tests to measure ANTIBODYlevels and biopsy of the
intestinal mucosa provide strong, though not con-
clusive, evidence of celiac disease. Antibody levels
become elevated only during active episodes of
the disease, and biopsy samples may not represent
the overall status of the small intestine.
The gastroenterologist considers these results in
conjunction with the pattern of symptoms, FAMILY
MEDICAL PEDIGREE, and response to a gluten-free
diet. Symptoms that disappear with a gluten-free
diet provide fairly conclusive diagnosis, though this
marker is useful only in people who have obvious
gastrointestinal or dermatologic symptoms.
Treatment Options and Outlook
The primary treatment for celiac disease is a
gluten-free diet. This means eliminating all wheat
and wheat products, as well as numerous
processed foods that contain gluten as filler. Many
foods that restaurants serve also contain gluten,
requiring great diligence to determine food ingre-
dients. Wheat-free products may still contain
gluten. Some people also need to eliminate oats,
barley, and rye and products made from them, as
these grains contain small amounts of gluten. Peo-
ple who have severe celiac disease may require
NUTRITIONAL SUPPLEMENTS or nutritional-replace-
ment therapies. Most people who follow a gluten-
free diet experience improvement within two
weeks and an end to their symptoms within a few
months. The longer there are no symptoms, the
more the intestinal mucosa restores itself and
often returns to normal in people who remain
symptom-free for several years.
Risk Factors and Preventive MeasuresCeliac disease appears to be genetic, and as yet
researchers do not know what, if any, risk factors
exist. Many people are able to control their symp-
toms and prevent disease flareups by avoiding
foods that trigger them. The doctor also may rec-
ommend nutritional supplements to minimize or
prevent nutritional deficiencies.
See also HUMAN LEUKOCYTE ANTIGENS (HLAS);
INFLAMMATORY BOWEL DISEASE(IBD); IRRITABLE BOWEL
SYNDROME(IBS); LEUKOCYTE; LYMPHOCYTE; MAJOR HIS-
TOCOMPATABILITY COMPLEX(MHC); MALNUTRITION; MIN-
ERALS AND HEALTH; NUTRITIONAL NEEDS; VITAMINS AND
HEALTH.
cholecystectomy A surgical OPERATIONto remove
the GALLBLADDER. Cholecystectomy is the most com-
mon treatment in the United States for GALLBLADDER
DISEASEincluding gallstones (cholelithiasis), chole-
cystitis (INFLAMMATIONor INFECTIONof the gallblad-
der), and biliary dyskinesia (diminished ability of
the gallbladder to eject BILE). About 500,000
Americans undergo cholecystectomy each year.Surgical Procedure
There are two methods for performing cholecys-
tectomy, laparoscopic and open. About 95 percent
of cholecystectomies surgeons perform in the
United States are laparoscopic. Surgeons perform
open cholecystectomy, once the standard, only
when there are contraindications for laparoscopic
cholecystectomy (such as extreme OBESITY) or
laparoscopic cholecystectomy cannot successfully
remove the gallbladder (such as when there are
many stones or there is extensive scarring from
long-standing gallbladder disease or repeated
infections). Both operations require general ANES-
THESIAand an overnight stay in the hospital.
Laparoscopic cholecystectomy In laparoscopic
cholecystectomy the surgeon makes four or five
small incisions and inserts a laparoscope and tiny
instruments through them. The surgeon operates
by visualizing the gallbladder via closed-circuit tel-
evision display. The operation takes 45 to 60 min-
utes. Most people then stay several hours in the
recovery room and overnight in the hospital. After
surgery, many people returning to regular daily
activities (except strenuous physical exercise)
within three weeks, though full recovery takes six
to eight weeks.
Open cholecystectomy This procedure is major
surgery. The surgeon makes an incision 5 to 8
inches long through the abdominal muscles to
expose the LIVERand the gallbladder beneath it.
The operation takes about two hours. Most people
then stay five to seven days in the hospital. Many
people can return to light activity in about four
weeks. Full recovery after open cholecystectomy
takes about 12 weeks.Risks and Complications
The primary risks of either operation are bleeding,
anesthesia reaction, damage to the bile ducts and
other adjacent organs and structures, and postop-22 The Gastrointestinal System