Aspects of celiac disease in children and adolescents

Celiac disease is an immunologically mediated systemic disorder with increasing prevalence that ranges from 0.9 % in Germany to 2.4 % in Finland. The broad clinical spectrum often delays or even prevents timely diagnosis. In those with a genetic predisposition (HLA-DQ2 and -DQ8 positive), ingested food containing gluten may lead to the production of antibodies against endomysium and tissue transglutaminase through a deviated immune response against gluten. High-affinity gliadin-specific T cells may play an additional important role leading to a characteristic inflammation of the small intestine. Celiac patients may be completely asymptomatic (screening results), may present typical gastrointestinal, or atypical symptoms (e.g., isolated headache). The diagnosis consists of a combination of clinical symptoms, serological (IgA antibodies against tissue transglutaminase), endoscopic and histological findings (Marsh classification). Lifelong gluten-free diet leads to a complete remission of clinical symptoms and serological and histological findings. According to new guidelines of ESPGHAN, histology may not be necessary in celiac children presenting with classical symptoms and very high (> 10-fold) tissue transglutaminase antibodies. © 2015, Springer-Verlag Berlin Heidelberg.