Celiac disease – a missed diagnosis
Authors:
T. Chvátalová; G. Vepřeková; A. Houska; P. Frič
Authors‘ workplace:
Interní klinika 1. lékařské fakulty UK a ÚVN Praha, přednosta prof. MUDr. Miroslav Zavoral, Ph. D.
Published in:
Vnitř Lék 2012; 58(2): 99-103
Category:
Original Contributions
Overview
Background:
In Czech population celiac disease is diagnosed infrequently and on the contrary frequently too late.
Aim:
The present quality of diagnostics, therapy, follow-up and relation of celiacs to causal therapy has been evaluated.
Methods:
A structured questionnaire was offered to celiacs followed at different out-patient departments (medicine, gastroenterology, dermatology, hematology, and endocrinology) of one institution (Central Military Hospital Prague) in the years 2000–2010. The following topics were analyzed: the health care provided to probands before the diagnosis of celiac disease (number and speciality of involved physicians, symptoms and suggested conditions), methods of celiac disease diagnosis, screening of the disease in first degree relatives, compliance of gluten-free diet and its limiting factors.
Results:
102 (77.3%) out of 132 distributed questionnaires were evaluated. The diagnosis of celiac disease remains a late issue. 36.8% of celiac patients were diagnosed after a period of more than 10 years of symptoms. Diarrhea has been frequently combined with extraintestinal symptoms (anemia, decreased body mass, depression, and osteoporosis). Gluten-free diet is an expensive dietary regimen and its adherence brings various restrictions to celiacs in every-day life.
Conclusion:
The present state of celiac disease diagnostics and follow-up requires interdisciplinary cooperation and increased interest of health and social care institutions including their leading representatives.
Key words:
celiac disease – diagnostics – gluten-free diet – quality of life – screening
Sources
1. Frič P, Bušinová I. Celiakie – pohledy z druhé strany. Interní Med 2008; 10: 482–484.
2. Fraser JS, King AL, Ellis HJ et al. An algorithm for family screening for coeliac disease. World J Gastroenterol 2006; 12: 7805–7809.
3. AGA Institute. AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease. Gastroenterology 2006; 131: 1977–1980.
4. Thomas HJ, Ahmad T, Rajaguru C et al. Contribution of histological, serological and genetic factors to the clinical heterogenity of adult-onset coeliac disease. Scand J Gastroenterol 2009; 44: 1076–1083.
5. Ho-Yen C, Chang F, van der Walt J et al. Recent advances in refractory coeliac disease: a review. Histopathology 2009; 54: 783–795.
6. Caproni M, Antiga E, Melani L et al. Italian Group for Cutaneous Immunopathology. Guidelines for the diagnosis and treatment of dermatitis herpetiformis. J Eur Acad Dermatol Venerol 2009; 23: 633–638.
7. Freeman HJ. Malignancy in adult celiac disease. World J Gastroenterol 2009; 15: 1581–1583.
8. Collin P, Huhtala H, Virta L et al. Diagnosis of celiac disease in clinical practice: physician’s alertness to the condition essential. J Clin Gastroenterol 2007; 41: 152–156.
9. Catassi C, Kryszak D, Louis-Jacques O et al. Detection of celiac disease in primary care. A multicenter case-finding study in North America. Am J Gastroenterol 2007; 102: 1454–1460.
10. Frič P, Houska A, Buřič I et al. Refrakterní celiakie a primární sklerozující cholangitida. Čes a Slov gastroent Hepatol 2009; 63: 172–176.
11. Toftedal P, Nielsen C, Trolle Madsen J et al. Positive predicitve value of serological diagnostic measures in celiac disease. Clin Chem Lab Med 2010; 48: 685–691.
12. Hopper AD, Cross SS, Hurlstone DP et al. Pre-endoscopy serological testing for coeliac disease: evaluation of a clinical decision tool. BMJ 2007; 334: 729–734.
13. Tursi A, Elisei W, Giorgetti GM et al. Prevalence of celiac disease and symptoms in relatives of patients with celiac disease. Eur Rev Med Pharmacol Sci 2010; 14: 567–572.
14. Viljamma M, Collin P, Huhtala H et al. Is coeliac disease screening in risk groups justified? A fourteen-year follow-up with special focus on compliance and quality of life. Aliment Pharmacol Ther 2005; 22: 317–324.
15. Whitaker JK, West J, Holmes GK et al. Patient perceptions of the burden of coeliac disease and its treatment in the UK. Aliment Pharmacol Ther 2009; 29: 1131–1136.
16. Shamir R, Yehezkely-Schildkraut V, Hartman C et al. Population screening for celiac disease: follow up of patients identified by positive serology. J Gastroenterol Hepatol 2007; 22: 532–535.
17. Collin P. Should adults be screened for celiac disease? What are the benefits and harms of screening? Gastroenterology 2005; 128 (Suppl 1): S104–S108.
18. Goldberg D, Kryszak D, Fasano A et al. Screening for celiac disease in family members: is follow-up testing necessary? Dig Dis Sci 2007; 52: 1082–1086.
19. Vilppula A, Kaukinen K, Luostarinen L et al. Increasing prevalence and high incidence of celiac disease in elderly people: A population-based study. BMC Gastroenterol 2009; 9: 49–54.
20. Nachman F, del Campo MP, Gonzáles A et al. Long-term deterioration of quality of life in adult patients with celiac disease in associated with treatment noncompliance. Dig Liver Dis 2010; 42: 685–691.
21. Hall NJ, Rubin G, Charnock A. Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther 2009; 30: 315–330.
22. Green PHR, Stavropoulos SN, Panagi SG et al. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol 2001; 96: 126–131.
23. Cellier C. Osobní sdělení.
24. Sumnik Z, Kolouskova S, Cinek O et al. HLA- -DQA1*05-DQB1*0201 positivity predisposes to coeliac disease in Czech diabetic children. Acta Pediatr 2000; 89: 1426–1430.
25. Walker-Smith JA, Guandalini S, Schmitz J et al. Revised criteria for diagnosis of celiac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Childhood 1990; 65: 909–911.
26. Fric P, Gabrovska D, Nevoral J. Celiac disease, gluten-free diet, and oats. Nutr Rev 2011; 69: 107–115.
27. Catassi C, Fabiani E, Iacono G et al. A prospective, double-blind, placebo-controlled trial to establish a safe threshold for patients with celiac disease. Am J Clin Nutr 2007; 85: 160–166.
28. Akobeng AK, Thomas AG. Systematic review: tolerable amount of gluten for people with celiac disease. Aliment Pharmacol Ther 2008; 27: 1044–1052.
29. Věstník MZ-ČR, částka 3 z 28. 2. 2011: 51–54.
30. Frič P, Nevoral J. Cílený screening celiakie. Interní Med 2009; 11: 484–487.
31. Kollárová H, Pektor R, Šmajstrla V et al. Rutinní biopsie z duodena prováděná během gastroskopie – jedna z možností vyhledávání asymptomatické celiakie. Čes a Slov Gastroent Hepatol 2007; 61: 245–248.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
![Issue 2](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/468688e161518058eb6865f914255e88.jpeg)
2012 Issue 2
Most read in this issue
- Clinical implications of enlargement of left atrium
- Medicines and thyroid gland
- Radioiodine 131I therapy of hyperthyroidism on an outpatient basis – safe, effective and economic option
- Good’s syndrome (thymoma associated hypogammalobulinaemia) – 2 case reports