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Diagnosis and management of coeliac disease in children
  1. Richard Steelefor the CRF*
  1. Correspondence to Dr Richard Steele, Immunology, Capital and Coast DHB, Wellington Hospital, Riddiford Street, Private Bag 7902, Wellington 6002, New Zealand; richard.steele{at}


Coeliac disease (CD) remains under diagnosed with only 10–20% of patients identified. Genes encoding HLA DQ2 or DQ8 are found in the vast majority of those with CD and testing for their presence can be useful to rule out the possibility CD. CD is more common in certain ethnic groups including those of North Indian origin. The classical presentation tends to occur in younger children, while atypical presentations occur at an older age. The number of children being diagnosed with CD is increasing; this may be due to greater recognition of the more atypical presentations, improved serologic tests, and the screening of asymptomatic groups at increased risk, but may also be due to an overall increased prevalence. Although serologic testing has become more reliable, there still remain significant problems around testing, particularly in those <18 months of age. All children should undergo a duodenal biopsy on a gluten containing diet in order to diagnose CD before recommending a gluten-free diet (GFD). A GFD should be offered to all children diagnosed with CD even when perceived as asymptomatic, as there is significant morbidity associated with CD later in life.

  • Immunology
  • coeliac disease
  • paediatric gastroenterology
  • gastroenterology

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  • * Coeliac Research Fund Clinical Advisory Committee Members: Peter Gibson, Department of Gastroenterology, Monash University, Melbourne, Victoria, Australia; Robert Anderson, Departments of Clinical Immunology and Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Andrew Day, Christchurch Hospital, Canterbury Health Board, Christchurch, New Zealand; Don Cameron, Monash University and Royal Children's Hospital, Melbourne, Victoria, Australia; Chris Hogan, Sunbury, Victoria, Australia; Sue Shepherd, Digestive Health Foundation, Gastroenterological Society Australia; Graham Price, The Coeliac Society of Australia; Penny Dellsperger, The Coeliac Society of New South Wales, Australia; Richard Steele, Wellington, New Zealand; Gill Keuskamp, The Coeliac Society, New Zealand; James Daveson, Princess Alexandra Hospital, Brisbane, Australia; Jason Tye Din, Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.