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>>> DR. KENNETH FALCHUK: Celiac disease is extremely common in our society. Close to
maybe 1 to 150 to 200 individuals or may be more who may well be symptom-free, asymptomatic,
have Celiac disease. There is a spectrum as to how Celiac disease presents. Most patients
do not have symptoms. Some will present with weight loss, diarrhea, sensation of fullness
in the stomach, do not want to eat. That used to be the common presentation when we knew
little about how to evaluate patients with celiac disease. The technology that is available
to us now allows us to, in a non-invasive fashion, evaluate and diagnose a potential
patient with celiac disease.
Now it turns out that it may well be that more patients do not have what we call wheat,
gluten intolerance, so Celiac is really an intolerance to food products that have gluten
such as wheat, rye, barley, may be oats. These foods that are taken into our system, we eat
them everyday pasta, white breads, damaged the lining of the small intestine that is
where digestion takes place. By doing there symptoms developed. Now as I said before,
the majority of patients may not even have symptoms, so how do we proceed to evaluate
someone that may carry the propensity or already have Celiac disease.
If they have symptoms it is very easy. If you have a family history of Celiac disease
with several members, you should test the other members because there is an increased
incidence of Celiac in relatives of patients with Celiac disease as well. So, there is
a blood test, there are several blood tests but the most specific ones that are available
to any physician done by any lab in the world is the serum transglutaminase level, others
called it the antiendomysial antibodies. It is a simple test. You take a small sample
of blood, you test it in the laboratory, if you get a tested as positive with the reading
above certain number then is something that the physician has to pursue it. It does not
have to be a specialist like myself, a gastroenterologist does that, any physician can do that.
Once their blood test is done, if it is positive, has a degree of positivity of so specificity
of 98% or greater. There are other more sophisticated testings that gastroenterologists do but for
the most part there is none. Now it is important to confirm the diagnosis, because as I said
it turns out the Celiac disease is common but less common than gluten intolerance, that
is there are patients who eat wheat products and feel lousy, they feel bloated, they develop
bloating, they have abdominal pain, they may or may not have diarrhea yet when you test
them with all the specific testing including biopsies of the intestine called duodenal
biopsy, they do not as yet or have not develop true celiac disease. That means of the biopsies
are normal. So that is important to differentiate true celiac cause.
Celiac, over the long-term, has inherent risks of conditions that can be detrimental to the
patient. They can affect the life of a patient. There are certain tumors that occur in patients
who have longstanding Celiac disease such as lymphomas, tumors that affect the small
intestine or even cancer of the small intestine. Patients with Celiac disease can be very malnourished;
can have deficiencies or many vitamins such as B12, vitamin D, and iron. Some of the common
ways for patients to present to the physician even though he or she may be symptom free
is to have a low iron in their blood; we call it an iron deficiency syndrome. It is caused
by many things but one of them is Celiac disease.
Some patients also may have a routine blood test, some abnormalities of liver blood test,
we call them transaminases and that could be also caused by Celiac disease and not hepatitis
or liver cancer or other serious illnesses affecting the liver. So it is important for
the physician to be aware of the other ways of Celiac disease’s presence.
There are other presentations that are more unusual very rare types of neurological changes,
severe headaches sometimes, but these are not the common presentation. The common is
to be symptom free or have some GI symptoms as I mentioned earlier or have a low serum
iron deficiency. When that happens, if the blood test is positive, the diagnosis must
be confirmed because it is strict diet, tough diet to follow but it can be followed. Today,
in our society, there are many ways to live with a gluten free diet and the final way
to confirm the diagnosis is to do a special test called endoscopy with a little light,
patients swallows the tiny tube, the physician goes down to the area concerned or the target
area and that is called the duodenum, you take samples, they were seen under microscope
and you find the changes there are compatible with Celiac disease.
down if it does not, is that pain having a significant impact on your quality of life
and if the answer to that is yes then surgery may be the right answer for you. However,
the majority of people over the ages of 35 or 40, surgery for meniscus tears is not necessary.