Celiac disease history and symptoms
|
Celiac disease Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Medical Therapy |
|
Case Studies |
|
Celiac disease history and symptoms On the Web |
|
American Roentgen Ray Society Images of Celiac disease history and symptoms |
|
Risk calculators and risk factors for Celiac disease history and symptoms |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
History and Symptoms
- May be asymptomatic
- Vague abdominal pain
- Diarrhea
- Weight loss
- Malabsorption / steatorrhea
- Symptoms and pathologic changes resolve with gluten-free diet
In majority of cases diagnosis can be made reliably with blood testing, but the "gold standard" is still small bowel intestinal biopsy (obtained via EGD). Ideally, a small bowel biopsy should be taken while the patient is on a gluten diet and then checked against a follow-up biopsy after 12 weeks on a gluten-free diet. IgA anti-endomysial antibody (EmA) is at least 99% specific, and about 93% sensitive, but some studies show it to be nearly 100% specific and sensitive. Tissue anti-transglutaminase (tTG) antibody is similarly accurate. Total serum IgA is usually normal, but may be low to undetectable in a small percentage patients. If total IgA is very low, EmA and tTG will not be accurate and a small bowel biopsy should be considered. IgA anti-gliadin antibody (AGA) is more useful as a screening test, and neither anti-gliadin IgA or IgG antibodies are as specific or sensitive as anti-endomysial antibodies or anti-transglutaminase antibodies.
Classic symptoms of coeliac disease include diarrhoea, weight loss (or stunted growth in children), and fatigue, but while coeliac disease is primarily a bowel disease, bowel symptoms may also be limited or even absent. Some patients are diagnosed with symptoms related to the decreased absorption of nutrients or with various symptoms which, although statistically linked, have no clear relationship with the malfunctioning bowel. Given this wide range of possible symptoms, the classic triad is no longer a requirement for diagnosis.
Children between 9 and 24 months tend to present with bowel symptoms and growth problems shortly after first exposure to gluten-containing products. Older children may have more malabsorption-related problems and psychosocial problems, while adults generally have malabsorptive problems.[1] Many adults with subtle disease only have fatigue or anaemia.[2]
- Behavioural changes
- Fatigue, malaise
- Growth delay
- weight loss (explained and unexplained)
References
- ↑ Ciclitira, P (2002). "Interim Guidelines for the Management of Patients with Coeliac Disease". British Society of Gastroenterology. Retrieved 2007-03-07.
- ↑