Celiac disease and Celiac Disease Diagnosis Video

March 2, 2009

There are several tests that can be used to assist in diagnosis.

The level of symptoms may determine the order of the tests, but all tests lose their usefulness if the patient is already taking a gluten-free diet.

Intestinal damage begins to heal within weeks of gluten being removed from the diet, and antibody levels decline over months.

For those who have already started on a gluten-free diet, it may be necessary to perform a re-challenge with 10 g of gluten (four slices of bread) per day over 26 weeks before repeating the investigations. Those who experience severe symptoms (e.g. diarrhoea) earlier can be regarded as sufficiently challenged and can be tested earlier. Combining findings into a prediction rule to guide use of endoscopy reported a sensitivity of 100% (it would identify all the cases) and specificity of 61% (it would be incorrectly positive in 39%).

The prediction rule recommends that patients with high risk symptoms or positive serology should undergo endoscopy. The study defined high risk symptoms as weight loss, anaemia (haemoglobin less than 120 g/l in females and less than 130 g/l in males), or diarrhoea (more than three loose stools per day).

This is a video with myself talking through my views.

Best regards
Paul Smith.


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