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 The study team found “faster and greater rates of improvements for
most gastrointestinal (GI) and extra-intestinal manifestations of
celiac disease in children as compared to adults,” senior author Dr.
Hilary Jericho from University of Chicago told Reuters Health by
email.
Celiac disease is an autoimmune disorder triggered by consuming the
gluten protein in wheat, rye and barley, Jericho’s team writes in
Journal of Pediatric Gastroenterology and Nutrition.
Diarrhea, abdominal pain, bloating and other GI symptoms are common
in people with celiac disease, but so are "extra-intestinal"
symptoms like joint and muscle pain, infertility and numbness and
tingling, they write.
In all age groups, Jericho noted, the study found greater
improvements in GI symptoms compared to the non-GI symptoms in
response to following a strict gluten-free diet.
The team used 13 years of medical records to compare symptoms in 513
children and adults with celiac disease, and to track how strictly
they stuck to a gluten-free diet and whether symptoms improved over
time.
Among children, abdominal pain, diarrhea and failure to thrive were
the most commonly reported GI symptoms and short stature, fatigue
and headache were the most common extra-intestinal symptoms.
Adults most commonly experienced diarrhea, bloating and abdominal
pain, along with anemia, fatigue, headache and mental problems.
More than two years after diagnosis, improvements in symptoms were
greater among children than among adults for bloating, diarrhea,
weight loss and abdominal pain.
Extra-intestinal symptoms in children and adults also had improved,
although slow to improve were short stature and mental problems in
children and muscle aches and poor mood in adults.
Only 8 percent of the children and 12 percent of adults did not
follow a strict gluten-free diet, and they were more likely to have
persistent symptoms.
Sticking to the gluten-free diet was associated with better
outcomes: 34 percent of kids who stayed on the diet, compared with
62 percent of kids who didn't, still had symptoms after two years.
Among adults, 52 percent who followed the diet closely and 70
percent of those who didn’t had ongoing symptoms.
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More than a third of children and nearly three quarters of adults
had other medical conditions, but these were not associated with the
likelihood of improvements in celiac disease symptoms.
“It is important to know that not all patients have resolution of
symptoms overnight and for some it can take up to 24 months before
all their labs and symptoms resolve,” Jericho said, adding that
often those that have the worst disease severity at presentation
will take the longest to see normalization of lab results and
symptoms.
“For children more often than adults, most GI and extra-intestinal
symptoms should improve if strictly adherent to the gluten-free
diet,” she said. “If they don’t, and the patient is 12-24 months
from the diagnosis and is strictly adherent to the diet, then it is
very important that the physician not blow off the symptoms but look
for another cause that may require an alternate treatment.”
Dr. Runa D. Watkins from University of Maryland School of Medicine
in Baltimore told Reuters Health, "It is important for patients to
adhere to a gluten-free diet, as this is only treatment we currently
have. It is also important for patients to receive yearly follow-ups
with both their GI physician and their dietician. Yearly serologies
and vitamin levels need to be checked to determine if a patient is
compliant and to monitor for any nutritional deficiencies.”
“The other point to be made is the importance of early diagnosis of
celiac disease and close follow-up of patients with celiac disease,”
she said.
SOURCE: http://bit.ly/2rYZrck Journal of Pediatric Gastroenterology
and Nutrition, online May 16, 2017.
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