B4647 - Coeliac Disease in the Children of the 90s - 04/07/2024

B number: 
B4647
Principal applicant name: 
Jennifer Hirst | DPhil (PhD) Supervisor (United Kingdom)
Co-applicants: 
Dr Christian Farrier, Dr Marta Wanat, Prof Anthony Harnden
Title of project: 
Coeliac Disease in the Children of the 90s
Proposal summary: 

Coeliac disease is a chronic illness that often begins in childhood. It is an autoimmune disorder, which means the body's immune system incorrectly attacks healthy tissues, causing inflammation. In coeliac disease, this attack occurs in the gut when gluten—a protein found in wheat and other grains—is consumed. About 1% of people have coeliac disease.

The symptoms of coeliac disease can range from minimal to no symptoms in some people, to vague symptoms often seen in childhood such as stomach upset, diarrhoea, fatigue, or poor growth. These symptoms can also be found in other illnesses, which makes it challenging for doctors to decide on the necessary tests or whether to refer a child to a specialist for a confirmed diagnosis. Delays in diagnosing coeliac disease can lead to delays in treatment and result in worse health outcomes, such as poor growth, weakened bones, and an increased risk of certain cancers.

Our team has performed a review of all the research looking at what is linked with a higher risk of getting coeliac disease in children. From this other work, breastfeeding was linked with lower rates of coeliac disease in some studies, and antibiotic use in early childhood was sometimes linked with a higher risk of coeliac disease.

In our proposed study, we will use data from the "Children of the 90s" cohort to examine whether breastfeeding and the use of antibiotics might be linked to the risk of developing coeliac disease along with associated GP/hospital records. We will employ statistical methods to analyse data from this cohort to determine whether breastfeeding may help to decreases the risk of developing coeliac and if use of antibiotics in young children is linked with an increase in coeliac disease.

What we learn from this project may be able to help doctors in knowing what questions to ask to understand which children are at risk for coeliac disease. This could help with making the diagnosis of coeliac disease as early as possible. This information will also be valuable for informing the guidelines on breastfeeding and antibiotic prescribing.

Impact of research: 
We hope to contribute to the evidence base regarding the diagnosis of coeliac disease in children and young people in primary care. The proposed cohort study using ALSPAC will further our understanding of potentially modifiable risk factors associated with coeliac disease in children in primary care in the UK. This work builds on information from existing observational studies, tools and models. This project is a part of a mixed-methods PhD focussing on the diagnosis of coeliac disease in children. In integrating the findings from all the components of Christian’s overall PhD work (a systematic review/meta-analysis, qualitative study and the cohort study using ALSPAC), we will generate a list of recommendations relevant to GPs about how to identify at-risk children and young people and to make a timely diagnosis of coeliac disease. There may be some areas with insufficient evidence to make a clear recommendation or with uncertain/borderline results. In this case, the findings from these areas and any identified limitations, will inform recommendations for next steps and future research rather than recommendations for a GP audience. The goal of this and future work is to continue to build this evidence base and improve the timely diagnosis of coeliac disease in children and young people in primary care in the UK. The results will all be shared with Coeliac UK to aid in dissemination and making the results available to those living with coeliac disease. If breastfeeding is found to have a protective effect, the results will also be shared with breastfeeding campaign/support groups.
Date proposal received: 
Monday, 24 June, 2024
Date proposal approved: 
Monday, 24 June, 2024
Keywords: 
Clinical research/clinical practice, Coeliac Disease, Statistical methods, Breastfeeding Antibiotic Use