Pediatric celiac disease.

Celiac disease is a disease of the small intestine caused by an immune response to ingested gluten. This response results in characteristic damage to the villi, resulting in malabsorption. It is far more prevalent and its presentation can be far more subtle than once recognized. The prevalence of celiac disease in children in the general U.S. population is estimated to be 1 in 100. Toddlers and young children classically present with failure to thrive, diarrhea, and abdominal distension sometime after the introduction of gluten in the diet, but more often they present with subtle gastrointestinal symptoms such as constipation. Some children may be asymptomatic. Symptomatic patients and high-risk individuals should have serologic testing and testing of their total immunoglobulin A. Seropositive patients should undergo upper endoscopy and small-bowel biopsy of the distal duodenum. Treatment is lifelong adherence to a gluten-free diet. Families must meet with a dietician and should be strongly encouraged to participate in celiac support groups. The gastroenterology nurse is in an unparalleled position to assist parents of children newly diagnosed with celiac disease to identify the necessary lifestyle changes to make their child's life gluten free.