In the celiac disease diagnosis a big supporting role is played by the identification of its extra-intestinal symptoms. One of the most striking and typical of these acts dermatitis, which is manifested by severe itching and symmetrical rash, most often located on the knees, elbows, shoulders and buttocks. Despite the fact that only a relatively small proportion of patients with symptoms of dermatitis revealed showing pathological of the gastrointestinal tract (GIT), in a study of the small intestine in practically all cases determined by changes characteristic of celiac disease. A gluten-free diet can achieve the resolution changes in the skin and mucous membranes.
Anemia – quite typical hematological manifestation of celiac disease.
If untreated celiac disease may develop in women with disorders of the reproductive system: earlier menopause, infertility, the risk of miscarriage and fetal malnutrition.
Neuro-psychiatric disturbances in celiac disease may include: hyperactivity, cognitive decline, irritability, depression, migraine, education calcification in the brain, seizures, ataxia.
For other diseases, the combination of which is described in the celiac disease include diabetes type 1 (3-8%), autoimmune thyroid disease (5%), Addison’s disease, etc. . The range of diagnostic search should be included as lactose intolerance, irritable bowel syndrome, bacterial overgrowth syndrome. When celiac disease increased the risk of developing non-Hodgkin’s lymphoma and bowel tumors extra-intestinal localization.
“Gold standard” in the celiac disease diagnosis
is a histological examination of small intestinal mucous.
A biopsy can lead to false-positive or false-negative results. Histological changes similar to those observed in the celiac disease, can be detected and peptic ulcer disease, parasitic diseases, bacterial overgrowth, infectious enteritis, tropical sprue, allergic enteropathy, radiation enteritis.
The immunological diagnostic methods include determination of antibodies. It is believed that the development of antibodies and their titer directly reflect the degree of sensitivity to gluten.
False positives research on anti-tTG can be observed in the outcome of viral infections.
Determination of AGA’s not used as a first line diagnosis of celiac disease due to lack of precision; informativeness of this method decreases with the age of the patient. In congenital deficiency of IgA test results, which are exploring the class IgA antibodies, may be negative.
Provocative tests with gluten is another method of celiac disease diagnosis. In the event that revealed enough specific histologic changes, and the antibody titer does not reach the diagnostic value for the diagnosis of celiac disease lack the required justification. In this situation, we recommend the use of a wider range of serological tests and / or provocative tests with gluten (the “target” level of consumption of gluten corresponds to 4 slices of bread a day). During the challenge with every 4-6 weeks monitored titer EMA and anti-tTG. With the development of diarrhea and / or receiving a positive test result shows the antibody endoscopy with biopsy. In the absence of antibodies in diagnostic titre after 3-6 months “provocations” should reconsider the diagnosis and discuss an individual plan of patient management.