What we are speaking of here is the iceberg effect - a large pool of undiagnosed patients who remain that way because their symptoms are less severe, atypical, or nonspecific, and subsequently the appropriate investigations are not done, or current diagnostic methods are not sensitive, or accurate enough to detect early, mild, or atypical disease even if the person decides to seek out medical care. Even a very astute, thorough Physician will have difficulty reaching a diagnosis when someone presents with an early, or less pronounced form of many diseases. Of course as medical science progresses, and diagnostic tests improve more of these diagnostic dilemmas will be solved just as the history of medicine tells us. Full Story
An example of this would be diagnostic advances in the diagnosis of Celiac disease - a potentially debilitating gastrointestinal disorder caused by immune sensitivity to gluten, a protein that is found in grains such as wheat, barley, and rye. The mucosal cells (villi or lining of the small bowel) become inflamed, damaged and dysfunctional usually causing some degree of malabsorption along with symptoms of fatigue, pain, bloating, and often diarrhea. In the middle of the last century the only definitive way to diagnose Celiac disease was a small bowel biopsy - an uncomfortable invasive procedure. In the last decade or two highly specific blood tests have been developed that can diagnose the condition - possibly followed by biopsy for confirmation. Despite a simple, ready method to make the diagnosis, Celiac disease demonstrates the classic iceberg phenomenon. Most people who have the condition remain undiagnosed because they do not present in a textbook fashion with signs of advanced celiac pathology, and the patients physician sees no reason to order the necessary blood test. Fortunately, in recent years the tide is changing as more Physicians understand this iceberg effect, and increase their vigilance while lowering their threshold for investigation of Celiac disease.
The implications of this are enormous as there can be tremendous long term physical and psychological health improvements for a newly diagnosed Celiac patient who adopts a gluten free diet. These patients may experience significant improvements in their health within weeks or months of going gluten free. Many other undiagnosed conditions could have a similar iceberg profile, and your symptoms may be related to a pathologic state that is submerged below the surface as well.
If you happen to fall into this category what are some options?
Diagnosis, Celiac Disease, Health,
Gluten, Iceberg Effect
1 comment:
Great article on Celiac's Beau, and a really good link to article and book. It's a disease that effects many more people than we think. I too was one who didn't have "classic Celiac" symptoms and have suffered for years with endless problems. Now that I am gluten-free I feel so much better.
Post a Comment