Textbook Problem

Chloe, age 30, has not had a period for over two years. Her gynecological exam turns up no abnormalities, but the hormones she is given to stimulate her menstrual periods do not work. Since the age of 10, Chloe has had painful stomach cramps, frequent diarrhea or constipation, and periodic iron-deficiency anemia. Multiple visits to doctors have failed to find the cause of Chloe’s health problems. At around the age of 20, Chloe had begun to wonder if she was a medical anomaly or a hypochondriac.

  Still bothered by her health problems and about to be married, Chloe seeks care again. This time she is seen by a nurse practitioner who has just read an article on celiac disease. The nurse sends Chloe to a registered dietitian, who advises Chloe on a gluten-free diet. After faithfully following the diet for a week, Chloe feels better. The cramps, diarrhea, and constipation arc much improved, and later on, her menstrual cycles return. She returns to her doctor for a checkup and requests a test for celiac disease. By that time, however, her intestinal biopsy comes back normal because she has been on the diet for months.

Questions

2.    What facts provide other clues to the possibility of celiac disease?