Diagnostic dilemmas in celiac disease

Ma, Michael X; John, Mina; Forbes, Geoffrey M

doi:10.1586/17474124.2013.834125

Cited by 11 publications

(10 citation statements)

References 97 publications

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“…There is a strong genetic component in celiac disease, with the HLA‐DQ2 haplotype present in 90–95% and HLA‐DQ8 present in 5–10% . The absence of either of these haplotypes virtually excludes the diagnosis of celiac disease (NPV > 99%) . The limiting feature of genetic testing is the low specificity, with these HLA subtypes present in 20–30% of the population .…”

Section: Discussionmentioning

confidence: 99%

Value of routine duodenal mucosal biopsies in the evaluation of anemia in a large Australian referral centre

2018

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Background and AimSmall bowel mucosal biopsies (SBBx) are routinely performed to investigate unexplained anemia; however, previous studies have demonstrated a low yield in diagnosing celiac disease. Our aim was to determine the yield of routine SBBx in a large cohort of patients who underwent gastroscopy for the investigation of anemia.MethodsData from consecutive patients who underwent gastroscopy for the investigation of anemia in a tertiary hospital, from January 2008–December 2011, were prospectively collected. Measured outcomes were the prevalence of celiac disease, the yield of duodenal biopsies, and the correlation between celiac serology and diagnosis.ResultsOver 4 years, 987 patients (385 M:602 F; 48.27 ± 15.89 years) underwent endoscopy for anemia, of which 534 (54.1%) had proven iron deficiency anemia (IDA). Abnormal SBBx consistent with celiac disease were found in 2% (22/987), with a higher prevalence in females (3.2%, n = 19 vs 0.8%, n = 3 in males) and in those with IDA (3.6%, n = 19 vs 0.7%, n = 3 in non‐IDA). Macroscopic endoscopic abnormalities were present in 86% (19/22) of patients with celiac disease. Of the 178 patients who had celiac serology, tissue transglutaminase antibody had the highest sensitivity (80%) and specificity (99%). Combined serology had a sensitivity of 85.7%.ConclusionOnly 2% of patients with unexplained anemia had abnormal SBBx consistent with celiac disease and even fewer patients in non‐IDA. Given the availability and high sensitivity of celiac serology and macroscopic changes on endoscopy, SBBx should not be routine during endoscopy but should be limited to those with positive celiac serology, abnormal endoscopic appearance, or females with IDA.

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Section: Discussionmentioning

confidence: 99%

Value of routine duodenal mucosal biopsies in the evaluation of anemia in a large Australian referral centre

2018

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“…These symptom patterns area also not unique to CeD. [10,11] Most participants here were diagnosed with CeD, based initially on the presence of gastrointestinal symptoms, but many participants reported high levels of extra-intestinal symptoms such as brain fog, moodiness, sinus congestion, and comorbid conditions such as chronic fatigue. This would suggest that it is still the case that "classic" symptoms are still the most salient aspect of discomfort and diagnosis.…”

Section: Diagnostic Challengesmentioning

confidence: 99%

“…[6,7,8,9] CeD was initially considered a childhood disorder but it is more commonly diagnosed in adults. [10,11] Non-Celiac Gluten sensitivity (NCGS) has been verified to be another condition potentially separate from CeD, and includes individuals who also react to gluten. [12,13,14,15,16] Diagnosis of a gluten-triggered pathology is more likely if the individual reports "classic symptoms" such as diarrhea, fatty stools, and bowel pains, and displays anemia, osteoporosis, and vitamin deficiencies (e.g., B9, B12).…”

Section: Introductionmentioning

confidence: 99%

Community Based Pilot Study of Diagnostic Paths to the Gluten Free Diet

Stevenson

Rankin-Sunter²,

Maki³

et al. 2016

IJCD

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Wheat consumption is increasing worldwide and also increasing is the frequency of celiac disease (CeD), a pathological response to wheat protein (gluten) in genetically susceptible individuals. Non-celiac gluten sensitivity (NCGS) is another, less studied wheat-induced pathology. The treatment for both is a gluten-free diet (GFD). More individuals choose the diet than predicted by the epidemiological 1-2% prevalence. A preliminary survey by questionnaire asked members and attendees of the local gluten information group (GIG) meetings and functions about their diagnostic experiences and symptom levels in order understand the increased demand for gluten-free foods. Same-aged and-sex friends participated as a comparative "control". Mixed methods were used including content analyses of prose narratives and independent and paired t tests of symptom levels measured with Likert scales. This convenience sample, surveyed in 2011-2012, is mostly female (54 F, 5 M) with an average age of 54.6 ± 2.0 years. Most participants consulted medical professionals with mean time to diagnosis of 7 years determined mostly from "classic" presenting symptoms. Negative biopsies or blood tests and atypical symptoms that overlap other conditions delayed diagnosis. There were 43 and 16 participants with CeD and NCGS, respectively differing little in symptom levels. Self-diagnosis and use of naturopaths account for some of the "excess" individuals. General practitioners should be encouraged to get additional nutrition training and to discuss with patients dietary choices that support wellness and minimize the risk for pathological immune responses. Patients with CeD particularly need support and follow-up in the transition to a GFD.

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“…Gluten and its related prolamins are the causes of immunological process and disease onset (1). Although celiac disease is primarily a digestive tract disease, it can cause complications in most organs of the body (2). Epidemiologic studies report a global increase in the prevalence of the celiac disease, with different distribution patterns.…”

Section: Introductionmentioning

confidence: 99%

“…In suspected cases of IgA deficiency, it should simultaneously be requested with its serum level (1). This early assessment method is also suggested in most reputable references (2). The employment of different tests depends on the geographical region, accessibility, and the need for a more accurate diagnosis of the disease.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Tissue Transglutaminase and Anti-Endomysial Antibody Tests in Diagnosis of Celiac Disease

Shahmirzadi

Sohrabi

2019

J Compr Ped

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Background: Although initially considered as a digestive tract disease, celiac disease (CD) can cause problems and complications in most other organs. Common serologic tests for the diagnosis of CD include anti-tissue transglutaminase (tTG) and anti-endomysial Ab (EMA). A more recent test includes anti-deamidated gliadin peptide. Objectives: This study aimed to compare the values of tissue transglutaminase and endomysial antibodies in A and G Immunoglobin subtypes in patients with a definitive diagnosis of CD. Methods: Patients suspected of CD referring to a Gastrointestinal Pediatric Clinic were evaluated for CD using IgG and IgA for tissue transglutaminase and endomysial antibodies and total IgA. Endoscopy and biopsy were done based on the CD diagnosis protocol. The demographic data of children were recorded in a questionnaire and then analyzed. Results: Of the 54 patients diagnosed with CD, 29 were females and 25 were males. TTG-IgA had the highest positivity rate. Tests based on IgA were more positive than IgG tests. More than one test was positive in 81.5% of the patients. All four tests were positive in 16 patients. In 18.5 percent of patients, just one test was positive. In the latter group, TTG-IgA was positive in four patients. The coefficient of agreement between EMA-IgA and TTG-IgA was 0.435, which was statistically significant. Conclusions: We suggest tissue transglutaminase and endomysial antibodies in A and G Immunoglobin subtypes for the diagnosis of CD. In this method, the diagnostic sensitivity of CD is high and in the next step, endoscopy and sampling can increase the specificity value. If the tests are not available, preferable tests are IgA subtype antibodies.

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Diagnostic dilemmas in celiac disease

Cited by 11 publications

References 97 publications

Value of routine duodenal mucosal biopsies in the evaluation of anemia in a large Australian referral centre

Value of routine duodenal mucosal biopsies in the evaluation of anemia in a large Australian referral centre

Community Based Pilot Study of Diagnostic Paths to the Gluten Free Diet

Comparison of Tissue Transglutaminase and Anti-Endomysial Antibody Tests in Diagnosis of Celiac Disease

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