All Things Celiac Disease with Dr. Claire Jansson-Knodell

Welcome to the Medicine Grand Rounder Podcast!

My name is Dick Wardrop and I am a Med-Peds clinician educator, Program Director, and hospitalist at the Cleveland Clinic in Cleveland Ohio.

We are so proud to host another great of our podcast cleverly titled to give you all that you may expect out of high quality, evidence-based Medicine Grand Rounds, right at your fingertips and right in your ears.

Our program is funded by a grant from the Cleveland Clinic Education Institute, but the views expressed herein are not necessarily the views of Cleveland Clinic.

The format of our production is very simple: we host world-class clinical experts in a variety of specialties of Internal Medicine and put forth important and high-impact clinical questions related to the practice of general medicine, with impact for providers at all levels of medicine including students, APP, generalists, and seasoned veterans.

Today’s Topic: Celiac Disease

Today, we have an absolutely wonderful episode planned. I am pleased to introduce our panel of distinguished guests.

First is our resident content expert, Dr. Kaitlin Payne. She is a stellar member of our PGY-3 class and as she nears graduation, she is preparing for her GI fellowship at Tufts University.

Our second expert guest today is David Gardinier, an IBD and Celiac Disease Dietician in the Center for Human Nutrition at Cleveland Clinic.

Finally, our staff physician expert Dr. Claire Jansson-Knodell joins us from the Department of Gastroenterology, Hepatology, and Nutrition at Cleveland Clinic. She is also an assistant professor of medicine at the CCLCM (Cleveland Clinic Lerner College of Medicine) and CWRU. She is a prized member of our Internal Medicine Residency Program faculty and, a mentor to many. and a world expert in Celiac Disease.

To our honored guests, please take a moment to say hi, tell us about yourselves, and start right in on the questions.

Part 1- questions for Dr. Claire Jansson Knodell

Dr. Wardrop - Question 1- What is celiac disease?

Kaitlyn Payne - Question 2- How common is celiac disease?

Kaitlyn Payne - Question 3- Everyone has heard about it, but what is gluten, and why can’t people with celiac disease eat it?

Kaitlyn Payne - Question 4- What's the difference between celiac disease and other forms of gluten sensitivity?

Dr. Wardrop - Question 5- Should we be recommending a Gluten free diet for other health conditions or people without celiac disease?

Part 2 (Case presentation)

A 60-year-old woman is evaluated in her primary care clinic for iron-deficiency anemia. She was noted to have a hemoglobin of 10 on routine lab work, and follow-up iron studies showed low iron, high TIBC, and low transferrin saturation. She has no melena or hematochezia and bowel movements are normal. The review of systems is notable only for fatigue and occasional "eczema” on her elbows. She is referred to gastroenterology for EGD and colonoscopy to assess for possible occult GI bleeding leading to IDA, and her duodenum is noted to appear “scalloped,” and a biopsy is obtained which eventually reveals villous blunting and intraepithelial lymphocytes.

Kaitlyn Payne - Question 6- How does celiac disease usually present, and what are the symptoms?

Dr. Wardrop - Question 7- How is celiac disease diagnosed?

Kaitlyn Payne - Question 8- What if my patient has already started a gluten-free diet before they were tested for celiac disease?

Kaitlyn Payne - Question 9- As an internist, when should I order celiac disease antibody testing? Which kinds of patients should I be considering for celiac disease in the differential?

Kaitlyn Payne - Question 10- If someone has positive celiac antibodies, do they really need a biopsy? What’s the sensitivity and specificity for TtG testing?

Kaitlyn Payne - Question 11- on the flip side, if someone has villous blunting and intraepithelial lymphocytes on a duodenal biopsy, is that sufficient to say someone has celiac disease?

Dr. Wardrop - Question 12- So we’ve diagnosed celiac disease in someone from antibodies and pathology from a duodenal biopsy. Do I need to do anything else besides tell them to start a gluten-free diet?

Kaitlyn Payne - Question 13- Are there medications available for celiac disease?

Part 3- Flip interviewer interviewee- Questions for Kaitlyn Payne

Here we will switch who is interviewing and who is being interviewed: now Dr. Jansson-Knodell will interview Kaitlin as a patient with celiac disease

Dr. Claire Jansson Knodell - Question 14- How did you find out you had celiac disease?

Dr. Claire Jansson Knodell - Question 15- How does celiac disease affect your daily life?

Dr. Claire Jansson Knodell - Question 16- What was the easiest part of going Gluten Free?

Dr. Claire Jansson Knodell - Question 17- What was the hardest part of going Gluten Free?

Dr. Claire Jansson Knodell - Question 18- What do you wish other people (family or friends) understood about celiac disease?

Part 4- Dietitian/ Nutritionist (David Gardinier, RD)-

Dr. Wardrop - Question 19- What is gluten and what foods is it found in?

Dr. Wardrop - Question 20- What does a gluten-free diet entail?

Kaitlyn Payne - Question 21- How "strict" does the gluten-free diet have to be in people with celiac disease?

Kaitlyn Payne - Question 22- How do people with celiac disease know if something is gluten-free?

Kaitlyn Payne - Question 23- How do you counsel patients with newly diagnosed celiac disease on a gluten-free diet?

Kaitlyn Payne - Question 24- Are there any good resources you recommend to patients on a gluten-free diet?

On behalf of the team, thank you to our Special guests for your expertise, wisdom, and insights

Additionally, we want to thank Dr. Payne as our resident host who developed and vetted the content for today’s episode

Team, I certainly enjoyed this time with all of you and imagine that many of our listeners will find the information illuminating and essential in their practice and in their careers.

Thank you also to the Cleveland Clinic Education Institute for the educational support of this project.

Until next time, please enjoy this and future Podcasts during your next Medicine Grand Rounders