Any undiagnosed chronic medical problem is coeliac/celiac disease until proved otherwise

 

In 1969, when I was a medical student, an important cause of unexplained symptoms was syphilis. If you couldn’t figure out what caused the rash/neurological problem in your final year clinical exam, and if you didn’t suggest a syphilis test, you failed.

Proteus. Woodcut by Jorg Breu 16th C

Syphilis had protean manifestations. After Proteus, the greek God who could change his shape in a wink. Fast forward to now, and Proteus has cast his mantle over coeliac disease.

Coeliac disease (spelt celiac in Nth America) is an autoimmune disease, not an allergy. It is triggered by gluten found in wheat (and wheat sub-species), barley and rye. We know coeliac disease increases with age. There is also some evidence that coeliac disease is increasing in prevalence within a particular age group. This is based on analysis of frozen serum from past decades (I appreciate feedback from Alex Gazzola via Twitter @HealthJourno for this information).  It is diagnosed more easily because of a simple blood test used as a screening tool. As a result, we now realise about 1% of the population suffers from this disorder. In 1969, you had to have chronic malabsorption of the bowel before a gastroenterologist would perform a duodenal bowel biopsy. That was the only way a diagnosis was made.

Wheat allergy and gluten intolerance are different conditions and are not discussed here.

 

The blood test has opened the door to Proteus. Here is a sample of chronic conditions now linked to coeliac disease:

  • Bowel: irritable bowel symptoms, indigestion, acid reflux
  • Brain: depression, ataxia, neuropathy, psychosis
  • Blood; anemia, iron deficiency, thromboembolism, coagulopathy, hyposplenism
  • Skin; dermatitis herpetiformis
  • Oral: aphthous ulcers, cheilosis, dental enamel problems
  • Growth: failure to thrive, short stature
  • Bone: osteoporosis
  • Limbs: neuropathy, muscle cramps, joint pains
  • Liver: abnormal liver tests, fatty liver
  • Immune: low IgA, malignant lymphoma, autoimmune diseases
  • Nutrition: low B12, folate, vit D, copper
  • Reproductive: Infertility (male and female), delayed puberty
  • General: fatigue, loss of weight
You can scan the literature and add more. The list is incomplete. And association does not prove cause and effect. But, and I say this with complete confidence, you will never go wrong, whether you are doctor or patient, if you remember:
Any undiagnosed chronic medical problem is coeliac disease until proved otherwise
Which means request a blood test BEFORE you start a gluten-free diet or you’ll get a false negative result.
It is estimated that most people with coeliac disease remain undiagnosed. Virgil wrote that Proteus only answered truthfully if you caught him and held him despite the appearance he took. There is a lesson here.
Like
Like Love Haha Wow Sad Angry