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Diagnosis of Adult Celiac Disease

HUGH J FREEMAN, MD, FRCPC, FACP

Celiac disease is a chronic intestinal disorder that is estimated to affect approximately 0.5–1% of the North American population, and adult celiac disease is becoming increasingly recognized [1]. Despite this, distinction from other disorders – some common, but not gluten-sensitive – is required. Celiac disease usually presents with chronic diarrhea for >1 month and negative fecal studies for bacterial pathogens and parasites. Some patients may present without diarrhea, but with iron deficiency or altered chemistry values (e.g. low serum folate or serum albumin levels). Alternatively, a closely related disorder may be evident, such as autoimmune thyroid disease, insulin-dependent diabetes, or dermatitis herpetiformis. Finally, positive results from screening blood tests (e.g. for antibodies to tissue transglutaminase), although not diagnostic, may lead the clinician to suspect celiac disease.

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