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Published on May 30, 2018
- Patients who should be tested for celiac disease include those with classic gastrointestinal manifestations or those deemed at high risk based on genetic susceptibility. - Diagnosis of celiac disease is usually initiated by serologic testing with anti-tTG, anti-DGP, or EMA and confirmed with duodenal biopsy. - Generally, patient nonresponse to gluten-free diet is typically caused by either unintentional gluten exposure or by a secondary cause, such as inflammatory bowel disease or small intestinal bacterial overgrowth. - Patients with refractory celiac disease may benefit from further radiologic or endoscopic evaluations including MRE, CT enterography/enteroclysis, capsule endoscopy, or deviceassisted enteroscopy to evaluate for complications including ulcerative jejunoileitis or malignancy. Video Capsule Endoscopy. Recommendations for screening in celiac disease.
TREATMENT WITH GLUTEN-FREE DIET: After diagnosis of CD through the measures discussed previously, a gluten-free diet with an intake of less than 10 mg of gluten per day should be initiated. Diet generally results in symptomatic improvement in most patients within 4 weeks. Generally serologic normalization of anti-tTG takes months to a year, and normalization of histologic results can take an estimated 3.8 years. After initiating this diet, about 20% of patients report persistent or recurrent symptoms after diagnosis termed nonresponsive CD. The most common cause of these symptoms is gluten exposure. Some hidden sources of gluten outside of the traditional wheat, rye, and barley include oats, soy sauce, certain marinades, some drug fillers, processed meats, and foods prepared in contact with gluten-containing foods.15 Persistent symptoms may also be caused by secondary etiologies, such as irritable bowel syndrome, colon cancer, primary or secondary lactose intolerance, pancreatic insufficiency, small bowel bacterial overgrowth, or microscopic colitis.