Celiac Disease (ICD-10: K90.0)

Name of the Condition

• Common Names: Celiac disease, Gluten-sensitive enteropathy
• Technical Terms: Celiac sprue, Nontropical sprue

Summary

Celiac disease is an autoimmune disorder that occurs in genetically predisposed individuals where the ingestion of gluten leads to damage in the small intestine. It affects absorption of nutrients from food.

Causes

The exact cause of celiac disease is not fully understood, but it involves a combination of genetic predisposition and consumption of gluten-containing foods like wheat, barley, and rye. The presence of certain genes, specifically HLA-DQ2 and HLA-DQ8, is associated with increased risk.

Risk Factors

• Genetic Factors: Family history is a predominant risk, particularly first-degree relatives.
• Associated Conditions: Type 1 diabetes, Down syndrome, and other autoimmune disorders.
• Environmental Factors: Early exposure to gluten, gastrointestinal infections.

Symptoms

• Diarrhea
• Bloating and gas
• Fatigue
• Weight loss
• Anemia
• Osteoporosis
• Skin rash (dermatitis herpetiformis)

Diagnosis

• Serological Tests: Anti-tissue transglutaminase (tTG) antibodies, and endomysial antibody (EMA) tests.
• Biopsy: Endoscopic biopsy of the small intestine to confirm villous atrophy.
• Genetic Tests: Checking for HLA-DQ2/DQ8 presence does not diagnose but supports the diagnosis.

Treatment Options

• Gluten-Free Diet: The primary and most effective treatment is a strict, lifelong gluten-free diet, which helps in the healing of the small intestine and alleviation of symptoms.
• Nutritional Supplements: Addresses any deficiencies like iron, calcium, and vitamins.

Prognosis and Follow-Up

With strict adherence to a gluten-free diet, most individuals experience improvement in symptoms and intestinal healing. Regular follow-ups with a healthcare provider to monitor progress and compliance with the diet are essential.

Complications

• Nutritional deficiencies
• Increased risk of intestinal lymphoma and other cancers
• Infertility and miscarriage, if untreated

Lifestyle & Prevention

• Diet: Adherence to a gluten-free diet is crucial.
• Education: Patients should be educated about reading food labels and recognizing hidden sources of gluten.

When to Seek Professional Help

• Persisting or worsening symptoms despite following a gluten-free diet
• Signs of severe malabsorption like significant weight loss or anemia
• New symptoms suggestive of complications

Additional Resources

• Celiac Disease Foundation: celiac.org
• National Celiac Association: nationalceliac.org

Tips for Medical Coders

• Ensure specificity in coding (use K90.0 for celiac disease).
• Verify accompanying conditions like dermatitis herpetiformis are coded separately when present.
• Avoid using non-specific gastrointestinal disorder codes for clear cases of celiac disease.