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 26 May 2018

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Celiac disease associated with surgical abdominal pain

Research in the latest issue of Annals of Surgery finds that 3% of patients presenting with acute abdominal pain to secondary care are diagnosed with celiac disease, and that targeting patients with nonspecific abdominal pain or celiac symptoms may improve the diagnostic yield.

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Acute abdominal pain is the most common indication for surgical admission.

Nonspecific abdominal pain may account for up to 40% of cases.

There has been no published prospective study in which adult patients presenting with acute abdominal pain are investigated for celiac disease.

Dr David Sanders aimed to assess the association of celiac disease with surgical abdominal pain.

The investigative team undertook a case-control study involving 300 consecutive new unselected patients presenting with acute abdominal pain and 300 healthy controls without abdominal pain.

The study was conducted in a university hospital and the controls were age and sex matched to the patients.

9 of 33 patients with abdominal pain and positive antibodies had confirmed celiac disease
Annals of Surgery

The team's initial investigations for celiac disease included immunoglobulins A and G anti-gliadin, and endomysial antibodies.

Any patient with a positive immunoglobulin A anti-gliadin, endomysial antibody, or only immunoglobulin G anti-gliadin in the presence of immunoglobulinA deficiency was offered a small bowel biopsy to confirm the diagnosis.

The team reported 33 patients with abdominal pain who had positive antibodies, of whom 9 had histologically confirmed celiac disease.

The team noted that 6 of the 9 patients were endomysial antibody positive and 3 were endomysial antibody negative.

One antibody positive patient declined duodenal biopsy and the remaining 23 had normal duodenal mucosa.

The investigators noted that within the control group, there were 2 cases of celiac disease.

Compared with matched controls, the team found that the association of acute abdominal pain with celiac disease gave an odds ratio 5.

The investigators observed that, when only considering nonspecific abdominal pain, the prevalence of celiac disease was highly significant at 11%.

In addition, the investigative team found that patients' symptoms improved on a gluten-free diet at 12- to 18-month follow-up.

Dr Sanders' team commented, “Celiac disease was diagnosed in 3% of patients who presented with unselected acute abdominal pain to secondary care.”

“Targeting patients who have nonspecific abdominal pain or celiac associated symptoms or diseases may improve the diagnostic yield.”

Ann Int Surg 2005: 242(2): 201-7
27 July 2005

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