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Celiac Disease: Part Two

Ann Dietrich, MD, Solomon Behar, MD, and Mary Schull, MD
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Tags celiac · GI

Ann and Sol discuss the management of celiac disease with Mary Schull, a pediatric GI doctor who herself is afflicted by the condition.

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Martin K., MD -

Could Dr. Schull comment on the increasing number of people who feel either they or their children are symptomatic from gluten sensitivity, but their celiac disease antibodies and/or biopsies are negative for celiac disease? Is this a real entity?

Solomon B., MD -

Hi Martin- thanks for your question- here is what Dr Shull had to say in response to your question:
"This is an excellent question and an area which can be quite confusing. Yes, I do think there are truly people who have non-celiac gluten sensitivity, but this is likely only a small percentage of the many people who are coming to clinic or in the media saying that they partially or completely restrict gluten and feel better in some way. Our best estimates (from adult literature) is that up to 6% of the population seems to have a true non-celiac gluten sensitivity. These patients can have similar GI symptoms to someone with celiac disease while eating gluten, but (while they are on a regular, gluten-containing diet) both their celiac serologies and duodenal biopsies will be negative. We don’t currently understand the pathogenesis of non-celiac gluten sensitivity. Often these patients can tolerate small amounts of gluten so cross-contamination isn’t as big of a problem as for someone with celiac disease, and often the amount of gluten they can tolerate will increase over time. Very little research has been done in pediatric populations so far, so this is an area where we still need to learn a lot more (for both kids and adults). For now, the important thing is to make sure that they have at least gotten a TTG IgA and serum IgA drawn while eating a regular diet so that celiac disease can be ruled out. Knowing whether or not they truly have celiac disease is important so we can know if they are at risk for other long-term issues and if a strict gluten-free diet must be lifelong. Once celiac disease is ruled out, if the patient/family feels that restricting gluten partially or completely is of benefit to the patient, it is reasonable to do this."

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Hairballs and Food Babies Full episode audio for MD edition 213:52 min - 100 MB - M4AHippo Peds RAP January 2018 Written Summary 417 KB - PDF