Differentiating celiac disease from other diseases

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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		Age of onset	History			Physical exam	Lab findings	Additional finding	Gold standard dignosis
Cause	Watery	Fatty	Age of onset	Weight loss	FTT	Abdominal pain	Physical exam	Lab findings	Additional finding	Gold standard dignosis
Celiac disease	+/-	+/-		+	+	+	Abdominal distention Tetany Mouth ulcers Dermatitis herpetiformis Signs of the fat-soluble vitamins A, D, E, and K deficiency		Gluten-free diet	IgA tissue transglutaminase Ab
Lactose intolerance	+	-		-	-	+	Abdominal tenderness		Avoidance of dietary lactose Substitution to maintain nutrient intake Regulation of calcium intake Use of enzyme lactase	Intestinal biopsy
Cystic fibrosis	-	+	Infancy and childhood	+	+	+	Digital clubbing Respiratory rale, wheeze, and crunckles Abdominal pain Cyanosis	Positive DNA analysis for CFTR multimutation method Evaluated nasal transepithelial potential difference (NPD)	Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein Disease manifestations in multiple organ systems: Diabetes Recurrent upper and lower respiratory tract infections Infertility	Elevated sweat chloride ≥60 mmol/L
Laxative overuse	+	-

Crohns	+	-		+		+	Abdominal tenderness when palpated in severe disease Blood seen on rectal exam Fever Tachycardia Hypotension		Topical mucosamine and corticosteroids are preferred Mesalamine and sulfasalazine are used for remission	Colonoscopy with biopsy
Hyperthyroidism	+	-					Lump in the neck Proptosis Tremors Increased DTR			TSH with T3 and T4
VIPoma	+	-		+			Tachycardia Rash Facial flushing Abdominal distention Abdominal tenderness in the right upper abdominal quadrant		Dehydration Lethargy, muscle weakness Nausea, vomiting Flushing	Elevated VIP levels Followed by imaging
Irritable bowel syndrome	+	-					Abdominal tenderness Hard stool in the rectal vault		High dietary fiber Osmotic laxatives such as polyethylene glycol, sorbitol, and lactulose Antispasmodic drugs (e.g. anticholinergics such as hyoscyamine or dicyclomine)	Clinical diagnosis ROME III criteria Pharmacologic studies based criteria
lactose intolerance	-	+					Abdominal tenderness when palpated in severe disease Fever Hypotension Tachycardia Nausea and vomiting	Bloating, Flatulence Symptoms begin mainly after ingestion of lactose		Lactose breath hydrogen test
Whipple disease	-	+		+	-	+		Leukocytopenia Thrombocytopenia	Skin hyperpigmentation Arthralgias	Upper endoscopy with biopsies of the small intestine for T. whipplei testing (histology with PAS staining, polymerase chain reaction [[[PCR]]] testing, and immunohistochemistry)
Allergic enteropathy/Food protein-induced enterocolitis syndrome (FPIES)	+	-	Infancy	+/-	+/-	+	Nausea Vomiting Abdominal distention	S/E: Blood-tinged and mucusy Polymorphonuclear leukocytes presence	triggered by cow's milk protein profuse, repetitive vomiting	oral food challenge (OFC)
Eosinophilic gastroenteritis	+	-	3rd decade	+/-	+/-	+	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	eosinophilic infiltration of the gastrointestinal tract on biopsy
Microscopic colitis	+	-	6th decde	+	-	+	Abdominal tenderness	autoantibodies include: RF ANA AMA ANCA	Fecal urgency Incontinence My be associated with extraintestinal symptoms, such as: Arthralgia Arthritis Uveitis	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
Cause	Diarrhea		Age of onset	History			Physical exam	Lab findings	Additional finding	Gold standard dignosis
Cause	Watery	Fatty	Age of onset	Weight loss	FTT	Abdominal pain	Physical exam	Lab findings	Additional finding	Gold standard dignosis
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	+	+	-	-	S/E: Alkaline Fecal sodium concentrations Serum: Metabolic acidosis Hyponatremia	May be associated with choanal or anal atresia
Glucose-galactose malabsorption	+	-	Infancy	+	+/-	+	Abdominal tenderness		severe life-threatening diarrhea Dehydration Symptomatic as long as the diet includes lactose or its hydrolysis products, glucose and galactose	positive glucose breath hydrogen test + normal intestinal biopsy
Congenital sucrase-isomaltase deficiency									Symptoms start with consumption of sucrose-containing formulas or foods

(solute-linked carrier family 26 member A3)

oral food challenge (OFC):

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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Differentiating celiac disease from other diseases

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Differentiating Celiac Disease from Other Diseases

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