- hartfordhospital.org 1
Jeffrey Gelwan, a gastroenterologist with Hartford HealthCare’s Digestive Health Institute and medical director of Connecticut GI’s Celiac Center, says these updates offer better guidelines for physicians, which in turn benefits patients.
Celiac disease is a chronic digestive and immune disorder that damages the small intestine.
The disease is triggered by eating foods containing gluten.
If left untreated, celiac damages the villi, which are tiny hairlike projections in your small intestine, leaving your body unable to absorb nutrients.
Additionally, it can lead to development of autoimmune disorders like type 1 diabetes and multiple sclerosis as well as small intestinal cancers. It can also cause conditions such as anemia, osteoporosis, infertility, epilepsy and migraines.
The guidelines answered a series of questions posed by experts over the last 10 years. They include:
Should a combination of blood tests and small intestine biopsy be used to confirm the diagnosis of celiac disease in children and adults?
The new guideline calls for blood work followed by biopsy to confirm diagnosis of celiac disease. In selected children who meet specific criteria as well as in adults who can’t tolerate an endoscopy, a non-biopsy approach is possible.
In existing celiac patients, should a follow up biopsy be performed two years after initial diagnosis?
The updated guideline sets a goal of intestinal healing as an end point of gluten-free diet therapy and includes follow up biopsies to determine degree of healing. In asymptomatic patients repeat biopsy at the two-year mark should be considered.
Should gluten detection devices be part of a patient’s standard care?
The new guideline says no, because the technology behind these devices is still new and they are not 100% accurate.
Should celiac patients be given a probiotic as part of standard care?
The new guidelines say no, saying there is insufficient evidence to recommend for or against the use of probiotics in treatment.
In newly diagnosed patients, what is the effect of a gluten-free diet without oats on rates of clinical remission and mucosal healing compared with a gluten-free diet with oats?
The guidelines recommend consumption of gluten-free oats in the diet of those with CD, but caution against gluten contamination.
For patients with CD, does the use of pneumococcal vaccine reduce the future risk of serious pneumococcal infection?
The guidelines advocate in favor of the vaccine, noting it is both safe and effective.
Should the general population be screened for celiac disease as a matter of course?
The guidelines are opposed to mass screening, but advocate for screening anyone deemed at risk due to symptoms or family history.