Diagnosis and management of celiac disease

Celiac disease affects between one and two percent of Canadians, yet many patients wait years before receiving a clear diagnosis. On this episode of the CMAJ Podcast, the hosts speak with two contributors to the CMAJ review article Diagnosis and management of celiac disease about the condition’s diverse clinical presentations, appropriate testing strategies, and the practical realities of long-term dietary management.

Jedid-Jah Blom, a registered dietitian at the McMaster Celiac Disease Clinic and researcher at the Farncombe Family Digestive Health Research Unit at McMaster University, shares her own experience being diagnosed and living with celiac. She explains how patients must identify hidden gluten sources in ingredients like dextrin and malt, and why cornmeal or corn flour products may be contaminated. Blom outlines the risks of cross-contamination and dining out challenges, emphasizing whole gluten-free grains over processed products that lack fortification.

Dr. Maria Ines Pinto-Sánchez, a gastroenterologist at Hamilton Health Sciences and director of the Celiac Clinic at McMaster University, explains why celiac is called a chameleon disease. She notes that about 30 percent of patients present with gastrointestinal symptoms, while others may have brain fog, fatigue, or anemia. She describes how TTG antibodies plus total IgA are used for screening, with positive results requiring endoscopy and biopsies for confirmation. Dr. Pinto-Sánchez emphasizes that patients should not start a gluten-free diet before testing. She discusses ongoing monitoring including TTG levels, bone density, and nutrient deficiencies.

For physicians, the discussion highlights the need for a low threshold when testing TTG antibodies in patients with unexplained fatigue, brain fog, or gastrointestinal symptoms. Both guests stress the importance of completing diagnostic testing before patients begin a gluten-free diet and arranging early dietitian referral.

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