Who should be screened for celiac disease?
It seems that I am seeing celiac disease diagnosed more frequently. I suspect this is because the antigliadin serology is available, but I worry that this is going to become an attention deficit disorder/fibromyalgia "diagnosis du jour." How good are these tests? What are the extra-GI symptoms associated with the disease? A friend was diagnosed after a suspicion based on depression and fatigue. Should I screen all those patients for celiac disease?—Nathan W. Keever, DO, Cazenovia, N.Y.
The prevalence of celiac disease in the United States is 0.5%-1.0%. Based on consensus recommendations from NIH and the American Gastroenterological Association, screening is appropriate for patients with (1) classic symptoms of malabsorption; (2) unexplained iron deficiency anemia, transaminitis, dermatitis herpetiformis, chronic fatigue, and other atypical symptoms; (3) conditions associated with a high risk of celiac disease, such as type 1 diabetes, autoimmune endocrinopathies, and Turner syndrome; and (4) first- or second-degree relatives with celiac disease (Gastroenterology. 2006;131:1977-1980). The most efficient screening test is immunoglobulin (Ig)A tissue transglutaminase (tTG) antibody. Antigliadin antibody testing is no longer recommended except in IgA deficiency. IgA endomysial antibody (EMA) is specific but testing is more time-consuming and operator-dependent than IgA tTG, with a lower sensitivity; IgA EMA is a confirmatory test. If serology is positive or high suspicion persists despite negative serology, small bowel biopsy is the next step.—Laura G. Kehoe, MD (139-8)