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 Teens with celiac disease, an immune disorder in which people cannot
tolerate the gluten protein found in wheat, rye and barley, should
gradually assume exclusive responsibility for their own care,
learning how to follow a gluten-free diet and the consequences of
not following it, the authors write.
“Adolescence is a period of time where young people like to revolt
and change things and they may be tempted to leave their gluten free
diet, which puts certain restraints on their life,” said senior
author Dr. Steffen Husby of Hans Christian Andersen Children’s
Hospital, Odense University Hospital in Denmark.
“The consequences can come years later with iron deficiency anemia
or osteoporosis,” he said.
“We recommend close communication with the doctor when transitioning
to adult care,” he said.
Traditionally, celiac disease management includes regular physician
visits to collect weight and height measurements, discuss dietary
adherence and check celiac disease-specific antibodies in the blood.
But unlike other chronic conditions, celiac disease does not require
prescription medication so patients may have less contact with
doctors, particularly if they believe they have mastered the gluten
free diet, the authors write. Even those who do not follow the
correct diet may not have symptoms like anemia or seizures for
years. This puts teens at risk for dropping out of the healthcare
system.
Adult gastroenterologists may believe that celiac disease is less
serious than gastrointestinal cancer or irritable bowel syndrome,
and assume celiac patients will be able to care for themselves,
which may not be the case if teen patients were not adequately
transferred to adult care, the researchers caution.
Ideally, teens with celiac disease could visit a clinic with
pediatric and adult services that handles such transitions, the
authors write. They recommend that the transition process also
include a “transition document” created by the pediatrician with
written information on the patient’s diagnosis, follow-up, body
composition data, other health conditions and dietary compliance.
The authors also conclude that most teens and young adults do not
need routine small intestine biopsies to reconfirm a childhood
diagnosis of celiac disease, unless pediatric diagnostic criteria,
like a blood test for gluten antibodies, were never fulfilled,
according to the recommendations published in the journal Gut.
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“We think it most important to stress that celiac disease is a
definite disorder,” Husby told Reuters Health. “We should make a
regular diagnosis of celiac disease before putting kids on a gluten
free diet.”
Three decades ago celiac disease was almost always diagnosed in
childhood, but since then diagnoses among adults have increased,
Husby said. Celiac disease is a lifelong chronic condition.
“All youth, whether or not you have a chronic disease, need a better
transition,” said Dr. Patience White, co-director of Got Transition,
the Center for Health Care Transition Improvement at the National
Alliance to Advance Adolescent Health in Washington, D.C. “We do it
poorly in every country.”
Managing conditions like celiac disease or type 1 diabetes does not
change much from childhood to adulthood, “but the way you go about
getting people to be adherent between age 14 and 25 changes,” White,
who was not part of the new consensus statement, told Reuters
Health.
Young people tend not to register risk for future health
consequences, whether the risk is lung cancer as a result of smoking
or osteoporosis as a result of eating gluten, she said.
A better motivator would be “boy, if you don’t adhere to your diet
you’re going to look terrible at prom,” she said.
SOURCE: http://bit.ly/1WTiMHe Gut, online April 18, 2016.
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