As celiac disease becomes more topical and common in today’s medical world, providers are increasingly doing all they can to stay current on the best ways to diagnose, manage and monitor the disease.
Here are the top 10 things to know:
- Serologic tests: When it comes to serologic tests, Oxentenko and Murray say “immunoglobulin A-based tissue transglutaminase (IgA TTG) is the single best” test to help detect celiac.
- To biopsy or not? Celiac disease can be suspected based on certain endoscopic features, but the authors still suggest doing a biopsy “even in the absence of endoscopic markers” given the low sensitivity of these features.
- What kind of biopsy? “Endoscopically obtained, non-jumbo duodenal biopsies are standard for the evaluation of celiac disease,” noted Oxentenko and Murray. They suggest taking “four biopsies from the post-bulbar duodenum and one to two biopsies from the 9 o’clock and/or 12 o’clock position of the duodenal bulb.”
- Who’s at risk? First-degree relatives should usually be tested, especially siblings of those with celiac disease, as well as “symptomatic patients with type 1 diabetes mellitus and those with Down’s, Turner’s and Williams’ syndromes.”
- How to diagnose gluten-free patients: If patients have already been following a gluten-free diet (GFD) prior to undergoing a work-up for possible celiac disease, the authors suggest testing for HLA DQ2 or DQ8, which can help you determine if additional testing needs to be done.
- Celiac management plan: If a patient is diagnosed with celiac disease, he or she should avoid rye, wheat and barley as part of a strict, lifelong GFD and should also receive counseling from a dietitian and medication review from a pharmacist.
- Additional things to check: Gastroenterologists should monitor recently diagnosed patients for things like: “complete blood count, ferritin, vitamin B12, folate, copper, zinc, calcium and 25-hydroxy vitamin D.” The authors also recommend checking bone density in adult celiac patients.
- What’s next? Patients should schedule a follow-up appointment three to six months after the initial diagnosis to assess for clinical and serologic improvement, and schedule annual visits (with serology) thereafter. Dieticians should conduct follow-up visits to determine if patients are able to adhere to a GFD.
- Nonresponsive patients: If patients are not responsive to a GFD, doctors should first verify the original celiac diagnosis, and then assess for possible gluten ingestion. If gluten ingestion is not present, they recommend duodenal and colonic biopsies.
- Refractory celiac disease: The authors say that gastroenterologists should check these patients for malignant transformation.