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Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 8/2019

01-08-2019 | Celiac Disease | Review

Diagnosis and Treatment Patterns in Celiac Disease

Authors: Allie B. Cichewicz, Elizabeth S. Mearns, Aliki Taylor, Talia Boulanger, Michele Gerber, Daniel A. Leffler, Jennifer Drahos, David S. Sanders, Kelly J. Thomas Craig, Benjamin Lebwohl

Published in: Digestive Diseases and Sciences | Issue 8/2019

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Abstract

Celiac disease (CD) is an immune-mediated gastrointestinal (GI) disorder driven by innate and adaptive immune responses to gluten. Presentation of CD has changed over time, with non-GI symptoms, such as anemia and osteoporosis, presenting more commonly. With improved screening and diagnostic methods, the reported prevalence of CD has increased globally, and there is considerable global variation in diagnostic and treatment practices. The objective of this study was to describe the current state of CD diagnosis and treatment patterns. A targeted review of literature from MEDLINE, Embase, the Cochrane Library, and screening of relevant conference abstracts was performed. The generally recommended diagnostic approach is GI endoscopy with small bowel biopsy; however, in selected patients, biopsy may be avoided and diagnosis based on positive serology and clinical symptoms. Diagnosis often is delayed; the average diagnostic delay after symptom onset is highly variable and can last up to 12 years. Barriers to accurate and timely diagnosis include atypical presentation, lack of physician awareness about current diagnostic criteria, misdiagnosis, and limited access to specialists. Currently, strict adherence to a gluten-free diet (GFD) is the only recommended treatment, which is not successful in all patients. Only one-third of patients are monitored regularly following diagnosis. Unmet needs for CD include improvements in the accuracy and timeliness of diagnosis, and the development of treatments for both refractory CD and GFD nonresponsive CD. Further research should investigate the impact of education about gluten-free eating and the availability of gluten-free foods support adherence and improve outcomes in patients with CD.
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Metadata
Title
Diagnosis and Treatment Patterns in Celiac Disease
Authors
Allie B. Cichewicz
Elizabeth S. Mearns
Aliki Taylor
Talia Boulanger
Michele Gerber
Daniel A. Leffler
Jennifer Drahos
David S. Sanders
Kelly J. Thomas Craig
Benjamin Lebwohl
Publication date
01-08-2019
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 8/2019
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-019-05528-3

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