Who to screen and how to screen for celiac disease

Abstract

Celiac disease (CeD) is a chronic gluten-induced enteropathy with plethoric manifestations. The typical manifestations of CeD such as chronic diarrhea and malabsorption are widely recognized, however, many patients have atypical manifestations like iron deficiency anemia, idiopathic short stature, hypertransaminesemia or infertility, etc. These patients often present to the primary care physicians and/or non-gastrointestinal specialties. However, due to a lack of awareness among the healthcare professionals about the various atypical manifestations, many patients are not screened for CeD. In this review, we have summarized the available literature about the prevalence of CeD in various gastrointestinal (chronic diarrhea) and non-gastrointestinal conditions (iron deficiency anemia, short stature, cryptogenic hypertransaminesemia, cryptogenic cirrhosis or idiopathic ataxia etc. ) where the diagnosis of CeD should be con-sidered. In addition, we also discuss special scenarios where screening for CeD should be considered even in absence of symptoms such as patients with type 1 diabetes, Down’s syndrome, and first-degree relatives of patients with CeD. Further, we discuss the diagnostic performance and limitations of various screening tests for CeD such as IgA anti-tissue transglutaminase antibodies, anti-endomysial antibodies and anti-deamidated gliadin antibodies. Based on the current recommendations, we propose a diagnostic algorithm for patients with suspected CeD.

Looking for coeliac disease hiding in the family

“…Consequently, many medical practitioners actively screen individuals in these risk groups, regardless of the presence of symptoms. The prevalence of coeliac disease among first degree relatives of Australians diagnosed with the disorder is likely to be similar to rates reported overseas (at least 7.5%) 6‐8 …”

“…Studies of focused screening of first degree relatives or other groups of people at high risk have found that many of those diagnosed with coeliac disease had no symptoms and may consequently not have been diagnosed otherwise 6‐8 . Muir and his colleagues did not report whether the first degree relatives in their study had symptoms or signs suggestive of coeliac disease 9…”

“…Some people are at significantly greater risk of developing coeliac disease, including those with certain autoimmune conditions (including type 1 diabetes mellitus) and, in particular, people with first degree relatives diagnosed with coeliac disease 6 . Consequently, many medical practitioners actively screen individuals in these risk groups, regardless of the presence of symptoms.…”

Celiac disease screening in patients with cryptogenic cirrhosis

“…We read with interest the article by Singh et al [ 1 ]. Liver cirrhosis is a disease with potential morbidity, which can progress to decompensation, hepatocellular carcinoma and death.…”

Manifestations of the gastrointestinal tract in systemic rheumatic diseases: A narrative review

“…Для целиакии характерен широкий спектр антител -к тканевой трансглутаминазе (IgA-tTGA (tissue transglutaminase)), эндомизию (IgA-анти-EMA (endomysial antibodies)), глиадину (к деамидированным пептидам глиадина -IgG-DGP (deamidated gliadin antibodies)), ретикулину (IgAи IgG-ARA (anti-reticulin antibodies)). Клинически целиакия проявляется стойким энтеритом с персистирующей диареей и мальабсорбцией [60,61]. Это заболевание нередко сопровождает ВЗК и РЗ, такие как ювенильный идиопатический артрит, РА и спондилоартрит [62][63][64].…”