Am Fam Physician. 2024;109(1):92-93
Author disclosure: No relevant financial relationships.
Key Points for Practice
• In symptomatic patients consuming a gluten-containing diet, serologic testing includes measuring tissue transglutaminase IgA levels and total IgA levels to rule out an IgA deficiency.
• Because serologic testing can have low sensitivity, endoscopy is recommended if suspicion for celiac disease is high but serology is negative.
• If patients with possible celiac disease are already consuming a gluten-free diet, testing for HLA DQ2 or DQ8 should be considered because a negative result rules out celiac disease.
From the AFP Editors
Nearly 1% of Americans are affected by celiac disease, a permanent immune-mediated response to gluten in wheat, barley, and rye. Celiac disease has multisystemic effects characterized by specific antibodies and small bowel injury. There is no effective medical treatment; therefore, celiac disease requires a lifelong, strict adherence to a gluten-free diet.
Diagnosis
In patients with unexplained diarrhea, weight loss, abdominal pain, or bloating, testing for celiac disease with serology should be considered. Although screening asymptomatic patients for celiac disease is not recommended, testing is an option in patients with unexplained iron deficiency, weight loss, or recurrent pancreatitis; osteopenia; elevated transaminase levels; dermatitis herpetiformis; peripheral neuropathy; oral aphthous ulcers; growth failure; or thyroid disease. Testing of asymptomatic patients who have first-degree relative with celiac disease can be considered.
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