Differentiating celiac disease from other diseases: Difference between revisions

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Revision as of 14:53, 13 September 2017

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

Overview

Celiac disease must be differentiated from other diseases presenting as chronic diarrhea. Common differntials of celiac disease include lactose intolerance, cystic fibrosis, Crohns disease, laxative overuse, hyperthyroidism and irritable bowel syndrome.

Differentiating Celiac Disease from Other Diseases

Celiac disease must be differentiated from other diseases presenting as chronic diarrhea (diarrhea for more than 2 weeks) and abdominal pain and discomfort. The table below summarizes the findings that differentiate causes of chronic diarrhea and abdominal pain:^[1]^[2]^[3]^[4]^[5]^[6]^[7]

Cause	Diarrhea		Peak age of onset	History			Physical exam	Lab findings	Additional finding	Cause/Pathogenesis	Gold standard dignosis
Cause	Watery	Fatty	Peak age of onset	Weight loss	FTT	Abdominal pain	Physical exam	Lab findings	Additional finding	Cause/Pathogenesis	Gold standard dignosis
Celiac disease	+/-	+/-	Childhood Adult	+	+	+	Abdominal distention Tetany Mouth ulcers Dermatitis herpetiformis	IgA endomysial antibody (IgA EMA) IgA tissue transglutaminase antibody (IgA tTG) IgG tissue transglutaminase antibody (IgG tTG) IgA deamidated gliadin peptide (IgA DGP) IgG deamidated gliadin peptide (IgG DGP)	Gluten-free diet Signs of the fat-soluble vitamins A, D, E, and K deficiency	HLA-DQ2 and/or DQ8 gene mutation Innate responses to wheat proteins	Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody
Grain allergy	+	-	Childhood	+	+	+	Vomiting Abdominal distention	Elevated IgE levels	Atopic dermatitis (eczema) dysphagia	Abnormal immune response to wheat antigens	Measurement of grain-specific immunoglobulin E (IgE)
Cystic fibrosis	-	+	Infancy and childhood	+	+	+	Digital clubbing Respiratory rale, wheeze, and crackle Abdominal pain Cyanosis	Positive DNA analysis for CFTR multimutation method Evaluated nasal transepithelial potential difference (NPD)	Disease manifestations in multiple organ systems: Diabetes Recurrent upper and lower respiratory tract infections Infertility	Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein	Elevated sweat chloride ≥60 mmol/L
Lactose intolerance	+	-	Adult	-	-	+	Abdominal tenderness	Stool osmotic gap of >125 mOsm/kg Stool pH <6	Avoidance of dietary lactose Substitution to maintain nutrient intake Regulation of calcium intake Use of enzyme lactase	Acquired primary lactase deficiency Adult-type hypolactasia Lactase nonpersistence)	Lactose breath hydrogen test
Crohns disease	+	-	Young adults (20th)	+	+/-	+	Abdominal tenderness when palpated in severe disease Tachycardia Hypotension	Anemia Iron deficiency Elevated white blood cell count Vitamin B12 deficiency Elevated erythrocyte sedimentation rate Elevated CRP	Blood seen on rectal exam Fever	Abnormal immune response to self antigens	Colonoscopy with biopsy
Laxative overuse	+	-	After childhood	+/-	-	+/-	Enhanced gastrointestinal motility and gastrointestinal sound Mild abdominal tenderness Abdominal bloating	Hypokalemia Metabolic alkalosis Hypermagnesemia(in case of magnesium laxative usage)	-	Laxative drug abuse	Laxative screening on a stool for: Diphenolic laxatives (eg, bisacodyl) Polyethylene glycol-containing laxatives
Hyperthyroidism	+	-	Any age	+	-	+/-	Lump in the neck Proptosis Tremors Increased DTR	Elevated T4 Elevated T3 Decreased level of TSH	Lid lag Sweating Hyperpigmentation	Graves' disease Hashimoto thyroiditis Toxic adenoma	TSH
Whipple disease	+/-	+	50th	+	-	+	Arthralgias of the large joints Hematochezia	Leukocytopenia Thrombocytopenia	Skin hyperpigmentation Arthralgias	Tropheryma whipplei	Upper endoscopy with biopsies of the small intestine for T. whipplei testing
Irritable bowel syndrome	+	-	Between 30 and 50	-	-	+	Abdominal tenderness Hard stool in the rectal vault	-	Bloating Flatulence	Postinfectious Inflammatory	Clinical diagnosis ROME III criteria Pharmacologic studies based criteria
VIPoma	+	-	Between 30 and 50	+	+/-	+/-	Tachycardia Rash Facial flushing Abdominal distention Abdominal tenderness in the right upper abdominal quadrant	Hypokalemia Hypochlorhydria or achlorhydria Low osmotic gap (<50 mOsm/kg)	Dehydration Lethargy, muscle weakness Nausea, vomiting Flushing	Primary secretory tumor	Elevated VIP levels Followed by imaging
Gastrinoma (Zollinger-Ellison syndrome)	+	-	Between the ages of 20 and 50	+	+/-	+	Mild to moderate upper abdominal tenderness	Positive secretin stimulation test Elevated serum chromogranin A	Heartburn	Gastrin producing tumor mainly in duodenum	Elevated basal or stimulated serum gastrin more than 1000 pg/mL
Lactose intolerance	-	+	Any age	+	-	+/-	Abdominal tenderness when palpated in severe disease Fever Hypotension Tachycardia Nausea and vomiting	Lactose breath hydrogen test	Bloating Flatulence Symptoms begin mainly after ingestion of lactose	Reduction of lactase enzyme activity or lactase nonpersistence Congenital lactase deficiency	Lactase activity assay
Allergic enteropathy/Food protein-induced enterocolitis syndrome (FPIES)	+	-	Infancy	+/-	+/-	+	Nausea Vomiting Abdominal distention	Stool examination: Blood-tinged and mucusy Polymorphonuclear leukocytes presence	Triggered by cow's milk protein Profuse, repetitive vomiting	Autoimmune/allergic response to food antigens	Oral food challenge (OFC)
Eosinophilic gastroenteritis	+	-	30th	+/-	+/-	+	Nausea Vomiting Abdominal distention	Elevated serum IgE levels Abnormal D-xylose test	One-half of patients have other allergic diseases Associated with an identifiable dietary antigen	Autoimmune/allergic response to food antigens	Eosinophilic infiltration of the gastrointestinal tract on biopsy
Primary bile acid malabsorption	+	+/-	Childhood Adolescents	+	+	+/-	-	Low vitamins A, D, E, and K Anemia	Disease hetergenicity lead to varying presentation from chronic diarrhea without significant fat malabsorption to severe watery diarrhea and steatorrhea with malnutrition	Genetic defects in SLC10A2 (solute carrier family 10 member 2 gene)	Total and specific bile acids from stool Gamma emitter selenium-75-homocholic acid taurine (SeHCAT)
Abetalipoproteinemia	-	+	Infancy	+	+	+	Abdominal distention Impaired visual acuity and visual field defects Dysarthria	Low triglyceride Low total cholesterol levels Acanthocytes Low vitamin E levels	Clumsiness Vision impairment Ataxia	Autosomal recessive disorder caused by mutations encoding the microsomal triglyceride transfer protein (MTP)	Clinical findings and low triglyceride and cholesterol level
Microscopic colitis	+	-	60th	+	-	+	Abdominal tenderness	Elevatedautoantibodies include: RF ANA AMA ANCA	Fecal urgency Incontinence May be associated with extraintestinal symptoms, such as: Arthralgia Arthritis Uveitis	Mucosal immune responses to luminal factors in a genetically predisposed individual	A colonoscopy with mucosal biopsy with mononuclear infiltrates: Collagenous colitis is characterized by a colonic subepithelial collagen band >10 micrometers in diameter Lymphocytic colitis is characterized by ≥20 intraepithelial lymphocytes (IEL) per 100 surface epithelial cells
Congenital chloride diarrhea	+	-	Neonate	+	+	-	-	Hyponatremia Hypochloremia Metabolic alkalosis	History of polyhydramnios	Mutations in the SLC26A3 gene Encodes for an epithelial anion exchanger	Excessive fecal secretion of chloride
Congenital sodium diarrhea	+	-	Neonate	+	+	-	-	Stool examination: Alkaline Fecal sodium concentrations Serum: Metabolic acidosis Hyponatremia	May be associated with choanal or anal atresia	Mutations in the SPINT2 gene	Clinical
Glucose-galactose malabsorption	+	-	Infancy	+	+/-	+	Abdominal tenderness	Stool examination: Acidic	Severe life-threatening diarrhea Dehydration Symptomatic as long as the diet includes lactose or its hydrolysis products, glucose and galactose	Mutations in solute carrier family 5, member 1 gene (SLC5A1, also known as SGLT1) Lead to deficiency in the intestinal sodium/glucose transporter	Positive glucose breath hydrogen test + normal intestinal biopsy

References

↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.

Template:WH Template:WS

[pmid16151544-1] 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.

[pmid12135027-2] 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.

[pmid1702075-3] 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.

[pmid14439871-4] 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.

[pmid8694025-5] 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.

[pmid9414969-6] 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.

[pmid15391722-7] 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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@@ Line 7: / Line 7: @@
 ==Differentiating Celiac Disease from Other Diseases==
-Celiac disease must be differentiated from other diseases presenting as chronic diarrhea (diarrhea for more than 2 weeks) and abdominal pain and discomfort. 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>
+Celiac disease must be differentiated from other diseases presenting as chronic diarrhea (diarrhea for more than 2 weeks) and abdominal pain and discomfort. The table below summarizes the findings that differentiate causes of chronic diarrhea and abdominal pain:<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"
 ! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Cause
@@ Line 54: / Line 56: @@
 * [[Immunoglobulin A]] (IgA) anti-tissue transglutaminase (TTG) antibody
 |-
-! align="center" style="background:#DCDCDC;" |[[Lactose intolerance]]
+!Grain allergy
 | +
 | -
-|Adult
+|Childhood
-| -
+| +
-| -
+| +
 | +
 |
-* [[Abdominal tenderness]]
+* Vomiting
+* Abdominal distention
 |
-* Stool [[osmotic]] gap of >125 mOsm/kg
+* Elevated IgE levels
-* Stool pH <6
 |
-* Avoidance of [[Dietary|dietary]]<nowiki/> [[lactose]]
+* Atopic dermatitis (eczema)
-* Substitution to maintain [[nutrient]] intake
+* dysphagia
-* Regulation of [[calcium]] intake
-* Use of [[enzyme]] [[lactase]]
 |
-* Acquired primary [[lactase deficiency]]
+* Abnormal immune response to wheat [[antigens]]
-** Adult-type [[hypolactasia]]
-** [[Lactase]] nonpersistence)
 |
-* [[Lactose]] breath hydrogen test
+* Measurement of grain-specific immunoglobulin E (IgE)
 |-
 ! align="center" style="background:#DCDCDC;" |[[Cystic fibrosis]]
@@ Line 103: / Line 101: @@
 * Elevated [[Sweat chloride test|sweat chloride]] ≥60 mmol/L
 |-
-! align="center" style="background:#DCDCDC;" |[[Laxative abuse|Laxative overuse]]
+! align="center" style="background:#DCDCDC;" |[[Lactose intolerance]]
 | +
 | -
-|After childhood
+|Adult
-|<nowiki>+/-</nowiki>
+| -
 | -
-| +/-
+| +
+|
+* [[Abdominal tenderness]]
 |
-* Enhanced [[gastrointestinal]] motility and [[gastrointestinal]] sound
+* Stool [[osmotic]] gap of >125 mOsm/kg
-* Mild [[abdominal tenderness]]
+* Stool pH <6
-* [[Abdominal distension|Abdominal bloating]]
 |
-* [[Hypokalemia]]
+* Avoidance of [[Dietary|dietary]]<nowiki/> [[lactose]]
-* [[Metabolic alkalosis]]
+* Substitution to maintain [[nutrient]] intake
-* [[Hypermagnesemia]](in case of [[magnesium]] [[laxative]] usage)
+* Regulation of [[calcium]] intake
-|<nowiki>-</nowiki>
+* Use of [[enzyme]] [[lactase]]
 |
-* [[Laxative]] drug abuse
+* Acquired primary [[lactase deficiency]]
+** Adult-type [[hypolactasia]]
+** [[Lactase]] nonpersistence)
 |
-* [[Laxatives|laxative]] screening on a stool for:
+* [[Lactose]] breath hydrogen test
-** [[Diphenolic laxatives]] (eg, [[bisacodyl]])
-** [[Polyethylene glycol|Polyethylene glyco]]<nowiki/>l-containing [[laxatives]]
 |-
 ! align="center" style="background:#DCDCDC;" |[[Crohns disease|Crohns disease]]
@@ Line 133: / Line 132: @@
 (20th)
 | +
-|
+|<nowiki>+/-</nowiki>
 | +
 |
@@ Line 153: / Line 152: @@
 |
 * [[Colonoscopy]] with [[biopsy]]
+|-
+! align="center" style="background:#DCDCDC;" |[[Laxative abuse|Laxative overuse]]
+| +
+| -
+|After childhood
+|<nowiki>+/-</nowiki>
+| -
+| +/-
+|
+* Enhanced [[gastrointestinal]] motility and [[gastrointestinal]] sound
+* Mild [[abdominal tenderness]]
+* [[Abdominal distension|Abdominal bloating]]
+|
+* [[Hypokalemia]]
+* [[Metabolic alkalosis]]
+* [[Hypermagnesemia]](in case of [[magnesium]] [[laxative]] usage)
+|<nowiki>-</nowiki>
+|
+* [[Laxative]] drug abuse
+|
+* [[Laxatives|Laxative]] screening on a stool for:
+** [[Diphenolic laxatives]] (eg, [[bisacodyl]])
+** [[Polyethylene glycol|Polyethylene glyco]]<nowiki/>l-containing [[laxatives]]
 |-
 ! align="center" style="background:#DCDCDC;" |[[Hyperthyroidism]]
@@ Line 180: / Line 202: @@
 |
 * [[TSH]]
+|-
+! align="center" style="background:#DCDCDC;" |[[Whipple's disease|Whipple disease]]
+| +/-
+| +
+|50th
+|<nowiki>+</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>+</nowiki>
+|
+* [[Arthralgia|Arthralgias]] of the large joints
+* [[Hematochezia]]
+|
+* [[Leukocytopenia]]
+* [[Thrombocytopenia]]
+|
+* [[Skin hyperpigmentation]]
+* [[Arthralgias]]
+|
+* ''[[Tropheryma whipplei]]''
+|
+* Upper [[endoscopy]] with [[biopsies]] of the [[small intestine]] for ''[[Tropheryma whipplei|T. whipplei]]'' testing
+|-
+! align="center" style="background:#DCDCDC;" |[[Irritable bowel syndrome]]
+| +
+| -
+|Between 30 and 50
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>+</nowiki>
+|
+* [[Abdominal tenderness]]
+* Hard stool in the rectal vault
+|<nowiki>-</nowiki>
+|
+* [[Bloating|Bloating]]
+* [[Flatulence]]
+|
+* Postinfectious
+* Inflammatory
+|
+* [[Diagnosis|Clinical diagnosis]]
+** ROME III criteria
+** [[Pharmacological|Pharmacologic]] studies based criteria
 |-
 ! align="center" style="background:#DCDCDC;" |[[VIPoma]]
@@ Line 210: / Line 275: @@
 * Followed by imaging
 |-
-! align="center" style="background:#DCDCDC;" |[[Irritable bowel syndrome]]
+! align="center" style="background:#DCDCDC;" |[[Gastrinoma]] ([[Zollinger-Ellison syndrome|Zollinger-Ellison syndrome]])
 | +
 | -
-|Between 30 and 50
+|Between the ages of 20 and 50
-|<nowiki>-</nowiki>
+| +
-|<nowiki>-</nowiki>
+| +/-
-|<nowiki>+</nowiki>
+| +
+|
+* Mild to moderate upper [[abdominal tenderness]]
 |
-* [[Abdominal tenderness]]
+* Positive [[secretin]] stimulation test
-* Hard stool in the rectal vault
+* Elevated serum [[chromogranin A]]
-|<nowiki>-</nowiki>
 |
-* [[Bloating|Bloating]]
+* [[Heartburn]]
-* [[Flatulence]]
 |
-* Postinfectious
+* [[Gastrin]] producing tumor mainly in [[duodenum]]
-* Inflammatory
 |
-* [[Diagnosis|Clinical diagnosis]]
+* Elevated basal or stimulated serum [[gastrin]] more than 1000 pg/mL
-** ROME III criteria
-** [[Pharmacological|Pharmacologic]] studies based criteria
 |-
 ! align="center" style="background:#DCDCDC;" |[[Lactose intolerance]]
@@ Line 254: / Line 316: @@
 * Reduction of lactase enzyme activity or lactase nonpersistence
 * Congenital lactase deficiency
-|Lactase activity assay
-|-
-! align="center" style="background:#DCDCDC;" |[[Whipple's disease|Whipple disease]]
-| +/-
-| +
-|50th
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|
-* [[Arthralgia|Arthralgias]] of the large joints
-* [[Hematochezia]]
 |
-* [[Leukocytopenia]]
+* Lactase activity assay
-* [[Thrombocytopenia]]
-|
-* [[Skin hyperpigmentation]]
-* [[Arthralgias]]
-|''[[Tropheryma whipplei]]''
-|Upper [[endoscopy]] with [[biopsies]] of the [[small intestine]] for ''[[Tropheryma whipplei|T. whipplei]]'' testing ([[histology]] with [[Periodic acid-Schiff stain|PAS staining]], [[polymerase chain reaction]] [[[PCR]]] testing, and [[immunohistochemistry]])
 |-
 ! align="center" style="background:#DCDCDC;" |Allergic enteropathy/Food protein-induced enterocolitis syndrome (FPIES)
@@ Line 292: / Line 336: @@
 * Triggered by cow's milk protein
 * Profuse, repetitive [[vomiting]]
-|[[Autoimmunity|Autoimmune]]/[[Allergy|allergic]] response to food [[antigens]]
+|
-|[[Oral]] food challenge (OFC)
+* [[Autoimmunity|Autoimmune]]/[[Allergy|allergic]] response to food [[antigens]]
+|
+* [[Oral]] food challenge (OFC)
 |-
 ! align="center" style="background:#DCDCDC;" |[[Eosinophilic gastroenteritis]]
@@ Line 312: / Line 358: @@
 * One-half of patients have other [[Allergic disorders|allergic diseases]]
 * Associated with an identifiable [[dietary]] [[antigen]]
-|[[Autoimmunity|Autoimmune]]/[[Allergy|allergic]] response to food [[antigens]]
+|
-|[[Eosinophilic]] infiltration of the [[gastrointestinal tract]] on [[biopsy]]
+* [[Autoimmunity|Autoimmune]]/[[Allergy|allergic]] response to food [[antigens]]
+|
+* [[Eosinophilic]] infiltration of the [[gastrointestinal tract]] on [[biopsy]]
+|-
+! align="center" style="background:#DCDCDC;" |Primary bile acid malabsorption
+| +
+| +/-
+|Childhood Adolescents
+| +
+| +
+| +/-
+| -
+|
+* Low  [[Vitamin A|vitamins A]], [[Vitamin D|D]], E, and K
+* [[Anemia]]
+|
+* Disease hetergenicity lead to varying presentation from chronic [[diarrhea]] without significant fat [[Malabsorption|malabsorptio]]<nowiki/>n to severe [[watery diarrhea]] and steatorrhea with [[malnutrition]]
+|
+* [[Genetic defects]] in ''SLC10A2'' (solute carrier family 10 member 2 gene)
+|
+* Total and specific [[bile acid]]<nowiki/>s from stool
+* [[Gamma emitter selenium-75-homocholic acid taurine]] (SeHCAT)
+|-
+! align="center" style="background:#DCDCDC;" |[[Abetalipoproteinemia]]
+| -
+| +
+|Infancy
+| +
+| +
+| +
+|
+* [[Abdominal distension|Abdominal distention]]
+* Impaired [[visual acuity]] and [[Visual field defect|visual field defects]]
+* [[Dysarthria]]
+|
+* Low [[triglyceride]]
+* Low total [[cholesterol]] levels
+* [[Acanthocytes]]
+* Low [[vitamin E]] levels
+|
+* [[Clumsiness]]
+* Vision impairment
+* [[Ataxia]]
+|
+* [[Autosomal recessive]] disorder caused by mutations encoding the [[microsomal]] [[triglyceride]] transfer protein (MTP)
+|
+* Clinical findings and low [[triglyceride]] and [[cholesterol]] level
 |-
 ! align="center" style="background:#DCDCDC;" |[[Microscopic colitis]]
@@ Line 391: / Line 483: @@
 | +/-
 | +
-|[[Abdominal tenderness]]
+|
+* [[Abdominal tenderness]]
 |[[Stool examination|Stool examination:]]
 * Acidic
@@ Line 403: / Line 496: @@
 |
 * Positive [[glucose]] breath [[hydrogen]] test + normal intestinal [[biopsy]]
-|-
-! align="center" style="background:#DCDCDC;" |[[Abetalipoproteinemia]]
-| -
-| +
-|Infancy
-| +
-| +
-| +
-|
-* [[Abdominal distension|Abdominal distention]]
-* Impaired [[visual acuity]] and [[Visual field defect|visual field defects]]
-* [[Dysarthria]]
-|
-* Low [[triglyceride]]
-* Low total [[cholesterol]] levels
-* [[Acanthocytes]]
-* Low [[vitamin E]] levels
-|
-* [[Clumsiness]]
-* Vision impairment
-* [[Ataxia]]
-|
-* [[Autosomal recessive]] disorder caused by mutations encoding the [[microsomal]] [[triglyceride]] transfer protein (MTP)
-|
-* Clinical findings and low [[triglyceride]] and [[cholesterol]] level
-|-
-! align="center" style="background:#DCDCDC;" |Primary bile acid malabsorption
-| +
-| +/-
-|Childhood Adolescents
-| +
-| +
-| +/-
-| -
-|
-* Low  [[Vitamin A|vitamins A]], [[Vitamin D|D]], E, and K
-* [[Anemia]]
-|
-* Disease hetergenicity lead to varying presentation from chronic [[diarrhea]] without significant fat [[Malabsorption|malabsorptio]]<nowiki/>n to severe [[watery diarrhea]] and steatorrhea with [[malnutrition]]
-|
-* [[Genetic defects]] in ''SLC10A2'' (solute carrier family 10 member 2 gene)
-|
-* Total and specific [[bile acid]]<nowiki/>s from stool
-* [[Gamma emitter selenium-75-homocholic acid taurine]] (SeHCAT)
-|-
-! align="center" style="background:#DCDCDC;" |[[Gastrinoma]] ([[Zollinger-Ellison syndrome|Zollinger-Ellison syndrome]]<nowiki/>)
-| +
-| -
-|Between the ages of 20 and 50
-| +
-| +/-
-| +
-|
-* Mild to moderate upper [[abdominal tenderness]]
-|
-* Positive [[secretin]] stimulation test
-* Elevated serum [[chromogranin A]]
-|
-* [[Heartburn]]
-|
-* [[Gastrin]] producing tumor mainly in [[duodenum]]
-|
-* Elevated basal or stimulated serum [[gastrin]] more than 1000 pg/mL
 |}

Differentiating celiac disease from other diseases: Difference between revisions

Revision as of 14:53, 13 September 2017

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Differentiating Celiac Disease from Other Diseases

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