Beyond Tummy Pain: Coeliac Disease in Children

In this episode, Dr Julia Rawlinson is joined in this two-part series by Dr Emma Turner, Paediatric Gastroenterologist and Hepatologist at Perth Children’s Hospital, and Dr Erin Horsley, GP Anaesthetist with a special interest in gastroenterology and lived experience parenting a child with coeliac disease.

Providing practical advice for GPs on recognising and investigating coeliac disease in Australian children.

Key points discussed:

• Prevalence and Risk: Coeliac disease affects about 1 in 70 Australians, with 80% undiagnosed. First-degree relatives have a 10-20% risk depending on family history.
• Clinical Presentation: Symptoms can include iron deficiency, growth failure, pubertal delay, abdominal pain, and altered bowel habits. Less obvious presentations might be behavioural issues, sleep problems, mild elevation of liver enzymes, dental enamel defects, and recurrent mouth ulcers. Diagnosis should still be considered in children who are growing normally or are obese.
• Testing Approach: The recommended initial tests are tissue transglutaminase IgA (TTG-IgA) and total IgA. Gluten intake must be adequate for accurate results. There is no current recommendation for population screening, but GPs are encouraged to maintain a low threshold for testing symptomatic children.
• Diagnosis and Specialist Involvement: Non-biopsy diagnosis can be considered for children with TTG-IgA >10× upper limit of normal plus confirmatory endomysial antibody testing, but all cases require confirmation by a paediatric gastroenterologist. Early gluten-free diets before testing complicate diagnosis and may require a supervised gluten challenge.
• Screening Relatives and Genetic Testing: All first-degree relatives should be screened, ideally at the time of index case diagnosis, and re-tested every 2–3 years if negative. HLA genetic testing is useful only to exclude coeliac disease, not to confirm it.

Part 2 will focus on managing coeliac disease long term and practical advice for GPs and families.

Links & Resources:

• https://coeliac.org.au/health-professionals/gluten-challenge/
• Health professionals - Coeliac Australia
• Ongoing management - Coeliac Australia
• https://coeliac.org.au/health-professionals/ongoing-management/

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!