AMERICAN GASTROENTEROLOGICAL ASSOCIATION (AGA)
Tennyson, C.A. ., Semrad C.E., Gastro Bites, Celiac Disease Update. AGA Lunch and Learn, September 22, 2021.
The AGA has come out with three updates for celiac disease regarding prevalence, symptoms and diagnoses.
- PREVALENCE: Celiac Disease occurs in about 1% of the population worldwide. This incidence is higher in Sweden and in Punjab India and it is up to 5% in Sub Sahara Africa without knowing why.
2. SYMPTOMS: Classic presentations is diarrhea (40%),weight loss as well as failure to thrive in children. Other clinical signs may now include, iron deficiency anemia, constipation, bloating, abdominal pain, infertility, abnormal liver tests, migraines, neuropathy, osteoporosis, family members with celiac and auto immune disease like TYPE 1 DM .
3. DIAGNOSIS: The best test for Celiac is: TTG ( Tissue Transglutaminase) IGA ( antibody needs to be negative). The problem is that patients often start a gluten free diet and celiac diseases cannot be detected. In addition a biopsy is recommended for those who have less than 10x the positive predictive value. The AGA states that biopsies in children are not necessary if levels of TTG IGA are greater 10x above normal with an EMA antibody. Biopsies may be necessary to rule out Eosinophilic Esophagistis (EoE), and look at other issues in adults . Only 30% of patients have 10x TTG IGA above normal.
GLUTEN CHALLENGE: To get a secure diagnoses, patients need to be on gluten diets. A gluten challenge may include 1-3 slices of bread for 1-3 months helps get a secure diagnoses. Other factors to reactions to the bread challenges could be a amylase trypsin deficiency or fructan ( FODMAP) sensitivity in wheat products.