Coeliac Disease in Children: Diagnosis, Gluten-Free Living, and Thriving in Dubai

What Is Coeliac Disease?

Coeliac disease is an autoimmune condition where the body's immune system attacks its own tissues when gluten is eaten. Gluten is a protein found in wheat, barley, and rye — meaning it's in bread, pasta, cereals, biscuits, cakes, and many processed foods.

When a child with coeliac disease eats gluten, their immune system damages the lining of the small intestine (the villi — tiny finger-like projections that absorb nutrients). Over time, this leads to malabsorption — the body cannot properly absorb vitamins, minerals, and calories from food.

Coeliac disease affects approximately 1 in 100 people worldwide, but studies suggest up to 75% remain undiagnosed because symptoms can be subtle or attributed to other conditions.

Is It Coeliac Disease, Gluten Sensitivity, or Wheat Allergy?

Parents often confuse these three conditions:

Signs of Coeliac Disease in Children

Coeliac disease is often called the "great mimicker" because it can present in many different ways:

Classic symptoms (gut-related):

• Chronic diarrhoea or constipation (or alternating)
• Bloated, distended tummy
• Excessive wind
• Stomach pain after meals
• Pale, foul-smelling, floating stools (steatorrhoea)
• Vomiting
• Poor appetite

Non-classic symptoms (often missed):

• Failure to thrive — falling off growth chart, not gaining weight
• Short stature — unexplained poor growth
• Iron-deficiency anaemia — not responding to iron supplements
• Fatigue and irritability — "always tired" child
• Delayed puberty — late onset compared to peers
• Dental enamel defects — pitting, discolouration of permanent teeth
• Recurrent mouth ulcers (aphthous ulcers)
• Dermatitis herpetiformis — intensely itchy blistering rash on elbows, knees, buttocks
• Joint pain — unexplained aches
• Headaches — chronic or recurrent
• Behavioural changes — mood swings, difficulty concentrating

Who should be tested:

• Children with any of the above symptoms
• First-degree relatives of someone with coeliac disease (10% risk)
• Children with Type 1 diabetes (10% have coeliac disease)
• Children with Down syndrome, Turner syndrome, or Williams syndrome
• Children with autoimmune thyroid disease
• Children with unexplained iron deficiency

How Coeliac Disease Is Diagnosed

Step 1: Blood test (tTG-IgA)

• Tissue transglutaminase (tTG) antibodies — the primary screening test
• Total IgA level (to rule out IgA deficiency, which causes false negatives)
• Must be eating gluten-containing diet for at least 6 weeks before testing
• Important: Do NOT start a gluten-free diet before testing — it makes diagnosis impossible

Step 2: Referral to paediatric gastroenterologist

• If blood test is positive, referral for further assessment

Step 3: Small bowel biopsy (endoscopy)

• Gold standard for diagnosis in most cases
• Performed under sedation — takes about 15 minutes
• Looks for villous atrophy (flattened intestinal lining)
• Child must still be eating gluten at time of biopsy

Step 4: Response to gluten-free diet

• Symptoms should improve within weeks
• Repeat blood tests at 6-12 months should normalise
• Confirms diagnosis

Gluten-Free Living in Dubai: A Practical Guide

Dubai has become increasingly gluten-free friendly, but navigating daily life still requires knowledge and planning.

Naturally gluten-free foods (always safe):

• Rice, potatoes, corn, quinoa, buckwheat (despite the name)
• All fresh fruits and vegetables
• Fresh meat, fish, eggs
• Dairy products (plain milk, cheese, yoghurt)
• Nuts and seeds
• Lentils, chickpeas, beans
• Arabic staples: hummus, baba ganoush, tabbouleh (if made with quinoa instead of bulgur)

Hidden gluten sources (check labels carefully):

• Soy sauce (contains wheat — use tamari instead)
• Processed meats (sausages, deli meats may contain wheat fillers)
• Soups and sauces (flour used as thickener)
• Crisps and snacks (flavourings may contain gluten)
• Medications and vitamins (wheat starch as filler)
• Play-Doh (contains wheat — use gluten-free alternatives)
• Communion wafers (gluten-free versions available)

Shopping in Dubai:

• Spinneys — dedicated gluten-free section, good range of Schär products
• Waitrose — extensive free-from aisle
• Carrefour — growing gluten-free selection, good value
• Kibsons — delivers gluten-free items
• iHerb — ships to UAE, wide range of GF products
• Look for the crossed grain symbol (international GF certification)

Dining out in Dubai:

• Many restaurants now offer gluten-free menus or mark GF items
• Always inform staff about coeliac disease (not just "preference")
• Be cautious with shared fryers (chips cooked in same oil as breaded items)
• Arabic restaurants: grilled meats, rice dishes, and salads are generally safe; avoid anything with bread, pastry, or kibbeh
• Sushi: use tamari instead of soy sauce; avoid tempura rolls
• Indian restaurants: rice dishes, tandoori (check marinade), dhal — avoid naan, roti, samosas
• Italian restaurants: many now offer GF pasta and pizza bases

School lunches:

• Provide a packed lunch with clearly labelled GF items
• Educate your child about what they can and cannot eat
• Inform the school about coeliac disease (it's medical, not a choice)
• Request that your child is not excluded from food-related activities
• Provide GF alternatives for birthday parties and celebrations

Monitoring and Follow-Up

Children with coeliac disease need regular monitoring:

• Blood tests (tTG) every 6-12 months to check compliance and response
• Growth monitoring — should catch up once gluten-free
• Nutritional assessment — check iron, vitamin D, calcium, B12, folate
• Bone density — if diagnosis was delayed or compliance is poor
• Dietitian review — especially in the first year, to ensure nutritional adequacy

The Al Das Team

At Al Das, our GPs and paediatricians can:

• Screen for coeliac disease with blood tests
• Refer for specialist gastroenterology assessment if needed
• Monitor growth and nutritional status
• Provide ongoing support and dietary guidance
• Check for associated conditions (thyroid, diabetes)

"I see many children in Dubai who have been labelled as 'fussy eaters' or told they have IBS, when in reality they have undiagnosed coeliac disease. If your child has chronic tummy problems, poor growth, or unexplained anaemia, a simple blood test can change their life. The transformation once they go gluten-free is often remarkable — parents tell me they have a 'new child'." — Dr. Riham Ammar, Specialist Paediatrician

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