Abstract: Objective To enhance pediatricians understanding of celiac disease and reduce the rates of misdiagnosis and missed diagnosis by reporting 2 cases of celiac disease. Methods The clinical data and follow-up results of two pediatric patients with celiac disease who were admitted to the Department of Pediatrics at Shandong Provincial Hospital Affiliated to Shandong First Medical University were analyzed. Patient 1 was a male infant aged 1 year and 7 months who presented with progressive abdominal distension, diarrhea, and growth retardation. Patient 2 was a male child aged 4 years and 6 months who presented with persistent diarrhea accompanied by wasting for > 3 months. Both patients exhibited elevated levels of cows milk protein-specific IgE antibodies and total IgE. Celiac antibody testing revealed a significant increase in the levels of anti-tissue transglutaminase, anti-endomysial, and anti-deamidated gliadin peptide antibodies. Wanfang, CNKI, Chinese Medical Journal, and PubMed databases were searched using the keywords "celiac disease" and "cows milk protein allergy". Results Following cows milk protein avoidance and stimulation tests, patient 1 was diagnosed with celiac disease combined with cows milk protein allergy. Subsequent adherence to a gluten-free diet, cows milk protein avoidance, and symptomatic treatment improved abdominal distension and diarrhea during a follow-up period of 46 months with satisfactory growth and development. Patient 2 was diagnosed with celiac disease and suspected cows milk protein allergy and was subsequently referred to the Childrens Hospital of Fudan University for further treatment. Subsequent follow-ups revealed reduced diarrhea symptoms following symptomatic treatment, adherence to a gluten-free diet, cows milk protein avoidance, and oral hormone administration. However, wasting did not improve. Conclusion Children presenting with prolonged abdominal distension, diarrhea, wasting, and growth retardation should be monitored for possible celiac disease. It is crucial to remain alert to the potential coexistence of cows milk protein allergy, and treatment should focus on adhering to a gluten-free and cows milk protein-avoidance diet.

Key words: Celiac disease, Cows milk protein allergy, Growth retardation, Gluten-free diet, Children