Differentiating celiac disease from other diseases: Difference between revisions

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! colspan="2" |Diarrhea
! colspan="2" |Diarrhea
! colspan="2" |Osmotic gap
! colspan="2" |Osmotic gap
! rowspan="2" |History
! colspan="4" |History
! rowspan="2" |Physical exam
! rowspan="2" |Physical exam
! rowspan="2" |Gold standard
! rowspan="2" |Age onset
! rowspan="2" |Treatment
! rowspan="2" |Additional findind
! rowspan="2" |Gold standard dignosis
!
|-
|-
!Watery
!Watery
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!< 50 mOsm per kg
!< 50 mOsm per kg
!> 50 mOsm per kg*
!> 50 mOsm per kg*
!Weight loss
!Abdominal pain
!FTT
!Anemia
!Lab findings
|-
|-
|[[Celiac disease (patient information)|Celiac disease]]
|[[Celiac disease (patient information)|Celiac disease]]
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| -
| -
| +
| +
|Primary manifestation:
| +
* Vague [[abdominal pain]]
| +
* [[Diarrhea|Watery diarrhea]]
| +
* [[Weight loss]]
|<nowiki>+</nowiki>
* Bloatedness
Late manifestation:
* [[Malabsorption]] / [[steatorrhea]]
** [[Diarrhea]] with bulky, [[Steatorrhea|foul-smelling stools]]
* [[Growth failure]] in children
* [[Anemia]]
* [[Neurologic diseases|Neurologic disorders]]
* [[Osteopenia]]
|
|
* [[Abdominal distention]]
* [[Abdominal distention]]
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* [[Dermatitis herpetiformis]]
* [[Dermatitis herpetiformis]]
* Signs of the fat-soluble [[Vitamin A|vitamins A]], D, E, and K deficiency
* Signs of the fat-soluble [[Vitamin A|vitamins A]], D, E, and K deficiency
|
|
* [[Gluten-free diet]]
|
|
* [[IgA]] tissue [[transglutaminase]] Ab
* [[IgA]] tissue [[transglutaminase]] Ab
|
|
* [[Gluten-free diet]]
|-
|-
|[[Lactose intolerance]]
|[[Lactose intolerance]]
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| -
| -
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
| +
| -
|
|
:* [[Abdominal pain]]
:-
:* [[Bloating]]
:* [[Diarrhea]]
:* [[Flatulence]]
|
|
* [[Abdominal tenderness]]
* [[Abdominal tenderness]]
|
|
* Intestinal [[biopsy]]
|
|
* Avoidance of dietary [[lactose]]
* Avoidance of dietary [[lactose]]
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* Regulation of [[calcium]] intake
* Regulation of [[calcium]] intake
* Use of [[enzyme]] [[lactase]]
* Use of [[enzyme]] [[lactase]]
|
* Intestinal [[biopsy]]
|
|-
|[[Cystic fibrosis]]
| -
| +
|
|
| +
| +
| +
| +
|
|
|
|
|
|-
|[[Laxative abuse|Laxative overuse]]
| +
| -
|
|
|
|
|
|
|
|
|
|
|
|-
|Congenital chloride diarrhea
|
|
|
|
|
|
|
|
|
|Neonate
|
* History of polyhydramnios
* Mutations in the ''SLC26A3'' gene
** Encodes for an epithelial anion exchanger 
*
|
* Excessive fecal secretion of chloride
|hyponatremia, hypochloremia, and metabolic alkalosis
|-
|-
|[[Crohns disease|Crohns]]
|[[Crohns disease|Crohns]]
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|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +
| +
|
|
|
* [[Abdominal pain]] followed by [[diarrhea]]
* [[Abdominal pain]] followed by [[diarrhea]]
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*[[Hypotension]]
*[[Hypotension]]
|
|
* [[Colonoscopy]] with [[biopsy]]
|
|
* Topical mucosamine and [[corticosteroids]] are preferred
* Topical mucosamine and [[corticosteroids]] are preferred
* [[Mesalamine]] and [[sulfasalazine]] are used for remission
* [[Mesalamine]] and [[sulfasalazine]] are used for remission
|
* [[Colonoscopy]] with [[biopsy]]
|
|-
|-
|[[Hyperthyroidism]]
|[[Hyperthyroidism]]
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|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
|
|
|
* Excessive [[sweating]]
* Excessive [[sweating]]
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* Increased DTR
* Increased DTR
|
|
* [[TSH]] with [[T3]] and [[T4]]
|
|
* [[Carbimazole]]  and [[methimazole]]  
* [[Carbimazole]]  and [[methimazole]]  
* [[Beta blockers]] like [[propylthiouracil]]
* [[Beta blockers]] like [[propylthiouracil]]
* [[Iodine-131]]
* [[Iodine-131]]
|
* [[TSH]] with [[T3]] and [[T4]]
|
|-
|-
|[[VIPoma]]
|[[VIPoma]]
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|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
| -
|
|
|
|
|
* Watery [[diarrhea]]
* Watery [[diarrhea]]
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* [[Abdominal distention]]
* [[Abdominal distention]]
* [[Abdominal tenderness]] in the right upper abdominal quadrant
* [[Abdominal tenderness]] in the right upper abdominal quadrant
|
|
* [[Sandostatin]] or [[chemotherapy]]  for [[malignant tumors]]
* Surgical removal of the [[tumor]]
|
|
* Elevated [[VIP]] levels
* Elevated [[VIP]] levels
* Followed by imaging
* Followed by imaging
|
|
* [[Sandostatin]] or [[chemotherapy]]  for [[malignant tumors]]
* Surgical removal of the [[tumor]]
|-
|-
|[[Irritable bowel syndrome]]
|[[Irritable bowel syndrome]]
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| -
| -
| -
| -
|
|
|
|
|
[[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:
[[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:
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* [[Abdominal tenderness]]
* [[Abdominal tenderness]]
* Hard stool in the rectal vault
* Hard stool in the rectal vault
|
|
* High [[dietary fiber]]
* [[Osmotic]] [[laxatives]] such as [[polyethylene glycol]], [[sorbitol]], and [[lactulose]]
* [[Antispasmodic]] drugs (e.g. [[Anticholinergic|anticholinergics]] such as [[hyoscyamine]] or [[dicyclomine]])
|
|
* [[Diagnosis|Clinical diagnosis]]
* [[Diagnosis|Clinical diagnosis]]
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** [[Pharmacological|Pharmacologic]] studies based criteria
** [[Pharmacological|Pharmacologic]] studies based criteria
|
|
* High [[dietary fiber]]
* [[Osmotic]] [[laxatives]] such as [[polyethylene glycol]], [[sorbitol]], and [[lactulose]]
* [[Antispasmodic]] drugs (e.g. [[Anticholinergic|anticholinergics]] such as [[hyoscyamine]] or [[dicyclomine]])
|-
|-
|[[lactose intolerance]]
|[[lactose intolerance]]
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| -
| -
| +
| +
|
|
|
|
|
* [[Bloating|Bloating,]]
* [[Bloating|Bloating,]]
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* [[Tachycardia]]
* [[Tachycardia]]
* [[Nausea and vomiting]]
* [[Nausea and vomiting]]
|
|Restriction of  [[lactose]] and  maintain [[calcium]] and [[vitamin D]] intake.
|[[Hydrogen Breath Test|Lactose breath hydrogen test]]
|[[Hydrogen Breath Test|Lactose breath hydrogen test]]
|Restriction of  [[lactose]] and  maintain [[calcium]] and [[vitamin D]] intake.
|
|-
|-
|[[Whipple's disease|Whipple disease]]
|[[Whipple's disease|Whipple disease]]
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| -
| -
| +
| +
|
|
|
|
|
* [[Arthralgias]]
* [[Arthralgias]]
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* [[Thrombocytopenia]]
* [[Thrombocytopenia]]
* [[Skin hyperpigmentation]]
* [[Skin hyperpigmentation]]
|
|[[Doxycycline]] and [[hydroxychloroquine]] are [[bactericidal]]
|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]])
|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]])
|[[Doxycycline]] and [[hydroxychloroquine]] are [[bactericidal]]
|
|}
|}
(solute-linked carrier family 26 member A3)
==References==
==References==


Revision as of 18:47, 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 Age onset Additional findind Gold standard dignosis
Watery Fatty < 50 mOsm per kg > 50 mOsm per kg* Weight loss Abdominal pain FTT Anemia Lab findings
Celiac disease +/- +/- - + + + + +
Lactose intolerance + - - + - + -
-
Cystic fibrosis - + + + + +
Laxative overuse + -
Congenital chloride diarrhea Neonate
  • History of polyhydramnios
  • Mutations in the SLC26A3 gene
    • Encodes for an epithelial anion exchanger 
  • Excessive fecal secretion of chloride
 hyponatremia, hypochloremia, and metabolic alkalosis
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 - + - + Restriction of lactose and maintain calcium and vitamin D intake. Lactose breath hydrogen test
Whipple disease - + - + Doxycycline and hydroxychloroquine are bactericidal Upper endoscopy with biopsies of the small intestine for T. whipplei testing (histology with PAS staining, polymerase chain reaction [[[PCR]]] testing, and immunohistochemistry)

(solute-linked carrier family 26 member A3)

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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