Heidi James, MD, and Vanessa Cardy, MD
Heidi and Vanessa kick off the penultimate month of ROP with a little celiac disease potpourri.
- Celiac disease is an autoimmune condition where the body wages war on celiac, a protein ubiquitously found in barley, rye, and wheat.
- Celiac disease can present classically with gastrointestinal (GI) disturbance, but we all know it can present in many other ways. Vanessa and Heidi have seen patients present with many other symptoms, including
- Vitamin and mineral deficiencies:
- Iron deficiency and iron deficiency anemia
- Low B12
- Low D
- Neurologic symptoms
- Psychiatric symptoms
- Failure to thrive
- Dermatitis herpetiformis
- Celiac disease can also be asymptomatic (fun!).
- Those who have a family member with celiac are at higher risk of developing the condition; roughly 1 in 10 for first-degree relatives. These patients should be screened.
- Screening for adults and children starts with transglutaminase tissue antibody (TTG) and immunoglobulin A (IgA) levels.
- Patients should continue to eat gluten while investigations are ongoing; stopping will stop the autoimmune response and hamper the diagnosis.
- Adults with elevated TTG should be referred to gastroenterology for small bowel biopsy.
- Children with TTG levels >10× upper limit of normal can skip the scope and have endomysial antibody levels done instead. If these levels are positive, there is no need to scope; they are considered diagnostic.
- Management of celiac includes
- Educating patients on avoiding gluten
- Dietitians and organizations like the Celiac Disease Foundation and support groups are helpful.
- Testing for known complications of disease:
- Vitamin and mineral deficiencies
- Ongoing monitoring for adherence to diet and potential complications, emotional support, documentation for income tax purposes.
PEARL: Celiac disease is a tricky beast! Be sure to screen those at high risk due to family history and don’t hesitate to include it in your differential for a whole host of presenting symptoms.
Crunch Time FM Gastro: Celiac Disease
PCMA Archive 2018 June Celiac Disease Is Misdiagnosed Based On Serology Only In A Substantial Proportion Of Patients
ROP 2021 June Abstract 5: Gluten Introduction and Celiac Disease