The following is a summary of “A Clinician’s Guide to Gluten Challenge,” published in the December 2023 issue of Pediatrics by Singh, et al.

For a study, researchers sought to provide a comprehensive overview of the current evidence and practical considerations associated with gluten challenges in diagnosing celiac disease (CD) in pediatric patients. The goal was to propose a clinical algorithm for guiding testing in this population.

Various factors such as childhood development, social circumstances, and long-term health concerns should be considered when identifying candidates for the gluten challenge. They stressed the importance of baseline serology, suggesting a minimum daily intake of 3–6 grams of gluten over 12 weeks to optimize diagnostic accuracy for CD evaluation. A formal provider check-in at 4–6 weeks is recommended to allow necessary adjustments to dosing or duration. Increasing the gluten dose further may enhance diagnostic yield in some cases, while a lower dose and shorter course (6–12 weeks) may suffice in select cases.

Consensus was observed regarding mild elevations in celiac serology (<10 times the upper limit of normal) or symptoms, which, while supportive, are not diagnostic for CD. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines emphasize histologic findings, including intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy, as the accurate and most appropriate endpoint for gluten challenge.

The study provided valuable insights for clinicians navigating gluten challenges in pediatric CD diagnosis, considering diagnostic accuracy and individual patient considerations.

Source: journals.lww.com/jpgn/abstract/2023/12000/a_clinician_s_guide_to_gluten_challenge.4.aspx