November Introduction
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
- Osteoporosis
- Dermatitis herpetiformis
- Fatigue
- 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
- Osteoporosis
- 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.
RELATED CONTENT:
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
David S. - November 6, 2023 10:21 AM
Very sad to see you all go. Maybe there isn't need for a full primary care series on EMRAP (?), but I would love to see some of this incorporated into the UC Maximus material. The primary care world overlaps a whole lot with the urgent care world, especially as fewer and fewer primary care clinicians are doing their own acute care and urgent care centers explode in availability.
Vanessa C. - November 15, 2023 1:27 PM
Thanks so much for listening and for writing in.
Vanessa
Heidi J., MD - November 17, 2023 2:08 PM
Thanks for connecting with us; it's been a pleasure making ROP for listeners.
Eric B. - November 7, 2023 10:14 AM
SAY IT ISN'T SO!!!!!!!!!!!!!!!!!!!!
Vanessa C. - November 15, 2023 1:28 PM
Thank you for letting us know you liked it!
Heidi J., MD - November 17, 2023 2:08 PM
Thanks for having been part of the ROP community :)
J. B. L. - November 9, 2023 7:42 AM
I found ROP to be extremely helpful/ As an EP that has aged - and can no longer do high volume EM or nite shifts - these segments aided me to help people in UC as I slowly make the transition out of EM
sure hope someone at EM RAP will let us know what the plans are and whether UC Max will be taking over or whether there will be something else similar
Vanessa C. - November 15, 2023 1:28 PM
Thank you for listening and writing in
Heidi J., MD - November 17, 2023 2:10 PM
Thanks for your kind words. We've enjoyed making ROP and are glad to hear it's been helpful to your UC work :)
Ola G. - November 12, 2023 1:03 PM
Why are you ending ROP? Replacing it with something else? Even as an anesthesiologist/intensivist I found ROP educational and entertaining. Would like to hear more from the hosts of ROP on the other shows.
Vanessa C. - November 15, 2023 1:29 PM
Thanks so much for the kind words, and for listening
Heidi J., MD - November 17, 2023 2:11 PM
Thanks for listening. Appreciate your writing in.
Charles P., M.D. - November 14, 2023 7:10 PM
Ruined my day. After 40 years in the ED, have increased my volunteering at a local free clinic - as I imagine many ED/UC docs do. ROP has been an essential part of my GP education.
Also, as we tend to be visible in our communities, we are often approached with general medicine questions, and with what I learned here, I can at least sound halfway intelligent.
Plus, the Canadians, who make a large part of the faculty are such nice people
I hope we are going to get real explanation from the organization - and it cannot be financial, since a large part of the faculty is Canadian - you can pay them in Canadian dollars
Chuck P
Heidi J., MD - November 17, 2023 2:11 PM
This Canadian thanks you as well! Take care and thank-you for for pending your time volunteering at a free clinic - inspiring :)
Vanessa C. - November 15, 2023 1:29 PM
This Canadian thanks you for the kind words and for listening!
Catherine K. - November 25, 2023 11:33 PM
I wish you weren't leaving! I really like listening to ROP. I found the content to be great and very helpful even though I only work in the ED; A lot of the time, patients want to know what to expect next, what kinds of testing or treatment to ask for when they see their PCP after leaving the ED. This program has helped me so much and I will miss it a lot. I do hope we get some kind of explanation for why you are being cut off!
Robert M. H. - November 29, 2023 3:11 PM
I endorse all the comments above. Mel you are an ignorant sl..
BRING IT BACK KANGAROO BOY!