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Diagnosing Celiac Disease in Primary Care Settings

Celiac.com 04/10/2007 - Celiac disease is one of the most common chronic health disorders in western countries. Yet, due largely to poor awareness of celiac disease by primary care physicians, most celiac cases in North America go undiagnosed. A recent study published in the American Journal of Gastroenterology suggests that the North American diagnostic rate for celiac disease can be improved through the use of active case-finding strategies in the primary care setting.

The study set out to determine the most common celiac symptoms faced by clinicians, and to determine how effective an active case-finding strategy might be in raising the levels of diagnosis. The study drew from a large pool of individuals who attended one of three participating North American clinical practices. 737 women and 239 men with symptoms or conditions known to be associated with celiac disease were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies, and those with elevated anti-tTG were then tested for IgA anti-endomysial antibodies (EMA). Those who tested positive for EMA were encouraged to undergo an intestinal biopsy and HLA typing.

The median age for those tested was 54.3 years. Of 976 subjects tested, 30 showed a positive anti-tTG test (3.07%, 95% CI 1.98–4.16). 22 patients (18 women, 4 men) were diagnosed with celiac. In these 22 cases, the most frequent reasons for celiac disease screening were bloating (12/22), thyroid disease (11/22), irritable bowel syndrome (7/22), unexplained chronic diarrhea (6/22), chronic fatigue (5/22), and constipation (4/22).

The prevalence of celiac disease in the serologically screened sample was 2.25% (95% CI 1.32–3.18).

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According to the study, active screening implementation substantially increased diagnostic rates from a baseline low of 0.27 cases per thousand visits (95% CI 0.13–0.41), to a rate of 11.6 per thousand visits (95% CI 6.8–16.4, P < 0.001).

The study concludes that the implementation of active strategies in primary care settings is likely to improve the diagnostic rate of celiac disease in North America.

Am J Gastroenterol 2007; 102:1–7

health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.

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you're lucky you dont catch colds. im the opposite i catch everything very easily and get alot sicker than whoever i caught it from and take much longer to get better.

Even one positive can be diagnostic. This is one: Gliadin deamidated peptide IgG 33.9. If unsure, a biopsy of the small intestine will provide definite confirmation. There is a control test to validate the other ones, but I don't see it there. What is does is validate the others by checking on the overall antibody levels. But it is to detect possible false negatives. A positive is a positive. I think your daughter has joined our club.

My daughter, almost 7 years old, recently had a lot of blood work done, her Dr is out of the office, but another Dr in the practice said everything looked normal. I'm waiting for her Dr to come back and see what she thinks. I'm concerned because there is one abnormal result and I can't find info to tell me if just that one test being abnormal means anything. The reason for the blood work is mainly because of her poor growth, though she does have some other symptoms. IgA 133 mg/dl Reference range 33-200 CRP <2.9 same as reference range Gliadin Deamidated Peptide IgA .4 Reference range <=14.9 Gliadin deamidated peptide IgG 33.9 Reference range <=14.9 TTG IgA .5 Reference range <=14.9 TTG IgG <.8 Reference range <=14.9

Just watch out. I just went to the expo in Schaumburg, IL, and ended up getting glutened. I realized afterward that I ate all these samples thinking they were gluten free, and they weren't. One company was advertising some sugar, and had made some cake, but then I realized.... How do I know if this contains any other ingredients that might have gluten? Did they make it with a blender or utensils that had gluten contamination? Makes me realize the only safe things would be packaged giveaways with gluten free labeling. My fault for not thinking things through. It was just too exciting thinking i could try it all and enjoy without worry.

No fasting required for a celiac blood test unless they were checking your blood glucose levels during the same blood draw.