Diagnostic Challenges of Celiac Disease

What About Patients on Gluten-free Diet?

June 2010

So, what about those patients on a gluten-free diet? They are often unhappy; this is not an easy diet to follow. Serology and biopsies can normalize. HLA typing might help. A challenge may not be acceptable to some patients who simply will not eat gluten. Other patients were too ill to risk a rechallenge with gluten. And, for patients with severe neurologic disease, elderly patients with severe nutritional impairment, are usually patients in which a gluten challenge is not recommended. And, of course, one must always remember that why argue with success if the diet itself is nutritionally adequate, if the patient is neither suitable nor willing to undergo a sufficient gluten challenge for accurate testing.

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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?