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    Down Syndrome: Celiac Disease Prevalent in Children With Down Syndrome


    Scott Adams


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    Am J Med Gen 2001;98:70-74.

    Celiac.com 02/15/2001 - Dr. Susan L. Neuhausen and associates at the University of Utah School of Medicine in Salt Lake City studied 97 Caucasian children with Down Syndrome, ages 2 to 18 years. Their results, which were published in the January issue of the American Journal of Medical Genetics, show that 10 of the children tested positive for celiac disease (IgA anti-endomysial antibody). This is a rate that is about 25 times the general population.

    According to the results of genetic testing on these children, their genetic predisposition is the same as in the general population, which leads the researchers to believe that a gene on chromosome 21 may be involved in the pathogenesis of celiac disease.. The only symptom exhibited by the children was bloating. Six of the children who were found to have celiac disease are now on a gluten-free diet and have experienced significant improvement of their symptoms.

    Conclusion: Children with Down Syndrome should be screened for celiac disease because there is a 10% incidence of the autoimmune disorder in this population. Screening for and treating celiac disease can improve the quality of life for children with Down Syndrome.

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    Guest Chris Wellington

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    My 3 y/o Daughter has Downs Syndrome and has digestion problems. We were recently informed of the possibility of celiac disease and she has been tested for it. It would explain a lot of the symptoms she is having and her trouble 'thriving'. I am glad I came across this article. It really helps knowing that there are easier solutions to some of the obstacles we face

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  • Related Articles

    Scott Adams
    November 1993. European Journal of Pediatrics. Authors Hilhorst MI. Brink M. Wauters EA. Houwen RH. Institution: Department of gastro-enterology, Wilhelmina Childrens Hospital, Utrecht, The Netherlands. The frequency of celiac condition is 43 times greater in children with Down syndrome than in children without Down syndrome. It should be strongly considered in all children with Down syndrome who have either persistent diarrhea or failure to thrive.
    Leyden University Medical School just finished a large scale investigation. 198 families with a child with DS aged between 1 and 9 years were approached. 115 decided to have their child participate. The first researcher, Elvira George, made home visits and collected blood and urine for testing. A. o. values of anti-endomysium (EmA) were determined. Only if one of the investigated blood or urine values was significantly different from the norm the child was referred to the hospital to take a biopsy. That was the case with 43 of the 115 children. In 9 cases no biopsy was taken, in six because the parents refused it and in 3 because the childs condition didnt allow for it. Of the 34 children that had a biopsy taken eight, or rather 7 % (!) of the original 115, had the intestinal appearance typical for celiac disease (according to international standards).
    Retrospectively, five of these eight children had complaints that were compatible with celiac disease, that were considered to be caused by DS as such until then. Three children were free of complaints. Their diagnosis was a complete surprise. In addition, it was proven that the value for EmA was the strongest indicator of a positive biopsy. If EmA was positive there always was celiac disease upon biopsy.
    Needless to say that all (so far but one) concerned children were put on a totally gluten free diet. It was reported that their complaints decreased rapidly. Celiac disease is considered to put people involved at risk for particular intestinal cancers, if they do not keep their diet. Therefore, the diet has to be maintained lifelong. This aspect makes testing for celiac disease so important in an at risk population as children with DS are. Even without complaints one in fourteen of our children might have it! It is postulated that the children who had different blood values, but no positive biopsy still can develop celiac disease in the future.
    Presently, the complete study is in the process of being published in the international literature. So, Im afraid Im only able to give a you a reference to a pre-publication:
    Reference: George, E. et al. The high frequency of celiac disease in DS: screening methods. Gastroenterology 1995; 108 (Supp 4): A 16.iv

    Scott Adams
    Erik de Graaf
    director, Stiching Down Syndrome (SDS)
    (i.e., the Dutch Down Syndrome Foundation)
    Vice-President of the European Downs Syndrome Association (EDSA)
    Bovenboerseweg 41
    NL-7941 AL Wanneperveen
    The Netherlands
    Tel.: -31-(0)522-28 13 37
    Fax.: -31-(0)522-28 17 99
    E-mail: sdswannl@knoware.nl
    Leyden University Medical School just finished a large-scale investigation using 198 families who have a child with DS between the ages of 1 and 9 years old. 115 decided to have their child participate. The first researcher, Elvira George, made home visits and collected blood and urine for testing. A. o. values of anti-endomysium (EmA) were determined. Only if one of the investigated blood or urine values was significantly different from the norm was the child referred to the hospital to take a biopsy. That was the case with 43 of the 115 children. In 9 cases no biopsy was taken, in six because the parents refused it and in 3 because the childs condition didnt allow for it. Of the 34 children that had a biopsy taken, eight, or rather 7 % (!) of the original 115, had the intestinal appearance typical for celiac disease (according to international standards).
    Retrospectively, five of these eight children had complaints that were compatible with celiac disease, that were considered to be caused by DS as such until then. Three children were free of complaints. Their diagnosis was a complete surprise. In addition, it was proven that the value for EmA was the strongest indicator of a positive biopsy. If EmA was positive there always was celiac disease upon biopsy.
    Needless to say that all (so far but one) concerned children were put on a totally gluten free diet. It was reported that their complaints decreased rapidly. Celiac disease is considered to put people involved at risk for particular intestinal cancers, if they do not keep their diet. Therefore, the diet has to be maintained lifelong. This aspect makes testing for celiac disease so important in an at risk population as children with DS are. Even without complaints one in fourteen of our children might have it!
    It is postulated that the children that had different blood values but no positive biopsy can still develop celiac disease in the future. Their condition will remain be followed. Presently, the complete study is in the process of being published in international literature. There is the following pre-publication reference:
    George, E. et al. The high frequency of celiac disease in DS: screening methods. Gastroenterology 1995; 108 (Supp 4): A 16 For more information:
    Medical & Surgical Care for Children with Down Syndrome Ed. by DC Van Dyke MD, Woodbine House l995 ISBN ## 0-933149-54-9 p. 185 ...one study found that individuals with DS are 20 times more likely than others to have a particular malabsorption syndrome known as celiac disease. This section is written by Timothy M Buie MD and references DS and Celiac Disease Pediatric Gastroenterology and Nutrition Vol. 10, No.1. l990 41-43 by Dias, J. and Walker-Smith, J.

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    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
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    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023