A gluten-free diet is the only effective treatment for celiac disease, and most adherent patients experience substantial clinical improvement within two weeks, with varying degrees of mucosal healing over time. But a small percentage of patients have malabsorptive symptoms (abdominal pain, diarrhea, weight loss) and histologic abnormalities that persist or recur, despite their best efforts to follow dietary recommendations.
When gluten isn't the issue, Dr. Murray says part of the evaluation should include a review of the original diagnosis — even if it means going back decades. "You have to have a very robust diagnosis. Some patients don't have adequate blood testing and some never had a biopsy because their gastroenterologist told them they didn't need it. Or there could have been an overcall on the biopsy; you have to review the pathology because something else may be damaging the small intestine, such as tropical sprue, which looks like celiac. There may also be drug-induced injury to the small intestine, collagenous sprue or, more rarely, autoimmune enteropathy. It can be very laborious to get the original data, but it may unmake the diagnosis."
Read more in the Digestive Diseases update.
To find out more about celiac disease, visit mayoclinic.org/celiacdisease.