Celiac Disease Could Take 3.5 Years to Diagnose | Loyola Medicine
Tuesday, February 20, 2018

Without GI Symptoms, Celiac Disease Takes 3.5 Years to Diagnose

bread and grains
 
MAYWOOD, IL – It takes an average of 3.5 years to diagnose celiac disease in patients who do not report gastrointestinal symptoms, a Loyola Medicine study has found.
 
Patients who reported gastrointestinal symptoms were diagnosed in an average of 2.3 months.
 
The study by senior author Mukund Venu, MD, and colleagues is published in the American Journal of Medicine.
 
An estimated 1 percent of the population worldwide has celiac disease and as many as six out of seven people with the disease are not diagnosed. In those with the disease, ingesting gluten triggers an immune response that damages the lining of the small intestine, preventing the proper absorption of some nutrients. The main treatment is avoiding gluten, a protein found in wheat, barley and rye.
 
Gastrointestinal symptoms of celiac disease include diarrhea, bloating, gas, abdominal pain, nausea, constipation, vomiting and weight loss. Non-gastrointestinal symptoms include anemia, thyroid dysfunction, osteoporosis, liver function test abnormalities and skin conditions such as dermatitis herpetiformis (itchy skin rash consisting of bumps and blisters).
 
Researchers reviewed the charts of 101 patients who had been diagnosed with celiac disease, confirmed by biopsy. Fifty-two presented with gastrointestinal symptoms and 49 had non-gastrointestinal complaints.
 
Among the findings:
  • 43.2 percent of patients with non-gastrointestinal symptoms had abnormal thyroid-stimulating hormone, compared to 15.5 percent in the gastrointestinal symptom group
  • 69.4 percent of the non-gastrointestinal symptom group had anemia, compared to 11.5 percent in the gastrointestinal symptom group
  • 68 percent of the patients in the non-gastrointestinal symptom group had abnormal bone density scans, compared to 41 percent in the gastrointestinal group
 
The study excluded patients who were diagnosed with celiac disease but had not undergone a small intestine biopsy, the gold standard for diagnosing the disease. Also excluded were patients who had non-celiac gluten sensitivity (intolerance to gluten), which is managed differently.
 
Undiagnosed celiac disease can lead to osteoporotic fractures, infertility, unnecessary surgeries and cancer. Patients with thyroid abnormalities, anemia or bone mineral density loss should be screened for celiac disease to ensure that a possible underlying diagnosis of celiac disease is not overlooked for several years, researchers concluded.
 
Dr. Venu, the corresponding author, is director of clinical operations in Loyola Medicine's division of gastroenterology. His co-authors are former Loyola residents Marco Paez, MD, and Anna Maria Gramelspacher, MD, James Sinacore, PhD, of Loyola University Chicago's department of public health sciences and Laura Winterfield, MD, of the Medical University of South Carolina.
 
The study is titled, "Delay in Diagnosis of Celiac Disease in Patients Without Gastrointestinal Complaints."
 

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.