Assessment, Diagnosis, and Management of Celiac Disease

Catherine Kolonko

With celiac disease becoming more prevalent, especially in adults, what are the most effective approaches to testing patients for this disease, and are there effective management strategies that can be used in conjunction with a gluten-free diet?

A diet free of gluten remains the standard treatment for celiac disease and related conditions, according to a medical researcher who spoke this week at a joint conference of the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy in Coronado, California.

Celiac disease is an immune disorder in the small intestine caused by dietary gluten. Symptoms of the chronic digestive condition include abdominal pain and diarrhea. Celiac disease is roughly four times more prevalent now than 50 years ago, said Sheila Crowe, MD, professor of medicine and director of research, Division of Gastroenterology, at the University of California, San Diego. The reason is unknown but may be related to increased use of wheat (which is a gluten source) in diets worldwide, she said.

The classic picture of the disease as a child with malabsorption is changing to include more and more middle-age adults. Many of Crowe’s patients are women with children, she said.

Biopsies are the gold standard for disease diagnosis, though they can in some cases produce false positive or false negative results, Crowe said. Studies show that as the number of biopsies increase so do the number of diagnoses, so Crowe cautioned physicians not to overdo it. She said she usually conducts no more than six biopsies on a patient, but no less than four.

Crowe also uses genetic screening in her practice, mainly for ruling out celiac disease for patients on a gluten-free diet. The test can be expensive but is useful for family members of someone diagnosed with the disease who want to know if they are at risk also, she said.

Less is known about the prevalence of gluten sensitivity, a “moving target” with various definitions but a common diagnosis is an absence of celiac disease, said Crowe. Gluten sensitivity lies in a sort of “no man’s land” between celiac disease and irritable bowel syndrome, she said.

Those who undertake a gluten-free diet have to be on it for a long time before the biopsy test returns to normal again, Crowe said. In some cases it can take up to a year before the patient’s blood test results return to normal, she said.

Those who stick to the diet tend to be healthier because they no longer make trips to the local fast-food restaurants, Crowe noted. “When you have to eat gluten free you end up getting rid of all kinds of harmful stuff in your diet,” Crowe said.

Potential new therapies are being investigated and may one day work in adjunct with a gluten-free diet. Meanwhile, the overall goal of celiac disease management is to return a patient to normal health and prevent complications, Crowe said. In addition, to a gluten-free diet, she suggests that patients consult with a knowledgeable nutritionist and, if needed, take calcium, vitamin D, iron, and folate supplements.

Crowe is a consultant to Wiley Canada LTD.