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      Adult-onset celiac disease for the primary care physician

      , 1 , a , 1 , b

      Family Medicine and Community Health


      Celiac disease, primary care, diagnosis, management

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          Celiac disease is a common autoimmune condition with a prevalence of 1%–2%. In recent years there has been a paradigm shift in management from tertiary care into the community. With a wide array of manifestations, including nonspecific and extraintestinal symptoms, this disorder can be difficult to diagnose, prolonging morbidity for patients.

          This review article aims to augment the primary physician’s knowledge of the common presentation, diagnosis, management, and follow-up of this disease.

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          Most cited references 12

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          Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet.

          Coeliac disease is increasingly diagnosed and weight changes are common after adoption of a gluten-free diet (GFD), however data on body mass index (BMI) changes are limited. To assess changes in BMI after diagnosis in a large coeliac population. A total of 1018 patients with biopsy confirmed coeliac disease seen at our centre were studied retrospectively. Initial and follow-up BMIs were recorded, as was GFD adherence as assessed by an expert dietitian. A total of 679 patients with at least two recorded BMIs and GFD adherence data were included in the study. Mean follow-up was 39.5 months. Compared to regional population data, the coeliac cohort was significantly less likely to be overweight or obese (32% vs. 59%, P < 0.0001). Mean BMI increased significantly after GFD initiation (24.0 to 24.6; P < 0.001). 21.8% of patients with normal or high BMI at study entry increased their BMI by more than two points. Individuals with coeliac disease have lower BMI than the regional population at diagnosis. BMI increases on the GFD, especially in those that adhere closely to the GFD. On the GFD, 15.8% of patients move from a normal or low BMI class into an overweight BMI class, and 22% of patients overweight at diagnosis gain weight. These results indicate that weight maintenance counselling should be an integral part of coeliac dietary education. © 2012 Blackwell Publishing Ltd.
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            Coeliac disease: is it time for mass screening?

            Screening studies indicate a prevalence of coeliac disease (CD) of up to 1% in populations of European ancestry, yet the majority of cases remain undiagnosed. Serological markers for CD now available have high sensitivity and specificity, offering the option of mass population screening. The principles of disease screening as set out by Wilson and Jugner can be applied to CD to predict whether this is appropriate. CD is an important health problem for the individual and the community because of high prevalence, associated specific and non-specific morbidity, and long-term complications of which the most important are gut malignancy and osteoporosis. However, recent studies indicate that the prevalence of malignancy and the health impact of osteoporosis are much less than previously supposed, so the prophylactic benefits of early diagnosis through screening may be low. While CD has an accepted and effective treatment, dietary gluten exclusion, this is difficult for the individual and asymptomatic cases may be poorly motivated to comply. Diagnosis of CD is by histological confirmation on duodenal biopsy. We now recognise milder degrees of gluten sensitive enteropathy without villous atrophy (Marsh I, II lesions) and the benefits to the individual by identifying these early lesions through screening is unknown: whether to treat such individuals needs to be agreed before programmes commence. Screening with serum antibodies is relatively non-invasive but may have to be repeated during each individual's lifetime. HLA typing beforehand to identify the 30% of the population with DQ2 or DQ8, who are at potential risk of CD, will allow one-off exclusion of a large percentage of the population but like all genetic testing has ethical implications. The economic costs of screening and treatment versus morbidity prevented have not been calculated.
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              The Oslo definitions for coeliac disease and related terms


                Author and article information

                Family Medicine and Community Health
                Compuscript (Ireland )
                October 2017
                October 2017
                : 5
                : 3
                : 211-214
                1The Aberfeldy Practice, 2a Ettrick Street, Poplar, London, UK
                aCore Surgical Training (London)
                bGPVTS, London (Tower Hamlets)
                Author notes
                CORRESPONDING AUTHOR: Kamil Naidoo, 9 Pine Grove, SW19 7HD London, UK, Tel.: +44-7545045618, E-mail: k.naidoo@ 123456me.com
                Copyright © 2017 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                Self URI (journal page): http://fmch-journal.org/


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