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Diagnosis of celiac disease during pre-operative work-up for bariatric surgery.

BACKGROUND AND AIM
Morbid obesity is a highly prevalent condition. In selected cases, bariatric surgery is indicated. Although for decades celiac disease (CD) has been associated with chronic diarrhea and weight loss, now it becomes clear that the clinical spectrum is extremely wide.


METHODS
We report 5 morbidly obese patients that were diagnosed of CD during preoperative work-up for bariatric surgery. Diagnosis was suspected during routine upper endoscopy, and confirmed by histology and positive CD-specific serology.


RESULT
Four of the 5 cases were asymptomatic. One complained of chronic diarrhea and anemia. All cases initiated a gluten-free diet. Due to CD, patients were offered a purely restrictive bariatric procedure. Three patients underwent a sleeve gastrectomy while the other two are still undergoing pre-operative evaluations.


CONCLUSION
This report enlarges the clinical spectrum of untreated CD. Although prevalence of CD in obese patients seems to be similar to that in the general population, morbid obese patients should be tested for CD in order to establish the best surgical strategy and outcome.