Celiac Disease Often Overlooked

Editor's note: In their recent article "Atypical Celiac Disease: Could You Be Missing This Common Problem?" Drs Manoj Kumar and Gregory Rutecki showed how reframing celiac disease as a systemic autoimmune disorder can lead to earlier diagnosis.

I have found that most of my patients with celiac disease actually have to convince their own physicians that they have the disorder. If a patient presents with migraine, mouth ulcers, diarrhea, weight loss, and anxiety, the physician will naturally believe the patient is depressed or has a neurological process such as multiple sclerosis.

Patients who are Internet-savvy are able to look up their symptoms on sites such as WebMD and figure out on their own that they may have celiac disease. Once they begin a gluten-free diet, their symptoms immediately improve. Most often, tests for the disorder are negative, leading the physician to believe the patient does not have sprue. However, patients will continue to do well as long as they remain on their special diets. My advice is to always believe these patients, especially those whose weight gain is responsive to the gluten-free diet.

Finally, these patients should be screened for osteoporosis, which is often quite severe. I have used teriparatide for these patients with excellent results.

I could not agree more with Dr Unger. His advice to always believe patients who suspect that they have celiac disease is important. He also is aware that what ails these people is not always in the gut. Osteoporosis can follow years without a diagnosis and a gluten-free diet. Celiac disease is out there; we need to be finding it in its many guises.