Celiac disease, also known as gluten sensitive enteropathy is very common but frequently missed. It is an autoimmune disease of intestinal damage due to gluten in people who are genetically predisposed. Classic Celiac disease is diagnosed by abnormal blood tests and an abnormal
appearing intestine on biopsy and symptoms that resolve with a gluten free diet.

Several blood tests exist for Celiac disease. They have varying degrees of accuracy. Some are more sensitive, meaning they will be positive in milder forms of the disease but are not specific, meaning a positive test may not indicate Celiac disease. Others are felt to be very specific, meaning that when they are positive, it is almost certain you have the disease.

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One of the symptoms many people experience frequently and most people have had sometime in their adult life is heartburn. The medical term for this is pyrosis, from the Greek word pyro meaning fire or heat. Heartburn is the classic symptom of gastroesophageal reflux (GER) or reflux. Most people have heard of these terms now because you can t sit through an hour of television these days without seeing at least one commercial if not several advertising antacids like tums or acid blockers like Pepcid AC and Nexium. Most people are not aware that heartburn is a common symptom of gluten intolerance or sensitivity.

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Celiac disease, also known as gluten sensitive enteropathy is very common but frequently missed. It is an autoimmune disease of intestinal damage due to gluten in people who are genetically predisposed. Classic Celiac disease is diagnosed by abnormal blood tests and an abnormal
appearing intestine on biopsy and symptoms that resolve with a gluten free diet.

Several blood tests exist for Celiac disease. They have varying degrees of accuracy. Some are more sensitive, meaning they will be positive in milder forms of the disease but are not specific, meaning a positive test may not indicate Celiac disease. Others are felt to be very specific, meaning that when they are positive, it is almost certain you have the disease.

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The diagnosis of celiac disease is confirmed by a characteristic abnormal appearance of the small intestine under the microscope. Flattening of the normal finger like projections called villi accompanied by signs of inflammation is taken to indicate damage or injury from the storage protein gluten in wheat and similar proteins in barley and rye. The small intestine biopsy has became the gold standard for establishing the diagnosis of Celiac disease or gluten sensitive enteropathy. Before 1960 gluten withdrawal followed by improvement and subsequent worsening upon rechallenge was the diagnostic criteria.

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When undergoing an evaluation for possible celiac disease or gluten sensitive enteropathy doctors usually recommend an upper endoscopy and small intestine biopsy. What that may mean or why it is recommended may not be clear to people who are facing the decision to undergo the procedure themselves or to subject their child to the exam.

Endoscopy in celiac: What is it and how is it done?

The medical name for upper endoscopy is esophagogastroduodenoscopy or EGD for short. The endoscope is a thin flexible tube about the diameter of a fat pencil that has a video chip in the end and channels for flushing of water, suctioning of secretions and passage of instruments. It has dials that allow the

tube to be turned up/down and right and left at the tip permitting it to be passed through the mouth, down the esophagus or feeding tube, into the stomach and then into the first part of the small intestine the duodenum, hence the name EGD.

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