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From:
"J. Murray" <[log in to unmask]>
Date:
Wed, 21 Dec 1994 23:28:09 -0600
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<<Disclaimer:  Verify this information before applying it to your situation.>>

I feel I should comment on the rationale that suggests that it is
acceptable practice not to investigate a patient for suspected CD when
the patient has already commenced the treatment .e. the GFD.
Certainly it is cheaper for the HMO and probably the patient in the short
term.
I feel that proper confirmation of the diagnosis is necessary and should
remain the "standard of care" with few exceptions such as a history of
life-threatening eactions to gluten challenge.
1. Lack of a firm diagnosis can leave some patients with an uncertainity
that can undermine thier motivation to remain on the diet.
2. There may be another diagnosis instead of celiac disease.  One can
occassionally see patients with crohn's disease respond to dietary
manipulation.
3. May patients who really have CD but have been treated with a gfd
without any real confirmation may not be gluten-free enough to result in
healing of the mucosa of the intestine.  The mucosal condition not
necessarily symptoms determine the risk of complications of CD
4. Many people really neeed to know for their own peace of mind
5. Family risk of CD is really dependent on the original patient having a
solid diagnosis of CD

I wonder if the rather cursory suggestion of well you're on the treatment
anyway so just continue is reasonalbe.  Would I want to continue to take
blood pressure pills if I really did not have hypertension?

I would be interested in hearing the conferences opinions on this
Joe Murray.

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