Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 5-2001. A 52-year-old man with chronic anemia and sudden severe abdominal pain

A new insight into non-specific abdominal pain

This review aims to change clinical practice and alert clinicians to consider that unrecognised coeliac disease may present acutely with abdominal pain. Targeting patients who have non-specific abdominal pain or coeliac-associated symptoms/diseases may improve diagnosis.

Association of adult celiac disease with surgical abdominal pain: a case-control study in patients referred to secondary care

BACKGROUND

Acute abdominal pain is the most common indication for surgical admission. Nonspecific abdominal pain (NSAP) may account for up to 40% of cases. There has been no published prospective study in which adult patients presenting with acute abdominal pain are investigated for celiac disease.

AIMS

We aimed to assess the association of celiac disease with surgical abdominal pain.

PATIENTS AND METHODS

A case-control study was undertaken involving 300 consecutive new unselected patients presenting with acute abdominal pain (in a university hospital) and healthy controls (age and sex matched) without abdominal pain (n = 300). Initial investigations for celiac disease were immunoglobulins, IgA/IgG anti-gliadin (AGA), and endomysial antibodies (EMA). Any patient with a positive IgA AGA, EMA, or only IgG AGA in the presence of IgA deficiency was offered a small bowel biopsy to confirm the diagnosis.

RESULTS

: There were 33 patients with abdominal pain who had positive antibodies, of whom 9 had histologically confirmed celiac disease (6 EMA positive; 3 EMA negative). One antibody positive patient (EMA in isolation) declined duodenal biopsy and the remaining 23 had normal duodenal mucosa. Within the control group, there were 2 cases of celiac disease. Compared with matched controls the association of acute abdominal pain with celiac disease gave an odds ratio 4.6. (P = 0.068, 95% confidence interval, 1.11-19.05). When only considering NSAP the prevalence of celiac disease was highly significant at 10.5% (9 of 86, P = 0.006). Patients' symptoms improved on a gluten-free diet at 12- to 18-month follow-up.

CONCLUSION

Celiac disease was diagnosed in 3% of patients who presented with unselected acute abdominal pain to secondary care. Targeting patients who have NSAP or celiac associated symptoms/diseases may improve the diagnostic yield.

Recognizing and managing celiac disease in primary care

PURPOSE

To heighten the awareness of primary care clinicians regarding the prevalence, clinical manifestations, diagnosis, and treatment of celiac disease (CD) in the primary care setting.

DATA SOURCES

Selected research, clinical guidelines, research and clinically based articles from current scientific literature, and current medical textbooks.

CONCLUSIONS

Celiac disease is commonly under diagnosed or misdiagnosed. Until recently, it was considered rare in the United States. New data indicate that 1:150 Americans are affected and demonstrate the protective effects of early diagnosis and treatment.

IMPLICATIONS FOR PRACTICE

Delays in the diagnosis and treatment of CD increase the risk of early mortality, associated autoimmune disease, neurologic complications, gastrointestinal malignancy, and fetal growth retardation, where pregnancy precedes diagnosis. Primary care clinicians must cultivate a high index of suspicion for CD in the primary care setting and bear it in mind as a differential diagnosis in many clinical situations.

Malnutrition and gastrointestinal disease

The recognition of several disease processes that cause or are associated with gastrointestinal malabsorption has led to extensive investigation into their pathogenesis, diagnosis, and treatment. This review of selected articles covers a range of subjects related to some of the more common malabsorptive disease. Selected topics including celiac disease, disaccharidase deficiencies, short bowel syndrome, and Crohn disease are discussed.

Malnutrition and gastrointestinal disease

The recognition of several disease processes that cause or are associated with gastrointestinal malabsorption has led to extensive investigation into their pathogenesis, diagnosis, and treatment. This review of selected articles covers a range of subjects related to some of the more common malabsorptive disease. Selected topics including celiac disease, disaccharidase deficiencies, short bowel syndrome, and Crohn disease are discussed.