Diagnostic Testing for Celiac Disease Among Patients With Abdominal Symptoms

Windt, D.A.W.M. van der; Jellema, Petra; Mulder, Chris J.; Kneepkens, C. M. F.; Horst, Henriëtte E. van der

doi:10.1001/jama.2010.549

Cited by 180 publications

(110 citation statements)

References 44 publications

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“…Student's unpaired T test was applied to compare mean of quantitative variables between CD and IBS-D. Chi square test with Continuity correction or Fisher Exact Probability test was used to compare percentages of qualitative variables. Binary logistic regression model was applied to predict group (CD or IBS-D) with the help of predictor variables like age more than or less than 40 year, sex (male or female), body mass index(BMI) more than or less than 18.5kg/ m 2 , weight loss of more than 10 % in 6 months, mean duration of symptoms (more than or less than 6months), Iron Deficiency anaemia (IDA)present or absent, mean hemoglobin(Hb) level more or less than 10gm/dl , mean platelet count more than or less than 4.5 lakh/cumm, mean serum B12 levels more than or less than 200 pg/ml, mean serum albumin more than or less than 3 gm%, bone pains present or absent, mean serum calcium more than or less than 8 mg% and alanine aminotransferase (ALT) more than or less than 40mu/ml [9][10][11][12][13][14].All statistical tests were two tailed. Level of Significance was taken as P<0.05.…”

Section: Discussionmentioning

confidence: 99%

“…In our study CD group had lower serum calcium levels and IDA but serum B12 levels were not significantly different in both groups which is explained by the pathophysiology of CD where there is more proximal bowel malabsorption. Previous studies have shown that CD predisposes a patient to low bone mineral density (BMD) at all sites of the skeleton and 26%-72% of patients with CD have osteoporosis or Osteopenia leading to bone pains [10][11][12]. Osteopenia develops as a result of impaired calcium absorption which is secondary to defective calcium transport by the diseased small intestine [12].While iron deficiency is the commonest cause of anaemia because of iron absorption from proximal small intestine, untreated subjects with CD can have folic acid and less commonly vitamin B12 deficiency [9].…”

Section: Discussionmentioning

confidence: 99%

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Factors Predicting Whom to Screen for Coeliac Disease in Patients with Diarrhoea Predominant Irritable Bowel Syndrome in Developing Countries

Somani¹,

Shah²,

Amarapurkar³

2016

JGPLD

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AIM: Screen all patients with irritable bowel syndromediarrhoea (IBS-D) for coeliac disease (CD) is no cost effective strategy in developing countries. So we planned this study to look for the clinical features and laboratory parameters useful to screen the patients of IBS-D for CD. Methods:We prospectively analyzed this retrospectively maintained data of 198 patients with chronic diarrhoea. IgA anti endomysial antibodies (EMA) and IgA were done in all patients and oesophagogastroduodenoscopy was done in patients with positive EMA (>40units/ml) and wherever indicated. Based on results of EMA, duodenal biopsy with or without HLADQ2or 8, we divided patients in to two groups (CD group and IBS-D group).We then analyzed clinical features and laboratory parameters by univariate and multivariate analysis, to look for the features more suggestive of CD.Results: Of 198 patients, 98 were diagnosed to have CD and of remaining 100 patients 78 patients had IBS-D. Multivariate analysis revealed duration of symptoms more than 6 months , iron deficiency anaemia(IDA), hemoglobin(Hb) less than 10gm/dl, presence of bone pains and transaminasemia (alanine aminotransferase more than 40mu/ml) to be statistically significant and suggestive of CD. Conclusion:Patient with chronic diarrhoea, who has any one or more of the following features like duration of symptoms more than 6 months, IDA, Hb less than 10gm/dl, bone pains and transaminasemia, should be screened for CD. .Individuals with IBS-D report abdominal pain, bloating, and diarrhoea, symptoms similar to those in CD. IBS-D is a diagnosis of exclusion and current professional society guidelines recommend performing a limited battery of tests to exclude common organic diseases masquerading as IBS [2]. Studies suggest that the prevalence of CD is increased in individuals with IBS; however, evidence is conflicting, and current guidelines do not always recommend screening for CD in these individuals. Prevalence of biopsy-proved CD in cases meeting diagnostic criteria for IBS was more than 4-fold that in controls without IBS [3].With data showing that patients with IBS-D may benefit from gluten free diet (GFD), GFD is used with increasing frequency in IBS-D patients [4][5][6]. Although there is little harm beyond cost to a patient on a balanced GFD,CD may be overlooked and complications ignored. So should panels of serologic studies for CD be more widely used in IBS-D patients? The widespread use of panels would not be cost-effective as first-line testing; although it may slightly improve overall sensitivity, it reduces specificity, leading to unnecessary endoscopy [7].We planned this study to look for the clinical features and laboratory parameters which can determine who should be screened for CD and referred for small bowel biopsy in patients presenting with diarrhoea and help to differentiate between CD and non CD aetiology like IBS-D. Materials and MethodsWe retrospectively analyzed prospectively maintained data of 198 consecutive patients attending the Gastroenterology clin...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors Predicting Whom to Screen for Coeliac Disease in Patients with Diarrhoea Predominant Irritable Bowel Syndrome in Developing Countries

Somani¹,

Shah²,

Amarapurkar³

2016

JGPLD

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“…6 The accepted screening tool for CD is the enzymelinked immunosorbent assay (ELISA) test for immunoglobulin A (IgA) against the tissue transglutaminase (tTG) antigen. 7,8 However, the combined detection of tTG IgA antibodies along with deamidated gliadin peptide antibodies increases both the sensitivity and the specificity of CD diagnosis. Our laboratory uses a novel algorithm, starting with a sensitive screening assay that uses human recombinant tTG crosslinked with gliadin-specific peptides as antigens, which allows detection of both IgG and IgA antibodies (Aesku Diagnostics, Wendelsheim, Germany).…”

Section: Introductionmentioning

confidence: 99%

A new algorithm for the diagnosis of celiac disease

et al. 2011

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Celiac disease (CD) affects at least 1% of the Western population but remains largely unrecognized. In our laboratory, we utilize a novel algorithm to diagnose pediatric CD that offers both high sensitivity and high specificity for diagnosis in an outpatient setting. The aim of the present study was to challenge this algorithm and to test its performance in children and adults suspected of having CD. Using a three-assay algorithm, screening with the most sensitive tissue transglutaminase (tTG) complexed with deamidated gliadin peptide neoepitope immunoglobulin A (IgA)1IgG assay and confirming with the two specific tTG IgA and tTG IgA1IgG assays, we examined the serological results from 112 children aged 0-17 years old and 60 adults in comparison to their respective biopsy results. The algorithm performance was calculated by statistical analysis. The use of the new algorithm enabled us to diagnose CD with 98% sensitivity, 93% specificity and 95% accuracy in the pediatric group and 94% sensitivity, 92% specificity and 93% accuracy in the total population studied. The false-negative cases in the adult group were attributed to previous adherence to a gluten-free diet, and the single false-negative result in a young child became a true positive after 6 months. We have also monitored three celiac patients before and after diagnosis and found that the algorithm may be suitable for disease monitoring. The newly proposed three-assay algorithm for celiac detection is very reliable in both children and adults. Due to the high performance of this assay, the further need for confirmatory intestinal biopsies will be reassessed.

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“…The etiology is not known, but environmental, immunological and genetic factors are held responsible for the condition. Celiac disease has been estimated to occur in up to 1% of the general population, and although was traditionally considered a childhood disease it may appear at any age, including the elderly (1)(2)(3)(4). Clinical presentations of the disease are highly variable.…”

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confidence: 99%

“…Though diarrhea and weight loss are usually present, in some patients manifestations of the disease may be protean. Moreover, some cases may present with only extra-intestinal symptoms without any obvious gastrointestinal changes (1,2). Neurological disorders, including peripheral neuropathy, ataxia, seizures and cognitive dysfunction have been reported in patients suffering from celiac disease; in some these disorders may be the initial manifestation of the disease, leading to its recognition (3-7).…”

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confidence: 99%

Celiac Disease Presenting with Motor Weakness

Demirci¹,

Cengizhan²,

Karahan³

2012

J Turgut Ozal Med Cent

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Many systemic diseases may present with neurological signs and symptoms. In this case report, it is aimed to emphasize some takehome lessons in regard with disease that may masquerade Guillain-Barre syndrome. A 23 years-old woman presented with acute ascending motor weakness and areflexia for which she was presumed to have a Guillain-Barre syndrome. On neurological examination she had a muscle power of 2/5 according to MRC with areflexia. She had severe hypokalemia which is thought to result from the diarrhea she had. With potassium replacement her motor power resolved to normal. Detailed differential work-up led to a diagnosis of celiac disease with positive anti-gliadin antibodies serology and duodenal biopsy. Differential of acute, bilateral muscle weakness requires consideration of a few neurological conditions. However, the physicians should be aware of that many other systemic diseases may also manifest with signs and symptoms mimicking these neurological conditions.

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Diagnostic Testing for Celiac Disease Among Patients With Abdominal Symptoms

Abstract: Among adult patients presenting with abdominal symptoms in primary care or other unselected populations, IgA antitissue transglutaminase antibodies and IgA antiendomysial antibodies have high sensitivity and specificity for diagnosing celiac disease.

Cited by 180 publications

References 44 publications

Factors Predicting Whom to Screen for Coeliac Disease in Patients with Diarrhoea Predominant Irritable Bowel Syndrome in Developing Countries

Factors Predicting Whom to Screen for Coeliac Disease in Patients with Diarrhoea Predominant Irritable Bowel Syndrome in Developing Countries

A new algorithm for the diagnosis of celiac disease

Celiac Disease Presenting with Motor Weakness

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