All gastroenterologists are very familiar with celiac disease, including its characteristic findings on small bowel biopsy and the treatment with a gluten-free diet. But I have noticed that we as gastroenterologists approach the possibility of sprue, or those suspected of having gluten sensitivity without sprue, with extraordinary variability. For instance, a negative screening tissue transglutaminase (TTG) has greater than a 99% negative predictive value (essentially excluding celiac disease), but a positive TTG has only\u00a0a 25% to 35% positive predictive value, meaning that most patients who test positive do not have celiac disease.<\/p>\n
So, first, here are some\u00a0questions:<\/p>\n
1) Do you still take biopsies in some patients with a negative TTG, and, if so, how do you decide\u00a0which patients should undergo\u00a0biopsy?<\/p>\n
2) Do you take biopsies in all patients with positive TTG screens? If not, do you put these patients on a gluten-free diet as a trial?<\/p>\n
3) Where and how many biopsies do you take to diagnose sprue? Do you always take biopsies in\u00a0the duodenal bulb?<\/p>\n
4) If you take duodenal biopsies, how long do you want the patient on gluten prior to the exam?<\/p>\n
Now, let’s talk about gluten sensitivity:<\/p>\n
1) If you take biopsies in\u00a0patients with symptoms suggestive of sprue, and\u00a0the biopsies\u00a0are normal, but the patiens are improved on a gluten-free diet, what do you tell\u00a0these patients? That they are\u00a0sprue-variant? That they do not have sprue, but they\u00a0are gluten sensitive?<\/p>\n
2) Do you prescribe the same diet to these patients?<\/p>\n
Please weigh in. I look forward to seeing your responses.<\/p>\n","protected":false},"excerpt":{"rendered":"
All gastroenterologists are very familiar with celiac disease, including its characteristic findings on small bowel biopsy and the treatment with a gluten-free diet. But I have noticed that we as gastroenterologists approach the possibility of sprue, or those suspected of having gluten sensitivity without sprue, with extraordinary variability. For instance, a negative screening tissue transglutaminase […]<\/p>\n","protected":false},"author":28,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-382","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts\/382","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/users\/28"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/comments?post=382"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts\/382\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/media?parent=382"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/categories?post=382"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/tags?post=382"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}