Pinky is 8 years old now and her parents are sick of visiting doctors every 15 to 20 days for loose stools. Jose is 5 years and his hemoglobin has never touched 10 g% mark despite having a balanced diet and Iron supplements. Hassan is 4 years and his parents are sick of the efforts he has to make daily to be able to pass what appear to be stony hard stools. Jasbir is 3 years but looks like a 1 year old as he weighs only 8 kg and his length is almost equal to his 14 months old neighbor.
You might be wondering what is common amongst all these children, which parents and doctors have missed all these years-The answer is- “Celiac Disease or gluten intolerance or in simple terms allergy to wheat”!
It has been more than 50 years when the first case of celiac disease was described in Indian children. But, last 10 to 20 years have seen a tremendous surge in the newly diagnosed cases of this disease in India, thanks to the availability of inexpensive laboratory tests, heightened physicians’ awareness and easy access to GI endoscopy services.
What is Celiac Disease?
Traditionally, it has been considered a disease of European races, but now it affects predominantly wheat eating population throughout the world with slight regional variations. It is a genetic intolerance to gluten (wheat component devoid of wheat starch) that can affect any organ but specifically affects intestinal tract. It is most commonly associated with diseases like hypothyroidism, Dermatiti herpetiformis, Diabetes and some immunodeficiency disorders. The disease becomes symptomatic within 3 to 4 months of weaning i.e. introduction of wheat based food products.
The typical presentation is associated with recurrent or persistent large amount, bulky, foul, smelling, semisolid stools that start around 8 months of age along with poor weight and height gain. Some children can go on become adults without being diagnosed, in case the presentation is atypical i.e. short height, anemia, constipation, and recurrent oral cancers. The disease not only causes poor growth but also has a malignant potential i.e. it increases the chances of gastrointestinal cancers.
What is the Diagnosis?
The diagnosis depends on detecting antibodies to the target antigen i.e. tissue transglutaminase antibodies of the IgA or IgG types. The confirmation often requires intestinal endoscopic biopsy, but in individuals with specific HLA and 10 times high titre of antibodies, biopsy may not be essential.
Is there any treatment available?
Withdraw yourself from all gluten containing food like wheat, rye and barley from your diet. Refrain from consuming pizza, biscuits, burger, chapatti, icecreams, sweets, cheese, ketchup and hing. Your family and school teachers have a critical role in dietary compliance and providing emotional support.
A strict gluten free diet evokes remarkable improvement in physical growth and all the symptoms within short time, but symptoms tend to recur in case of non compliance. Research is being done to find a cure for this disease but results have not been optimal. Till we have a cure, the only treatment remains adherence to strict gluten free diet based on rice, jawar, besan, milk products,, meat, fishes, vegetable and pulses.