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<sup>1</sup> <b>Common conditions to consider testing for CD:</b> malabsorption, diarrhea w/ wt↓, chronic diarrhea w/ or w/o abd pain, chronic Fe deficiency and unexplained anemia, metabolic bone dz/premature osteoporosis, postprandial bloat/gas, unexplained wt↓, ↑liver enzymes, incidental villous atrophy, dermatitis herpetiformis, peripheral neuropathy, oral aphthous ulcers, growth failure, discolored teeth/developmentally synchronous enamel loss, thyroid dz, IBS, Down/Turner syndrome, unexplained recurrent pancreatitis.
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<sup>2</sup> <b>Less common (but treatable) conditions to consider testing for CD:</b> pulmonary hemosiderosis, infertility, dyspepsia, amenorrhea, chronic fatigue, apparent malabsorption of thyroid meds, epilepsy, ataxia, constipation, recurrent abd pain, chronic arthralgia, “brain fog,” recurrent headache/migraine.
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<sup>3</sup> <b>EGD/duodenal bx:</b><br>
• Multiple duodenal biopsies (1 or 2 from bulb and 4 from distal duodenum) are necessary for CD dx.<br>
• EGD and duodenal biopsies can aid the DDx of other malabsorptive disorders or enteropathies.<br>
• Lymphocytic duodenosis (≥25 intraepithelial lymphocytes/100 epithelial cells) in absence of villous atrophy isn’t specific to CD; consider other causes.
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<sup>4</sup> <b>TTG, EMA, DGP testing:</b><br>
• TTG-IgA and EMA-IgA are reported to be less accurate in children <2 yo.<br>
• Current guidelines recommend both TTG-IgA and DGP-IgG in children <2 yo.
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<sup>5</sup> <b>Case finding:</b><br>
• Test for CD in pts w/ s/sx/labs suggestive of malabsorption (e.g., chronic diarrhea w/ wt↓, steatorrhea, abd pain, bloating).<br>
• Consider testing for CD in pts w/ s/sx or lab evidence for which CD is a treatable cause.<br>
• Pts w/ a 1st-degree relative who has confirmed CD should be tested whether they show possible s/sx or lab evidence of CD.<br>
• Consider testing of asymptomatic relatives w/ a 1st-degree family member who has confirmed CD.
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<sup>2</sup> <b>Less common (but treatable) conditions to consider testing for CD:</b> pulmonary hemosiderosis, infertility, dyspepsia, amenorrhea, chronic fatigue, apparent malabsorption of thyroid meds, epilepsy, ataxia, constipation, recurrent abd pain, chronic arthralgia, “brain fog,” recurrent headache/migraine.
<br><br>
<sup>3</sup> <b>EGD/duodenal bx:</b><br>
• Multiple duodenal biopsies (1 or 2 from bulb and 4 from distal duodenum) are necessary for CD dx.<br>
• EGD and duodenal biopsies can aid the DDx of other malabsorptive disorders or enteropathies.<br>
• Lymphocytic duodenosis (≥25 intraepithelial lymphocytes/100 epithelial cells) in absence of villous atrophy isn’t specific to CD; consider other causes.
<br><br>
<sup>4</sup> <b>TTG, EMA, DGP testing:</b><br>
• TTG-IgA and EMA-IgA are reported to be less accurate in children <2 yo.<br>
• Current guidelines recommend both TTG-IgA and DGP-IgG in children <2 yo.
<br><br>
<sup>5</sup> <b>Case finding:</b><br>
• Test for CD in pts w/ s/sx/labs suggestive of malabsorption (e.g., chronic diarrhea w/ wt↓, steatorrhea, abd pain, bloating).<br>
• Consider testing for CD in pts w/ s/sx or lab evidence for which CD is a treatable cause.<br>
• Pts w/ a 1st-degree relative who has confirmed CD should be tested whether they show possible s/sx or lab evidence of CD.<br>
• Consider testing of asymptomatic relatives w/ a 1st-degree family member who has confirmed CD.
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In pts w/ s/sx/labs suggestive of malabsorption or CD,<sup>1,2</sup> detection of CD-specific antibodies useful for initial screening; intestinal bx required in most pts to confirm dx.