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New protocol for the early diagnosis of celiac disease

This new protocol was born with the objective of updating the already published in 2008 to promote, homogenize and approximate to the best scientific knowledge the early diagnosis of celiac disease, because it is estimated that despite advances up to 70% of celiac patients remain still without diagnosis.

Gastroenterologist experts in celiac disease (CD) emphasize that it is a difficult disease to diagnose due to the systemic nature of the disease, with involvement of multiple organs and systems, and also the lack of specificity of its clinical manifestations. In addition, the clinical characteristics of the disease differ considerably depending on the age of presentation.

It is necessary to carry out a clinical follow-up of the patients, with the objective of monitoring and evaluating their evolution, as well as compliance with the gluten-free diet and controlling growth in children. In those patients who continue with symptoms despite being on a gluten-free diet, it is mandatory to carry out an intentional search for hidden sources of gluten in the diet or minimal transgressions.

The information has been extracted from the official document drafted by the Ministry of Health.

 

The most important points of the new protocol are:

  • Its emphasis is placed on the importance of ensuring that the patient continues consuming gluten before the beginning of the celiac disease diagnosis, because this will cause the fall in antibodies levels and give false negatives that will difficult the disease diagnose.
  • Clinical monitoring of celiac patients is necessary, in order to monitor and assess the evolution of their symptoms and the degree of compliance with the gluten-free diet, in addition to controlling the correct growth in the case of pediatric patients.
  • This document catalogue gluten immunogenic peptides (GIP) as the most effective method for the monitoring of the gluten-free diet, assess transgressions in the diet and dismiss the involuntary intake of gluten during the diagnosis of refractory CD.
  • It is possible that celiac patients have negative levels of antibodies. In these cases, genetic tests can help to diagnose the disease. In addition, this test is useful to identify individuals with a high risk of developing CD between first-degree relatives and patients with associated diseases who have positive serology and normal biopsy.
  • Except in pediatric patients and in very specific cases, the CD diagnosis requires a duodenal biopsy showing the atrophy of the intestinal villi characteristic of this disease.

 

To read the complete protocol, please click on the following link:

https://www.mscbs.gob.es/profesionales/prestacionesSanitarias/publicaciones/Celiaquia/enfermedadCeliaca.pdf