Celiac disease remains difficult to diagnose

The consumption of wheat, rye or barley may cause a wide variety of symptoms in people with the disorder.

By Susan J. Landers — Posted July 26, 2004

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Washington -- As many as 3 million people in the United States have celiac disease but only about a tenth have been diagnosed, concluded an independent panel of experts convened by the National Institutes of Health to examine the disease.

"We know that celiac disease is caused by an immune response to the gluten in certain common grains, so we have a very effective treatment -- a gluten-free diet -- but if physicians don't recognize when to test for the disease, patients are going to suffer needlessly," said Charles Elson, MD, professor of medicine at the University of Alabama.

Dr. Elson chaired the NIH Consensus Development Conference panel that spent three days in late June developing recommendations for diagnosing and managing the disease.

The wide variety of symptoms that can signal the presence of celiac disease, which has a strong genetic component, may make diagnosis more difficult today. "The newer cases are presenting in a different way than they were when I went to medical school," said Dr. Elson. "We used to identify celiac disease as the ultimate paradigm of malabsorption syndromes."

While malabsorption, diarrhea and weight loss in children are still identifiers, new signs among older people include constipation, pain that is not clearly defined, an intensely itchy rash, anemia, infertility in women, osteoporosis and fatigue.

This change may be the result of a successful public health campaign to promote breastfeeding and delay the introduction of solid foods to infants, said Douglas Rogers, MD, section head of pediatric endocrinology at the Cleveland Clinic, and a panel member.

The first step in pursuing a diagnosis of the disease is a serologic test that can be followed by a small bowel biopsy in those who test positive. All testing should be done when a patient is consuming food containing gluten.

However, the panel states that no single test can diagnose or exclude celiac disease in every individual. Definitive diagnosis is made when symptoms resolve with a gluten-free diet.

Back to top

External links

National Institutes of Health Consensus Development Conference Statement on Celiac Disease, in pdf (link)

Celiac Sprue Assn. (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn