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 watery causes of chronic diarrhea[1][2][3][4]
Cause | Osmotic gap | History | Physical exam | Gold standard | Treatment | |||
---|---|---|---|---|---|---|---|---|
< 50 mOsm per kg | > 50 mOsm per kg* | |||||||
Watery | Secretory | Crohns | + | - |
|
|
|
|
Hyperthyroidism | + | - |
|
|||||
VIPoma | + | - |
|
|
|
| ||
Osmotic | Lactose intolerance | - | + |
|
||||
Celiac disease | - | + |
|
|
|
|||
Functional | 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:
History of straining is also common |
|
|
|
The table below summarizes the findings that differentiate fatty causes of chronic diarrhea[5][6][7]
Cause | Osmotic gap | History | Physical exam | Gold standard | Treatment | |
---|---|---|---|---|---|---|
< 50
mOsm per kg |
> 50
mOsm per kg* | |||||
lactose intolerance | - | + |
|
|
Lactose breath hydrogen test | Restriction of lactose and maintain calcium and vitamin D intake. |
Celiac sprue | - | + |
|
Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody followed by upper endoscopy with biopsy. | Dietary counseling, elimination of gluten in the diet. | |
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
- ↑ 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.