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Dig Dis Sci. 2019 Aug;64(8):2095-2106. doi: 10.1007/s10620-019-05528-3. Epub 2019 Mar 1.

Diagnosis and Treatment Patterns in Celiac Disease.

Author information

1
IBM Watson Health, 75 Binney Street, Cambridge, MA, 02142, USA.
2
IBM Watson Health, 75 Binney Street, Cambridge, MA, 02142, USA. elizabethmearns@gmail.com.
3
Takeda Development Centre Europe, 61 Aldwych, London, WC2B 4AE, UK.
4
Takeda Pharmaceuticals International Co, 35 Landsdowne Street, Cambridge, MA, 02139, USA.
5
Royal Hallamshire Hospital and University of Sheffield, Glossop Road, Sheffield, S10 2FJ, UK.
6
Department of Medicine, Celiac Disease Centre, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA.

Abstract

Celiac disease (CD) is an immune-mediated gastrointestinal (GI) disorder driven by innate and adaptive immune responses to gluten. Presentation of CD has changed over time, with non-GI symptoms, such as anemia and osteoporosis, presenting more commonly. With improved screening and diagnostic methods, the reported prevalence of CD has increased globally, and there is considerable global variation in diagnostic and treatment practices. The objective of this study was to describe the current state of CD diagnosis and treatment patterns. A targeted review of literature from MEDLINE, Embase, the Cochrane Library, and screening of relevant conference abstracts was performed. The generally recommended diagnostic approach is GI endoscopy with small bowel biopsy; however, in selected patients, biopsy may be avoided and diagnosis based on positive serology and clinical symptoms. Diagnosis often is delayed; the average diagnostic delay after symptom onset is highly variable and can last up to 12 years. Barriers to accurate and timely diagnosis include atypical presentation, lack of physician awareness about current diagnostic criteria, misdiagnosis, and limited access to specialists. Currently, strict adherence to a gluten-free diet (GFD) is the only recommended treatment, which is not successful in all patients. Only one-third of patients are monitored regularly following diagnosis. Unmet needs for CD include improvements in the accuracy and timeliness of diagnosis, and the development of treatments for both refractory CD and GFD nonresponsive CD. Further research should investigate the impact of education about gluten-free eating and the availability of gluten-free foods support adherence and improve outcomes in patients with CD.

KEYWORDS:

Adherence; Celiac disease; Diagnosis; Gluten-free diet; Review; Treatment patterns

PMID:
30820708
DOI:
10.1007/s10620-019-05528-3
[Indexed for MEDLINE]

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