Much of the new literature points toward inflammation as the cause of many diseases and often links this problem to multiple diseases in one individual. I know of a patient who has diabetes, asthma, and a family history of celiac disease. Should she be tested for celiac disease? She has no specific signs or symptoms but is concerned about the connection between these conditions.
—SHANNON VELASQUEZ, CFNP, MSN, RN, West Columbia, S.C.
Celiac disease, an inherited allergy to gluten, has emerged as a common cause of a plethora of nonspecific symptoms. Once thought to affect one in 5,000 individuals, celiac disease is now believed to affect roughly one in 133. Historically, the symptoms of celiac disease were a result of malabsorption. Diarrhea, steatorrhea, weight loss, anemia, and malnutrition would prompt a workup for the disorder. We have since realized that the majority of people with celiac disease do not have significant malabsorption and present with such nonspecific symptoms as gas, bloating, and abnormal liver enzymes. Many conditions, including diabetes, are now known to run hand-in-hand with celiac disease. In light of this patient’s family history and the fact that she has diabetes, it is reasonable to test her for celiac disease. Start with a serum tissue transglutaminase antibody (anti-tTG) determination and a serum immunoglobulin (Ig) A level (IgA deficiency invalidates the test). If the anti-tTG is positive, proceed to an upper endoscopy with biopsy to confirm the diagnosis. She needs to continue to consume gluten prior to testing, as the blood test and biopsy will be normal in a celiac patient who is not consuming gluten.
—Bruce D. Askey, MSN, CRNP (128-2)