Celiac Disease
Pt with family h/o Celiac disease presents with acute, recurrent abdominal pain. Reports weight-loss, fatigue, N/V, recurrent mouth ulcers, abdominal bloating, diarrhea. Food diary shows symptom correlation with gluten-containing foods. Herpetiform rash on exam.
Dermatitis herpetiformis. By BallenaBlanca - Own work.
Initial diagnosis: Pt advised to keep a food diary/symptom log
Labs
Obtain CBC to r/o anemia
Anti-tissue transglutaminase IgA >10x ULN
Total IgA level WNL
Consider HLA DQ2, HLA DQ8, endomysial antibody testing
Elevated Anti-tissue transglutaminase IgA: Refer for endoscopy with duodenal biopsy
Counseling
Pt educated about elimination of dietary gluten including wheat, rye, and barley products
Recommend Celiac Disease Foundation’s guide to eating gluten free
Notes
Total IgA must be obtained to rule out IgA deficiency
Intestinal symptoms are significantly more common extraintestinal manifestations, e.g. dermatitis herpetiformis, anemia