Patient Care - Allergy & Immunology - October 2007 - (Page 6)

When to suspect CELIAC DISEASE— and how to proceed from there As many as 80% of patients found to have celiac disease have either no symptoms or non-GI symptoms, making the diagnosis of this devastating disorder elusive. A high degree of suspicion can lead to proper testing and implementation of a lifesaving diet. CONTRIBUTORS GAVIN F. CHICO, MD, is Medical Director of Christus Coushatta Hospital, Coushatta, La. MICHELLE A. CHICO, MD, is an endocrinologist in private practice, Shreveport, La. C Article at a glance I I I ILLUSTRATION: JOEL AND SHARON HARRIS I I The T cell-mediated inflammatory response to gluten with an autoimmune component is the primary pathophysiologic mechanism involved in celiac disease. Celiac disease is associated with an increased incidence of GI and lymphoproliferative cancers and increased mortality. Clinical suspicion and serologic screening by the primary care provider can improve the rate of diagnosis. Biopsy remains the gold standard for diagnosis and must be used for confirmation before the patient begins a gluten-free diet. A gluten-free diet can resolve the complications of weight loss, osteoporosis, autoimmune diseases, and infertility, and may possibly forestall cancer. eliac disease is now known to be one of the most common immune-mediated disorders that primary care doctors have an important role in identifying and treating. Primarily a GI disorder, it has extraintestinal manifestations. When left untreated, this often-overlooked condition can lead to deadly consequences, including cancer and autoimmune disorders. Suspicion of celiac disease is key to making the diagnosis, which is aided by serologic testing. Research suggests that early recognition and treatment may reduce the incidence of cancer. Early treatment possibly results in the resolution of associated morbidities such as osteoporosis, liver disease, and infertility. Epidemiology and disease mechanisms Previously thought to occur mainly in children and young adults, celiac disease is now known to occur even into the eighth decade of life. The prevalence rate is 1 in 250 in the United States and is greater among first- and second-degree relatives of those who have the disease.1 About 3 million Americans have celiac disease, but most do not know they have it. Only 3% are being treated, with the rest being diagnosed an average of 11 years after developing the disease. This delay in treatment leads to serious consequences of infertility, type 1 diabetes, and cancer. Untreated women are at risk for miscarriages and having babies with congenital anomalies.2 Children who are not treated often develop short stature and other problems.3 Celiac disease has environmental, genetic, and autoimmune components. There is a 75% concordance rate among monozygotic twins, due in part to the close linkage to human leukocyte class II antigens. HLA DQ2, found in 95% of patients with 6 PATIENT CARE ALLERGY & IMMUNOLOGY www.patientcareonline.com http://www.patientcareonline.com

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Patient Care - Allergy & Immunology - October 2007 Research Digest Contents Medicine in the News When to Suspect Celiac Disease and How to Proceed From There Averting Angioedema’s Potentially Dire Consequences Is There a Role for Leukotriene Receptor Antagonists in Treating Allergic rhinitis? Clinical Clips Dermatology Case Challenge Classified Advertising

Patient Care - Allergy & Immunology - October 2007

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