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Pediatric Q&A with Dr. Butzner
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Dr. Butzner held a Q & A session for parents of celiac children:
Q: What are the symptoms of IDDM (Type I diabetes) in children?
A: They tend to eat too much, drink too much, and urinate too often.
Q: How many biopsy samples do you get in a biopsy?
A: There are two ways to do a biopsy: capsular (older method), or
endoscopy. With the capsule method, they get one large sample.
With an endoscopy, you get 4-6 smaller samples. (But this varies
from doctor to doctor.)
Q: Is there any research being done on the connection between epilepsy
and Celiac Disease?
A: Dr. Butzner is not doing any research along these lines. He
mentioned a study in Italy, involving about 500 children with
seizures, where about 5 were found to have CD.
Q: Should the relatives of a celiac be tested for CD?
A: All first-degree relatives (parents, siblings, children) should be
screened for CD.
Q: Why are there different blood tests?
A: The IgA antigliadin antibody test was developed first, but it is
not specific to just CD. The IgA antiendomysial antibody test was
developed later and is more specific to CD. Also there is the IgG
version of the antibody tests, which is not specific to CD.
However, it is the only blood screening test that can be used in
patients that are IgA deficient (which is occasionally seen in CD).
Q: Is a gluten-challenge necessary to confirm diagnosis?
A: This used to be the practice, but isn't often done anymore.
Antibody tests can serve this purpose. If they are positive before
the GF diet and negative afterwards, that may be all that is
needed. In fact, even the second biopsy (after the GF diet) may
not be necessary. Dr. Butzner generally doesn't do a second biopsy
if the GF diet results in rapid recovery.
If giardia is suspected as well as CD, then the three-biopsy,
gluten-challenge approach might be needed. (Dr. Butzner said some
of his colleagues would argue that point.)
Q: How young can a child be diagnosed?
A: Not before age 2, unless there are symptoms.
Q: What do you recommend to a teenage celiac who wants to eat oats?
A: If the teenager intends to eat oats, then 1) do a blood test, 2)
eat one bowl of oatmeal per day (and no more), 3) if symptoms
develop, do another blood test and a biopsy, and 4) check
antibodies annually.
Q: If you already have all the typical celiac symptoms, why do you
need a biopsy?
A: The problem with screening or diagnosing based on symptoms is that
there are so many other possible causes of the same symptoms. NO
child should ever have the diagnosis of CD made without a biopsy.
No exceptions!
Q: What about lymphomas in celiac children?
A: Dr. Butzner knows of no studies on the subject. He has only heard
of one case of a child that had small intestinal lymphoma. We
don't know what the effect may be 50 years later. Studies in
adults suggest that after a GF diet the risk of lymphoma goes down
to near (but still slightly above) that of the general population.
Q: Someone diagnosed at age 3, and who is now in her 60's, asked what
(if anything) she should do regarding her risk of lymphoma?
A: The prevalence of intestinal T-cell lymphoma is 1:100,000. In
untreated celiacs it is about 1:10,000, which is still pretty rare.
Q: If diagnosis in a child is delayed, can there be stunted growth?
A: Usually the height isn't affected unless the delay is long. Weight
usually "catches up" within 3-6 months; if not, then Dr. Butzner
starts looking for another underlying problem.
Q: Should I worry about my 2-year-old's pot belly?
A: No, that alone is fairly normal in 2-year-olds. Without other
symptoms there is probably no cause for alarm.
Q: How do you convince the doctor to do a biopsy when there are
symptoms, if the doctor doesn't want to do it?
A: If all efforts fail, and you are convinced it's a mistake, then
change doctors.
Q: What about behavior in celiac kids?
A: Dr. Butzner has no hard data on this topic, though he noted that
undiagnosed celiac kids tend to be irritable.
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