Celiac Disease

The diagnosis of celiac disease involves serologic testing (generally for IgA anti–tissue transglutaminase antibodies first) followed by upper endoscopy with biopsy for confirmation in most patients. Patients with celiac disease should follow a lifelong, strict gluten-free diet. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage A 22-year-old woman fractures her wrist while playing volleyball. She reports a history of fatigue and intermittent oral ulcerations but no other symptoms. Radiography of her wrist shows osteopenia. Laboratory testing is notable for a hematocrit of 32% and low levels of ferritin and 25-hydroxyvitamin D. Although she reports no gastrointestinal symptoms, celiac disease is suspected. How should she be further evaluated and, if testing indicates celiac disease, how should her case be managed? The Clinical Problem Celiac disease is a systemic immune-mediated disorder triggered by dietary gluten in genetically susceptible persons. Gluten is a protein complex found in . . .