Celiac disease in the pediatric population: Could you be missing the diagnosis?
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Celiac disease is a life-long autoimmune disorder of the small intestine caused by exposure to gluten. Classic symptoms of celiac disease include gastrointestinal symptoms such as abdominal pain, weight loss, and diarrhea. In the pediatric population, a large number of patients present with extraintestinal symptoms such as joint pain, anemia, and neurologic symptoms, often resulting in a delay in the diagnosis of celiac disease. Pediatricians can screen for celiac disease with various serologic tests such as tissue transglutaminase antibodies; however, the gold standard for diagnosis is histologic evaluation of duodenal tissue obtained during upper endoscopy. Typical endoscopic findings are mucosal atrophy, fissuring, and scalloping. Currently, the only treatment for celiac disease is strict and life-long adherence to a gluten-free diet. The management of pediatric celiac disease also involves monitoring and repletion of vitamins and minerals, screening for other autoimmune diseases including thyroid disease and diabetes mellitus, and close observation of growth and height velocity in the developing child.