In Adults Referred with Non-specific Abdominal Symptoms, Lower BMI (Body Mass Index) is Associated with Celiac Disease

Abstract

Purpose: To evaluate whether BMI could help identify patients with celiac disease, amongst those referred with symptoms suggestive of celiac disease, such as abdominal pain, bloating and diarrhea; and to thereby identify a subset of patients likely to require duodenal biopsies during upper endoscopy. Methods: We measured the BMI of 229 patients with a clinical suspicion of celiac disease undergoing upper endoscopy. Duodenal biopsies were obtained on all patients. The diagnosis of celiac disease was made in 14 patients on the basis of characteristic histology. Of the remaining 215 patients with normal histology, 115 followed up as did all 14 patients with celiac disease. All patients were followed for an minimum of 6 months. All celiac patients improved on a gluten-free diet. Results: In patients with celiac disease, the mean BMI was 24.9 kg/m2, median 24 (n=14) with confidence limits of +/−1.8. In patients without celiac disease, the mean BMI was 28.8, median 28 (n=115) with confidence limits of +/−1.3. The difference was statistically significant (p<0.001). Conclusion: The clinical presentation of celiac disease is often non-specific. The gold standard for diagnosis remains small bowel biopsy. The results indicate that a lower BMI may help to distinguish patients with celiac disease. In the current environment, the expense of small bowel biopsies on all patients with non-specific symptoms may be challenged. The BMI may afford gastroenterologists a clinical tool to evaluate the pre-test probability of celiac disease and thereby decide whether or not to biopsy the small bowel.