Celiac Disease - NIH Consensus Development Program - National ...

More documents

Recommendations

Info

10. Rewers M, Liu E, Simmons J, Redondo MJ, Hoffenberg EJ. Celiac disease associated withtype 1 diabetes mellitus. Endocrinol Metab Clin North Am. 2004;33:197–214.11. Buysschaert M. Coeliac disease in patients with type 1 diabetes mellitus and auto-immunethyroid disorders. Acta Gastroenterol Belg. 2003;66:237–240.64
The Many Faces of Celiac Disease: Clinical Presentationof Celiac Disease in the Adult PopulationPeter H. R. Green, M.D.The presentation of adults with celiac disease can be broadly divided in two types: theclassical diarrhea-predominate type and the silent type in which gastrointestinal symptoms arenot prominent. (1) The latter group includes patients that may present with secondarymanifestations of celiac disease (e.g., anemia or osteoporosis), associated autoimmune diseases(type 1 diabetes or peripheral neuropathy), or associated malignancies. The silent group includesthose that are asymptomatic, and detected by screening relatives of patients with celiac disease.The lag between the clinical prevalence (2) and the serologic prevalence (3) of celiac disease(the iceberg phenomenon) in the United States demonstrates that most people with celiac diseaseare currently not diagnosed and probably have the silent form of celiac disease. This wasconfirmed in a population-based screening study from England in which those with undetectedceliac disease (1.2 percent of those screened) had mild anemia, osteoporosis, and low serumcholesterol values and considered themselves well, and had a trend to participate in lesscardiovascular events. (4)Celiac disease is a proximal small intestinal inflammatory disease that may involve avariable length of the intestine. The proximal intestine is the site of absorption of iron, calcium,fat-soluble vitamins, and folic acid, as well as the products of the digestion of fats,carbohydrates, and proteins. When limited to the proximal intestine, vitamins and mineralsusually absorbed may be selectively malabsorbed; however, diarrhea may not occur because thedistal small intestine can compensate and absorb the products of the digestion of fats andcarbohydrates. The length of intestine involved is more important than the degree of villousatrophy present in duodenal biopsies in determining whether diarrhea will occur. Other factorscontributing to diarrhea include a reversible pancreatic insufficiency, secondary lactoseintolerance, and bacterial overgrowth.In view of the lack of information about the clinical spectrum of celiac disease in theUnited States, we conducted a survey to obtain data. Information from more than 1,600 patientswas obtained. This study confirmed a female predominance over males (3:1). The majority ofpatients were diagnosed in their fourth to sixth decades and 85 percent presented with diarrhea.The mean duration of symptoms prior to diagnosis was 11 years. (5) This delay in diagnosis is notunique to the United States and is considered to be physician-based rather than due to delay inpatients seeking health care. (6) A contributing factor is that patients receive alternative diagnosessuch as an irritable bowel syndrome. (7)Two studies have shown a relative decrease in the percent of patients presenting withdiarrhea, though it remains the most common mode of presentation accounting for about50 percent of patients. (2,8) The increasing availability of serologic testing may contribute to boththe increased rate of diagnosis and to diagnosis of patients with nondiarrheal presentations.Despite an increased rate of diagnosis, patients still experience a long duration of symptoms65
Page 1 and 2:
NIH Consensus Development Conferenc
Page 3 and 4:
III. What Are the Manifestations an
Page 5 and 6: • What is the management of celia
Page 7 and 8: Monday, June 28, 2004 (continued)I.
Page 9 and 10: Monday, June 28, 2004 (continued)II
Page 11 and 12: Wednesday, June 30, 2004 (continued
Page 13 and 14: Lisa H. RichardsonConsumer Represen
Page 15 and 16: Ciaran P. Kelly, M.D.Director, Celi
Page 17 and 18: Van S. Hubbard, M.D., Ph.D.Director
Page 19 and 20: AbstractsThe following are abstract
Page 21 and 22: susceptibility (e.g., DR17 homozygo
Page 23 and 24: The Pathology of Celiac DiseaseDavi
Page 25 and 26: In this regard, the transport pathw
Page 27 and 28: for the IgG-based test, while speci
Page 29 and 30: 15. de Lecea A, Ribes-Koninckx C, P
Page 31 and 32: Clinical Algorithm in Celiac Diseas
Page 33 and 34: Considera diagnosisof celiac diseas
Page 35 and 36: There are populations at particular
Page 37 and 38: Serological Testing for Celiac Dise
Page 39 and 40: Estimates of the sensitivity of the
Page 41 and 42: the risk and severity of CD may als
Page 43 and 44: What Are the Prevalence and Inciden
Page 45 and 46: ascribed to excess menstrual loss.
Page 47 and 48: ReferencesFamily History of Celiac
Page 49 and 50: Carroccio A, Iannitto E, Cavataio F
Page 51 and 52: identified by surveys or through so
Page 53 and 54: Clinical Presentation of Celiac Dis
Page 55: een widely reported. The question r
Page 59 and 60: References1. Green PH, Jabri B. Coe
Page 61 and 62: Association of Celiac Disease and G
Page 63 and 64: Does the Gluten-Free Diet Protect F
Page 65 and 66: Skin Manifestations of Celiac Disea
Page 67 and 68: allow a better understanding of the
Page 69 and 70: 4. Henriksson KG, Hallert C, Walan
Page 71 and 72: characterized, clinically-identifie
Page 73 and 74: 10. Hoffenberg EJ, Emery LM, Barrig
Page 75 and 76: ataxia, epilepsy with posterior cer
Page 77 and 78: Consequences of Testing for Celiac
Page 79 and 80: Osteoporosis/FracturesThere were 11
Page 81 and 82: Dietary Guidelines for Celiac Disea
Page 85 and 86: 21. Thompson T. Thiamin, riboflavin
Page 88 and 89: In order to effectively counsel ind
Page 90 and 91: 9. Hallert C, Granno C, Hulten S, M
Page 92 and 93: adhered to the GFD after more than
Page 94 and 95: Patient education, close supervisio
Page 96: 26. Mustalahti K, Lohiniemi S, Laip
show all

Celiac Disease - NIH Consensus Development Program - National ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?