Diagnosis and management of coeliac disease in children.

Coeliac disease (CD) is an autoimmune gluten-dependent condition with a prevalence of 1% in the population, if screened. However, approximately only a third of children with CD are diagnosed. When CD is suspected, serological screening with anti-tissue transglutaminase titres should be performed. Children with a positive result should be referred to a specialist in CD for confirmation of the diagnosis. The European Society for Paediatric Gastroenterology Hepatology and Nutrition revised their diagnostic guidance for CD in 2020 and this article discusses the current diagnostic pathways. Lifelong strict adherence to a gluten-free diet is necessary to prevent complications. Nurses and specialist paediatric dietitians have an important role in recognising and diagnosing CD early, as well as offering ongoing dietary and clinical support.

Use of an Educational Module to Improve Confidence and Knowledge of Celiac Disease Among Nurse Practitioners in Pennsylvania: A Quasi-Experimental Mixed-Methods Design.

Accurate and prompt diagnosis of celiac disease has proven difficult due to the myriad of presenting symptoms and a lack of a clear diagnostic protocol. This pilot study investigated the use of an evidence-based multimedia educational module on nurse practitioner confidence and knowledge of celiac disease. Thirteen nurse practitioners in Pennsylvania completed all study activities, which involved the use of an online pretest, learning component, an immediate post-test, along with 2 follow-up surveys. Results revealed that nurse practitioner confidence (p ≤ .05) and knowledge (p ≤ .05) levels significantly improved after participation in the educational intervention. Qualitative data also revealed that nurse practitioners are more aware of the various presentations and symptoms of celiac disease and stated that with this knowledge, their clinical practice has changed to include recognition of the various celiac disease presentations. Findings suggest that nurse practitioners are now more knowledgeable of the various presentations of celiac disease and may be more likely to consider celiac disease as a diagnosis if patients present with typical or atypical symptoms.

Gaining perspective on own illness - the lived experiences of a patient education programme for women with treated coeliac disease.

AIMS AND OBJECTIVES: To explore the lived experiences of women with coeliac disease after attending a patient education programme, to gain a broader perspective of its influence. BACKGROUND: Adults, particularly women, with coeliac disease report suffering from poor well-being and reduced quality of life in terms of health. Patient education programmes might support and encourage them in the search for possible improvements in lifestyle and in their approach to the disease. DESIGN: A qualitative phenomenological study. METHODS: Personal narrative interviews with 14 women suffering from coeliac disease who had participated in an educational programme. Data analysis in accordance with Giorgi was performed. RESULTS: The essential structure of women's lived experiences following their participation in the patient education programme was found to be an interaction with others with the same disease, which left the women feeling individually strengthened. The interaction enabled the participants to acquire a broader view of their life with coeliac disease. As a result, this realigned their sense of self in relation to their own disease. CONCLUSION: In coping with coeliac disease, it seems that women need interaction with others with the disease to experience togetherness within a group, get the opportunity to compare themselves with others and to exchange knowledge. The interaction appears to result in that women acquire an overview of life with the disease, develop a greater confidence and dare to try new things in life. RELEVANCE TO CLINICAL PRACTICE: When designing a patient education programme it seems important to consider the needs of persons to meet others with the same disease, and to ask them about their need for knowledge, rather than simply assuming that health care professionals know what they need.

The role of nurses and dietitians in managing paediatric coeliac disease.

Coeliac disease (CD) is an immune-mediated genetic condition elicited by the ingestion of gluten, leading to proximal small bowel enteropathy. It affects around 1% of the population, although only a small proportion of cases are actually diagnosed. It is a multisystem disorder presenting with both gastrointestinal and extra-intestinal manifestations such as diarrhoea, abdominal pain, constipation, vomiting, iron deficiency anaemia, faltering growth, dental enamel defects, short stature, liver disease, arthropathy and recurrent aphthous ulcers. Nurses, working in different clinical settings, are best placed for early recognition and diagnosis of CD in children. Suspicion of CD should lead to immunoglobulin A (IgA)-based anti-tissue transglutaminase antibody screening tests and a diagnosis confirmed by an intestinal biopsy. Modification of European (ESPGHAN) guidelines now enables CD to be diagnosed without a small-bowel biopsy in a select group of symptomatic children. A gluten-free diet should preferably be started by paediatric dietitians. Strict adherence to a gluten-free diet is essential to maintain good health and to prevent long-term complications. A case study demonstrating some of the challenges that may be faced in children with CD in clinical practice is described. Specialist nurse-led CD clinics are gaining popularity and have been found to be equally effective in providing continuity of quality care.

Children and adolescents living with diabetes and celiac disease. / Crianças e adolescentes que convivem com diabetes e doença celíaca.

Objective To understand the experience of children and adolescents living with type 1 diabetes and celiac disease. Method This is a qualitative exploratory-descriptive study. The participants were 3 children and 2 adolescents. The data were collected by means of semi-structured interviews between January and September 2012 at the participant's residence or at the diabetic outpatient clinic of the Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo in São Paulo, Brazil. The content analysis technique was used to process the data. Results The key aspect of the illness experience of the patients was their diet, but with different meanings. The children had difficulty following the diet, while the adolescents reported that they had greater difficulty coping with the social and affective aspects of their diet. Conclusion The results reinforce the importance of nurses who seek strategies, together with the patients and their families, that help minimize the difficulties of these patients, especially with regard to managing the diet imposed by both diseases.

Parent experiences raising young people with type 1 diabetes and celiac disease.

Authors of this qualitative descriptive study interviewed 30 parents concerning their experiences raising a child or adolescent with type 1 diabetes (T1D) and celiac disease (CD). Analysis revealed six themes: (a) health complications of T1D, (b) challenges of daily disease management, (c) financial concerns, (d) the young person's emotional/mental health, (e) experiences with healthcare providers, and (f) experiences with people outside the family and at school. Results suggest nurses need to be sensitive to challenges young people living with T1D and CD and their parents face, conduct ongoing assessments, and provide time during interactions to adequately address concerns.

Gluten-Related Disorders: Celiac Disease, Gluten Allergy, Non-Celiac Gluten Sensitivity.

Gluten is a protein complex found in the endosperm portion of wheat, rye, and barley. "Gluten-related disorder" is a term used to describe conditions related to ingestion of gluten-containing foods. Gluten has been implicated as the cause of a variety of gastrointestinal (GI) and extraintestinal symptoms. These symptoms are often non-specific and variable, making it difficult for the primary care provider to diagnose the cause and develop a management plan. Recently, gluten-related disorders have received much attention in the popular press, and the sale of gluten-free foods has become a multi-billion dollar business. It is important for pediatric primary care providers to understand the potential role of gluten in GI health and symptomatology so appropriate screening, diagnostic testing, and management can be provided.

The Gluten-Free Frenzy: Fad or Fitting?

Although the gluten-free diet has been recognized as therapeutic for individuals suffering from celiac disease, it has been promoted recently for other indications, such as autism, chronic fatigue syn- drome, and irritable bowel syndrome, or simply as a healthy dietary choice for anyone. The basics of the gluten-free diet are explored, with evidence-based indications and nursing implications when patients choose gluten-free.

Celiac disease: Guideline update overview.

ABSTRACT: The American College of Gastroenterology revised its recommendations for diagnosing and managing celiac disease in its updated 2023 clinical guideline. Celiac disease is an autoimmune disorder causing malabsorption following exposure to gluten. A wide range of both gastrointestinal and nongastrointestinal signs and symptoms can occur. This article provides an overview of the diagnosis and management of celiac disease, aiding the NP in developing a greater awareness of the condition both to diagnose it and to refer patients as needed to gastroenterology for evaluation.

Clinical update: coeliac disease in children.

Coeliac disease (CD) is a lifelong condition and occurs in children (also adults) who are sensitive to gluten protein. It affects around 1% of children, although many cases remain undiagnosed. It is important that the community practitioners remain aware of the classic gastrointestinal features of CD and make an early referral for diagnosis. Suspicion of CD should lead to antibody screening tests and positive results should be followed by an intestinal biopsy for a definitive diagnosis. Paediatric dietitians should always be involved before commencing a gluten-free diet (GFD) as they play a vital role in supporting families. Extra-intestinal manifestations can pose a diagnostic challenge and a suspicion of CD should always be discussed with a medical professional. School nurses play an important role in supporting the child in the school environment and are in a position to recognise non-compliance and school absences. Strict adherence to a GFD is essential to maintain good health and to prevent long-term complications.

Adolescents with celiac disease: a literature review of the impact developmental tasks have on adherence with a gluten-free diet.

Celiac disease is an autoimmune disease affecting individuals at any time across the developmental lifespan. The only treatment for celiac disease is lifelong adherence to a gluten-free diet to prevent future complications and malignancies. The ratio of occurrence between children and adolescents is 1:104. When the phase of adolescence is coalesced with having celiac disease, normal developmental tasks become more challenging, therefore impacting adherence with the gluten-free diet. An abundance of both qualitative and quantitative studies from the Netherlands, Europe, and Canada focusing on adolescents with celiac disease and adherence to the gluten-free diet was found in the literature. Conversely, in the United States, there was a dearth of literature examining adolescents diagnosed with celiac disease, their adherence to a gluten-free diet, and their lived experience of having celiac disease. The relevance to nursing practice and recommendations for future research are discussed in light of these findings.

Celiac disease: implications for patient management.

Celiac disease is an autoimmune disorder that is known specifically for causing inflammation of the mucosa in the small intestine. Through multiple diagnostic and screening tools such as small intestinal biopsy sample, serological testing, and human leukocyte antigen testing, healthcare providers can diagnose this disease that contains components related to genetic predisposition and intake of gluten proteins found in wheat, barley, and rye. There are some who believe that having an autoimmune disease may predispose one to acquiring another disease. With patients experiencing mostly diarrhea, abdominal pain, and weight loss, the implementation of a gluten-free diet is the treatment that healthcare providers recommend. Through monitoring gluten intake and providing nutritional supplementation, those diagnosed with celiac disease can lead a relatively normal life without complications. With celiac disease affecting all age ranges in the population, and with a documented higher frequency, there is a growing awareness in society that can be easily seen in grocery stores, restaurants, and food manufacturers.

The relationship between quality of life and coping strategies of adults with celiac disease adhering to a gluten-free diet.

In the United States, the prevalence of celiac disease has increased from 1 in 4,600 persons to 1 in 133 persons during the past 10 years. Although celiac disease can be managed by strict adherence to a gluten-free diet, dietary management can be challenging. A descriptive, correlational design was used to examine factors and perceived causes that interfere with adherence to a gluten-free diet, identify coping strategies, and examine the relationship between coping strategies and quality of life in 156 adults with a diagnosis of celiac disease. The Psychological General Well-Being Index and the Brief COPE were used to measure the major variables. Results indicated that problems outside the home interfere with dietary adherence. A moderate negative significant relationship (r [154] = -.46, p < .01) was found between quality of life and stress, with 54% of participants reporting a minimal amount of stress. Emotion-focused coping was found to have a significant negative effect on quality of life (H[18] = 56.67, p < .001). Implications for future research should include investigation of cognitive behavioral interventions to decrease the negative effects of stress on quality of life for adults with celiac disease adhering to a gluten-free diet.

Accuracy of the clinical indicators of ineffective health management in celiac people.

OBJECTIVE: to analyze the accuracy of clinical indicators of "Ineffective health management" in celiac patients and to verify associations between sociodemographic characteristics and clinical indicators. METHOD: a cross-sectional study, conducted from May to September 2017, with 83 celiac patients, through an interview. Accuracy measures were defined by latent class model. RESULTS: there was a prevalence of "Ineffective health management" of 55.69%. "Failure to take action to reduce risk factor" and "Failure to include treatment regimen in daily living" better predict this diagnosis. Paid occupation reduces the chance of the presence of "Difficulty with prescribed regimen". Participation in support association reduces the chance of the presence of "Difficulty with prescribed regimen", "Ineffective choices in daily living for meeting health goal" and "Failure to take action to reduce risk factor". CONCLUSION: accurate clinical indicators identification assists clinical reasoning for diagnostic inference in specific health contexts.

Gastrointestinal symptoms and well-being of adults living on a gluten-free diet: a case for nursing in celiac disease.

Women with celiac disease (CD) living on a gluten-free diet (GFD) show a lower health-related quality of life and report a higher rate of gastrointestinal (GI) symptoms than men with CD. Uncertainty exists as to whether GI symptoms may explain the poorer treatment outcome of women with CD. This study was designed to explore relationships of GI symptoms and psychological well-being in men and women with long-standing CD. Patients with CD (n = 108; 59% women), aged 45-64 years, treated with a GFD for at least 8 years were evaluated by the Gastrointestinal Symptom Rating Scale and the Psychological General Well-Being index. The results show that women with a high rate of GI symptoms have no lower level of psychological well-being than corresponding men with CD and that women with CD with reduced psychological well-being have no more GI symptoms than corresponding men. Our results fail to support the notion that the reduced subjective health in CD is explained by GI symptoms. They may be secondary to perceived difficulties in managing everyday life, suggesting that launching a nurse-led follow-up may be helpful, as has been proven to be useful in other lifelong disorders.

Celiac Disease Awareness: Unraveling the Secrets of Celiac Disease.

School nurses play a major role in the care of students with food-related diversities balancing responsibilities such as providing a safe environment, encouraging leadership and community outreach, giving guidance to family and peers with care coordination, and providing needed accommodations so that all students may thrive in the school setting. It is essential that school nurses share their understanding of what it is like to live with the serious genetic autoimmune disorder known as celiac disease. With improved knowledge, the school education team, nutritional staff, and guidance counselors will have a better understanding of what the student is facing and the unique challenges it presents, because celiac disease is not a food allergy, but much more.