Managing the pediatric patient with celiac disease: a multidisciplinary approach

Abstract

Celiac disease (CD) is an autoimmune reaction to gluten, leading to intestinal inflammation, villous atrophy, and malabsorption. It is the most common autoimmune gastrointestinal disorder, with an increasing prevalence. A life-long gluten-free diet (GFD) is an effective treatment to alleviate symptoms, normalize autoantibodies, and heal the intestinal mucosa in patients with CD. Poorly controlled CD poses a significant concern for ongoing malabsorption, growth restriction, and the long-term concern of intestinal lymphoma. Achieving GFD compliance and long-term disease control poses a challenge, with adolescents at particular risk for high rates of noncompliance. Attention has turned toward innovative management strategies to improve adherence and achieve better disease control. One such strategy is the development of multidisciplinary clinic approach, and CD is a complex life-long disease state that would benefit from a multifaceted team approach as recognized by multiple national and international bodies, including the National Institutes of Health. Utilizing the combined efforts of the pediatric gastroenterologist, registered dietitian, registered nurse, and primary care provider (general practitioner or general pediatrician) in a CD multidisciplinary clinic model will be of benefit for patients and families in optimizing diagnosis, provision of GFD teaching, and long-term adherence to a GFD. This paper discusses the benefits and proposed structure for multidisciplinary care in improving management of CD.

Keywords:

• celiac disease
• multidisciplinary care
• team
• pediatric

Acknowledgments

We would like to acknowledge Dr Collin Barker, Dr Herbert Brill, Dr Dominica Gidrewicz, Dr Bob Issenman, Dr David Mack, and Dr Mohsin Rashid for their valuable input on pediatric CD and IBD care across Canadian pediatric gastroenterology centers. We would also like to acknowledge the work of Emily Dao and Stephanie Thornton, Dietetic Interns at the University of Alberta.

Disclosure

The authors report no conflicts of interest in this work.