Q & A

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QUESTION: Would you recommend a gluten challenge for children diagnosed at very young ages (12-20 months old)? Suppose the child's original diagnosis was based on positive blood screening and an endoscopy with positive biopsy findings?

DR. RUDERT: One needs to proceed extremely carefully prior to recommending a gluten challenge and this is based on the individual after taking an extensive history. In the exceptional patient that I do decide to challenge, I follow them closely since they may become severely symptomatic. I am recommending gluten challenge less and less although there are some patients in which the original diagnosis may be in doubt and, once again, I base my decision after taking a detailed history and physical exam in addition to reviewing past labs and biopsies. If, indeed, the child's original diagnosis was Celiac Disease based on positive bloods and small bowel biopsy I would see no benefit in recommending a gluten challenge. Celiac Disease is a life long disorder and requires life long adherence to a gluten free diet.

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