Celiac Disease

Michael DiMarino, M.D.
Disclosures		Relationship: Yes Consultant: Dr. DiMarino wishes to disclose that he is a consultant for Genentech.

Anthony J. DiMarino, Jr., M.D., F.A.C.P., F.A.C.G.
Disclosures		Relationship: Yes Grants/Research Support: Centocor, Alba Theraputics. Also Research Grant Advisor for Astra Zeneca. Honorarium: Speaker's Bureau (Astra Zeneca, TAP, Centocor and Alba Theraputics)

The Planners of this activity have no relationships to disclose.

Anthony J. DiMarino, MD, is the William Rorer professor of medicine, and chief of gastroenterology and hepatology at Thomas Jefferson University, where co-author Michael DiMarino, MD, is a clinical assistant professor of medicine. Here, they describe and define celiac disease, a gluten-sensitive enteropathy and discuss its symptoms as well as the consequences of undiagnosed celiac disease.

This lecture and the post-test is worth 1.5 credit hours.

New serological tests in celiac disease have shown the disease to be much more prevalent than originally thought ... some experts having labeled it a "hidden epidemic," with an incidence of one in 133 found in one study of 13,000 individuals. The authors describe its cause, sensitivity to gluten which is the protein fraction of wheat, rye, and barley. Genetics' role in gluten-sensitive enteropathy is discussed, as is the influence of the environment, particularly ingestion of gluten by infants. Inherent autoimmune deregulation can lead to celiac disease.

A number of disorders, including Sjogren's syndrome are associated with celiac disease. While biopsy and serologic testing are the main approaches to diagnosis, treatment is the obvious one of ordering a gluten-free diet which may also improve or eliminate associated autoimmune disorders. Physicians should rule out lymphoma or other malignancies in the nonresponsive celiac patient.

Because of the insidious presentation of celiac disease, it may go undiagnosed or underdiagnosed ... which can lead to malabsorption and weight loss in celiac disease, and perhaps to the emaciated and wasted appearance of an elderly patient shown in one of the 40 illustrations that accompany this lecture.