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==Differentiating Celiac Disease from Other Diseases==
==Differentiating Celiac Disease from Other Diseases==


'''The table below summarizes the findings that differentiate watery causes of chronic diarrhea'''<ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }} </ref><ref name="pmid12135027">{{cite journal| author=Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D| title=Bowel habits and bile acid malabsorption in the months after cholecystectomy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 7 | pages= 1732-5 | pmid=12135027 | doi=10.1111/j.1572-0241.2002.05779.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12135027  }} </ref><ref name="pmid1702075">{{cite journal| author=Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R et al.| title=Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia. | journal=Gastroenterology | year= 1991 | volume= 100 | issue= 2 | pages= 359-69 | pmid=1702075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1702075  }} </ref><ref name="pmid14439871">{{cite journal| author=RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC| title=Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. | journal=Gastroenterology | year= 1960 | volume= 38 | issue=  | pages= 28-49 | pmid=14439871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14439871  }} </ref>
'''The table below summarizes the findings that differentiate causes of chronic diarrhea'''<ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }} </ref><ref name="pmid12135027">{{cite journal| author=Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D| title=Bowel habits and bile acid malabsorption in the months after cholecystectomy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 7 | pages= 1732-5 | pmid=12135027 | doi=10.1111/j.1572-0241.2002.05779.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12135027  }} </ref><ref name="pmid1702075">{{cite journal| author=Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R et al.| title=Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia. | journal=Gastroenterology | year= 1991 | volume= 100 | issue= 2 | pages= 359-69 | pmid=1702075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1702075  }} </ref><ref name="pmid14439871">{{cite journal| author=RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC| title=Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. | journal=Gastroenterology | year= 1960 | volume= 38 | issue=  | pages= 28-49 | pmid=14439871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14439871 }} </ref><ref name="pmid8694025">{{cite journal| author=Hertzler SR, Savaiano DA| title=Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. | journal=Am J Clin Nutr | year= 1996 | volume= 64 | issue= 2 | pages= 232-6 | pmid=8694025 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8694025  }} </ref><ref name="pmid9414969">{{cite journal| author=Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC| title=Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect? | journal=Gut | year= 1997 | volume= 41 | issue= 5 | pages= 632-5 | pmid=9414969 | doi= | pmc=1891556 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9414969  }} </ref><ref name="pmid15391722">{{cite journal| author=BLACK-SCHAFFER B| title=The tinctoral demonstration of a glycoprotein in Whipple's disease. | journal=Proc Soc Exp Biol Med | year= 1949 | volume= 72 | issue= 1 | pages= 225-7 | pmid=15391722 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15391722 }} </ref>


{| class="wikitable"
{| class="wikitable"
! colspan="3" rowspan="2" |Cause
! rowspan="2" |Cause
! colspan="2" |Diarrhea
! colspan="2" |Osmotic gap
! colspan="2" |Osmotic gap
! rowspan="2" |History
! rowspan="2" |History
Line 17: Line 18:
! rowspan="2" |Treatment
! rowspan="2" |Treatment
|-
|-
!Watery
!Fatty
!< 50 mOsm per kg
!< 50 mOsm per kg
!> 50 mOsm per kg*
!> 50 mOsm per kg*
|-
|-
| rowspan="5" |Watery
|[[Celiac disease (patient information)|Celiac disease]]
| rowspan="3" |Secretory
| +/-
| +/-
| -
| +
|Primary manifestation:
* Vague [[abdominal pain]]
* [[Diarrhea|Watery diarrhea]]
* [[Weight loss]]
* Bloatedness
Late manifestation:
* [[Malabsorption]] / [[steatorrhea]]
** [[Diarrhea]] with bulky, [[Steatorrhea|foul-smelling stools]]
* [[Growth failure]] in children
* [[Anemia]]
* [[Neurologic diseases|Neurologic disorders]]
* [[Osteopenia]]
|
* [[Abdominal distention]]
* [[Tetany]]
* [[Mouth ulcers]]
* [[Dermatitis herpetiformis]]
* Signs of the fat-soluble [[Vitamin A|vitamins A]], D, E, and K deficiency
|
* [[IgA]] tissue [[transglutaminase]] Ab
|
* [[Gluten-free diet]]
|-
|[[Lactose intolerance]]
| +
| -
| -
|<nowiki>+</nowiki>
|
:* [[Abdominal pain]]
:* [[Bloating]]
:* [[Diarrhea]]
:* [[Flatulence]]
|
* [[Abdominal tenderness]]
|
* Intestinal [[biopsy]]
|
* Avoidance of dietary [[lactose]]
* Substitution to maintain nutrient intake
* Regulation of [[calcium]] intake
* Use of [[enzyme]] [[lactase]]
|-
|[[Crohns disease|Crohns]]
|[[Crohns disease|Crohns]]
| +
| -
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 40: Line 91:
|-
|-
|[[Hyperthyroidism]]
|[[Hyperthyroidism]]
| +
| -
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 59: Line 112:
|-
|-
|[[VIPoma]]
|[[VIPoma]]
| +
| -
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
| -
Line 83: Line 138:
* Surgical removal of the [[tumor]]
* Surgical removal of the [[tumor]]
|-
|-
| rowspan="2" |[[Osmotic]]
|[[Irritable bowel syndrome]]
|[[Lactose intolerance]]
| +
| -
|<nowiki>+</nowiki>
|
:* [[Abdominal pain]]
:* [[Bloating]]
:* [[Diarrhea]]
:* [[Flatulence]]
|
* [[Abdominal tenderness]]
|
* Intestinal [[biopsy]]
|
* Avoidance of dietary [[lactose]]
* Substitution to maintain nutrient intake
* Regulation of [[calcium]] intake
* Use of [[enzyme]] [[lactase]]
|-
|[[Celiac disease (patient information)|Celiac disease]]
| -
| -
| +
|
* May be asymptomatic
* Vague [[abdominal pain]]
* [[Diarrhea]]
* [[Weight loss]]
* [[Malabsorption]] / [[steatorrhea]]
* Bloatedness
|
* [[Abdominal pain]] and [[cramping]]
* [[Abdominal distention]]
* [[Tetany]]
* [[Mouth ulcers]]
* [[Dermatitis herpetiformis]]
* Signs of the fat-soluble [[Vitamin A|vitamins A]], D, E, and K deficiency
|
* [[IgA]] tissue [[transglutaminase]] Ab
|
* [[Gluten-free diet]]
|-
|
|Functional
|[[Irritable bowel syndrome]]
| -
| -
| -
| -
Line 150: Line 164:
* [[Osmotic]] [[laxatives]] such as [[polyethylene glycol]], [[sorbitol]], and [[lactulose]]
* [[Osmotic]] [[laxatives]] such as [[polyethylene glycol]], [[sorbitol]], and [[lactulose]]
* [[Antispasmodic]] drugs (e.g. [[Anticholinergic|anticholinergics]] such as [[hyoscyamine]] or [[dicyclomine]])
* [[Antispasmodic]] drugs (e.g. [[Anticholinergic|anticholinergics]] such as [[hyoscyamine]] or [[dicyclomine]])
|}{{WikiDoc Help Menu}} {{WikiDoc Sources}}
'''The table below summarizes the findings that differentiate fatty causes of chronic diarrhea'''<ref name="pmid8694025">{{cite journal| author=Hertzler SR, Savaiano DA| title=Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. | journal=Am J Clin Nutr | year= 1996 | volume= 64 | issue= 2 | pages= 232-6 | pmid=8694025 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8694025  }} </ref><ref name="pmid9414969">{{cite journal| author=Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC| title=Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect? | journal=Gut | year= 1997 | volume= 41 | issue= 5 | pages= 632-5 | pmid=9414969 | doi= | pmc=1891556 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9414969  }} </ref><ref name="pmid15391722">{{cite journal| author=BLACK-SCHAFFER B| title=The tinctoral demonstration of a glycoprotein in Whipple's disease. | journal=Proc Soc Exp Biol Med | year= 1949 | volume= 72 | issue= 1 | pages= 225-7 | pmid=15391722 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15391722  }} </ref>
{| class="wikitable"
! rowspan="2" |Cause
! colspan="2" |Osmotic gap
! rowspan="2" |History
! rowspan="2" |Physical exam
! rowspan="2" |Gold standard
! rowspan="2" |Treatment
|-
!< 50
mOsm
per kg
!> 50
mOsm
per kg*
|-
|-
|[[lactose intolerance]]
|[[lactose intolerance]]
| -
| +
| -
| -
| +
| +
Line 187: Line 184:
|Restriction of  [[lactose]] and  maintain [[calcium]] and [[vitamin D]] intake.
|Restriction of  [[lactose]] and  maintain [[calcium]] and [[vitamin D]] intake.
|-
|-
|[[Celiac sprue]]
|[[Whipple's disease|Whipple disease]]
| -
| -
| +
| +
|
* [[Diarrhea]] with bulky, [[Steatorrhea|foul-smelling stools]]
* [[Growth failure]] in children,
* [[Weight loss|Weight loss,]]
* [[Anemia]],
* [[Neurologic diseases|Neurologic disorders]]
* [[Osteopenia]]
|
* [[Neuropsychiatric|Neuropsychiatric disease]]
* [[Dermatitis herpetiformis]]
* [[Arthritis]]
* [[Iron deficiency]]
* [[Metabolic]] bone disease
* [[Hyposplenism]]
* [[Kidney disease]]
* [[Idiopathic pulmonary hemosiderosis]]
|[[Immunoglobulin A]] ([[IgA]]) [[Tissue transglutaminase|anti-tissue transglutaminase]] (TTG) antibody followed by upper [[endoscopy]] with [[biopsy]].
|Dietary counseling, elimination of [[gluten]] in the diet.
|-
|[[Whipple's disease|Whipple disease]]
| -
| -
| +
| +
Line 224: Line 201:
|[[Doxycycline]] and [[hydroxychloroquine]] are [[bactericidal]]
|[[Doxycycline]] and [[hydroxychloroquine]] are [[bactericidal]]
|}
|}
==References==
==References==


Revision as of 18:09, 12 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Celiac Disease from Other Diseases

The table below summarizes the findings that differentiate causes of chronic diarrhea[1][2][3][4][5][6][7]

Cause Diarrhea Osmotic gap History Physical exam Gold standard Treatment
Watery Fatty < 50 mOsm per kg > 50 mOsm per kg*
Celiac disease +/- +/- - + Primary manifestation:

Late manifestation:

Lactose intolerance + - - +
Crohns + - + -
Hyperthyroidism + - + -
VIPoma + - + -
  • Elevated VIP levels
  • Followed by imaging
Irritable bowel syndrome + - - -

Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:

  • Onset associated with change in frequency of stool
  • Onset associated with change in appearance of stool

History of straining is also common

lactose intolerance - + - + Lactose breath hydrogen test Restriction of lactose and maintain calcium and vitamin D intake.
Whipple disease - + - + Upper endoscopy with biopsies of the small intestine for T. whipplei testing (histology with PAS staining, polymerase chain reaction [[[PCR]]] testing, and immunohistochemistry) Doxycycline and hydroxychloroquine are bactericidal

References

  1. ↑ Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
  2. ↑ Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
  3. ↑ Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
  4. ↑ RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.
  5. ↑ Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
  6. ↑ Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
  7. ↑ BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.

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