What’s New in Celiac Disease

 Has enough been said about the symptoms of Celiac Disease?  Better yet, does everyone have celiac disease?  If you can’t prove that you have gluten intolerance (another name for celiac disease), you might consider this collection of case studies.  And tell them I sent you!

Diagnosing Celiac Disease by Video Capsule Endoscopy (VCE) When Esophogastroduodenoscopy (EGD) and Biopsy is Unable to Provide a Diagnosis

Matthew S Chang, Moshe Rubin, Suzanne K Lewis, Peter H Green  BMC Gastroenterol. 2012;12(90) (Nov 01,2012)

Video capsule endoscopy (VCE) is mainly used to evaluate patients with celiac disease in whom their course after diagnosis has been unfavorable and the diagnosis of adenocarcinoma, lymphoma or refractory celiac disease is entertained, but it has been suggested that VCE could replace esophagogastroduodenoscopy (EGD) and biopsy under certain circumstances.
Methods: We report a single center case series of 8 patients with suspected celiac disease who were diagnosed by VCE.
Results: EGD and biopsy had been performed in 4 patients resulting in a negative biopsy, declined by 2, and contraindicated in 2 due to hemophilia and von Willebrand disease. In all patients, mucosal changes of scalloping, mucosal mosaicism and reduced folds were seen in either the duodenum or jejunum on VCE. Follow-up in 7 patients demonstrated improvement in either their serological abnormalities or their presenting clinical features on a gluten-free diet.
Conclusions:Our case series demonstrates that VCE and the visualization of the characteristic mucosal changes of villous atrophy may replace biopsy as the mode of diagnosis when EGD is either declined or contraindicated, or when duodenal biopsies are negative and there remains a high index of suspicion. Further study is needed to clarify the role and cost of diagnosing celiac disease with VCE.

Here’s my comments on this series:

1. New technology, although expensive, can really change the way we diagnose and treat disease.  This method (VCE) would bypass the need for endoscopy….what that means is no sedation and a less extensive bowel prep. 

2.  As with any new technology, results have to be confirmed in larger studies and by other research groups.  I’ll be waiting to hear about more published work.

3.  If it becomes easier to diagnose celiac disease, perhaps we can limit the number of patients who think they are intolerant to gluten but have never taken the time or money to find out conclusively. 

What do you think?  Would a video camera that you have to swallow make you more likely to find out if you really have celiac disease?



#coeliac-disease, #gluten-free-diet

Celiac disease & gluten-free diets–now I can have pizza!

Finally, the voice of consumers is being heard!  That is gluten-sensitive patients. 


#coeliac-disease, #food, #gluten, #gluten-free, #gluten-free-diet

The Teen Who Can’t Swallow

Try Your hand at diagnosis!  This comes from Medscape on-line. 

The Case

Chief complaint. Molly is a 14-year-old teen who presents to your office with a 9-month complaint of that certain foods “get stuck” in her throat. The sensation is intermittent, occurring about once a week, and more frequently when she eats meat, poultry, and crackers. She reports it is lessened by overchewing her food and by drinking water with each bite. Earlier this month, a friend performed the Heimlich maneuver to dislodge an item which “felt stuck in her throat.” She has steadily increased the numbers of foods that she avoids, even those which she used to regularly enjoy because they take a lot of effort to swallow at times. Her parents have noted she will drink more than 4 cups of water with each meal, and takes a long time to chew and swallow. However, she does not complain of any pain when swallowing.

Additionally, she reports becoming more full with less and less amounts of food, and often coughs right after eating. However, her weight and activity level are unaffected. On questioning, she describes at least a 2-year history of intermittent epigastric and mid-sternal burning that is occasionally relieved with over-the-counter remedies such as omeprazole.

Medical history. She has well-controlled asthma and allergic rhinitis that were first noted several years previously. Her mother reports that as a very young child, Molly had a milk allergy but she “outgrew” that by about 6 years of age. She has no other allergic diseases.

Review of systems. Review of systems is positive for frequent nausea, occasional vomiting several hours after eating (less than 5 episodes a month, which improves when she takes omeprazole), and abdominal pain that will wake her from her sleep once or twice a month.

Family history. Her father suffers from gastroesophageal reflux disease (GERD) and some similar swallowing difficulties.

Physical examination. Her physical exam is unremarkable. Her parents are concerned that she may have irritable bowel syndrome or celiac disease after researching their daughter’s symptoms on the Internet. They seek your advice.


What is the most likely diagnosis? Give me your best guess–to be continued tomorrow.





#abdominal-pain, #annals-of-internal-medicine, #coeliac-disease, #conditions-and-diseases, #gastroesophageal-reflux-disease, #gerd, #health, #irritable-bowel-syndrome