Q & A
Return to ->Ask the Doctor->Tests and Their Results | QUESTION: What do you do with patients who have self diagnosed, gone gluten free, and seen an improvement of symptoms? For your own patients who have self diagnosed, do you wish for them to go back on gluten, have the blood tests, and have an endoscope? If so, is the standard gluten challenge one month on gluten with the equivilant of three pieces of bread each day? Do you ever make the diagnosis of celiac disease short of an endoscope (with the exception of a diagnosis of dermititis herpetiformis)? If so, under what circumstances? What would the main reason for a self diagnosed patient to go through the process for an official diagnosis be? Would one reason be that a gluten free lifestyle is a very rigorous demand, and, the official diagnosis of celiac, with the increased possibility of small intestine cancer, would be more incentive to comply with this rigorous demand for life? | | DR. RUDERT: I most certainly have had the pleasure of seeing individuals who have self diagnosed, gone gluten free, and seen an improvement in their symptoms. I follow these patients on an individual basis and not always would I recommend a gluten challenge unless they wanted a definitive biopsy proven diagnosis. Celiac Disease at the present time requires a small bowel biopsy with appropriate villous changes in order to make the diagnosis. In these individuals that have not had a small bowel biopsy, yet noticed improvement on a gluten-free diet, I tend to label them as severely gluten sensitive. Only a gluten challenge (which most people do not want to do)with subsequent small bowel biopsy would tell us whether or not they are truly Celiac. I would never challenge anyone during pregnancy. Recent data from Italy indicates that if an individual has Celiac Disease and continues to eat gluten they have a high likelihood of developing another autoimmune disorder within four (4) years. If one desires a gluten challenge, one month on gluten with an equivalent of three (3) pieces of bread daily is thought to be adequate. |
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