Regarding Screening For Celiac Disease

Coeliac disease should be excluded in all patients who are diagnosed with:
A. Splenomegaly
B. Pancreatitis
C. Colon cancer
D. Type 2 diabetes mellitus
E. Graves' disease

Answer:
E. Graves' disease

Discussion: Coeliac disease is caused by sensitivity to the protein gluten. Repeated exposure leads to villous atrophy which in turn causes malabsorption. 

Conditions associated with coeliac disease include

• dermatitis herpetiformis (a vesicular, pruritic skin eruption) and 
• autoimmune disorders (type 1 diabetes mellitus and autoimmune hepatitis). 

It is strongly associated with HLA-DQ2 (95% of patients) and HLA-B8 (80%) as well as HLA-DR3 and HLA-DR7 

In 2009 NICE issued guidelines on the investigation of coeliac disease. They suggest that the following patients should be screened for coeliac disease:

1. Depending on Clinical Signs And Symptoms: 

 Chronic or intermittent diarrhea 

 Failure to thrive or faltering growth (in children) 

 Persistent or unexplained gastrointestinal symptoms including nausea and vomiting 

 Prolonged fatigue ('tired all the time') 

 Recurrent abdominal pain, cramping or distension 

 Sudden or unexpected weight loss 

 Unexplained iron-deficiency anemia, or other unspecified anemia

2. Depending On Medical Conditions: 

 Autoimmune thyroid disease 

 Dermatitis herpetiformis 

 Irritable bowel syndrome 

 Type 1 diabetes 

 First-degree relatives (parents, siblings or children) with coeliac disease

Complications of celiac disease include: 

•  Anemia: iron, folate and vitamin B12 deficiency (folate deficiency is more common than vitamin B12 deficiency in coeliac disease) 
• Hyposplenism 
• Osteoporosis
• Osteomalacia 
• Lactose intolerance 
• Enteropathy-associated T-cell lymphoma of small intestine 
• Subfertility, unfavourable pregnancy outcomes 
• Rare: oesophageal cancer, other malignancies