TOC | GI
Celiac sprue (nontropical sprue) See Celiac Disease 2007 | celilacdisease2007.pdf
A disorder with gluten sensitive enteropathy.
Symptoms: weight loss, chronic diarrhea, malabsorption, abdominal distention, bloating, fatigue, anemia, usually of megaloblastic type, intermittent diarrhea, etc.
Current guideliness suggeset that anyone with chronic diarrhea, malabsorption (abnormal xylose absorption test, 72 hr stool fat test), weight loss, & persistent abdominal distention should be tested.
All lab testing must be done while the patient is on a gluten-containing diet.
Prevalence of Celiac Disease among Children in
Conclusions: The presence of serum tissue transglutaminase and endomysial autoantibodies is predictive of small-bowel abnormalities indicative of celiac disease. There is a good correlation between autoantibody positivity and specific HLA haplotypes. We estimate that the prevalence of celiac disease among Finnish schoolchildren is at least 1 case in 99 children. N Engl J Med June 19, 2003, 348: 2517
Accuracy of Serologic Tests and HLA-DQ Typing for
Diagnosing Celiac Disease | See
Annals of Int Med 4 September 2007 | Volume 147 Issue 5 | Pages 294-302
Results: Sixteen of 463 participants had celiac disease (prevalence,
3.46% [95% CI, 1.99% to 5.55%]). A positive result on both TGA and EMA testing
had a sensitivity of 81% (CI, 54% to 95.9%), specificity of 99.3%
(CI, 98.0% to 99.9%), and negative predictive value of 99.3% (CI,
98.0% to 99.9%).
Testing positive for either HLA-DQ type maximized sensitivity (100% [CI, 79% to 100%]) and negative predictive value (100% [CI, 98.6% to 100%]), whereas testing negative for both minimized the negative likelihood ratio (0.00 [CI, 0.00 to 0.40]) and posttest probability (0% [CI, 0% to 1.4%]). The addition of HLA-DQ typing to TGA and EMA testing, and the addition of serologic testing to HLA-DQ typing, did not change test performance compared with either testing strategy alone.
Conclusions: In a patient population referred for symptoms and signs of celiac disease with a prevalence of celiac disease of 3.46%, antitransglutaminase antibodies [TGA] and antiendomysium antibodies [EMA] testing were the most sensitive serum antibody tests and a negative HLA-DQ type excluded the diagnosis. However, the addition of HLA-DQ typing to TGA and EMA testing, and the addition of serologic testing to HLA-DQ typing, provided the same measures of test performance as either testing strategy alone.