Celiac specialist discusses why it is still under diagnosed in the U.S.

by Tiffany Janes on December 2nd, 2009


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We are very lucky to have Dr. Cynthia Rudert, MD practicing in Atlanta. She is the only nationally recognized celiac specialist in the Southeast.

Recently I was fortunate enough to interview the very busy Dr. Rudert about celiac and her thoughtful answers were so informative that the interview will be posted in several parts. Unlike many doctors I've encountered, Dr. Rudert is always learning as much as she can about celiac so can help her many patients with the condition, as well as those with severe gluten-intolerance. I boldfaced some of the most crucial comments in Dr. Rudert's reply below.

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Dr. Rudert, you have been treating people with celiac for many years now, but it seems that many doctors still think the condition is rare. Since we now know the condition affects almost 1 out of every 100 Americans, it is far from rare. What do you consider the main problem is, in getting the word out to the medical community about this greatly under diagnosed disease?

"Celiac Disease is the most common autoimmune illness of humankind. If one were to take all the patients with Crohn's Disease and all the patients with Ulcerative Colitis and add in all those with Cystic Fibrosis and then triple the numbers that would be equal to the number of individuals with Celiac Disease. For my Math friends: 3X (Crohn's +Ulcerative Colitis +Cystic Fibrosis ) = Celiac Disease. Approximately 98% of those with Celiac are not diagnosed or misdiagnosed. Celiac Disease was felt to be quite rare in the US and therefore many physicians were not including this disorder in their thought processes, or what we refer to as including this in the differential diagnosis. It took Alessio Fasano M.D.'s interest (and many other physicians with an interest in Celiac) and subsequent publication of his landmark article on prevalence to gradually cause an increase in awareness: Fasano A.,Berti I,Geraduzzi T, et al. Prevalence of celiac disease in at-risk and not at-risk groups in the United States:A large multicenter study. Arch Intern Med 2003; 163:286-292. The article was published and two years later the NIH held a Consensus Conference on Celiac Disease.

A consensus conference is generally held when there is new information about a disease based on clinical and scientific studies. It would have been wonderful if every physician could have been informed about their summary and conclusions but it is available online...of course one would need to know to look for it. Thereafter published studies increased significantly. Many potential patients and those diagnosed with Celiac found out about these studies on line. Many patients have told me that after reading reviews of some of the published studies they requested Celiac serology and/or genetic testing from their physicians.

Physician education is crucial in order to increase physician awareness. Celiac Disease is a chameleon like disorder and may present in many ways. Some may not have any gastrointestinal problems. These individuals may suffer from infertility, arthritis, neurologic problems and many other disorders. It may be hidden under diagnoses such as irritable bowel syndrome, chronic fatigue, fibromyalgia, and chronic abdominal pain to name a few. I lecture extensively to physicians and find that the vast majority are eager to learn about the increasing wealth of published information available.A wonderful study was published in the American Journal of Gastroenterology 2007;102:1454-1460: Detection of Celiac Disease in Primary Care: A Multi center Case-Finding Study in North America. Dr. Carlo Catassi and many of his colleagues in various centers found that by actively educating primary care providers about celiac disease their diagnostic ability dramatically increased. When given specific guidelines on when to order serology their rate of diagnosis went from 0.27 cases per thousand visits to 11.6 per thousand visits.

I lecture to physicians, nurses, nursing assistants, physician assistants and patient support groups. Interested groups can contact my office directly or arrange lectures through their hospital CME coordinator. Celiac patients are seen in every sub specialty and several years ago I was invited to speak at a national psychiatric meeting. Celiacs are everywhere!"

Cynthia S. Rudert, M.D.,F.A.C.P.

Medical Adviser Celiac Disease Foundation

Medical Adviser Gluten Intolerance Group

Medical Director Atlanta Metro Celiacs

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For more info: Please call Dr. Rudert's office 404-943-9820.

-------------------- Author Information: Tiffany Janes, Atlanta, GA website : www.glutenfreepromotions.com e-mail : makemineglutenfree@yahoo.com www.triumphdining.com/blog www.celiac-disease.com www.twitter.com/ATLglutenfree


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