Celiac Sprue (cont.)
IN THIS ARTICLE
When to Seek Medical Care for Celiac Disease
Celiac disease can be a debilitating condition, especially if the diagnosis is not considered early in the course of the disease. As a result, persons with any of the symptoms mentioned above (see Signs and Symptoms) or those with a family history of the disease are encouraged to seek medical advice. Because celiac disease is hereditary, close family members of persons with celiac disease should be tested for the disease.
Females who are pregnant and have worsening anemia should seek medical care. This diagnosis should be considered in females with significant worsening of anemia during pregnancy.
Celiac Disease Diagnosis
The likelihood of celiac disease determines the approach to diagnosis. If a low or moderate suspicion exists that celiac disease is present, a blood test for tissue transglutaminase (tTG) or anti-endomysial antibody is performed. If the likelihood that someone has celiac disease is very high or the blood test result is positive, then biopsies of the small intestinal should be performed.
Genetic testing is only performed in certain circumstances.
Blood tests Blood chemistry, red blood cell, and clotting test results suggest but do not confirm the diagnosis of celiac disease. The same abnormalities may be seen in many other diseases.
The best diagnostic tests for celiac disease include measurements of antibody levels to endomysium and to an enzyme called tissue transglutaminase (tTG). The 2 tests are very specific for celiac disease in persons who are untreated.
Measurements of antibodies to gliadin and reticulin (a part of the cell structure) are other diagnostic tests that are less specific for celiac disease.
Small intestine imaging tests
Radiology tests, such as small-bowel barium studies and abdominal/pelvic CT scanning, are usually not helpful in establishing the diagnosis of celiac disease. In video capsule endoscopy, a tiny camera in a capsule films the small intestine as the camera moves through it. However, this study cannot examine the tissue microscopically. These tests should be considered in the evaluation of persons with suspected celiac disease and those who have dramatic weight loss, severe abdominal pain, intestinal bleeding, significant decrease in albumin levels, and intestinal obstruction. These symptoms may suggest the presence of tumors or ulcers in the small intestine.
Small intestine biopsy
The lining of the small intestine usually consists of fingerlike projections called villi. The villi contain digestive enzymes and provide the large absorptive surface area of the small intestine. In celiac disease, the villi are destroyed because of the inflammatory and autoimmune process. Once the villi are destroyed, nutrients cannot be absorbed. Biopsy samples of the small intestine show mild, moderate, or severe destruction of the villi depending on the severity of the inflammation. Biopsy samples of the small intestine are obtained by introducing a small, flexible endoscope through the mouth, the stomach, and into the small intestine while the patient is sedated.
Medically Reviewed by a Doctor on 5/26/2016
Mohammed Wehbi, MD
YOU MAY ALSO LIKE
Must Read Articles Related to Celiac Sprue
Patient Comments & Reviews
The eMedicineHealth doctors ask about Celiac Disease:
Celiac Disease - Symptoms
What were your symptoms of celiac disease?
Celiac Disease - Patient Experience
What symptoms led you to first find out you had celiac disease? Please describe your experience.
Celiac Disease - Self-Care at Home
What measures have you taken to reduce the impact of your celiac disease?