radiology report for a celiac disease patient

Radiology: Some radiological findings may indicate the presence of celiac disease

, e.g., small-bowel dilation, wall thickening, vascular changes, and others. 2 The Gluten Challenge If you are currently on a gluten-free diet, your physician may recommend a gluten challenge to allow antibodies to build in your bloodstream prior to testing.

Full Answer

What is celiac disease and how to be diagnosed?

Symptoms of celiac disease vary among sufferers and include:

• No symptoms at all (like some family members of celiac patients).
• Digestive problems (abdominal bloating, pain, gas, constipation, diarrhea, pale stools and weight loss).
• A severe blistering skin rash called dermatitis herpetiformis and sores in the mouth (called aphthous ulcers).

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Is celiac really a disease?

Celiac disease is an autoimmune disease that means people who have it and eat gluten will damage their small intestine. And when people eat things like wheat, rye, or barley, their body reacts, and that reaction is harmful to their small intestine. Millions of people are impacted by celiac disease.

What happens if celiac disease is left untreated?

Wide range of neurological manifestations, like infertility, epileptic seizures, ataxia, dementia, neuropathy, migraine, short stature, myopathy, and multifocal leuco encephalopathy. Untreated celiac disease may also result in the development of several other autoimmune problems, like multiple sclerosis and Type 1 diabetes.

How accurate is a biopsy for celiac disease?

The researchers note that no current blood test is 100% accurate for identifying celiac disease, and they recommend that physicians continue to perform biopsies in most cases. Click to see full answer

Presentation

Long standing abdominal pain, on and off diarrhea, unexplained anemia, weight loss of 6 kg in last 6 months and bilateral lower limb edema for last 2 weeks. Past history of multiple miscarriages.

Case Discussion

Prior to CT scan, patient underwent different laboratory investigations among which positive laboratory findings were low serum albumin level, low serum iron and low total iron binding capacity. After CT scan, anti-tissue transglutaminase IgA (tTG-IgA) level was done which was 215.30 Units (> 30 units is moderate to strong positive).

How common is celiac disease?

Celiac disease is now recognized as a common disease, occurring in about 1 in every 200 Americans ( 1 ). However, less than 10% of cases are currently diagnosed ( 2 ), with a diagnostic delay of more than 10 years from onset of symptoms. Celiac disease is a chronic autoimmune disorder induced in genetically susceptible individuals after ingestion of gluten proteins, which are found in wheat, rye, barley, and certain other grains.

How many people have celiac disease?

Once thought to be a relatively rare diarrhea-associated debilitating disease affecting 1 in 10,000–30,000 individuals, primarily children, celiac disease is now estimated to occur in 1 in 200 Americans of any age ( 26 ).

What are the symptoms of iron deficiency anemia?

Abdominal pain, iron deficiency anemia, and guaiac-positive stools ( 29) are considered common presenting symptoms. It is now recognized that if diagnosis is delayed for more than a decade from the time symptoms develop, there is increased morbidity (including iron deficiency anemia, lactose intolerance, osteoporosis, increased fracture risk, miscarriage, low birth weight, lymphoma, seizures, and depression) and increased mortality. Studies show a fourfold increase in deaths during a 45-year follow-up of undiagnosed cases ( 1 ).

Is celiac disease a common disease?

Celiac disease is now recognized as a common disease, occurring in about one in every 200 Americans. However, less than 10% of cases are currently diagnosed, with a diagnostic delay of more than 10 years from onset of symptoms. In the past, barium examination of the small bowel demonstrated a pattern of abnormal findings caused by the pathophysiologic changes induced by malabsorption, thus leading to diagnosis of celiac disease and other diseases of malabsorption. Although not specific, that pattern prompted further patient evaluation. The number of barium examinations performed and the skill necessary to interpret their results are both in decline. Abdominal pain in celiac disease is a common early complaint that often leads to computed tomography (CT). Improved CT resolution now permits better depiction of the small bowel, colon, and mesenteric lymph nodes, all of which are affected by celiac disease. Detection of celiac disease with CT will allow treatment to be initiated to prevent the significant morbidity and increased mortality associated with a delay in diagnosis. The abnormal CT findings seen over the past decade during review of more than 200 cases of celiac disease demonstrate that CT depicts more features of celiac disease than did barium examination. Pattern recognition for the diagnosis of small bowel diseases that create structural changes in the bowel wall is well accepted. Because it demonstrates features of celiac disease not detected with barium examination, CT may be more sensitive than barium examination for diagnosis of this disease.

Does celiac disease cause abdominal pain?

Abdominal pain in celiac disease is a common early complaint that often leads to computed tomography (CT). Improved CT resolution now permits better depiction of the small bowel, colon, and mesenteric lymph nodes, all of which are affected by celiac disease.

When does Celiac sprue occur?

Celiac sprue typically presents in the second decade of life. While no clear inheritance pattern has been established, the disease does occur more often in patients demonstrating the serum histocompatibility antigens HLA-DR3 and HLA-DQw2. This association suggests a possible immune reaction mediated within the intestinal mucosa. Additional hypotheses include adenovirus infection, secondary to homology of the amino acid sequence involving gluten and a viral-encoded protein.

What is celiac sprue?

Celiac sprue, or gluten-induced enteropathy as it is more appropriately known, is characterized by intolerance to wheat glutens. More common in women, the disease has widely variable symptomology. Clinically, the symptoms range from severe malabsorption to mild abdominal pain, though many patients are asymptomatic. The classic presentation of malabsorption and weight loss occurs in only a minority of patients. Diarrhea is the most common feature of the disease. The cause of diarrhea in celiac sprue is multifactorial, resulting from impaired absorption by the duodenum and jejunum, and net secretion by jejunal mucosa. Additionally, osmotic diuresis in the colon from unabsorbed fats contributes to water in the stool.

What is abdominal CT?

The abdominal CT demonstrates absence of the spleen and multiple rounded hypodensities in the retrocrural and aortocaval regions representing cavitary lymph nodes. The differential diagnosis includes lymphoma, infection ( Mycobacterium avium-inreacellulare ), Whipple’s disease, and metastatic carcinoma post-therapy.

Can a Celiac disease be asymptomatic?

Celiac disease may be asymptomatic. The abdomen CT excludes possible abscess. In other patients, studies have found cavitation of mesenteric lymph nodes is an original feature, which may be associated with splenic atrophy and a flat small intestinal mucosa; and some of these patients may have celiac disease. 1

What is the best test for celiac disease?

For most children and adults, the best way to test for celiac disease is with the Tissue Transglutaminase IgA antibody, plus an IgA antibody in order to ensure that the patient generates enough of this antibody to render the celiac disease test accurate.

What is the risk of developing celiac disease in first degree family members?

First-degree family members (parents, siblings, children), who have the same genotype as the family member with celiac disease, have up to a 40% risk of developing celiac disease. The overall risk of developing celiac diseaes when the genotype is unknown is 7% to 20%.

What is the purpose of a total serum IgA test?

Total serum IgA: This test is used to check for IgA deficiency, a condition associated with celiac disease that can cause a false negative tTG-IgA or EMA result . If you are IgA deficient, your doctor can order a DGP or tTG-IgG test.

How long do you have to eat cereal for celiac disease?

Children must be eating wheat or barley-based cereals for some time, up to one year, before they can generate an autoimmune response to gluten that shows up in testing. A pediatric gastroenterologist should evaluate young children experiencing a failure to thrive or persistent diarrhea for celiac disease. 1.

When can you take a gluten challenge?

A gluten challenge is not recommended before the age of 5 or during puberty. 2 Never undertake a gluten challenge when pregnant.

Is a blood test for celiac disease accurate?

All celiac disease blood tests require that you be on a gluten-containing diet to be accurate. Tissue Transglutaminase Antibodies (tTG-IgA) – the tTG-IgA test will be positive in about 98% of patients with celiac disease who are on a gluten-containing diet. The test’s sensitivity measures how correctly it identifies those with the disease.

Can a biopsy of the small intestine be used to diagnose celiac disease?

There are other antibody tests available to double-check for potential false positives or false negatives, but because of potential for false antibody test results, a biopsy of the small intestine is the only way to diagnose celiac disease.

What type of test is used to confirm celiac disease?

If serologic tests suggest that a patient could have celiac disease, health care professionals should order an upper GI endoscopy with biopsies of the duodenum—including the duodenal bulb and distal duodenum—to confirm the diagnosis.

What percentage of people with celiac disease have HLA-DQ2.5?

About 95% of people with celiac disease have HLA-DQ2.5. 1 Among the other 5%, most have HLA-DQ8. 1 A very small percentage have other genetic variants, such as DQ2.2, which are very rarely associated with celiac disease.

What if a TTG IGA test is negative?

If a tTG-IgA or EMA-IgA test result is negative in a patient with suspected celiac disease, health care professionals may order a total IgA test, a serology test for IgA deficiency.

Why do doctors use serologic tests?

In addition to using serologic tests to help diagnose celiac disease, health care professionals may use them to monitor how well patients are following a gluten-free diet. Ordering serologic tests is typically the first step in diagnosing celiac disease.

What does it mean when IgA is low?

Note that if the total IgA is undetectably low, this suggests that the patient may have an immunoglobulin deficiency disorder , the most common type being selective IgA deficiency. Further evaluation may be needed.

What is the National Institute of Diabetes and Digestive and Kidney Diseases?

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

Can genetic testing confirm celiac disease?

Genetic tests that confirm the presence or absence of specific genes associated with celiac disease may be beneficial in some cases.

What is the purpose of CT for celiac disease?

Detection of celiac disease with CT will allow treatment to be initiated to prevent the significant morbidity and increased mortality associated with a delay in diagnosis.

Is celiac disease a common disease?

Celiac disease is now recognized as a common disease, occurring in about one in every 200 Americans. However, less than 10% of cases are currently diagnosed, with a diagnostic delay of more than 10 years from onset of symptoms. In the past, barium examination of the small bowel demonstrated a pattern of abnormal findings caused by the pathophysiologic changes induced by malabsorption, thus leading to diagnosis of celiac disease and other diseases of malabsorption. Although not specific, that pattern prompted further patient evaluation. The number of barium examinations performed and the skill necessary to interpret their results are both in decline. Abdominal pain in celiac disease is a common early complaint that often leads to computed tomography (CT). Improved CT resolution now permits better depiction of the small bowel, colon, and mesenteric lymph nodes, all of which are affected by celiac disease. Detection of celiac disease with CT will allow treatment to be initiated to prevent the significant morbidity and increased mortality associated with a delay in diagnosis. The abnormal CT findings seen over the past decade during review of more than 200 cases of celiac disease demonstrate that CT depicts more features of celiac disease than did barium examination. Pattern recognition for the diagnosis of small bowel diseases that create structural changes in the bowel wall is well accepted. Because it demonstrates features of celiac disease not detected with barium examination, CT may be more sensitive than barium examination for diagnosis of this disease.

Introduction

Selection of Ct Studies

Clinical Presentation

Pathophysiology

Small Bowel MABP

Ct Features of Celiac Disease

• Small Bowel MABP
  Small bowel loops are often dilated and fluid-filled as a result of the chronic inflammatory process (Fig 3). This leads to progressive dilution of enteric contrast material (Fig 4). Small hyperattenuating flecks of barium may be seen precipitating in the dilated small bowel loops, a p…
• Mesenteric Lymph Node Prominence
  Lymphadenopathy is a feature of, or response to, a variety of pathologic conditions that can be categorized into benign and malignant processes. In celiac disease and other autoimmune conditions, nodal enlargement is due to follicular hyperplasia caused by proliferation of reactive …

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Other Findings That Add Suspicion

Conclusions