Early Detection and Integrated Management of Pediatric Celiac Disease: A Multidisciplinary Approach through general practitioner, nursing , laboratory and pediatric gastroenterologist

Abstract

Celiac disease (CD) in children is a chronic, immune-mediated enteropathy precipitated by gluten exposure in genetically predisposed individuals, with a global prevalence approaching 1% and substantial underdiagnosis that delays treatment and increases the risk of growth failure, micronutrient deficiencies, bone demineralization, pubertal delay, neurocognitive and psychosocial sequelae, and coexisting autoimmune disease burdens. In the pediatric setting, where manifestations are protean and may evolve from “classical” malabsorption to extra- intestinal or subtle phenotypes, early detection hinges on vigilant general practitioner (GP) case-finding, intelligent nursing-led symptom surveillance and adherence support, laboratory accuracy in preanalytic, analytic, and interpretive steps of serology and genetics, and decisive, evidence-basedpediatric gastroenterology leadership for diagnosis confirmation, biopsy-sparing eligibility assessment, complication screening, and structured follow-up. Contemporary guidance—particularly the ESPGHAN 2020 update—endorses standardized serologic algorithms emphasizing tissue transglutaminase IgA (tTG-IgA) with total IgA, reflex IgG-based assays when IgA deficiency is present, and carefully delimited no-biopsy pathways when tTG-IgA is ≥10× the upper limit of normal (ULN) with endomysial antibody (EMA) positivity on a second sample; these developments have simplified pathways, reduced invasive procedures, and reinforced the centrality of quality- assured laboratory methods in getting the diagnosis right the first time (1–6). Saudi Arabia contributes an important perspective: population-based and risk-group studies reveal a CD burden comparable to or higher than Western cohorts, especially among children with type 1 diabetes and autoimmune thyroid disease, while regional practice has increasingly adopted ESPGHAN-aligned strategies, highlighting opportunities to strengthen case-finding in primary care, expand dietetic access, and standardize gluten-free food labeling and school-based support (7–13). This review synthesizes epidemiology, pathophysiology, clinical spectrum, and the multidisciplinary operational model—detailing GP triggers for testing, nursing workflows, laboratory quality imperatives, and pediatric gastroenterologist decision- points—then proposes integrated metrics and implementation tactics (including Saudi-specific enablers) to accelerate diagnosis, improve adherence to the gluten- free diet (GFD), minimize complications, and optimize long-term quality of life.