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Monday, May 10, 2010

Celiac Disease Diagnosis

Before launching into this week's blog on celiac disease, Rick and I would like to invite you to view our YouTube. And now, on to the topic at hand:

Lots of people complain of gastrointestinal symptoms. In point of fact, this week's meta-analysis on diagnosing celiac disease in JAMA states that between 35 and 40 individuals out of every 1000 who visit their primary care doctor do so because of abdominal discomfort, bloating, diarrhea, or other chronic symptoms, and these can adversely impact quality of life.

Among the plethora of conditions that can cause chronic abdominal distress is celiac disease, with an estimated prevalence (medspeak for how many people have this in the population at large) of 0.5%-1.0%. That's a lot of people. And what exactly is celiac disease?

Celiac disease can be defined as a sensitivity to gluten, a protein found in wheat, barley and rye, that largely affects the small bowel or intestine. This sensitivity gives rise to nonspecific symptoms such as diarrhea and bloating, but can have long term consequences, including fertility problems, osteoporosis, and cancer. The best news about celiac disease is it can be managed very well by avoiding foods that contain gluten. Few conditions respond so well to such simple intervention.

Since both cause and cure are well known, diagnosing celiac disease properly is pivotal. This analysis makes the case that abdominal symptoms alone are not sufficient to diagnose the condition, and that two blood tests, used sequentially, may be the way to start. IgA antitissue transglutaminase antibodies and IgA antiendomysial antibodies are two types of antibodies found circulating in the blood in the majority of folks with celiac disease, and both tests are widely available. Those who test positive for the first can then be tested for the second, but as Rick points out in the podcast, the definitive test is a biopsy of the lining of the small bowel. I would be sorely tempted if I tested positive for both tests, however, to try eliminating gluten from my diet and see what happened rather than undergo biopsy.

Other topics this week include the benefits of early follow up in avoiding rehospitalization in people with congestive heart failure in JAMA, a new type of stent for the heart in NEJM, and the risk of Alzheimer's disease in spouses who provide care for their affected spouse in the Journal of the American Geriatrics Society. Until next week, y'all live well. And please watch the YouTube!

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