Pica as a presenting symptom in childhood celiac disease

Article Abstract:

Pica is the practice of eating any substance compulsively; the item may be a food or something not considered food, such as soil or clay. Many theories have been suggested to explain why pica develops. Pica may be a sign of psychological illness, or in some cultures, an accepted religious ritual. Physical causes are also possible, as shown by research linking both iron deficiency and zinc deficiency with pica. These nutritional deficiencies may be either the cause or the result of pica. The cases of three young children who had persistent pica are discussed; all had a type of pica called geophagia, meaning they ate soil, clay, and stones. All three were severely iron-deficient. The cases were unusual because the children were found to have celiac disease, a gastrointestinal condition caused by allergy to gluten, a protein found in wheat and certain other grains. Before celiac disease is diagnosed, patients may suffer from severe diarrhea, malabsorption and intestinal bleeding. In these children, the intestinal symptoms were quite mild, but they developed severe iron deficiency and growth failure as a result of their chronic malabsorption. Once put on a gluten-free diet, the children experienced large growth spurts, and their pica resolved completely. In these children, pica was apparently the result of iron deficiency, which in turn was caused by celiac disease. Children with pica and anemia should be evaluated for celiac disease, particularly if they are growing poorly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Pediatric diseases, Compulsive eating, Binge eating disorder, Eating disorders in children, Childhood eating disorders, Pica (Pathology), Pica, Iron deficiency anemia, Iron deficiency anemia in children

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The duodenal string test

Article Abstract:

The collection of fluid samples from the upper digestive tract can be both traumatic and expensive for the patient if the usual methods (duodenal intubation, endoscopy, or biopsy) are used. The "string test" utilizes a simple device consisting of an absorbent string in a capsule that is small enough to be swallowed. The string is subsequently retrieved through the mouth with samples of duodenal secretions adhering to it. No special facilities, personnel or patient pretreatment are required for its use. The capsules come in adult and children's sizes, with accompanying pH indicator sticks to help identify the section of the intestine through which parts of the string passed. After a 4-hour or overnight fast, the tail of the string is taped to the cheek and the capsule with string enclosed is swallowed, with assistance if needed. Then the patient simply waits for three to four hours; drinking fluids is suggested in the first two hours to facilitate passage of the string into the intestine. After four hours, the string is withdrawn through the open mouth. The duodenal secretions on the end of the string can be squeezed off into a sterile Petri dish for subsequent culture or microscopic examination. The string test is used primarily for detection of Giardia lamblia, a parasite. Other parasites have been successfully diagnosed as well. Salmonella typhi has been isolated from string cultures when other procedures failed to diagnose the problem. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Medical examination, Parasitic diseases, Giardia, Giardia lamblia, Digestive system diseases, Duodenum, String

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A gut issue

Article Abstract:

Coeliac disease may be diagnosed by detecting 'structurally abnormal jejunal mucosa' when a person eats gluten. This should improve when gluten is removed. A child with coeliac disease will have chronic diarrhoea and distention of the abdomen. Adults may have a range of symptoms and may be overweight. Twice as many adult women as men have coelics disease but in children the proportion is about equal. The condition runs in families and it is polygenic. Gluten should not be give to babies who are genetically vulnerable until they are at least six months old.

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