4 Apr 2005 - Recomended Reading
MAY BE REPOSTED
Some doctors still believe that coeliac disease is uncommon and only
seen in children. They therefore fail to consider it as a diagnostic possibility in people who have ME/CFS-like fatigue, especially when this is also accompanied by irritable bowel symptoms -ie abdominal pain, change in bowel habit - or signs of food malabsorption such as weight loss.
Diagnosing ME/CFS when someone really has coeliac disease is
unfortunate to say the least because treatment of coeliac disease with a gluten-free diet can be extremely effective. Yet this misdiagnosis continues to occur.
This week in the British Medical Journal there is a very helpful editorial
on the diagnosis of coeliac disease:
http://bmj.bmjjournals.com/cgi/content/full/330/7494/739?eaf
along with a further article on antibody-negative coeliac disease:
http://bmj.bmjjournals.com/cgi/content/full/330/7494/775?ehom
and case reports of aytpical presentations:
http://bj.bmjjournals.com/cgi/content/full/330/7494/773?ehom
There is now a very strong case for using simple screening tests (eg
anti-endomysial antibodies ) to largely rule out coeliac disease in people with ME/CFS like symptoms,
especially when these are accompanied by any type of irritable bowel symptomatology, signs of malabsorption, or unexplained anaemia.
This is the policy adopted by the MEA in section 6.6 of our 'purple
book'guidelines for doctors. This publication is available to download on
the MEA website at:
www.meassociation.org.uk >> medical information >> 'ME/CFS/PVFS - An
exploration of the key clinical issues'.
And as these three BMJ papers point out:
1 Weight loss is not always present - coeliac disease can sometimes
occur in people who are clinically obese.
2 Some people with coeliac disease have minimal or no gastrointestinal
symptoms.
3 There are rare instances where commonly used antibody screening tests
are negative.
Dr Charles Shepherd
Medical Adviser, ME Association
Some doctors still believe that coeliac disease is uncommon and only
seen in children. They therefore fail to consider it as a diagnostic possibility in people who have ME/CFS-like fatigue, especially when this is also accompanied by irritable bowel symptoms -ie abdominal pain, change in bowel habit - or signs of food malabsorption such as weight loss.
Diagnosing ME/CFS when someone really has coeliac disease is
unfortunate to say the least because treatment of coeliac disease with a gluten-free diet can be extremely effective. Yet this misdiagnosis continues to occur.
This week in the British Medical Journal there is a very helpful editorial
on the diagnosis of coeliac disease:
http://bmj.bmjjournals.com/cgi/content/full/330/7494/739?eaf
along with a further article on antibody-negative coeliac disease:
http://bmj.bmjjournals.com/cgi/content/full/330/7494/775?ehom
and case reports of aytpical presentations:
http://bj.bmjjournals.com/cgi/content/full/330/7494/773?ehom
There is now a very strong case for using simple screening tests (eg
anti-endomysial antibodies ) to largely rule out coeliac disease in people with ME/CFS like symptoms,
especially when these are accompanied by any type of irritable bowel symptomatology, signs of malabsorption, or unexplained anaemia.
This is the policy adopted by the MEA in section 6.6 of our 'purple
book'guidelines for doctors. This publication is available to download on
the MEA website at:
www.meassociation.org.uk >> medical information >> 'ME/CFS/PVFS - An
exploration of the key clinical issues'.
And as these three BMJ papers point out:
1 Weight loss is not always present - coeliac disease can sometimes
occur in people who are clinically obese.
2 Some people with coeliac disease have minimal or no gastrointestinal
symptoms.
3 There are rare instances where commonly used antibody screening tests
are negative.
Dr Charles Shepherd
Medical Adviser, ME Association