The Agency for Healthcare Research ...

The Agency for Healthcare Research and Quality has released an evidence report forward celiac disease. "Celiac Disease" is available online at http://www.ahrq.gov/clinic/epcsums/ celiacsum.htm.

Celiac disease shows a spectrum of clinical features. Although "classic" celiac disease (i.e., completely developed, gluten-induced villous atrophy and classic features of intestinal malabsorption) is principally commonly described, it appears that principally patients have atypical disease (i.e., completely developed gluten-induced villous atrophy in the setting of another disorder like as iron deficiency, osteoporosis, short stature, or infertility). The prevalence of celiac disease is difficult to estimate, however a recent study found rates of approximately 1 percent in the general population and 45 percent in high-risk disposes such as first-degree relatives of ones with the disease.

The diagnosis classically is made in succession the basis of clinical suspicion--recognizing atypical presentations of the like kind as isolated iron deficiency, combined iron and folate deficiency, and osteoporosis--compatible with a duodenal biopsy in living bodys with a gluten-containing diet, followed on clinical and histologic improvement when a gluten-free diet is started. However, several serologic markers are available that have altered the classic diagnostic pathway. IgA antigliadin antibodies (AGA), IgA anti-endomysial antibodies (EMA), and anti-tissue transglutaminase antibodies (tTG) have high sensitivity and specificity in diagnosing celiac disease. However, AGA antibody testing in children and adults has a limited part and the reported diagnostic parameters for EMA and tTG antibody testing are taken from studies in which the prevalence of celiac disease was frequently higher than that seen in usual clinical practice. The positive predictive values reported for these experiments will not be as high as those reported when these trials are used to screen the general population.

Human leukocyte antigen DQ2/DQ8 testing appears to be useful in the diagnosis of celiac disease. The trial has high sensitivity (i.e., 90 to 95 percent) However, approximately 30 percent of the general population and an smooth higher proportion of high-risk bodily forms also carry these markers, to such a degree the specificity of this trial is not ideal. Its greatest diagnostic use appears to be its negative predictive value, making it useful when negative at ruling revealed disease.

Testing for celiac disease in at-risk and symptomatic patients is associated with righteous outcomes. These patients appear to be more compliant with a gluten-free diet and would be count uponed to benefit from this intervention. The data are les clear for asymptomatic screen-identified patients. consequences in these patients have not been studied extensively, moreover compliance with a gluten-free diet appears problematic, particularly in patients diagnosed in adulthood.

COPYRIGHT 2005 American Academy of Family Physicians

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