Celiac disease is a disease of the immune system caused by the consumption of gluten, a protein found in some cereals, mainly wheat, oats, barley and rye. To develop this disease it is necessary to be a carrier of certain genes, but not all people who have them end up developing the disease. Its diagnosis is not always simple. In children it can be delayed up to six months and among adults it is where the greatest delay occurs, which can exceed two years.
This diagnostic delay is motivated above all by the lack of specific tests that serve to have an affirmative answer. Many experts point out that it is difficult to give figures on its incidence due to underdiagnosis, as explained by Dr. Pilar Vaque, spokesperson for the Nutrition Working Group of the Spanish Society of Family and Community Medicine (semFYC). “We say that only the tip of the iceberg is visible given the great variability of symptoms that this disease can present.”
The methods for diagnosing celiac disease are based mainly on the study of disease-specific antibodies in the blood, which must be found ten times above the minimum reference value. However, many children usually take 5 to 13 years for these antibodies to become positive, which means they can develop more serious symptoms. In clear cases of celiac disease, when the concentration of antibodies is not detectable, a second test is usually performed, consisting of a digestive biopsy, a more invasive test. In adults things are even more complicated. “For many years it was thought that it was a childhood disease, but research has shown that sometimes symptoms begin in adulthood, after years of exposure to gluten,” says Pilar Vaque.
Lack of reliable evidence
The difficulty in identifying the symptoms and the lack of reliable tests that confirm the disease before the patient is greatly affected in their quality of life are the two great milestones to overcome to improve the diagnosis of a disease that can have a great impact on people's health.
This has led to various projects being launched in recent years that seek to identify new markers that can be used in clinical practice to detect the disease more effectively; however, many of these projects are still in very early stages. There are also different projects that are working to improve existing tests, such as those that evaluate the presence of specific antibodies for celiac disease. “New antibody detection methods are being studied for point-of-contact tests that improve sensitivity and specificity, but there are still no evaluable results,” comments Dr. Fernando Fernández, clinical head of the Digestive Service at the Mútua Terrasa Hospital in Spain. .
In pharmacies it is possible to find tests that, with a simple drop of blood taken from the fingertip, can determine the presence or absence of specific antibodies. “They offer qualitative results, that is, positive or negative. Various studies have shown that these tests have high sensitivity and specificity, between 90 and 94 percent, being, therefore, useful in the initial screening of celiac disease. It seems, in any case, that they have less diagnostic accuracy than the tests performed in hospitals, especially due to the presence of false positives,” comments Dr. Fernando Fernández.
What to do if there is a positive result?
What all the experts emphasize is that if a pharmacy test for the diagnosis of celiac disease gives a positive result, it is always best to go to primary care services. “If a person has decided to take a test in a pharmacy and it has been positive, I would recommend that they go to their family doctor to clinically assess what symptoms they present in order to carry out a study,” explains Dr. Fernando Fernández. If it is negative and you continue to observe symptoms, it is important to go to a health professional.
Other useful products for celiacs
There are other tests that also offer other valuable information to patients. “In pharmacies there are products that allow us to detect the presence of gluten in food, urine or feces. This group of tests serve to check whether or not a strict gluten-free diet is being followed or also to see if any food contains gluten and, therefore, should not be consumed," says Aquilino García, national member of Food of the General Council. of Pharmaceutical Colleges of Spain.
"These tests that detect gluten peptides can be helpful in celiac patients with clinical or serological suspicion of dietary transgressions that are often unnoticed and, therefore, these tests can be an important tool to assess strict compliance with the diet,” adds Dr. Fernando Fernández.
However, despite the existence of all these tests, the role of doctors in the diagnosis of this disease remains fundamental and this is emphasized by Dr. Pilar Vaque. “If a pathology suggestive of celiac disease is suspected, a medical evaluation is always recommended. It is a disease that should be evaluated in a medical consultation, because the professional should take it into account when faced with certain symptoms, especially when there is a suspicion of digestive symptoms or deficiency problems such as iron deficiency anemias that do not improve with an optimal intake. of iron".
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"Because prevention is better than cure"
