What Tests are Available for Celiac Disease?


Patient Presentation

A 14 year old male came to diagnostic clinic for a second opinion concerning loose stools and abdominal pain.

He had had several months of loose stools up to 5-7 times/day which were described as loose and pudding-like without undigested food or blood. He said that sometimes his stool seemed to float on top of the toilet water and smelled bad, but this was not consistent.

About 2-3 months ago he began having abdominal pain that occurred several times per week. Some episodes woke him at night. These could make him cry but he was consolable.

He had no recent travel, pet or antibiotic exposures and he had a chlorinated urban water supply. His family members had been healthy
.
The past medical history revealed constipation around the time of toilet training.
The family history was positive for a father with Celiac disease and lactose intolerance.
The review of systems was negative for fevers, excessive fatigue, weight loss, sweats, skin changes, or joint involvement.
The pertinent physical exam showed a gregarious male in no acute distress. His weight was 75% and height 50%. His abdominal examination revealed normal bowel sounds, no hepatosplenomegaly or masses, and a soft abdomen without guarding.
Rectal examination revealed a small amount of liquid stool that was released after the examination. The stool was guiaic negative. He had no edema.
The previous work-up by the local physician included an endomysial, transglutaminase, and antigliadin antibodies, all of which were negative.

He also had a hemoglobin level of 13.2 g/L, platelet count of 210 x 1000/mm2, erythrocyte sedimentation rate that was slightly elevated at 24 mm/hour (normal up to 20 mm/hour). C-reactive protein, total protein, albumin, urinalysis, liver function tests and electrolytes were normal.
Abdominal radiographs showed a non-specific bowel gas pattern. Serial stool examinations were negative for blood, bacteria or parasites.
Repeated laboratory evaluation in the clinic was positive for IgA antigliadin antibody and the patient was referred to a pediatric gastroenterologist.

An upper endoscopy with a small bowel biopsy was performed and showed villous atrophy on 4 of 6 samples.
The diagnosis of Celiac disease was made and the patient was instructed on elimination of gluten from his diet. The parents were very supportive as the father had to follow the same diet restrictions already.
The patientís clinical course over the next month showed clinical improvement with resolution of the abdominal pain, and the loose stools occurring only 1-2 times/day. He had gained ~1 pound of weight.
The patient was screened again for iron deficiency, Vitamin D, calcium, fasting glucose and thyroid function tests. All were normal.
The patient was to follow up again in 2 months.

For Discussion

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