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home - Small Bowel - Coeliac Disease - Coeliac Diagnosis Written by Dr Sebastian Zeki

Coeliac Diagnosis

Non-human tTG have more frequently been associated with false positive results so repeat with human TTG.Review biopsies with expert eye for coeliacIf not help, put on gluten diet and repeat biposies Low pre-test probability (<2-5%):(No FH/ no symptoms/ no malabsorptionPurely Chinese/ Japanese/ sub-Saharan) Moderate/ high pre-test probability (>5%)ie any associated condition (see below) or FH or sugges-tive symptoms Small bowel biopsyMultiple biopsies D3/D4 Histology negative/ serology positive Both positive Histology positive/ serology negative Both negative Treat Diagnosis excluded Alternative causes of villous atrophy:Giardiasis.Peptic duodenitis.Tropical sprue.Bacterial overgrowth.Crohn’s.Common variable immunodeficiency. HLA TestingHLA typing is useful in symptomatic patients who are already on a gluten-free diet without having achieved a firm diagnosis.Those without are unlikely to have coeliac disease.Testing for these haplotypes HLA DQ2 or DQ8 has a sensitivity and specificity of 95% and 30% respectively. Therefore disease is unlikely if -ve. TTG IgA or anti-endomysial IgACurrent anti gliadin tests no longer used but newer version (AGA II has sensitivity 94 %, specificity 99 %)Serologic testing may not be as accurate in children < age five Written by Dr Sebastian Zeki Atypical celiac diseaseIt is defined as fully developed villous atrophy in the setting of milder clinical features such as iron deficiency, osteop-rosis, short stature, and/or infertility.This form appears to be the most common. Coeliac Disease Diagnosis Reasons for suggestive clinical features but -ve serologic tests:The individual may have selective IgA deficiency.The serologic test could be false negative in which case it should be repeated or a small bowel biopsy should be obtained.The patient may not have celiac disease in which case other causes of symptoms or villous atrophy should be considered. Difficult Diagnoses Assay sensitivity and specificityIgA endomysial antibodies-sensitivity 93 %; specificity 99 %bind to connective tissue surrounding smooth muscle cells in the endomysium of human umbilical cord in the lab- stain visualised by immunofluorescenceIgA tissue transglutaminase antibodies-sensitivity 95 %; specificity 96 %IgA antigliadin antibodies-s-sensitivity 85%; specificity 90 %.ELISA testIgG antigliadin antibodies-s-sensitivity 80 %; specificity 82 %More sensitive if disease more severe Classic coeliac disease main features:Villous atrophy which is worse proximally due to increased gluten exposure).Symptoms of malabsorption such as steatorrhea, weight loss or other signs of nutrient or vitamin deficiency.Resolution upon withdrawal of gluten-containing foods.o Latent coeliac disease It is defined as a normal jejunal mucosa and no or minor symptoms at least at one time point while on a normal, gluten-containing diet.2 variants exist- previous coeliac and previous normal.Previous coeliac are patients with prior coeliac who then have a normal mucosa even when a normal diet is started.Previous normal occurs in patients with a previously normal mucosa who then develop coeliac. Silent coeliac disease It is defined as villous atrophy found after testing asymptomatic patients.

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