Celiac Awareness Month is almost over, but it’s always a good time to learn about what your doctor should know to be able to better assist you.
We know most doctors are not pleased when we visit their offices with our own research, but by knowing what to expect from them you can, at least, choose the doctor that you believe does the best job based on your research.
According to the scientific article Celiac Disease: Ten Things That Every Gastroenterologist Should Know by Oxentenko AS, Murray JA there are 10 things that all gastroenterologists should know about celiac disease (CD).
1) The immunoglobulin A tissue transglutaminase is the single best serologic test to use for the detection of CD.
2) CD can be recognized endoscopically, and water immersion enhances villi detection, although a normal endoscopic appearance does not preclude the diagnosis.
3) It is recommended that 4 biopsies be taken from the second part of the duodenum and 2 bulb biopsies be taken at the 9 o’clock and 12 o’clock positions to maximize the sensitivity for histologic confirmation of CD.
4) Consider serologic testing of first-degree relatives, patients with type 1 diabetes mellitus, Down’s, Turner’s, and Williams’ syndromes, as well as those with premature osteoporosis, iron deficiency, abnormal liver biochemistries, and other manifestations of CD.
5) Patients already on a prolonged gluten-free diet (GFD) should be tested for the presence of HLA DQ2 or DQ8, thereby avoiding the need for further evaluation of CD in non-allelic carriers.
6) The basic treatment of CD is a strict, lifelong GFD, enabled by an expert dietitian.
7) Newly diagnosed adults with CD should be assessed for micronutrient deficiencies (iron, B12, folate, zinc, copper), fat soluble vitamin deficiencies (vitamin D), and bone densitometry.
8) All patients diagnosed with CD should have clinical follow-up to ensure response and adherence to a GFD.
9) In those with persistent or relapsing symptoms, the robustness of the original diagnosis should be reviewed, gluten exposure sought, and a systematic evaluation for alternative and associated diseases performed.
10) Evaluate those with refractory disease for malignant transformation.