Diagnostic Challenges of Celiac Disease

Minimal Disease: Uncertain Histology

June 2010

The next case. A 65-year-old female patient with dyspepsia and a 6-month history of epigastric pain and bloating. Is not anemic. However, a duodenal biopsy performed shows increased intraepithelial lymphocytes without villous atrophy.

The next logical step could be:
1. Put her on a gluten-free diet, presuming that she has celiac disease;
2. Give her a drug called budesonide, a powerful, topically active steroid;
3. Order a Celiac Disease Comprehensive Cascade; or
4. Treat her for Crohn disease.

In this case, rather than assuming that this patient has celiac disease, or treating her with an anti-inflammatory or treating for another disease, that’s Crohn disease, the next logical test would be to undertake the Celiac Disease Comprehensive Cascade.

< Previous Slide

Minimal Disease: Uncertain Histology

Next Slide >

 

Jump to section:

• Introduction
• Case 1: Negative Serology for Celiac Disease
• Limitations of Serology
• Case 2: Symptomatic Malabsorption
• Biopsy First?
• Comparison of Serological Tests
• Comparison of Serological Tests
• Marsh Classification
• Autoimmune Enteropathy²
• Autoimmune Enteropathy²
• False-Positive Biopsies
• False-Positive Biopsies
• Minimal Disease: Uncertain Histology
• Lymphocytic Duodenosis⁴
• Patient Presenting on Gluten-free Diet
• What About Patients on Gluten-free Diet?
• Gluten Challenge Testing
• Celiac Disease and HLA Risk
• Genetic Tests-Big Limitation⁵
• References
• Questions?