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CD (also called gluten-sensitive enteropathy or non-tropical sprue) is an autoimmune disorder of the small intestine that manifests itself when patients consume foods containing gluten.3
IBD are a group of chronic inflammatory disorders of the GI tract. Most notable among this group are Crohn’s disease (CrD) and ulcerative colitis.4
IBS is a chronic, relapsing and often lifelong disorder with medically unexplained symptoms. IBS is the most common functional GI disorder.5
GI Cancer is the fourth most common cause of cancer-related death in the world, and it remains difficult to cure in Western countries, primarily because most patients present with advanced disease.6
Following your clinical history, there are many investigations you can use to help diagnose patients with GI symptoms easier. These include:
The potential for GI cancer should prompt referral to secondary care in patients that present the following red flag symptoms:
Following clinical history, in the case of recurrent lower-GI symptoms when you have no clinical suspicion of GI cancer, first line serological or stool-based tests are used to rule out more serious conditions and/or determine the need for further investigations.10-13
Adapted from Husby, et al 2012, Werkstetter et al., 2017, and World Health Organization, 2015. Please be aware that additional analytical parameters can be necessary.
Even though CD is one of the most common lifelong autoimmune disorders in the world, correct diagnosis rates are surprisingly low.14 This can be attributed to CD’s atypical clinical presentation, as well as its shared characteristics with other GRDs.15
GRDs cover a broad spectrum of diseases triggered by gluten including CD non-celiac gluten sensitivity (NCGS), gluten ataxia, dermatitis herpetiformis (DH) or wheat allergy. NCGS can be used to describe patients who may experience symptoms similar to CD because their bodies do not tolerate gluten. However, NCGS does not cause the same extreme bodily response and intestinal damage that CD does.16
Misdiagnosis when differentiating between GI disorders is common due to similar symptoms, especially as CD can also present with osteoporosis, malabsorption symptoms, sterility, and poliabortivity.10,11,17,18
When left untreated, patients with CD are at risk for serious long-term complications, such as autoimmune disease, osteoporosis, and even certain cancers.19,20
Differentiating between GI conditions, the symptoms of which are very similar, can be difficult and frustrating for both patients and healthcare providers. However, serological testing can be used to help differentiate between GI conditions, potentially reducing the time to diagnosis.12,13,15,17,21-23
These tests can be used to help support the ruling in or ruling out of possible conditions, confirm the presence of inflammation, and help differentiate diseases.
Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv
i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238
Gastrointestinal (GI) diseases exact heavy social costs, which are associated with losses in productivity caused by lost or impaired ability to work, as well as the intangible costs of pain and suffering. It’s clear that GI diseases impose a significant impact on quality of life, particularly for patients with chronic issues.24,25 Designing a treatment strategy based on severity of symptoms includes dietary modification, pharmacotherapy, and behavioral or psychological therapy. These should be tailored to the symptoms and individual patient preferences, and integrated when necessary.26
Disease management and treatment is tailored to the specific GI disease and can vary based on disease and severity.24,25