In one examining room is an adorable 2-year-old girl in pigtails who is finally gaining weight. In the past six weeks, she has put on 2 pounds - in the year before that, she gained just 1.
In another room is an athletic 11-year-old whose debilitating migraines caused her to miss long stretches of school, spend time in two hospital emergency rooms and go back and forth between doctors in an effort to find out why she was so sick.
Down the clinic hallway is a 20-year-old college student who's exhausted all the time with unexplained stomach pains.
All three patients of Dr. Alessio Fasano have different symptoms. Yet all could have the same malady: celiac disease.
This autoimmune disorder interferes with absorption of nutrients from food and is triggered by the consumption of gluten, a protein in wheat and other grains found in many staples of the American diet, including pizza, pasta and bread.
For all the misery they cause, most celiac symptoms disappear with a simple if inconvenient lifestyle alteration: eliminating gluten from the diet. Doctors are working on a pill that could eliminate that hassle, too.
Fasano is a gastroenterologist who directs the Center for Celiac Research at the University of Maryland School of Medicine. In 2003, he found that the disease - once believed to be rare - might instead be found in as many as 3 million people in the United States. That's nearly 1 percent of the population.
Fasano's pioneering study helped persuade the National Institutes of Health to recognize the problem and encourage doctors to look beyond the traditional celiac symptoms of malnutrition and diarrhea in their medical textbooks.
"The problem is celiac disease often is not on their radar screen," Fasano said. They often don't realize celiac can manifest itself as anemia, infertility or any number of medical problems - and can appear at any age.
Now Fasano and his colleagues are trying to build on their research. In a paper published last summer, they
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determined that targeted screening of patients with just one symptom associated with celiac led to a more than 40-fold increase in diagnosis.
The screening is a relatively inexpensive blood test - one that may provide an elusive diagnosis for patients who have been feeling lousy for months or even years.
