Celiac disease is often underdiagnosed.

About 1 in 133 Americans has celiac disease, but fewer than 5% were diagnosed in 2003. Many practitioners believe that the condition is a childhood disease; but traumatic events, viral infection, and pregnancy can activate it in adults. Underdiagnosis is the norm, partly because national guidelines encourage practitioners to make a diagnosis based on symptoms. More times than not, these lead to a diagnosis of irritable bowel syndrome or spastic colon. Neither of these conditions has a definite, successful treatment. Celiac disease, however, does: avoid gluten. In genetically susceptible people, gluten sets off an immune response in the small intestine that eventually changes the mucosa structure and atrophies the villi. Malabsorption results.

Gluten is a protein substance found in wheat, rye, barley, and possibly oats. It is also added to an array of processed foods, including soups, salad dressings, soy sauce, marinades, candy, soy milk, beer, energy bars, processed lunch meats, frozen dinners, prescription drugs, and vitamins. Avoiding gluten in our culture is not an easy task, but it is a sure cure for celiac disease. Classic symptoms of celiac disease include bloating, chronic diarrhea, constipation, excessive gas, fatty stools, vomiting, weight loss, irritability, and lethargy. Over time, osteoporosis, dental enamel defects, muscle wasting, and other effects of malabsorption can result.

Some people with celiac disease present none of these symptoms. A 2006 study in rural South Wales (UK) reported that "most adults with coeliac disease have a sub clinical form of the disease and iron deficiency anaemia may be its sole presenting symptom." Even without overt GI symptoms, damage to the small intestine mucosa occurs, which is why it is important to diagnose the condition as quickly as possible.

Antibody blood tests that look for IgA-class antigliadin antibodies (AGA), endomysial antibodies (EMA), or tissue transglutaminase antibodies (tTGA) can tell whether a person is reacting to gluten in his diet; but false negatives are possible. Only an intestinal biopsy that shows villi damage is considered definitive. In their 2009 systematic review and meta-analysis of 14 studies, a Canadian-American team says, "If screening is to be undertaken, then EMA or tTGA testing should be preferred to IgA-class AGA testing because of a higher positive predictive value, although the yield will depend on the prevalence in the population being studied." This team found that about 4% of the 2278 people who met the diagnostic criteria for irritable bowel syndrome had biopsy-proved celiac disease.

Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BMR, Moayyedi P. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome. Arch Intern Med. April 13, 2009;169(7):651-656. Available at: www.archinternmed.com. Accessed April 14, 2009.

Jones S, D'Souza C, Haboubi NY. Patterns of clinical presentation of adult coeliac disease in a rural setting. Nutr J. September 14, 2006:5(24). Available at: www.nutritionj.com/content/5/1/24. Accessed. November 20, 2006.

Richards K. Stomach pain in a slice of bread: gluten is a quiet culprit. AlterNet. October 27, 2007. Available at: www.alternet.org/story/66176/. Accessed January 28, 2009.

briefed by Jule Klotter

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