CONCLUSION
The overall management of celiac disease requires patient education, adherence to a gluten-free diet, consultation with a dietitian, and long-term clinical follow-up6,13 (Table 2). Because strict lifelong adherence to a gluten-free diet is so challenging, referral to a support group is also recommended. 6 A number of online resources—for example, the Celiac Sprue Association—provide educational material and may assist physician assistants and patients in complying with treatment recommendations.
Once gluten is eliminated from the diet, most patients will have noticeable improvement of symptoms within days or weeks.18 Continued follow-up care should include treatment of iron, folic acid, calcium, and vitamin D deficiencies and evaluation for osteoporosis.6,13 Clinicians should also monitor dietary compliance and periodically assess patients for potential complications.13 Because of the risk of GI malignancy, the development of alarm symptoms such as abdominal pain, diarrhea, and weight loss despite a gluten-free diet should prompt further investigation.18
Manifestations of celiac disease range from asymptomatic to severe, including the consequences of malabsorption. As demonstrated in the two reported cases, many patients present with atypical complaints. Even for those who do not exhibit nutritional deficiencies, identification and treatment of celiac disease can significantly improve quality of life and may prevent future complications.
Celiac disease is not uncommon in this country,3-5 yet it remains widely unrecognized.11 The diagnosis should be considered in patients who present with compatible symptoms, typical or atypical, and in those with other indications for screening. Treatment for celiac disease can alleviate symptoms, reverse manifestations such as nutritional deficiencies, improve bone mineral density, and minimize the risk of associated malignancy.6 Broader recognition of the disease will thus likely produce improved outcomes for a substantial number of patients. JAAPA
Bettie Coplan is an assistant professor in the PA program at Midwestern University, Glendale, Arizona, and practices as a PA in gastroenterology. She has indicated no relationships to disclose relating to the content of this article.
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