Central PA Medicine - Summer 2017 - 13

daup h i n c m s .o rg

Although initially described @ 2AD by
Areteus, the historical description most
alluded to is credited to an astute Dutch
physician during World War II. He described
a significant reduction in diarrheal and other
GI illnesses during bread shortages caused
during periods of sustained bombing.

DIAGNOSIS:
Patients diagnosed with celiac disease
need expert care and guidance to help
navigate their initial evaluation, dietary
changes, and management of the associated
nutritional problems.

higher levels of certain metals in blood of
individuals substituting other grains for
wheat based products. There is also a risk of
weight gain and vitamin deficiency because
of the calorie dense, non-vitamin-fortified
nature of some gluten free products. On
the other hand, patients with Irritable
bowel syndrome may notice some symptom
improvement because gluten free products
may be low on FODMAPs.

Celiac disease can be difficult to recognize
and symptoms may mimic other gastroPatients with suspected celiac disease
intestinal diseases, such as irritable bowel require blood tests and upper GI endoscopy
syndrome, chronic fatigue, inflammatory while on a regular diet to make an accurate All my testing for celiac disease is negative but I
bowel disease and intestinal infections.
diagnosis. A genetic test that helps exclude don't tolerate gluten containing foods, could I be
the likelihood of having celiac disease is also gluten sensitive?
Increased awareness, availability of reliable available. However, a positive genetic test
blood tests as well as distinguishing features does not diagnose celiac disease.
"Gluten sensitivity/intolerance" is a fason small intestine biopsies, has led to timely
cinating but evolving phenomenon. It is
diagnosis in recent times.
IgA based tests are more sensitive and difficult to separate an allergy or intolerance
specific. Initial testing is best done with -total to other products in gluten containing foods
In celiac disease, gluten triggers an im- IgA levels in conjunction with IgA anti-Tis- from true intolerance of gluten. The best way
mune mediated reaction mainly in the sue Trans Glutaminase antibodies (TTG)/ to make a definitive determination is to be
gastrointestinal tract with extensive potential IgA anti endomysial antibodies(EMA)/IgA exposed to two identical foods without prior
clinical implications. The inflamed lining deamidated gliadin antibodies.
knowledge of which one contains gluten
of the small intestine predisposes to maland which is gluten free. A clinician can
absorption of vitamins and micronutrients
In patients with IgA deficiency, IgG then help evaluate the reaction/response
and can result in multiple symptoms. These deamidated gliadin antibodies are helpful. after the exposure.
include abdominal discomfort, bloating,
diarrhea, weight loss and fatigue. However,
TREATMENT:
There is also a small subset of patients with
less than 30% of patients with celiac disease
negative blood tests for celiac disease who
have classic abdominal symptoms. The vast
* The only proven and effective treatment
have positive genetic testing and endoscopic
majority of patients are diagnosed during
is avoiding ingestion of gluten.
findings. The abnormal endoscopic findings
evaluation of other conditions including
resolve on a gluten free diet. This condition
fatigue, anemia, difficulty conceiving, weight
* Other important additional measures
is referred to as seronegative celiac disease.
loss and skin rashes thought to be due to
include evaluation and treatment of:
dermatitis herpetiformis.
Should I have my family members tested if I have
* Conditions that may be associated with
celiac disease?
Celiac disease has been associated with
celiac disease (diabetes, thyroid disease,
several conditions. These include osteopobone disease)
Yes, testing of first degree relatives with
rosis, depression, thyroid disease, anxiety,
IgA anti-TTG antibodies and total IgA levels
diabetes, menstrual disturbances, seizures
* Nutritional and other vitamin deficiencies
is recommended. Testing in children is best
and a skin rash to name a few.
done @ age 4 years or above.
* Scheduled follow up with a clinician
Patients with celiac disease are at risk of
and a dietician with knowledge of the Can I "cheat" and eat a regular diet while on a
developing a variety of health problems
condition is helpful.
gluten free diet for celiac disease?
and complications. The inability to absorb nutrients from food could result in
COMMON QUESTIONS:
Although "cheating" may not result in
anemia, bone disease and multiple vitamin
symptoms, it is not advisable. The ingestion
deficiencies. Other concerning but rare Is there any advantage in adopting a gluten free of gluten will trigger the immune response.
complications include refractory celiac diet if I don't have celiac disease?
disease and intestinal lymphoma.
The Penn State Hershey Celiac Center
Perhaps not; gluten free products are opened in July 2017.
expensive and there may be potential disadvantages. These include the recently reported
Continued on page 14
Central PA Medicine Summer 2017 13


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