Celiac disease is an immune-mediated systemic disease triggered by intake of gluten in genetically susceptible individuals. The prevalence of celiac disease in the general population is estimated to be 1% in the world. Its prevalence differs depending on geographical and ethnic variations. The prevalence of celiac disease has increased significantly in the last 30 years due to the increased knowledge and awareness of physicians and the widespread use of highly sensitive and specific diagnostic tests for celiac disease. Despite increased awareness and knowledge about celiac disease, up to 95% of celiac patients still remain undiagnosed. The presentations of celiac disease have significantly changed in the last few decades. Classical symptoms of celiac disease occur in a minority of celiac patients, while older children have either minimal or atypical symptoms. Serologic tests for celiac disease should be done in patients with unexplained chronic or intermittent diarrhea, failure to thrive, weight loss, delayed puberty, short stature, amenorrhea, iron deficiency anemia, nausea, vomiting, chronic abdominal pain, abdominal distension, chronic constipation, recurrent aphthous stomatitis, and abnormal liver enzyme elevation, and in children who belong to specific groups at risk. Early diagnosis of celiac disease is very important to prevent long-term complications. Currently, the only effective treatment is a lifelong gluten-free diet. In this review, we will discuss the epidemiology, clinical findings, diagnostic tests, and treatment of celiac disease in the light of the latest literature.

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Background: Type 1 Diabetes Mellitus (DM), autoimmune disorders, relatives of celiac patients have higher risk of developing celiac disease (CD) because they share the same HLA type. Celiac disease and type 1 DM are autoimmune and common in children. According to international guidelines, serological screening for CD in children and adults with type 1 DM is recommended but there is no consensus on how often it will be performed. Objectives: We aimed to investigate the prevalence of CD in children with type 1 diabetes mellitus (DM). Methods: This current study was carried out between 01 March 2017 and 15 December 2018. 273 children with type 1 DM were included in the study. Tissue transglutaminase antibody IgA (tTG IgA) and total IgA levels were measured in all patients. The patients with tTG IgA positivity underwent gastroduodenoscopy. Results:Of the 273 patients (139 girls), the mean age was 11.61 ± 3.73 years. tTG IgA was positive in 23 patients, and 2 of them refused the process of endoscopy. Gastroduodenoscopy was performed on other patients. 11 patients with Marsh 3, 2 patients with Marsh 2, 4 patients with Marsh 1, and 4 patients with Marsh 0 were detected in the present study. In other words, 12 patients were diagnosed with CD. Nine of 12 patients diagnosed with CD were diagnosed within the first 5 years after the diagnosis of type 1 DM. Conclusions:We found that the prevalence of biopsy-proven CD in children with type 1 DM was 4.4%, which was approximately 9 times higher than the prevalence of CD in the general population. In the current study, 9 of 12 patients diagnosed with CD were diagnosed within the first 5 years after DM. According to our results, we recommend that screening tests for CD should be performed at least once a year for 5 years in children with Type 1 DM, even if the patients are asymptomatic.

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Congenital chylothorax is the accumulation of lymphatic fluid within the pleural space. Cases unresponsive to conservative management usually require surgery. Octreotide has been used successfully to treat post-traumatic chylothoraces in the pediatric and adult population. Its exact mode of action is uncertain but it is believed to reduce lymphatic drainage by a direct action on splanchnic lymph flow. We report a case of congenital chylothorax where surgery was avoided with the compassionate trial of the somatostatin analogue, octreotide. A 33 week gestation female infant, born with the presence of large bilateral pleural effusion, was unresponsive to conservative management. Octreotide was commenced on day 15, with 10 days of an octreotide infusion, initially 0.5 microg/kg per hour and increased daily by 1 microg/kg per hour to 10 microg/kg per hour. Treatment was associated with prompt respiratory improvement prior to cessation of pleural drainage over the 10 day. She remains well at 6 months of age. Further studies are required to ascertain its true value in congenital chylothorax.