Keypoints coeliac. 08.11.01


                                                   DOWN'S SYNDROME
                 COELIAC DISEASE/GLUTEN SENSITIVITY

                                                                      Key Points
(based on DSMIG Clinical Awareness Notes. J Dennis, C.Charlton. G Holmes)

·  Prevalence 4 ­ 17% depending on age of sample and
      country of origin

·  May be associated with type 1 diabetes and/or thyroid
      disease

·  Clinical diagnosis difficult because of overlap with
      normal features of the syndrome therefore need to have
      low threshold of clinical suspicion

·  Whole population screening not currently recommended.

·  AGA screen not useful in DS population. AEA effective

·  AEA screen for all with major or minor symptoms as
      follows:

          · Disordered bowel function tending to diarrhoea or to new onset
                 constipation
          · Failure to thrive as indicated using Down's syndrome specific reference
                 charts (Harlow Printing 2000);
          · Abdominal distension
          · General unhappiness and misery
          · Arthritis
          · Rash suggesting dermatitis herpetiformis
          · Existing type 1 diabetes, thyroid disease or anaemia

·  If AEA positive, or if negative but with significant
      symptoms, proceed to small intestinal biopsy as in
      general population.

·  Treat with gluten free diet as for general population

·  Dietary compliance seems no more problematic than in
      general population

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DSMIG (UK) 2001   www.dsmig.org.uk                                                                                                                           16.01.02