Celiac disease, also called gluten-sensitive enteropathy or celiac sprue, is an immune response to the gluten protein, mainly found in wheat, rye, and barley. The condition can occur at any age due to exposure to gluten among individuals with a genetic predisposition to this immune system disorder. Poor management and lack of treatment can cause severe health problems, such as malabsorption and weak growth in children and teens (1).
Read this post to know more about the causes, symptoms, signs, diagnosis, and treatment of celiac disease. We will also tell you about a gluten-free diet and the best food choices for your teen with celiac disease.
Signs And Symptoms Of Celiac Disease In Teens
Symptoms and signs of celiac disease may vary in each person. They may include both intestinal (digestive) and extraintestinal symptoms. Extraintestinal manifestations can be due to malabsorption of essential nutrients. Children tend to have more digestive manifestations compared to celiac sprue signs in adults.
The common symptoms and signs of celiac disease may include (2):
- Chronic diarrhea
- Abdominal pain
- Flatulence and bloating (intestinal gas)
- Pale, foul-smelling, and greasy stools
- Tooth enamel damage
- Weight loss
- Anemia (iron deficiency anemia)
- Delayed puberty
- Short stature compared to parents’ height
- Learning difficulties
- Skin rash
- Mouth ulcers
These symptoms and signs are not specific to celiac disease, so your teen requires medical assessment for diagnosis.
What Does The Celiac Rash Look Like?
Cutaneous manifestation of celiac disease is evident as skin rashes that are known as dermatitis herpetiformis. They manifest as incredibly pruritic (itchy) skin lesions often on elbows, scalp, buttocks, knees, and torso (3).
Rashes similar to dermatitis herpetiformis are also seen in certain other autoimmune disorders and skin diseases. Therefore, it is best to let the doctor take a look to make a diagnosis.
Causes Of Celiac Disease In Teens
Celiac disease is caused by an abnormal response of the immune system to gluten, a protein found in barley, wheat, and rye. It leads to an immune-mediated inflammation of the small intestine. This gluten sensitivity is caused by a problematic HLA DQ protein-coding gene located on chromosome number six. This gene can be inherited (hereditary), which means the condition can run in families. One in ten teens with close relatives or family members with celiac disease could develop the condition (4).
If a person with celiac disease eats gluten or gliadin-containing foods, then it triggers an immune response, which could damage the small intestine leading to inadequate nutrient intake or nutritional deficiencies (5).
Gluten Sensitivity Vs. Celiac Disease
Celiac disease is an autoimmune disorder. It causes damage to the intestine from the immune system’s response to gluten, whereas gluten sensitivity is more like a food allergy to gluten.
Gluten sensitivity is intolerance to a gluten-containing diet, which may often result in symptoms such as abdominal pain, diarrhea, bloating, and gasses. This condition is called non-celiac gluten sensitivity (NCGS) or gluten intolerance (6).
The symptoms usually improve with a gluten-free diet and recur with the consumption of gluten. However, blood tests and endoscopic imaging show normal results in gluten sensitivity.
Risk Factors For Celiac Disease
The following conditions may increase the risk of developing celiac disease (7).
- Autoimmune thyroid diseases
- Down syndrome
- Turner syndrome and Williams syndrome
- Positive family history of dermatitis herpetiformis or gluten intolerance
- Diabetes mellitus type I
- Selective IgA deficiency
- Addison’s disease
- Microscopic colitis also known as collagenous colitis or lymphocytic colitis
When To See A Doctor
You may consult a doctor if your teen has any concerning signs and symptoms of celiac disease. Also, see a doctor in the following scenarios.
- Digestive issues, such as diarrhea, abdominal pain, or any other gastrointestinal discomfort, lasting longer than two weeks.
- If you have a close relative or family member with celiac disease. You can mention it to your teen’s doctor during regular visits. They can make early assessments and prevent its complications.
Trying a gluten-free diet before diagnosis may give false-negative results. Therefore, seek consultation when your teen is on a regular diet that includes gluten for an exact diagnosis.
Diagnosis Of Celiac Disease
If the signs and symptoms are suggestive of celiac disease or if there is a positive family history, then your teen’s doctor may order the following tests (8).
- Serology tests look for antibodies against gluten, which are produced during an immune reaction.
- Genetic tests help identify defective genes that point towards celiac disease.
If the results from serologic and genetic tests are positive, then your teen may have to undergo the following tests to visualize the intestines (8).
- Endoscopy uses a tiny flexible tube with a camera to visualize the digestive tract.
- Capsule endoscopy uses a tiny wireless camera to look for intestinal damages.
- Skin tissue is collected for skin biopsy if dermatitis herpetiformis is seen.
Nonresponsive And Refractory Celiac Disease
- Nonresponsive celiac disease: This is a complex autoimmune disorder where people continue to display symptoms of celiac disease and intestinal damage despite following a gluten-free diet for six months to a year. People with this condition may show improvement initially, but then experience a relapse of symptoms.
- Refractory celiac disease (RCD) or refractory sprue: This is a rare and severe form of celiac disease and affects no more than 4% of individuals with celiac disease. It is marked by persistent symptoms and intestinal damage (villous atrophy) despite having a gluten-free diet.
The above conditions may require an additional examination to exclude the following diseases (11):
- Pancreatic insufficiency
- Bacterial overgrowth
- Microscopic colitis
- Irritable bowel syndrome
- Lactose intolerance
- Fructose intolerance
Unresolved celiac disease can also indicate contamination of diet with gluten. In such scenarios, your teen may require help from specialized dieticians.
Treating Celiac Disease In Teens
The initial management plan for celiac disease is a gluten-free diet. Sometimes medications are required to control intestinal inflammation. They include (11):
- Steroid medications to relieve symptoms of refractory celiac disease and if your teen has severe damage of the intestinal wall.
- Immunosuppressive medicines, such as Entocort EC or Uceris (budesonide) and Azasan or Imuran (azathioprine), to help relieve the symptoms.
- Oral intake of the antibiotic dapsone with a gluten-free diet to heal celiac skin rash. Your teen may require regular blood tests to assess the side effects of dapsone therapy.
- Vitamins and mineral supplements for nutritional deficiencies and anemia due to malabsorption. Oral supplementations are given for most teens. Intravenous supplementation may be considered in cases of severe malabsorption.
During the treatment period, you may have to follow up with tests, including blood tests, to assess the effectiveness of treatment and gluten-free diet. It can take months for intestines to heal. Your doctor may order an endoscopy if symptoms persist.
Foods And Ingredients To Avoid
The best way to manage celiac disease and control dermatitis herpetiformis is to consume an entirely gluten-free diet for the entire life. The gluten-containing foods are (12):
- Graham flour
The following ingredients or products may contain gluten and often go unnoticed (13).
- Food preservatives
- Food stabilizers
- Modified food starch
- Supplements of essential nutrients
- Communion wafers
- Malt vinegar
- Sauces such as soy sauce
- Salad dressings
- Baked items
Processed, marinated, coated, and imitation meat, poultry, or seafood can also be contaminated with gluten. You may also avoid seasoned snacks and packed foods. Celiac patients can eat pure oats and oats products. However, oats have a higher chance of contamination with wheat during processing. Always make a habit of reading food labels to find gluten content.
Avoiding gluten in diet may reduce small intestinal inflammation and damage. You need to educate the teen about the importance of avoiding a gluten diet.
The following food items, among various others, can be included in the diet (14).
- Fresh meat and poultry
- Dairy products
- Corn and cornmeal
- Gram flour
Dairy products should be taken after consultation with the doctor. If your teen has lactose intolerance due to intestinal damage, then dairy products might worsen the condition. Distilled alcohol and wine are gluten-free alcoholic beverages.
Complications Of Celiac Disease In Teens
- Malnutrition can occur due to malabsorption of essential nutrients from the small intestine. This may cause weight loss, short stature, growth delay, and anemia in teens.
- Long term malabsorption of vitamin D and calcium may result in weakening of the bones. Children may have rickets or softening of bones (osteomalacia) and may develop osteoporosis as adults.
- Malabsorption may also affect reproduction in the future by causing conditions such as miscarriage or infertility.
- Untreated gluten enteropathy may pose an increased risk of small bowel cancer and intestinal lymphoma.
- Seizures and peripheral neuropathy in nerves of hands and feet are often seen in some cases.
- Intestinal wall damage may cause lactose intolerance, resulting in abdominal pain, gas, and diarrhea on the consumption of dairy products.
Ongoing disease conditions can also cause psychiatric issues in teens, such as depression or anxiety. They may require psychotherapies and endless support from you to get along with the disease and new diet changes. Follow vitamin and mineral supplements as recommended and consult a doctor if your teen has symptoms and signs of gluten sensitivity.
Although a manageable disease, it can be challenging to follow a completely gluten-free diet. You may follow your teen’s doctors or dieticians’ recommendations to choose food. Finding a support group can help you to cope with the stress of your teen’s diet changes.
2. Symptoms & Causes of Celiac Disease; The National Institute of Diabetes and Digestive and Kidney Diseases
3. Dermatitis Herpetiformis (For Health Care Professionals); The National Institute of Diabetes and Digestive and Kidney Diseases
4. What is Celiac Disease?; Celiac Disease Foundation
5. Celiac Disease; MSD Manual
6. Celiac Disease, Non-Celiac Gluten Sensitivity or Wheat Allergy: What is the Difference?; Gluten Intolerance Group
7. Coeliac disease; National Health Service
8. Diagnosis; Celiac Disease Center; The University of Chicago Medicine
9. Non responsive and refractory coeliac disease; Coeliac UK; Livewell
10. Carol Semrad, What is nonresponsive celiac disease?; The University of Chicago Medicine
11. Abdulbaqi Al-Toma et al., European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders; United European Gastroenterology Journal
12. Eating, Diet, & Nutrition for Celiac Disease; The National Institute of Diabetes and Digestive and Kidney Diseases
13. Sources of Gluten; Celiac Disease Foundation
14. Gluten free diet for coeliac disease; My Nutrition; The Queensland Government
15. C J R Goddard and H R Gillett; Complications of coeliac disease: are all patients at risk?; The United States National Library of Medicine