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Abdominal pain, chronic diarrhea, iron-deficiency anemia, and other malabsorption symptoms:1,2 These are just a few of many similar symptoms that can make differentiating between Gastrointestinal (GI) conditions difficult and frustrating for you and your patients. Such is the case with Celiac Disease (CD), Inflammatory Bowel Diseases (IBD) and Irritable Bowel Syndrome (IBS). Diagnosing these diseases can be particularly challenging because they often target the same organ, the bowel.1 Laboratory investigations can be used to diagnose patients with GI symptoms easier, potentially reducing time to diagnosis and therefore the risk of long-term complication for your patient.
IBS, GI cancers, CD and IBD can all present with varying patterns of similar GI symptoms:
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.
The following diagnostic algorithm serves as an example of best practice in the diagnosis of lower GI-conditions:3,7,8
Algorithm recommended by Thermo Fisher Scientific, *adapted from Husby, et al 2012, Werkstetter et al., 2017, and World Health Organization, 2015.￼
The potential for GI cancer should prompt referral to secondary care in patients that present the following red flag symptoms:
Following your 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
Even though CD is one of the most common lifelong autoimmune disorders in the world, correct diagnosis rates are surprisingly low.6 This can be attributed to CD’s atypical clinical presentation, as well as its shared characteristics with other GRDs.6
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.7
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.8-11
When left untreated, patients with CD are at-risk for serious long-term complications, such as increased autoimmunity, osteoporosis, and even certain cancers.12-14
Differentiating between GI conditions, the symptoms of which are very similar, can be difficult and frustrating for both patients and healthcare professionals. However, serological testing can be used to help differentiate between GI conditions, potentially reducing the time to diagnosis.8,9,13,14
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.
Discover how antibody assays and calprotectin testing can aid in the diagnosis of GI disorders and why they are such a valuable tool for your practice.