Case Scenario: Celiac Disease Consultation

Summary:

This case involves a patient with positive anti-tissue transglutaminase (TTG) antibodies suggestive of celiac disease. The consultation focuses on confirming the diagnosis, explaining the condition, addressing patient concerns, and outlining management, including dietary changes and follow-up investigations.

Key Points:

Active Listening & Patient Engagement

Never interrupt or talk over the patient.
Actively listen and respond directly to patient concerns.
Clarify and check understanding by repeating key points if necessary.

Data Gathering

Confirm patient's name and details.
Explore the reason for prior blood tests.
Rule out differentials by asking about symptoms beyond gastrointestinal issues, such as tiredness (potentially due to anemia).
Identify long-term symptoms and their impact.

Diagnosis Explanation

Patients often don’t associate fatigue with a bowel condition.
Clearly connect the lack of nutrient absorption to anemia and fatigue.
Provide a simple, structured explanation: Celiac disease → Malabsorption → Iron/B12/Folate deficiency → Anemia → Fatigue.

Important Considerations

Endoscopy Confirmation: Explain that a biopsy via endoscopy is needed for definitive diagnosis.
DEXA Scan: Assess bone density due to risk of osteoporosis.
Family Screening: First-degree relatives should be tested as celiac disease has a genetic component.
Long-term Management: Regular follow-up, dietary adherence, and repeat endoscopy/DEXA scans as needed.
Patient Education: Provide informational leaflets on a gluten-free diet and disease impact.

Diagnostic Approach

History Taking:
- Symptoms: GI symptoms, fatigue, weight loss, bloating, anemia signs.
- Dietary history: Gluten exposure.
- Family history of celiac or autoimmune diseases.
Investigations:
- TTG IgA levels (already positive).
- Endoscopy with duodenal biopsy (confirmatory).
- Bone health assessment: DEXA scan.
- Blood tests: Full blood count (FBC), iron studies, vitamin B12, folate.

Management Plan

Gluten-Free Diet: Emphasize lifelong adherence.
Nutritional Support: Correct any deficiencies (iron, B12, folate, vitamin D).
Follow-Up:
- Regular serological testing to monitor dietary compliance.
- Repeat endoscopy if symptoms persist.
- Annual assessment of nutritional status.
Referral:
- Gastroenterologist for endoscopy.
- Dietitian for dietary education.
- Bone specialist if osteoporosis is suspected.

Communication Skills

Ensure the patient understands the link between symptoms and diagnosis.
Use simple, non-medical language.
Allow space for patient questions and validate concerns.
Offer educational materials for better self-management.

Ethical Considerations

Consent: Obtain consent for endoscopy.
Confidentiality: Discuss testing for family members with patient’s permission.
Shared Decision Making: Discuss management plans with patient input.