Celiac Disease Diagnosis and Management

Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist, discusses how celiac disease is diagnosed and managed through diet.

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Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist, discusses how celiac disease is diagnosed and managed through diet.
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Featuring Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist

Duration: 3 minutes, 9 seconds

Celiac disease is quite common in our community, and it has two times that the onset is more common. Interestingly, there’s an onset that occurs in the second decade of life, there’s a peak incidence then.

But also there’s another surge in incidence that can occur in the 50s and 60s, for unknown reasons. So as a practitioner we try and be aware of these peaks and incidences, and look for patients that have it.

The underlying problem is an intolerance to gluten. Gluten is a compound that’s derived from wheat and similar grains. It gives the doughy feeling to breads that we so much like. And people with celiac disease cannot tolerate gluten. They have an inflammatory response to it when their intestine comes in contact with the gluten.

The diagnosis is first part clinical: suspecting the disease based on the pattern of what the patient’s been eating and how they’re reacting. Usually, if you have a food intolerance, it’s what you ate one or two days previously. What you ate a week ago generally doesn’t have a big impact on what your intestines feel like today.

So if you think you’re intolerant to gluten or wheat products, and usually that includes wheat, barley and rye – grains predominantly – then you can consider discussing this with your family practitioner or primary care physician.

The diagnosis is made by blood testing. There are serological tests - tests to look for antibodies in your bloodstream - that are directed against gluten, which are reasonably good tests actually.

But today the gold standard – the best test – is still upper gastrointestinal endoscopy, where a gastroenterologist or someone who’s skilled in that procedure looks in through the mouth into the small bowel and biopsies the small bowel. And there’s a characteristic abnormality to the intestine that you can see in celiac disease or gluten sensitivity.

Once the diagnosis is made, it’s important to sit down with a dietitian and review where gluten is in foods, because unfortunately it’s just about everywhere. Gluten gets added to a lot of foods that you might not suspect, such as wieners for example. It’s often used to bulk up and put foods together, so it’s important to know where it is, to go to gluten-free grains and avoid foods where it’s been put in as an additive.

If you think you have symptoms of celiac disease or gluten sensitivity, discuss it with your primary care physician.

Presenter: Dr. Richard Bebb