An article in the New York Times (15th February) describes the case of a 48-year old woman in Pennsylvania who despite a lifetime of chronic bloating, diarrhoea, weight loss and ten years of anaemia, has only just been diagnose with coeliac disease.

Celiac disease is often difficult to detect because the symptoms vary so widely from person to person. Ten years ago, the medical community thought it was a rare disorder that affected only 1 in every 10,000 people, primarily children who had digestive problems and failure to thrive.
But physicians now know that the disease is much more common. Most patients never experience the so-called classic symptoms: bloating, chronic diarrhea and stomach upset. Instead, the signs are often as nebulous as anemia, infertility and osteoporosis.

“Diagnosis a problem,” said Dr. Ritu Verma, section chief of gastroenterology, hepatology and nutrition and director of the Children’s Celiac Center at the Children’s Hospital of Philadelphia. “The majority of patients do not have the traditional signs and symptoms. If someone’s only presenting symptom is anemia, physicians will think of a hundred other things before they think of celiac disease.”
As a result, the condition is also commonly mistaken for other ailments. Ms. Sawka, for one, was told she had everything from irritable bowel syndrome to lupus to an allergic reaction from a spider bite before celiac disease was confirmed.
Part of the problem is also a lack of education among physicians, particularly internists. Most primary care physicians are simply unaware of new research that shows the disease is common and can manifest itself in unusual ways.

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