I was delighted to see an article this morning focusing on the need for celiac awareness in the medical community and how to diagnose it — this time for physician assistants.  This extensive article was published in the December issue of the Journal of the American Academy of Physician Assistants.

Why direct the article toward physician assistants?  Well it didn’t say.  But physician assistants often see people with general health issues like strep, the flu, and even some women’s issues. So it is very possible they would be seeing people with symptoms (typical or atypical) of celiac disease; ie: stomach pain, vomiting, diarrhea, fatigue and much, much more.  I think it is a great medical population to target for this quick update and education, but I also think everyone can learn from this article.

Getting a celiac diagnosis

The online version of the article was three pages of details explaining which blood tests you request, why even people with atypical symptoms should be checked for celiac, and even reminding them that the tests must be conducted while the person is still eating gluten.

The last reminder on that list is a big one I think.  I still hear from people who have been told by their doctor to just try the diet and see what happens — many without knowing how it could impact future celiac tests.  While, I personally can see where an educated person, or maybe someone with celiac in the family and understands the consequences, may just try the diet.  But for a brand new patient (like my daughter was) we didn’t know starting the diet would possibly skew any future results.  But our GP told us to do the diet before we got in to see our gastroenterologist. Luckily Emma’s results weren’t impacted, but others may very well be.

With atypical symptoms or asymptomatic patients, the article also warns to take these cases seriously,

“Manifestations of celiac disease range from asymptomatic to severe, including the consequences of malabsorption. As demonstrated in the two reported cases, many patients present with atypical complaints. Even for those who do not exhibit nutritional deficiencies, identification and treatment of celiac disease can significantly improve quality of life and may prevent future complications.”

Questioning IBS

The article also talked about Irritable Bowel Syndrome and how many times patients are incorrectly diagnosed with IBS before being correctly diagnosed with celiac. “In one study,” the article said, “before treatment was initiated, nearly 50% of patients’ presenting symptoms were consistent with the Rome II criteria for IBS.”  Meaning, the diagnosis can be a little tricky, but don’t just blow off possible celiac as IBS.  I believe this article is telling the medical community to check for celiac disease too.

What to do with a False Negative Blood Test

Those blood tests come back negative, more often than people would like — especially when they actually really do have celiac disease.  This section of the article even reminds PA’s to refer the patient to a gastroenterologist when all signs still point to celiac disease, despite a negative blood test.

Conclusion

This was a great summary, easy read and even a go-to guide for dealing with a celiac patient.  The author, Bettie Coplan, cited research from Dr. Joseph Murray from the Mayo Clinic, Dr. Alessio Fasano from the University of Maryland and Dr. Peter Green from Columbia University in her article. There were tables explaining foods that are forbidden and accepted on the gluten-free diet, a checklist of sorts for a newly diagnosed patient and even an algorithm on diagnosing celiac disease.

Officially she summed it up by saying, “Broader recognition of the disease will thus likely produce improved outcomes for a substantial number of patients.”

Yes indeed.  I hope people in the medical community take note and even save this article if needed.

Manifestations of celiac disease range from asymptomatic to severe, including the consequences of malabsorption. As demonstrated in the two reported cases, many patients present with atypical complaints. Even for those who do not exhibit nutritional deficiencies, identification and treatment of celiac disease can significantly improve quality of life and may prevent future complications.

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