Celiac Disease (cont.)

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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, small intestinal resection, extensive Crohn's disease of the small intestine, and chronic pancreatitis), stools with large amounts of fat only raises 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 albumin, the most concentrated protein in blood. Other proteins in blood, for example, 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:

  1. Iron deficiency anemia: Iron is an important component of hemoglobin in red blood cells. When iron is deficient, the 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.
  2. 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.

Medically Reviewed by a Doctor on 8/12/2013

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