Frequency of Celiac Disease in Patients With Chronic Diarrhea

Panezai, Muhammad Saleem; Ullah, Asad; Ballur, Kalyani; Gilstrap, Lauren; Khan, Jaffar; Tareen, Bisma; Kakar, Mirwais; Khan, Junaid; Rasheed, Amna; Waheed, Abdul; Ghleilib, Intisar; White, Joseph; Cason, Frederick D

doi:10.7759/cureus.20495

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…Chronic diarrhea is a predominant manifestation in 43%-85% of patients with newly diagnosed CeD. Conversely, the prevalence of CeD in patients referred to secondary care with chronic diarrhea has been reported to range from 3% to 12.2%[ 17 , 18 ]. Given the high occurrence of CeD in patients with chronic diarrhea and the delay in diagnosis of CeD, several gastroenterology societies such as American Gastroenterological Association, and British Society of Gastroenterology has recommended screening for CeD as first line investigation in patients with chronic diarrhea[ 17 , 19 ].…”

Section: Definite Indications For Screening For Cedmentioning

confidence: 99%

Who to screen and how to screen for celiac disease

Singh¹,

Singh²,

Ahuja³

et al. 2022

WJG

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Celiac disease (CeD) is a chronic gluten-induced enteropathy with plethoric manifestations. The typical manifestations of CeD such as chronic diarrhea and malabsorption are widely recognized, however, many patients have atypical manifestations like iron deficiency anemia, idiopathic short stature, hypertransaminesemia or infertility, etc. These patients often present to the primary care physicians and/or non-gastrointestinal specialties. However, due to a lack of awareness among the healthcare professionals about the various atypical manifestations, many patients are not screened for CeD. In this review, we have summarized the available literature about the prevalence of CeD in various gastrointestinal (chronic diarrhea) and non-gastrointestinal conditions (iron deficiency anemia, short stature, cryptogenic hypertransaminesemia, cryptogenic cirrhosis or idiopathic ataxia etc. ) where the diagnosis of CeD should be con-sidered. In addition, we also discuss special scenarios where screening for CeD should be considered even in absence of symptoms such as patients with type 1 diabetes, Down’s syndrome, and first-degree relatives of patients with CeD. Further, we discuss the diagnostic performance and limitations of various screening tests for CeD such as IgA anti-tissue transglutaminase antibodies, anti-endomysial antibodies and anti-deamidated gliadin antibodies. Based on the current recommendations, we propose a diagnostic algorithm for patients with suspected CeD.

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Section: Definite Indications For Screening For Cedmentioning

confidence: 99%

Who to screen and how to screen for celiac disease

Singh¹,

Singh²,

Ahuja³

et al. 2022

WJG

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“…Certain group of patients with conditions like chronic diarrhea, short stature, iron deficiency anemia, type I diabetes mellitus, and first-degree relatives of patients with CeD, however, should be screened as the prevalence of CeD has been reported to be much higher in them as compared with that in the general population. [27][28][29][30][31] Although the results found in this study are based upon a large number of adult patients who were recruited from different regions of the country, this study has certain limitations. This study is a retrospective study that highlights the delay in diagnosis from symptom onset in CeD patients, but there was limited data available to highlight the delay in diagnosis from the time of first medical contact which is a clinically relevant variable to analyze and improve the existing health care facilities and practices.…”

Section: Discussionmentioning

confidence: 96%

“…Certain group of patients with conditions like chronic diarrhea, short stature, iron deficiency anemia, type I diabetes mellitus, and first‐degree relatives of patients with CeD, however, should be screened as the prevalence of CeD has been reported to be much higher in them as compared with that in the general population 27–31 …”

Section: Discussionmentioning

confidence: 99%

“…1). Also, the median age of symptom onset of patients with CeD having short stature was 14 years, [10][11][12][13][14][15][16][17][18][19][20] and it was significantly lower than the median age of symptom onset of patients with CeD having no short stature, in whom it was 24 years [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] (Fig. 2).…”

Section: Impact Of Delay In the Diagnosis Of Celiac Diseasementioning

confidence: 99%

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Impact of delay in the diagnosis on the severity of celiac disease

Mehta,

Agarwal,

Pachisia

et al. 2023

J of Gastro and Hepatol

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Background and AimCeliac disease (CeD) has now become a global disease with a worldwide prevalence of 0.67%. Despite being a common disease, CeD is often not diagnosed and there is a significant delay in its diagnosis. We reviewed the impact of the delay in the diagnosis on the severity of manifestations of CeD.MethodsWe reviewed clinical records of 726 consecutive patients with CeD from the Celiac Clinic database and the National Celiac Disease Consortium database. We extracted specific data including the demographics, symptoms at presentation, time of onset of symptoms, time to diagnosis from the onset of the symptoms, and relevant clinical data including fold‐rise in anti‐tissue transglutaminase antibody (IgA anti‐tTG Ab) and severity of villous and crypt abnormalities as assessed using modified Marsh classification.ResultsThe median duration between the onset of symptoms and the diagnosis of CeD was 27 months (interquartile range 12–60 months). A longer delay in the diagnosis of CeD from the onset of symptoms was associated with lower height for age, lower hemoglobin, higher fold rise in IgA Anti tTG titers, and higher severity of villous and crypt abnormalities. About 18% of patients presented with predominantly non‐gastrointestinal complaints and had a longer delay in the diagnosis of CeD.ConclusionsThere is a significant delay in the diagnosis of CeD since the onset of its symptoms. The severity of celiac disease increases with increasing delay in its diagnosis. There is a need to keep a low threshold for the diagnosis of CeD in appropriate clinical settings.

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