Celiac Disease (cont.)
How are malabsorption and malnutrition evaluated in celiac disease?
Celiac disease causes malabsorption of nutrients and leads to malnutrition.
Tests are available that help in the evaluation of malabsorption and
malnutrition; however, because other diseases can cause both malabsorption and
malnutrition, these tests cannot be used to diagnose celiac disease.
Stool examination for malabsorption
Fat in a sample of stool placed on a glass slide can be stained with a dye
(Sudan stain) to make the fat visible under the microscope as globules. Stool
from patients with celiac disease often contains many stained globules of fat, and
Sudan staining is a quick and easy screening test for increased amounts of fat
in the stool (steatorrhea). To conclusively diagnose steatorrhea, however, stool
is collected over a 72-hour period, and the fat in the stool is chemically
measured and quantified. Steatorrheic stools have abnormally high quantities of
fat. Since malabsorption and steatorrhea can occur with other intestinal
diseases (such as small intestinal bacteria overgrowth, prior small intestinal
resection, extensive Crohn's disease
of the small intestine, and chronic pancreatitis), stools with large amounts of fat only raise the suspicion of
celiac disease but cannot be used to diagnose celiac disease.
Blood tests for malnutrition and vitamin deficiencies
Malabsorption reduces the absorption of protein and causes a reduction in
blood protein levels. This can be seen commonly as a reduced blood level of
albumen, the most concentrated protein in blood. Other proteins in blood, for
example, pre-albumen and transferrin also may be reduced.
Intestinal malabsorption can lead to deficiencies and low blood levels of
iron, calcium, vitamin B12, folate, Vitamin D and vitamin K. These deficiencies,
in turn, can lead to other blood test abnormalities such as:
- Iron deficiency anemia: Iron is an important component of hemoglobin in
red blood cells. When iron is
deficient, production of red blood cells is impaired, and anemia develops.
Iron deficiency anemia can occur either through loss of blood (with its
iron-containing red blood cells) or lack of intestinal iron absorption.
Heavy
menstrual bleeding and cancer of the colon that bleeds into the intestine are
two common causes of iron deficiency anemia due to blood loss. Celiac disease
causes iron deficiency anemia by reducing intestinal iron absorption. In fact,
iron deficiency anemia can be an important clue to the presence of celiac
disease.
- Abnormally prolonged prothrombin time (ProTime): ProTime is a blood test
that measures how quickly blood clots. Clotting of blood requires special
proteins or clotting factors, many of which are made by the liver. Formation of
clotting factors by the liver requires vitamin K. When vitamin K absorption from
the intestine is reduced, as in celiac disease, the production of clotting factors
by the liver is inadequate, and blood clotting is delayed. Delayed clotting is
reflected in an abnormal ProTime, and individuals with an abnormal ProTime have a
higher risk of abnormal or excessive bleeding.
Iron deficiency anemia, abnormal ProTime, steatorrhea, and low iron and
vitamin levels can occur in diseases other than celiac disease. Therefore the
presence of these abnormalities only raises the suspicion of celiac disease but
does not specifically diagnose celiac disease.
Next: What is the treatment of celiac disease? »
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