Diagnostic Challenges of Celiac Disease

Case 2: Symptomatic Malabsorption

June 2010

The second case. This is a case of a 58-year-old woman with diarrhea and a 6-month history of steatorrhea and bloating. She is anemic, she has lost over 25 pounds, and her endoscopic biopsy shows partial villous atrophy.

The next logical step would be:
1. To make a definite diagnosis of celiac disease at this point and start a gluten-free diet;
2. Do HLA testing;
3. Order gliadin antibody levels; or
4. Order a choice of a Comprehensive Celiac Disease Cascade or a Serology Cascade.

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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?