Abstract

110 children with coeliac disease investigated over a period of 19 years are presented in 2 groups, 74 children presenting under 4 years and 36 over 4 years.

Sixty per cent of the older children showed extreme stunting of growth, while 28% in the younger group at referral were on or below the 3rd centile. 75% of the younger children were anaemic as compared with over 90% of the older children.

Since 1952 all patients have been treated with a gluten-free diet, but in acute cases fluids only were allowed until dilatation of the small bowel had subsided. Thereafter, a low-fat-milk, and gluten-free diet was introduced in easy stages. Nearly all the younger children showed a good response to treatment, and an average weight gain of 1·6 kg was recorded 2 months after treatment had begun. There was no clinical evidence of lactase deficiency.

Relapses occurred in every child who had returned to a gluten-containing diet for any length of time. In younger children symptoms soon became apparent, but in the older group symptoms were sometimes delayed for months—or even years. Methods for detecting such subclinical relapses are described.

Forty-four children were followed up for periods of 8 to 19 years. 20 children who remained on a gluten-free diet gained weight, grew normally, and had no complications. The remainder, who did not, developed suboptimal growth and chronic ill health and were prone to diarrhoeal attacks, iron deficiency, and megaloblastic anaemia. 2 developed dermatitis herpetiformis. One had a crisis at pregnancy.

Reasons are given for recommending a life-long gluten-free diet.