an IgE-mediated wheat allergy causing symptoms. Most of the children in the study were between 8 and 10 years old.

Here is a brief overview of the research study:

  • The main symptoms in the gluten sensitive group included abdominal pain, chronic diarrhea, bloating, failure to thrive (poor growth), vomiting, and constipation. These symptoms were similar to those seen in the group of children with active celiac disease. The “control” group of children with functional (IBS-type symptoms) had only abdominal pain and indigestion as symptoms.
  • The gluten sensitive children had “extraintestinal” symptoms of tiredness, headaches, and limb pains. Interestingly, these were not seen in children with active celiac disease. The celiac group of children had anemia and elevated liver function enzymes but the gluten sensitive children did not.
  • Two thirds of the gluten sensitive children had abnormally high antigliadin IgG antibodies (this is an older antibody that was used in the past to assess for celiac disease, but is no longer used because it is non-specific for celiac disease). None of the gluten sensitive children had elevated celiac antibodies (TTG IgA and endomysial IgA). All of the children with active celiac disease had abnormally high TTG IgA and endomysial IgA levels and 13/15 with celiac disease had elevated antigliadin antibodies. The control group kiddos with functional abdominal pain were negative for all antibodies (antigliadin, TTG, and endomysial).
  • Seven of the 15 children with GS had one of the celiac genes (DQ2/8) and 8 did not. The 8 gluten sensitive children who were DQ2/8 negative all had some combination of HLA DQ1, DQ5, and DQ7.
  • Eleven of the 15 GS children had an intestinal biopsy while on a gluten-containing diet. All of those with GS had normal to mildly inflamed intestinal mucosa, corresponding to Marsh stage 0 to 1.

In summary, the authors provide findings that support the existence of gluten sensitivity in children as a distinct problem from celiac disease. Children with gluten sensitivity have celiac-like symptoms that resolve on a gluten free diet and return when gluten is reintroduced. Although gluten sensitive children often have elevated antigliadin IgG levels, they have normal TTG IgA and endomysial IgA levels, at least in this study. Their small bowel biopsies show no evidence of villous blunting and, in the majority of cases, the biopsies are normal. In addition, these children’s symptoms are not as a result of being allergic to wheat. Although this is a small study, it is a step in the right direction toward the recognition of non-celiac gluten sensitivity in the pediatric population, and I am thankful that there is finally a research study to support its existence. I am looking forward to being able to read and share similar articles with you.

Reference:

Francavilla, R., Cristofori, F., Castellaneta, S., et al. Clinical, serologic, and histologic features of gluten sensitivity in children. Journal of Pediatrics. E-pub ahead of print. Nov. 16, 2013.

3 thoughts on “Non-celiac gluten sensitivity in children

  1. Magali

    Thank you so much for this information. My 10 years old boy is not growing or gaining weight (he is 127 cm and 21kg at 10) despite eating. He has a diagnosis of enemal hypoplasya, ADHD, asthma. When he eats gluten (he is not a big fan of pasta, pizza and bread anyways, so it is only a few times a week), he gets alternation of constipation and diarrhea, sometimes a rash on his buttocks, he is irritable, has foul semlling gas and feels tired all of a sudden. The doctors have bben looking for what he has for 6 years. He finally had celiac tests that show he has one DQ8 gene. Now That celaic has been ruled out, I think he has a sensitivity to gluten (his dad only lives healthy when off gluten). I think we are going to put him on a GF diet and see if he starts growing. Then, I’ll know to blame gluten. Is that what you would do ?

    1. Jess Post author

      Hi Magali,
      It sounds like your instincts are correct and that there’s a strong possibility that gluten is the culprit for your son’s symptoms. However, based on his story, it seems unclear whether or not he has celiac disease or non celiac gluten sensitivity (as having one copy of DQ8 would place him at risk). Did he also have celiac antibody testing while eating gluten? This would have been some combination of blood tests for TTG, DGP, endomysial, and/or anti-gliadin antibodies. In his case and with his symptoms, celiac disease could not be ruled out based on genetic testing alone.
      If celiac has been properly ruled out, then it sounds like it may be worthwhile to see if his symptoms improve when he goes GF. But you need to make sure that celiac has been properly ruled out, because is he does have celiac disease, he is at risk for vitamin and mineral deficiencies, anemia, etc. and needs to be placed on supplements as necessary.
      I hope this helps.
      Jess

  2. Katerina

    Hello Jess!

    My son is 4 years old and he is not growing, he is 16kg and 104cm. He was negative in testing for gluten antibodies. But we did urine peptide that shows that his lacking of opioid peptides from intestinal wall. It should that he has bacterial overgrowth also. Psychologist say that he has a atipical autism.
    And the question is:
    Do you think than his height is influences by this findings?
    Kind regards

Comments are closed.