Celiac Disease: Beyond the Basics

Diagnostic Approach

Testing should occur while on gluten-containing diet. IgA anti-tTG is first-line (IgG in IgA deficiency). Duodenal biopsy confirms diagnosis. HLA-DQ2/DQ8 testing helps rule out disease if negative.

Gluten-Free Diet

Strict avoidance of wheat, barley, rye is essential. Oats are controversial. Dietitian referral improves adherence. Monitor for nutritional deficiencies (iron, B12, vitamin D).

Non-Responsive Celiac

Persistent symptoms require evaluation for gluten exposure, microscopic colitis, or refractory disease. Refractory celiac may need immunosuppressants. Rule out enteropathy-associated T-cell lymphoma.

Associated Conditions

Screen for thyroid disease, type 1 diabetes, and dermatitis herpetiformis. Bone density assessment is recommended. Neurologic manifestations include peripheral neuropathy and ataxia.

Emerging Therapies

Glutenases, tight junction modulators, and immune modulation approaches are under investigation. Currently, strict gluten-free diet remains only effective treatment.