Celiac Disease Testing: Is It For Me?

>>>DR. KENNETH FALCHUK: Celiac disease is
extremely common in our society. Close to maybe 1 to 150 to 200 individuals or may be
more who may well be symptom-free, asymptomatic, have Celiac disease. There is a spectrum as
to how Celiac disease presents. Most patients do not have symptoms. Some will present with
weight loss, diarrhea, sensation of fullness in the stomach, do not want to eat. That used
to be the common presentation when we knew little about how to evaluate patients with
celiac disease. The technology that is available to us now allows us to, in a non-invasive
fashion, evaluate and diagnose a potential patient with celiac disease. Now it turns out that it may well be that
more patients do not have what we call wheat, gluten intolerance, so Celiac is really an
intolerance to food products that have gluten such as wheat, rye, barley, may be oats. These
foods that are taken into our system, we eat them everyday pasta, white breads, damaged
the lining of the small intestine that is where digestion takes place. By doing there
symptoms developed. Now as I said before, the majority of patients may not even have
symptoms, so how do we proceed to evaluate someone that may carry the propensity or already
have Celiac disease. If they have symptoms it is very easy. If
you have a family history of Celiac disease with several members, you should test the
other members because there is an increased incidence of Celiac in relatives of patients
with Celiac disease as well. So, there is a blood test, there are several blood tests
but the most specific ones that are available to any physician done by any lab in the world
is the serum transglutaminase level, others called it the antiendomysial antibodies. It
is a simple test. You take a small sample of blood, you test it in the laboratory, if
you get a tested as positive with the reading above certain number then is something that
the physician has to pursue it. It does not have to be a specialist like myself, a gastroenterologist
does that, any physician can do that. Once their blood test is done, if it is positive,
has a degree of positivity of so specificity of 98% or greater. There are other more sophisticated
testings that gastroenterologists do but for the most part there is none. Now it is important
to confirm the diagnosis, because as I said it turns out the Celiac disease is common
but less common than gluten intolerance, that is there are patients who eat wheat products
and feel lousy, they feel bloated, they develop bloating, they have abdominal pain, they may
or may not have diarrhea yet when you test them with all the specific testing including
biopsies of the intestine called duodenal biopsy, they do not as yet or have not develop
true celiac disease. That means of the biopsies are normal. So that is important to differentiate
true celiac cause. Celiac, over the long-term, has inherent risks
of conditions that can be detrimental to the patient. They can affect the life of a patient.
There are certain tumors that occur in patients who have longstanding Celiac disease such
as lymphomas, tumors that affect the small intestine or even cancer of the small intestine.
Patients with Celiac disease can be very malnourished; can have deficiencies or many vitamins such
as B12, vitamin D, and iron. Some of the common ways for patients to present to the physician
even though he or she may be symptom free is to have a low iron in their blood; we call
it an iron deficiency syndrome. It is caused by many things but one of them is Celiac disease. Some patients also may have a routine blood
test, some abnormalities of liver blood test, we call them transaminases and that could
be also caused by Celiac disease and not hepatitis or liver cancer or other serious illnesses
affecting the liver. So it is important for the physician to be aware of the other ways
of Celiac disease’s presence. There are other presentations that are more
unusual very rare types of neurological changes, severe headaches sometimes, but these are
not the common presentation. The common is to be symptom free or have some GI symptoms
as I mentioned earlier or have a low serum iron deficiency. When that happens, if the
blood test is positive, the diagnosis must be confirmed because it is strict diet, tough
diet to follow but it can be followed. Today, in our society, there are many ways to live
with a gluten free diet and the final way to confirm the diagnosis is to do a special
test called endoscopy with a little light, patients swallows the tiny tube, the physician
goes down to the area concerned or the target area and that is called the duodenum, you
take samples, they were seen under microscope and you find the changes there are compatible
with Celiac disease. down if it does not, is that pain having a
significant impact on your quality of life and if the answer to that is yes then surgery
may be the right answer for you. However, the majority of people over the ages of 35
or 40, surgery for meniscus tears is not necessary.

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