Celiac.com 07/30/2007 - A study published in the journal Clinical Gastroenterology and Hepatology suggests that a newly proposed system of classifying duodenal pathology on celiac disease provides an improved inter-observation than the less Marsh-Oberhuber classification, and offers an advance towards making a simpler, better, more valid diagnosis of celiac disease.
Celiac disease is presently classified according to the Marsh-Oberhuber system of classifying duodenal lesions.
Recently, a more elementary method has been suggested. That method is based on three villous morphologies—non-atrophic, atrophic with villous crypto ratio <3:1, and atrophic, villi idnetectable—combined with intraepithelial counts of >25/100 enterocytes.
The study team chose a group of sixty people to be part of the study. Of the 60 patients the team studied, 46 were female and 14 were male. The average age was 28.2 years with a mean range of 1-78 years. 10 people had celiac disease, 13 had celiac disease with normal villi, but a pathological increase in epithelial lymphocytes >25/100 & hyperplastic crypts. 37 patients had celiac disease with villous aptrophy.
Patients were given biopsies, with at least 4 biopsies were taken from the second part of the duodenum. Biopsies were fixed in formalin and processed according to standard procedures, with cuts at six levels, and stained with hematoxylin resin. The slides were sent randomly to 6 pathologists who were blind to one another.
The results showed that this new method of classification yielded better inter-observer agreement and more accurate diagnosis that the more difficult Marsh-Oberhuber system.
Clinical Gastroenterology and Hepatology 2007;5:838–843
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
Tuesday, March 3, 2009
AT-1001 May Be Effective Treatment for Celiac Disease
Celiac.com 09/10/2007 - A study published recently in the journal of Alimentary Pharmacology and Therapeutics shows that the paracellular permeability inhibitor AT-1001 effectively reduces intestinal barrier dysfunction, proinflammatory cytokine production, and gastrointestinal symptoms in people who have celiac disease.
At present, a lifetime devoted to following a strict gluten-free diet is the backbone of current treatment for celiac disease. However, as researchers have come to know more about celiac disease, they’re insights are leading to developments that offer more effective prognosis and treatment of the disease.
One of those promising new approaches involves treating celiac patients with doses of AT-1001, a paracellular permeability inhibitor that is structurally derived from a protein secreted by Vibrio cholerae. Recently, a team of medical researchers set out to assess the safety and tolerability of 12 mg doses of AT-1001 in people with celiac disease who submitted to acute gluten exposure.
For the in-patient, double-blind, randomized placebo-controlled safety study, researchers looked at twenty men and women with celiac disease and measured intestinal permeability, through fractional excretions of lactulose and mannitol, as an exploratory measure of the efficacy of AT-1001 in treating celiac disease.
The test subjects were men and women with age ranging from 18 to 59 years old. Each was pre-screened and referred by a gastroenterologist. Each had positive biopsy and antibody screens that indicated celiac disease. Each had also been on a gluten-free diet at least six months, was not known to be IgA deficient, and presented with anti-tTG titres of <10 EU at enrollment.
Study shows safety and tolerability of 12 mg doses of AT-1001 in celiac disease
In the placebo group, acute gluten exposure brought an observable 70% increase in intestinal permeability, compared to no change at all in the AT-1001 group. Four of seven patients (57%) of the placebo group showed increased levels of interferon-gamma levels, but in the AT-1001 group only four of 14 patients (29%) showed such increases. Also, the placebo group showed gastrointestinal symptoms more frequently than the AT-1001 group (P = 0.018).
From the results, the researchers concluded that AT-1001 is well tolerated and appears to reduce intestinal barrier dysfunction, pro-inflammatory cytokine production, and gastrointestinal symptoms in celiac patients subjected to gluten exposure.
Aliment Pharmacol Ther 26, 757-766
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
At present, a lifetime devoted to following a strict gluten-free diet is the backbone of current treatment for celiac disease. However, as researchers have come to know more about celiac disease, they’re insights are leading to developments that offer more effective prognosis and treatment of the disease.
One of those promising new approaches involves treating celiac patients with doses of AT-1001, a paracellular permeability inhibitor that is structurally derived from a protein secreted by Vibrio cholerae. Recently, a team of medical researchers set out to assess the safety and tolerability of 12 mg doses of AT-1001 in people with celiac disease who submitted to acute gluten exposure.
For the in-patient, double-blind, randomized placebo-controlled safety study, researchers looked at twenty men and women with celiac disease and measured intestinal permeability, through fractional excretions of lactulose and mannitol, as an exploratory measure of the efficacy of AT-1001 in treating celiac disease.
The test subjects were men and women with age ranging from 18 to 59 years old. Each was pre-screened and referred by a gastroenterologist. Each had positive biopsy and antibody screens that indicated celiac disease. Each had also been on a gluten-free diet at least six months, was not known to be IgA deficient, and presented with anti-tTG titres of <10 EU at enrollment.
Study shows safety and tolerability of 12 mg doses of AT-1001 in celiac disease
In the placebo group, acute gluten exposure brought an observable 70% increase in intestinal permeability, compared to no change at all in the AT-1001 group. Four of seven patients (57%) of the placebo group showed increased levels of interferon-gamma levels, but in the AT-1001 group only four of 14 patients (29%) showed such increases. Also, the placebo group showed gastrointestinal symptoms more frequently than the AT-1001 group (P = 0.018).
From the results, the researchers concluded that AT-1001 is well tolerated and appears to reduce intestinal barrier dysfunction, pro-inflammatory cytokine production, and gastrointestinal symptoms in celiac patients subjected to gluten exposure.
Aliment Pharmacol Ther 26, 757-766
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
NU206 (R-spondin1) Drug Shows Promise in Treating Colitis and Celiac Disease
Celiac.com 09/10/2007 - Nuvelo has announced Phase 1 trials of NU206 (R-spondin1) gastrointestinal growth factor product on cancer patients who are receiving radiation or chemotherapy treatment for cancer.
NU206 is a recombinant, secreted protein that early animal studies show to act as a highly specific stimulator of the gastrointestinal (GI) epithelial cells. Preclinical studies suggest NU206 promotes growth and regeneration of gastrointestinal tissues in animal models of radiation and chemotherapy treatment for cancer, as well as in animal models of inflammatory bowel disease and short bowel syndrome. They expect to follow shortly thereafter with trials on patients with IBD.
Mice deficient in IL-10 with drug-inducted colitis serve as research models for human IBD. Studies on such mice show that R-spondin1 substantially prevents mucosal damage and restored mucosal integrity.
The implications for repairing and preventing mucosal damage in celiac disease are obvious. In addition to restoring other normal mucosal functions, rapid mucosal repair in celiacs through the use of NU206 therapy would provide relief from the problems caused by increased intestinal permeability.
Gastroenterology. 2007 April; 132(4) pgs 1331-1343
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
NU206 is a recombinant, secreted protein that early animal studies show to act as a highly specific stimulator of the gastrointestinal (GI) epithelial cells. Preclinical studies suggest NU206 promotes growth and regeneration of gastrointestinal tissues in animal models of radiation and chemotherapy treatment for cancer, as well as in animal models of inflammatory bowel disease and short bowel syndrome. They expect to follow shortly thereafter with trials on patients with IBD.
Mice deficient in IL-10 with drug-inducted colitis serve as research models for human IBD. Studies on such mice show that R-spondin1 substantially prevents mucosal damage and restored mucosal integrity.
The implications for repairing and preventing mucosal damage in celiac disease are obvious. In addition to restoring other normal mucosal functions, rapid mucosal repair in celiacs through the use of NU206 therapy would provide relief from the problems caused by increased intestinal permeability.
Gastroenterology. 2007 April; 132(4) pgs 1331-1343
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
Study Shows that a Strategy of Active Case-finding can Increase Rates of Diagnosis for Celiac Disease
Celiac.com 09/28/2007 - Celiac disease is one of the most common lifelong disorders in western countries. However, most cases in North America remain currently undiagnosed, mostly because they present unusual symptoms and because of the low number of doctors who have a sound awareness of celiac disease.
In a large European survey, the ratio between diagnosed and undiagnosed cases, found by mass serological screening, was as high as 1 to 7 , an effect termed the ‘celiac iceberg’. In addition to having chronic symptoms that might otherwise respond to a gluten-free diet, undiagnosed patients are exposed to the risk of long-term complications of celiac disease, such as anemia, infertility, osteoporosis, or cancer, particularly an intestinal lymphoma.
Celiac Disease is diagnosed by confirming the presence of intestinal damage to the small intestine through a biopsy, along with a clinical response to the gluten-free diet. However, serological markers, e.g., the IgA class anti-tissue transglutaminase (tTG) antibodies, are useful screening tests. The sensitivity and the specificity of the IgA anti-tTG test are 94% and 97%, respectively.
To address the large number of undiagnosed cases, a team of researchers recently set out to assess whether an active case-finding strategy in primary care could lead to increased frequency of celiac disease diagnosis, and to assess the most common clinical manifestations of the condition.
The team was made up of Carlo Catassi, M.D., M.P.H.; Deborah Kryszak, B.S.; Otto Louis-Jacques, M.D.; Donald R. Duerksen, M.D.; Ivor Hill, M.D.; Sheila E. Crowe, M.D.; Andrew R. Brown, M.D.; Nicholas J. Procaccini, M.D.; Brigid A Wonderly, R.N.; Paul Hartley, M.D.; James Moreci, M.D.; Nathan Bennett, M.D.; Karoly Horvath, M.D., Ph.D.; Margaret Burk, R.N.; Alessio Fasano, M.D.
737 women and 239 men, with a median age of 54.3 years, who attended one of the practices participated in a multi-center, prospective study involving adult subjects during the years 2002-2004. All individuals with celiac-associated symptoms or conditions were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies. Those with elevated anti-tTG were then tested for IgA antiendomysial antibodies (EMA). All who were positive for EMA were advised to undergo an intestinal biopsy and HLA typing.
30 out of 976 study subjects showed a positive anti-tTG test (3.07%, 95% CI 1.98-4.16). 22 patients,18 women, 4 men, were diagnosed with celiac disease. In these 22 cases the most common reasons for screening for celiac disease was: bloating (12/22), thyroid disease (11/22), irritable bowel syndrome (7/22), unexplained chronic diarrhea (6/22), chronic fatigue (5/22), and constipation (4/22).
The prevalence of celiac disease in the serologically screened sample was 2.25% (95% CI 1.32-3.18). The diagnostic rate was low at baseline (0.27 cases per thousand visits, 95% CI 0.13-0.41) and rose sharply to 11.6 per thousand visits (95% CI 6.8-16.4, P < 0.001) with active screening.
This study shows that the diagnosis rate for celiac disease can be significantly increased through the implementation of a strategy of active case-finding.
Am J Gastroenterol. 2007;102(7):1454-1460.
In a large European survey, the ratio between diagnosed and undiagnosed cases, found by mass serological screening, was as high as 1 to 7 , an effect termed the ‘celiac iceberg’. In addition to having chronic symptoms that might otherwise respond to a gluten-free diet, undiagnosed patients are exposed to the risk of long-term complications of celiac disease, such as anemia, infertility, osteoporosis, or cancer, particularly an intestinal lymphoma.
Celiac Disease is diagnosed by confirming the presence of intestinal damage to the small intestine through a biopsy, along with a clinical response to the gluten-free diet. However, serological markers, e.g., the IgA class anti-tissue transglutaminase (tTG) antibodies, are useful screening tests. The sensitivity and the specificity of the IgA anti-tTG test are 94% and 97%, respectively.
To address the large number of undiagnosed cases, a team of researchers recently set out to assess whether an active case-finding strategy in primary care could lead to increased frequency of celiac disease diagnosis, and to assess the most common clinical manifestations of the condition.
The team was made up of Carlo Catassi, M.D., M.P.H.; Deborah Kryszak, B.S.; Otto Louis-Jacques, M.D.; Donald R. Duerksen, M.D.; Ivor Hill, M.D.; Sheila E. Crowe, M.D.; Andrew R. Brown, M.D.; Nicholas J. Procaccini, M.D.; Brigid A Wonderly, R.N.; Paul Hartley, M.D.; James Moreci, M.D.; Nathan Bennett, M.D.; Karoly Horvath, M.D., Ph.D.; Margaret Burk, R.N.; Alessio Fasano, M.D.
737 women and 239 men, with a median age of 54.3 years, who attended one of the practices participated in a multi-center, prospective study involving adult subjects during the years 2002-2004. All individuals with celiac-associated symptoms or conditions were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies. Those with elevated anti-tTG were then tested for IgA antiendomysial antibodies (EMA). All who were positive for EMA were advised to undergo an intestinal biopsy and HLA typing.
30 out of 976 study subjects showed a positive anti-tTG test (3.07%, 95% CI 1.98-4.16). 22 patients,18 women, 4 men, were diagnosed with celiac disease. In these 22 cases the most common reasons for screening for celiac disease was: bloating (12/22), thyroid disease (11/22), irritable bowel syndrome (7/22), unexplained chronic diarrhea (6/22), chronic fatigue (5/22), and constipation (4/22).
The prevalence of celiac disease in the serologically screened sample was 2.25% (95% CI 1.32-3.18). The diagnostic rate was low at baseline (0.27 cases per thousand visits, 95% CI 0.13-0.41) and rose sharply to 11.6 per thousand visits (95% CI 6.8-16.4, P < 0.001) with active screening.
This study shows that the diagnosis rate for celiac disease can be significantly increased through the implementation of a strategy of active case-finding.
Am J Gastroenterol. 2007;102(7):1454-1460.
Accuracy of Serologic Tests and HLA-DQ Typing for Diagnosing Celiac Disease
Celiac.com 09/28/2007 - Figures concerning the diagnostic accuracy of various serologic test and HLA-DQ typing for diagnosing celiac disease have largely come from case–control studies.
A team of doctors recently set out to assess the performance of serologic testing and HLA-DQ typing in the diagnosis of celiac disease. Results of their study were published recently in the Annals of Internal Medicine.
The team was made up of Muhammed Hadithi, MD; B. Mary E. von Blomberg, PhD; J. Bart A. Crusius, PhD; Elisabeth Bloemena, MD, PhD; Pieter J. Kostense, PhD; Jos W.R. Meijer, MD, PhD; Chris J.J. Mulder, MD, PhD; Coen D.A. Stehouwer, MD, PhD; and Amado S. Peña, MD, PhD
Their study looked at patients who had been referred for small bowel biopsy to determine weather they had celiac disease, and evaluated the effectiveness of serologic testing for celiac disease, specifically of antigliadin antibodies (AGA), antitransglutaminase antibodies (TGA), and anti-endomysium antibodies (EMA) and HLA-DQ typing.
Data was measured by comparing the performance of serologic testing and HLA-DQ against a reference baseline of abnormal histologic findings and clinical resolution after a gluten-free diet.
Of 463 participants, sixteen had celiac disease (prevalence = 3.46% [95% CI, 1.99% to 5.55%]).
Testing positive on both TGA and EMA showed a corresponding sensitivity of 81% (CI, 54% to 95.9%), specificity of 99.3% (CI, 98.0% to 99.9%), and negative predictive value of 99.3% (CI, 98.0% to 99.9%).
A positive test for either HLA-DQ type increased both sensitivity (100% [CI, 79% to 100%]) and negative predictive value (100% [CI, 98.6% to 100%]), while testing negative for both minimized the negative likelihood ratio (0.00 [CI, 0.00 to 0.40]) and post-test probability (0% [CI, 0% to 1.4%]). Adding HLA-DQ typing to TGA and EMA testing, and adding serologic testing to HLA-DQ typing, saw no corresponding difference in test performance compared with either testing strategy alone.
Overall results show TGA and EMA testing were the most sensitive serum antibody tests and a negative HLA-DQ type excluded the celiac disease from the diagnosis.
However, the addition of HLA-DQ typing to TGA and EMA testing, and the addition of serologic testing to HLA-DQ typing, provided no change of test performance compared with either form of testing alone.
Finally, the findings were somewhat limited, as low number of overall cases of celiac disease rule out meaningful comparisons of testing strategies.
Annals of Internal Medicine (volume 147, pages 294-302)
A team of doctors recently set out to assess the performance of serologic testing and HLA-DQ typing in the diagnosis of celiac disease. Results of their study were published recently in the Annals of Internal Medicine.
The team was made up of Muhammed Hadithi, MD; B. Mary E. von Blomberg, PhD; J. Bart A. Crusius, PhD; Elisabeth Bloemena, MD, PhD; Pieter J. Kostense, PhD; Jos W.R. Meijer, MD, PhD; Chris J.J. Mulder, MD, PhD; Coen D.A. Stehouwer, MD, PhD; and Amado S. Peña, MD, PhD
Their study looked at patients who had been referred for small bowel biopsy to determine weather they had celiac disease, and evaluated the effectiveness of serologic testing for celiac disease, specifically of antigliadin antibodies (AGA), antitransglutaminase antibodies (TGA), and anti-endomysium antibodies (EMA) and HLA-DQ typing.
Data was measured by comparing the performance of serologic testing and HLA-DQ against a reference baseline of abnormal histologic findings and clinical resolution after a gluten-free diet.
Of 463 participants, sixteen had celiac disease (prevalence = 3.46% [95% CI, 1.99% to 5.55%]).
Testing positive on both TGA and EMA showed a corresponding sensitivity of 81% (CI, 54% to 95.9%), specificity of 99.3% (CI, 98.0% to 99.9%), and negative predictive value of 99.3% (CI, 98.0% to 99.9%).
A positive test for either HLA-DQ type increased both sensitivity (100% [CI, 79% to 100%]) and negative predictive value (100% [CI, 98.6% to 100%]), while testing negative for both minimized the negative likelihood ratio (0.00 [CI, 0.00 to 0.40]) and post-test probability (0% [CI, 0% to 1.4%]). Adding HLA-DQ typing to TGA and EMA testing, and adding serologic testing to HLA-DQ typing, saw no corresponding difference in test performance compared with either testing strategy alone.
Overall results show TGA and EMA testing were the most sensitive serum antibody tests and a negative HLA-DQ type excluded the celiac disease from the diagnosis.
However, the addition of HLA-DQ typing to TGA and EMA testing, and the addition of serologic testing to HLA-DQ typing, provided no change of test performance compared with either form of testing alone.
Finally, the findings were somewhat limited, as low number of overall cases of celiac disease rule out meaningful comparisons of testing strategies.
Annals of Internal Medicine (volume 147, pages 294-302)
Dental Enamel Defects in Children Strong Indicators of Celiac Disease
Celiac.com 10/12/2007 - A team of Dutch dentists recently conducted a study to determine if Dutch children with proven celiac disease exhibit corresponding defects in dental enamel and to gauge whether children without proven celiac disease, but showing celiac-associated gastro-intestinal complaints lack any such defects in their dental enamel.
The research team included CLAAR D. WIERINK, General dentist, DENISE E. VAN DIERMEN, Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry, Amsterdam, The Netherlands, IRENE H. A. AARTMAN, Department of Social Dentistry and Behavioral Sciences, Academic Centre for Dentistry, Amsterdam, The Netherlands, HUGO S. A. HEYMANS Emma Children’s Hospital, Academic Medical Centre, Amsterdam, The Netherlands
The team was led by Claar D. Wierink, and looked at a group of 81 children, 53 who were known to have celiac disease, and 28 of whom served as a control group.
The children underwent examinations from 2003-2004 and the Oral Surgery Outpatient Clinic of the Academic Medical Center in Amsterdam. 29 (55%) of the 53 children with celiac disease showed enamel defects, compared with 5 (18%) of the 28 non-celiac control subjects.
Enamel defects were diagnosed as being specific in 20 of the 53 children with celiac disease, compared with only 1 (4%) of the 28 control subjects. Overall, children with celiac disease showed more specific enamel defects than did the control subjects.
From these results, the researchers concluded that dentists might have a significant role to play in the early screening of patients who have undiagnosed celiac disease.
International Journal of Paediatric Dentistry 2007
The research team included CLAAR D. WIERINK, General dentist, DENISE E. VAN DIERMEN, Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry, Amsterdam, The Netherlands, IRENE H. A. AARTMAN, Department of Social Dentistry and Behavioral Sciences, Academic Centre for Dentistry, Amsterdam, The Netherlands, HUGO S. A. HEYMANS Emma Children’s Hospital, Academic Medical Centre, Amsterdam, The Netherlands
The team was led by Claar D. Wierink, and looked at a group of 81 children, 53 who were known to have celiac disease, and 28 of whom served as a control group.
The children underwent examinations from 2003-2004 and the Oral Surgery Outpatient Clinic of the Academic Medical Center in Amsterdam. 29 (55%) of the 53 children with celiac disease showed enamel defects, compared with 5 (18%) of the 28 non-celiac control subjects.
Enamel defects were diagnosed as being specific in 20 of the 53 children with celiac disease, compared with only 1 (4%) of the 28 control subjects. Overall, children with celiac disease showed more specific enamel defects than did the control subjects.
From these results, the researchers concluded that dentists might have a significant role to play in the early screening of patients who have undiagnosed celiac disease.
International Journal of Paediatric Dentistry 2007
Video Capsule Enteroscopy Shows Promise in Diagnosing Celiac Disease
Celiac.com 10/30/2007 - A recent study published in the August issue of American Journal of Gastroenterology suggest that villous atrophy in suspected cases of celiac disease can be reliably detected by video capsule enteroscopy (VCE).
Reliable diagnosis presently demands the identification of tell-tale lesions in the mucosa of the small bowel. Accomplishing such identification requires an endoscopy of the upper gastrointestinal tract, and multiple duodenal biopsies.
A team of Italian researchers evaluated the effectiveness of Video Capsule Enteroscopy against the standard endoscopy of the upper GI with biopsies of the second portion of the duodenum in patients suspected of having celiac disease. The research team included Emanuele Rondonotti, M.D.; Cristiano Spada, M.D.; David Cave, M.D.; Marco Pennazio, M.D.; Maria E. Riccioni, M.D.; Italo De Vitis, M.D.; David Schneider, M.D.; Tatiana Sprujevnik, M.D.; Federica Villa, M.D.; Jennifer Langelier, M.D.; Arrigo Arrigoni, M.D.; Guido Costamagna, M.D.; Roberto de Franchis, M.D.
The research team tested a total of 43 patients. In 41 patients, VCE reached the ileocecal valve during the reading time. 32 patients were found to exhibit diagnostic histology. Of those, 28 were diagnosed with celiac disease using capsule enteroscopy, for a total sensitivity of 87.5%.
Overall, for diagnosing celiac disease, VCE was shown to be 90.9% specific, 96.5% predictive, 71.4% negative predictive, with positive and negative likelihood ratios of 9.6% and 0.14% respectively. Four patients showed normal VCE findings, but were still diagnosed with celiac disease. Of these patients, three had Marsh grade III lesions, and one had Marsh grade I lesions.
The ability of VCE to offer high-quality images of small bowel mucosa including high-resolution of the individual villi led the team to conclude the VCE may offer an effective alternative to duodenal biopsy among some patients.
As VCE is also far less invasive than the endoscopy/biopsy approach, it may also generate greater patient acceptance. Also, unlike conventional endoscopy/biopsy, VCE offers exploration of the entire small intestine, and may lead to the discovery of damaged villi beyond those areas accessible via endoscopy.
Because of the small number of the test subjects, the results, though encouraging, invite a larger and more comprehensive study before VCE becomes an acceptable alternative to conventional endoscopy/biopsy method for diagnosing celiac disease.
American Journal of Gastroenterology 2007; 102(8): 1624-1631
Reliable diagnosis presently demands the identification of tell-tale lesions in the mucosa of the small bowel. Accomplishing such identification requires an endoscopy of the upper gastrointestinal tract, and multiple duodenal biopsies.
A team of Italian researchers evaluated the effectiveness of Video Capsule Enteroscopy against the standard endoscopy of the upper GI with biopsies of the second portion of the duodenum in patients suspected of having celiac disease. The research team included Emanuele Rondonotti, M.D.; Cristiano Spada, M.D.; David Cave, M.D.; Marco Pennazio, M.D.; Maria E. Riccioni, M.D.; Italo De Vitis, M.D.; David Schneider, M.D.; Tatiana Sprujevnik, M.D.; Federica Villa, M.D.; Jennifer Langelier, M.D.; Arrigo Arrigoni, M.D.; Guido Costamagna, M.D.; Roberto de Franchis, M.D.
The research team tested a total of 43 patients. In 41 patients, VCE reached the ileocecal valve during the reading time. 32 patients were found to exhibit diagnostic histology. Of those, 28 were diagnosed with celiac disease using capsule enteroscopy, for a total sensitivity of 87.5%.
Overall, for diagnosing celiac disease, VCE was shown to be 90.9% specific, 96.5% predictive, 71.4% negative predictive, with positive and negative likelihood ratios of 9.6% and 0.14% respectively. Four patients showed normal VCE findings, but were still diagnosed with celiac disease. Of these patients, three had Marsh grade III lesions, and one had Marsh grade I lesions.
The ability of VCE to offer high-quality images of small bowel mucosa including high-resolution of the individual villi led the team to conclude the VCE may offer an effective alternative to duodenal biopsy among some patients.
As VCE is also far less invasive than the endoscopy/biopsy approach, it may also generate greater patient acceptance. Also, unlike conventional endoscopy/biopsy, VCE offers exploration of the entire small intestine, and may lead to the discovery of damaged villi beyond those areas accessible via endoscopy.
Because of the small number of the test subjects, the results, though encouraging, invite a larger and more comprehensive study before VCE becomes an acceptable alternative to conventional endoscopy/biopsy method for diagnosing celiac disease.
American Journal of Gastroenterology 2007; 102(8): 1624-1631
New Improved Confocal Laser Endomicroscopy System
Celiac.com 11/24/2007 - A new confocal laser microscopic probe has been developed by Mauna Kea Technologies which works in conjunction with conventional endoscopes providing real-time video sequences of the intestinal mucosa magnified 500-1000 times greater than the conventional endoscopic view. Both normal endoscopic images and confocal images are available simultaneously, allowing the confocal probe to be visually positioned with the endoscope. This system allows for an immediate diagnosis and eliminates the need to take and prepare intrusive biopsy samples. The new system is an improvement over previously available confocal laser endomicroscopy systems, being easier and more intuitive to use. Studies have shown the system to be effective in diagnosing celiac disease. The Mauna Kea technologies website provides a detailed description of the device.
New clinical studies confirm Mauna Kea Technologies’ endomicroscopy system in a range of procedures
23 November 2007
http://www.mtbeurope.info/news/2007/711022.htm .
Mauna Kea Technologies -
Cellvizio® GI: first ever confocal miniprobes for GI endoscopy
(See "System Description")
New clinical studies confirm Mauna Kea Technologies’ endomicroscopy system in a range of procedures
23 November 2007
http://www.mtbeurope.info/news/2007/711022.htm .
Mauna Kea Technologies -
Cellvizio® GI: first ever confocal miniprobes for GI endoscopy
(See "System Description")
How Early Can Celiac Disease Be Diagnosed?
This article appeared in the Summer 2007 edition of Celiac.com's Scott-Free Newsletter.
This question, “how early can you diagnose celiac disease?” is a major concern for both parents and paediatricians. This is because, like many diseases, celiac disease comes on slowly. This means that it can take a long time to make the diagnosis.
Celiac disease can develop slowly?
Yes, celiac disease can develop very slowly. The symptoms can be subtle. It is a progressive disease. When you are first born, you cannot have celiac disease as you have never been exposed to gluten. However, if you have the right genetic make up (that is you have the celiac gene) and the right environmental circumstances (eating gluten and getting gut inflammation), then celiac disease can develop.
Finding tissue damage
Celiac disease is a condition that is recognised when you get damage to your small bowel tissue. This damage is triggered by gluten.
The standard way to detect this tissue damage is by taking a gut biopsy of the small bowel skin (also called the mucosa). This is done by the technique of upper endoscopy whilst under an anaesthetic. Tiny fragments of gut tissue are snipped off with a pair of forceps. This tissue is then sent to a pathology lab. The lab people (histologists) look down their microscopes at this tissue sample. They are looking for the gut damage called villous atrophy which is characteristic of disease.
Early antibody changes – IgG-gliadin
Importantly, long before the tissue becomes obviously damaged by gluten, your body can begin to react to the gluten in your diet.
An early sign of a gluten immune reaction is that your body produces antibodies to the gluten in your diet. This can be seen in a blood test that looks for an antibody called the IgG-gliadin antibody (also known as anti-gliadin-antibody). Also the IgA-gliadin antibody can develop at this time.
Even in these early stages of gluten reactions (before the development of any gut damage of celiac disease), you or your child can be feeling unwell. Many of the symptoms of celiac disease can be recognized in these early stages. This is before the tissue damage can be seen by the histologist.
The blood test to look for tissue damage is called the tissue transglutaminase antibody (abbreviated as tTG).
Early bowel damage cannot be seen
The next thing to happen is that the tissue in the small bowel gets slightly injured but not enough to be identified by the histologist. However, such damage can be shown by an electron microscope. This early damage can also be detected by the presence of the tTG antibody.
Usually, when the tTG blood test goes up, then this is an indication to do the endoscopy and look for any tissue damage. However, early in the progression of celiac disease, this damage may not show up by conventional methods. This means that the small bowel biopsy and the histology results are good for confirming celiac disease, but they cannot rule it out.
To act or to wait?
In my experience, I have seen a number of children develop celiac disease whilst I have watched and waited. While we doctors wait and see if the gut will become progressively damaged, these children will continue to experience their gut symptoms and they may not be growing so well. We doctors are waiting to make a certain diagnosis of celiac disease. We want to repeat their blood tests and do another endoscopy.
Is this reasonable? Experience has changed my mind. I have come to the conclusion that this is not an appropriate way to deal with these children. Currently, most medical specialists are adamant. They will not make a diagnosis of celiac disease until the histologist can confirm the typical tissue damage.
How long can you wait?
I have given up the “wait and see” approach. I act. I carefully scrutinize the symptoms and the blood test results - the gluten antibodies (IgG-gliadin) and tissue damage antibody (tTG) levels. I may organise an endoscopy test. If these findings suggest the development of celiac disease, then I make a pre-emptive diagnosis of “early celiac disease”, often before the gut gets badly damaged. I give these children a trial of a gluten-free diet – I see what their clinical response is. Pleasingly, most get completely better! If they get better, then they want to stay gluten-free.
The problem is that the diagnosis of celiac disease currently hinges on the abnormal appearance of the small bowel. This damage can take years to develop.
The main argument against my approach is that if you do not have a “definite” diagnosis of celiac disease, then you cannot advise a gluten-free diet for life. In my opinion, the decision to go on a gluten-free diet is not a black and white choice. For children, I give them the option of a gluten-free diet early in their disease. Let them feel well. Let them grow properly. Later, as an adult, they can challenge their diagnosis and have a formal gluten challenge when they understand the issues.
Conclusion – my approach
As you can see, it is difficult to say how early you can diagnose celiac disease. It is my practice to carefully assess children regarding their symptoms, their antibody levels, their genetic status and their endoscopy results (if appropriate).
I do not think it is logical to leave children with significant symptoms waiting for the small bowel damage to eventually occur. Indeed, I think that these long delays in treatment are inhumane. Postponement of a gluten-free diet will cause these children to suffer ongoing symptoms. Worse, they can have growth failure, from which they may not recover.
My approach is to put these children on a gluten-free diet early. I watch and see if thy have a clinical response: if they get better. The evidence shows that you cannot rely entirely on the small bowel biopsy for your diagnosis of celiac disease. These children can have a gluten challenge later in their lives.
The onset of celiac disease is progressive. Why wait until the bitter end before going gluten-free? The onset of celiac disease is progressive. Why wait until the bitter end before going gluten-free? You can find out a lot more from my webpage
This question, “how early can you diagnose celiac disease?” is a major concern for both parents and paediatricians. This is because, like many diseases, celiac disease comes on slowly. This means that it can take a long time to make the diagnosis.
Celiac disease can develop slowly?
Yes, celiac disease can develop very slowly. The symptoms can be subtle. It is a progressive disease. When you are first born, you cannot have celiac disease as you have never been exposed to gluten. However, if you have the right genetic make up (that is you have the celiac gene) and the right environmental circumstances (eating gluten and getting gut inflammation), then celiac disease can develop.
Finding tissue damage
Celiac disease is a condition that is recognised when you get damage to your small bowel tissue. This damage is triggered by gluten.
The standard way to detect this tissue damage is by taking a gut biopsy of the small bowel skin (also called the mucosa). This is done by the technique of upper endoscopy whilst under an anaesthetic. Tiny fragments of gut tissue are snipped off with a pair of forceps. This tissue is then sent to a pathology lab. The lab people (histologists) look down their microscopes at this tissue sample. They are looking for the gut damage called villous atrophy which is characteristic of disease.
Early antibody changes – IgG-gliadin
Importantly, long before the tissue becomes obviously damaged by gluten, your body can begin to react to the gluten in your diet.
An early sign of a gluten immune reaction is that your body produces antibodies to the gluten in your diet. This can be seen in a blood test that looks for an antibody called the IgG-gliadin antibody (also known as anti-gliadin-antibody). Also the IgA-gliadin antibody can develop at this time.
Even in these early stages of gluten reactions (before the development of any gut damage of celiac disease), you or your child can be feeling unwell. Many of the symptoms of celiac disease can be recognized in these early stages. This is before the tissue damage can be seen by the histologist.
The blood test to look for tissue damage is called the tissue transglutaminase antibody (abbreviated as tTG).
Early bowel damage cannot be seen
The next thing to happen is that the tissue in the small bowel gets slightly injured but not enough to be identified by the histologist. However, such damage can be shown by an electron microscope. This early damage can also be detected by the presence of the tTG antibody.
Usually, when the tTG blood test goes up, then this is an indication to do the endoscopy and look for any tissue damage. However, early in the progression of celiac disease, this damage may not show up by conventional methods. This means that the small bowel biopsy and the histology results are good for confirming celiac disease, but they cannot rule it out.
To act or to wait?
In my experience, I have seen a number of children develop celiac disease whilst I have watched and waited. While we doctors wait and see if the gut will become progressively damaged, these children will continue to experience their gut symptoms and they may not be growing so well. We doctors are waiting to make a certain diagnosis of celiac disease. We want to repeat their blood tests and do another endoscopy.
Is this reasonable? Experience has changed my mind. I have come to the conclusion that this is not an appropriate way to deal with these children. Currently, most medical specialists are adamant. They will not make a diagnosis of celiac disease until the histologist can confirm the typical tissue damage.
How long can you wait?
I have given up the “wait and see” approach. I act. I carefully scrutinize the symptoms and the blood test results - the gluten antibodies (IgG-gliadin) and tissue damage antibody (tTG) levels. I may organise an endoscopy test. If these findings suggest the development of celiac disease, then I make a pre-emptive diagnosis of “early celiac disease”, often before the gut gets badly damaged. I give these children a trial of a gluten-free diet – I see what their clinical response is. Pleasingly, most get completely better! If they get better, then they want to stay gluten-free.
The problem is that the diagnosis of celiac disease currently hinges on the abnormal appearance of the small bowel. This damage can take years to develop.
The main argument against my approach is that if you do not have a “definite” diagnosis of celiac disease, then you cannot advise a gluten-free diet for life. In my opinion, the decision to go on a gluten-free diet is not a black and white choice. For children, I give them the option of a gluten-free diet early in their disease. Let them feel well. Let them grow properly. Later, as an adult, they can challenge their diagnosis and have a formal gluten challenge when they understand the issues.
Conclusion – my approach
As you can see, it is difficult to say how early you can diagnose celiac disease. It is my practice to carefully assess children regarding their symptoms, their antibody levels, their genetic status and their endoscopy results (if appropriate).
I do not think it is logical to leave children with significant symptoms waiting for the small bowel damage to eventually occur. Indeed, I think that these long delays in treatment are inhumane. Postponement of a gluten-free diet will cause these children to suffer ongoing symptoms. Worse, they can have growth failure, from which they may not recover.
My approach is to put these children on a gluten-free diet early. I watch and see if thy have a clinical response: if they get better. The evidence shows that you cannot rely entirely on the small bowel biopsy for your diagnosis of celiac disease. These children can have a gluten challenge later in their lives.
The onset of celiac disease is progressive. Why wait until the bitter end before going gluten-free? The onset of celiac disease is progressive. Why wait until the bitter end before going gluten-free? You can find out a lot more from my webpage
* Home * Celiac Disease Diagnosis, Testing & Treatment (Gluten-Free Diet) * Most People Diagnosed With Celiac Disease Show No Symptoms
Celiac.com 02/18/2008 - A greater awareness of celiac disease, coupled with better and more accurate tests for celiac disease have helped to bring about a situation where most people currently diagnosed with celiac disease show no symptoms at the time of their diagnosis. Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. This finding has caused doctors to call for an adjustment to screening procedures for high-risk populations.
A team of researchers led by Dr. Grzegorz Telega recently surveyed medical records of people diagnosed with celiac disease at Children's Hospital of Wisconsin from 1986 to 2003. The statistics showed that the number of celiac disease diagnosis rose from a single case in 1986 to 93 cases in 2003. The total number of cases during that period was 143.
Before the mid-1990’s, more than 85% of children diagnosed with celiac disease were under 10 years old, with the average age being just over 5 years old. After 1995, less than 50% of children diagnosed with celiac disease were under 10 years old, and the average age at diagnosis had risen to about 8.5 years of age. Children diagnosed before the age of 3 years old usually complained of classic celiac-associated gastrointestinal symptoms, such as malnutrition, diarrhea, abdominal pain, and bloating, while children diagnosed at older ages had less pronounced symptoms.
One of the important conclusions made by the research group is that the possibility of celiac disease should be strongly considered in people with other autoimmune disorders, even if those people do not show gastrointestinal symptoms traditionally associated with celiac disease.
The research team called upon primary care doctors to adopt a practice of celiac screening for all people with elevated risk factors, including people with a family history of celiac disease, people with Addison’s disease Down Syndrome type 1 diabetes, thyroiditis, Turner syndrome, and type 1 diabetes. The team also called for screening of patients with short stature, iron deficiency anemia, and high transaminase levels.
Arch Pediatr Adolesc Med 2008;162:164-168.
A team of researchers led by Dr. Grzegorz Telega recently surveyed medical records of people diagnosed with celiac disease at Children's Hospital of Wisconsin from 1986 to 2003. The statistics showed that the number of celiac disease diagnosis rose from a single case in 1986 to 93 cases in 2003. The total number of cases during that period was 143.
Before the mid-1990’s, more than 85% of children diagnosed with celiac disease were under 10 years old, with the average age being just over 5 years old. After 1995, less than 50% of children diagnosed with celiac disease were under 10 years old, and the average age at diagnosis had risen to about 8.5 years of age. Children diagnosed before the age of 3 years old usually complained of classic celiac-associated gastrointestinal symptoms, such as malnutrition, diarrhea, abdominal pain, and bloating, while children diagnosed at older ages had less pronounced symptoms.
One of the important conclusions made by the research group is that the possibility of celiac disease should be strongly considered in people with other autoimmune disorders, even if those people do not show gastrointestinal symptoms traditionally associated with celiac disease.
The research team called upon primary care doctors to adopt a practice of celiac screening for all people with elevated risk factors, including people with a family history of celiac disease, people with Addison’s disease Down Syndrome type 1 diabetes, thyroiditis, Turner syndrome, and type 1 diabetes. The team also called for screening of patients with short stature, iron deficiency anemia, and high transaminase levels.
Arch Pediatr Adolesc Med 2008;162:164-168.
ActoGeniX Is Progressing Toward Celiac Disease Treatment
Celiac.com 04/20/2008 - ActoGeniX is a recently formed Belgian company specializing in the development and use of genetically altered probiotic Lactococcus lactis bacteria designed to secrete and deliver therapeutic peptides and proteins to treat gastrointestinal disorders. Their product is called ActoBiotics™. Celiac disease is among the disorders ActoGeniX is currently investigating. Research has already shown efficacy in a celiac disease model where ActoBiotics™ continuously secrete small segments of gluten peptides to induce tolerance to gluten. Further research and trials are in the pipeline.
Shortly after the release of a recent paper by Italian researchers demonstrating that a peptide from durum wheat is able to completely suppress the immune response to gluten in a culture of celiac disease intestinal T cells (see Durum Wheat Peptide Could Lead To Celiac Disease Treatment ), I contacted ActoGeniX to suggest they work with the Italian researchers to create an ActoBiotic™ designed to continuously secrete the durum wheat peptide as a therapy for celiac disease. ActoGeniX replied and was very interested in the durum wheat peptide, indicating it was possible for them to produce an ActoBiotic™ to secrete the durum wheat peptide and they would contact the Italian group. I also attempted to contact the Italian researchers to inform them about ActoGeniX, but they did not reply. I strongly believe that a collaboration between these two groups would result in the speediest and most successful development of a treatment which could effectively "cure" celiac disease through continuous secretion of the durum wheat peptide by genetically modified probiotic bacteria in the gut.
ActoGeniX has recently totally revised their website which is now much more informative and includes short videos discussing ActoBiotics™ as well as a short video presentation of their celiac disease research. More about this article can be found on their website at http://www.actogenix.com/eng/products/celiacdisease.php.
Technical information describing their product and initial research and development in detail is presented in the following patent application:
Shortly after the release of a recent paper by Italian researchers demonstrating that a peptide from durum wheat is able to completely suppress the immune response to gluten in a culture of celiac disease intestinal T cells (see Durum Wheat Peptide Could Lead To Celiac Disease Treatment ), I contacted ActoGeniX to suggest they work with the Italian researchers to create an ActoBiotic™ designed to continuously secrete the durum wheat peptide as a therapy for celiac disease. ActoGeniX replied and was very interested in the durum wheat peptide, indicating it was possible for them to produce an ActoBiotic™ to secrete the durum wheat peptide and they would contact the Italian group. I also attempted to contact the Italian researchers to inform them about ActoGeniX, but they did not reply. I strongly believe that a collaboration between these two groups would result in the speediest and most successful development of a treatment which could effectively "cure" celiac disease through continuous secretion of the durum wheat peptide by genetically modified probiotic bacteria in the gut.
ActoGeniX has recently totally revised their website which is now much more informative and includes short videos discussing ActoBiotics™ as well as a short video presentation of their celiac disease research. More about this article can be found on their website at http://www.actogenix.com/eng/products/celiacdisease.php.
Technical information describing their product and initial research and development in detail is presented in the following patent application:
Is it Time to Revise the Criteria Used to Diagnose Celiac Disease?
Celiac.com 06/03/2008 - Among the main things doctors look for when they’re trying to make a classic diagnosis of celiac disease are small intestinal mucosal membrane villous atrophy and inflammation. However, the latest research indicates that these criteria are possibly too narrow, leading to a lack of diagnosis and treatment of people with celiac disease. If this turn out to be the case, then far more people than previously imagined may suffer from celiac disease and not even know it.
In an effort to find out if present current diagnostic criteria are in fact too narrow, Finnish researchers led by Markku Maki, MD, professor of pediatrics at the University of Tampere, Celiac Disease Study Group, Tampere, Finland, evaluated 145 patients who were presumed to have celiac disease. Just under half (71) of the patients showed positive endomysial antibodies, and out of these only 48 patients met the textbook definition for celiac disease.
The research team then split the 23 patients left into two groups. They put the first group on a gluten-free diet for one year, and the second group on a on a standard gluten-inclusive diet for one year. At the end of the year, the doctors conducted follow-up biopsies on all 23 patients. The doctors discovered that the patients who had been on the gluten-free diet did in fact have celiac disease (even though they didn't have any obvious symptoms), and any symptoms that they did have disappeared—they lost their endomysial antibodies and any inflammation that was detected in their intestinal mucosa.
On the other hand, the patients in the second group whose diets included gluten showed no such positive changes, and their symptoms continued. The still showed positive endomysial antibodies, along with inflammation of intestinal Mucous Membrane, and gluten-induced lesions in the small intestine.
The study director said that each of the patients on the gluten-free diet had chosen to remain gluten-free thereafter, and that the patients on the gluten-inclusive diet had chosen to eliminate gluten from their diets and over time also became symptom-free—endomysial antibody-free and showed signs of healing of the mucous membrane.
Other studies have shown that over time untreated patients who show positive endomysial antibodies may develop the gut injury that is currently required as part of the criteria for diagnosing celiac disease. A greater understanding of the negative effects of untreated or undiagnosed celiac disease, coupled with better testing methods have led to a new strategy that allow doctors to detect celiac disease as early as possible—before any serious damage can occur—this new strategy is likely to be resoundingly welcome among celiac disease sufferers.
Hopefully the results of this study and others like it will lead to a new awareness among doctors, and will ultimately lead to better methods for diagnosing celiac disease at an earlier stage. This could ultimately mean less suffering and long term physical damage for many people.
Presented at 2009 Digestive Disease Week in San Diego, CA by Dr. Kurppa, a member of Dr. Maki’s research team, on Tuesday, May 20 at 10:30 a.m. Pacific Time in room 10 (San Diego Convention Center).
In an effort to find out if present current diagnostic criteria are in fact too narrow, Finnish researchers led by Markku Maki, MD, professor of pediatrics at the University of Tampere, Celiac Disease Study Group, Tampere, Finland, evaluated 145 patients who were presumed to have celiac disease. Just under half (71) of the patients showed positive endomysial antibodies, and out of these only 48 patients met the textbook definition for celiac disease.
The research team then split the 23 patients left into two groups. They put the first group on a gluten-free diet for one year, and the second group on a on a standard gluten-inclusive diet for one year. At the end of the year, the doctors conducted follow-up biopsies on all 23 patients. The doctors discovered that the patients who had been on the gluten-free diet did in fact have celiac disease (even though they didn't have any obvious symptoms), and any symptoms that they did have disappeared—they lost their endomysial antibodies and any inflammation that was detected in their intestinal mucosa.
On the other hand, the patients in the second group whose diets included gluten showed no such positive changes, and their symptoms continued. The still showed positive endomysial antibodies, along with inflammation of intestinal Mucous Membrane, and gluten-induced lesions in the small intestine.
The study director said that each of the patients on the gluten-free diet had chosen to remain gluten-free thereafter, and that the patients on the gluten-inclusive diet had chosen to eliminate gluten from their diets and over time also became symptom-free—endomysial antibody-free and showed signs of healing of the mucous membrane.
Other studies have shown that over time untreated patients who show positive endomysial antibodies may develop the gut injury that is currently required as part of the criteria for diagnosing celiac disease. A greater understanding of the negative effects of untreated or undiagnosed celiac disease, coupled with better testing methods have led to a new strategy that allow doctors to detect celiac disease as early as possible—before any serious damage can occur—this new strategy is likely to be resoundingly welcome among celiac disease sufferers.
Hopefully the results of this study and others like it will lead to a new awareness among doctors, and will ultimately lead to better methods for diagnosing celiac disease at an earlier stage. This could ultimately mean less suffering and long term physical damage for many people.
Presented at 2009 Digestive Disease Week in San Diego, CA by Dr. Kurppa, a member of Dr. Maki’s research team, on Tuesday, May 20 at 10:30 a.m. Pacific Time in room 10 (San Diego Convention Center).
High Content Analysis Helpful in Spotting Celiac-Related Lesions Before They Occur
Celiac.com 09/25/2008 - mucosal inflammation of the small intestine, coupled with damage to intestinal villi, is a classic indication of celiac disease. Recently, doctors have begun to embrace the idea that some patients with positive celiac blood tests may have mucosal lesions that are too small to appear on routine histopathological analysis.
In the first study of its kind, a team of researchers based in Ireland set out to analyze enterocyte morphology and cytoskeletal structures using a high content analysis technology.
The research team was made up of doctors Bashir M. Mohamed, Conleth Feighery, Yvonne Williams, Anthony Davies, Dermot Kelleher, Yuri Volkov, Jacinta Kelly and Mohamed Abuzakouk.
The team examined duodenal biopsies from 14 untreated and 10 treated celiac patients and from 20 non-celiac control subjects. They also investigated tissue sections from six study group subjects before and after the development of gluten-sensitive enteropathy.
The research team used an anti-α-tubulin antibody to conduct immunohistochemical studies on paraffin-embedded tissue sections. They found important differences in enterocyte morphology and intracellular cytoskeletal structures in the patients with proven celiac disease and those in the study group.
Moreover, the team observed that these changes existed in the study group prior to any indication of enteropathy, as determined by standard microscopy.
This is the first time researchers have used high content analysis to show specific details of enterocyte morphology. Such an approach permits doctors to quantitatively analyze enterocyte intracellular structure from standard biopsy samples and allows for detection of minute changes that develop before the classic histological lesion.
This process could become important for improving the diagnosis of celiac disease. If doctors can spot celiac-related intestinal lesions before they develop, they can begin to prevent celiac disease before it develops and thereby save lives.
Central European Journal of Biology
Volume 3, Number 3 / September, 2008
In the first study of its kind, a team of researchers based in Ireland set out to analyze enterocyte morphology and cytoskeletal structures using a high content analysis technology.
The research team was made up of doctors Bashir M. Mohamed, Conleth Feighery, Yvonne Williams, Anthony Davies, Dermot Kelleher, Yuri Volkov, Jacinta Kelly and Mohamed Abuzakouk.
The team examined duodenal biopsies from 14 untreated and 10 treated celiac patients and from 20 non-celiac control subjects. They also investigated tissue sections from six study group subjects before and after the development of gluten-sensitive enteropathy.
The research team used an anti-α-tubulin antibody to conduct immunohistochemical studies on paraffin-embedded tissue sections. They found important differences in enterocyte morphology and intracellular cytoskeletal structures in the patients with proven celiac disease and those in the study group.
Moreover, the team observed that these changes existed in the study group prior to any indication of enteropathy, as determined by standard microscopy.
This is the first time researchers have used high content analysis to show specific details of enterocyte morphology. Such an approach permits doctors to quantitatively analyze enterocyte intracellular structure from standard biopsy samples and allows for detection of minute changes that develop before the classic histological lesion.
This process could become important for improving the diagnosis of celiac disease. If doctors can spot celiac-related intestinal lesions before they develop, they can begin to prevent celiac disease before it develops and thereby save lives.
Central European Journal of Biology
Volume 3, Number 3 / September, 2008
Is the Multiplex Immunoassay (MIA) the Best Test for Diagnosing Celiac Disease?
Celiac.com 10/16/2008 - When faced with possible cases of celiac disease, it is known that testing for tissue transglutaminase (TTG) antibodies and newly developed deamidated gliadin peptide (DGP) antibodies offers greater accuracy than testing for native gliadin antibodies. But what is the best overall test for TTG and DGP?
A research team recently set out to compare multiplex immunoassay (MIA) testing for antibodies against enzyme-linked immunosorbent assay (ELISA) testing for antibodies in biopsy-proven celiac patients and control subjects, and to determine the helpfulness of using the two tests in combination for making diagnosis of celiac disease.
The research team was made up of doctors S. Rashtak, M. W. Ettore, H. A. Homburger & J. A. Murray. Doctors Rashtak and Murray are with the Mayo Clinic in Rochester, Minnesota.
The team compared sensitivity, specificity and accuracy of MIA and ELISA testing methods for TTG and DGP antibodies in 92 adults with untreated celiac disease, and 124 healthy control subjects. For every test, except TTG IgG, the results showed strong agreement and a significant correlation between the results of MIA and ELISA methods (j > 0.8, r > 0.7). For TTG IgG, both showed low sensitivity (MIA-13.0% vs. ELISA-28.3%), high specificity (MIA-100.0% vs. ELISA-96.8%), and about the same levels of overall accuracy (MIA-63.0% vs. ELISA-67.6%).
They found no significant differences between diagnosis accuracy made using the MIA method compared to diagnosis made using ELISA, or between either of those against a combination of the two methods.
Compared to using either test alone, using both tests together made for a slight increase in overall test sensitivity where any one of the tests was positive, and an increase in specificity when all tests were positive.
The team determined that MIA testing for antibodies is as accurate as ELISA for celiac disease diagnosis and offers practical advantages over ELISA method. MIA testing measures multiple antibodies simultaneously, provides a complete antibody phenotype, and offers a quicker turnaround time and lower cost. They further noted that carefully targeted combination testing can help identify patients who require intestinal biopsy, which may reduce unnecessary biopsies.
A research team recently set out to compare multiplex immunoassay (MIA) testing for antibodies against enzyme-linked immunosorbent assay (ELISA) testing for antibodies in biopsy-proven celiac patients and control subjects, and to determine the helpfulness of using the two tests in combination for making diagnosis of celiac disease.
The research team was made up of doctors S. Rashtak, M. W. Ettore, H. A. Homburger & J. A. Murray. Doctors Rashtak and Murray are with the Mayo Clinic in Rochester, Minnesota.
The team compared sensitivity, specificity and accuracy of MIA and ELISA testing methods for TTG and DGP antibodies in 92 adults with untreated celiac disease, and 124 healthy control subjects. For every test, except TTG IgG, the results showed strong agreement and a significant correlation between the results of MIA and ELISA methods (j > 0.8, r > 0.7). For TTG IgG, both showed low sensitivity (MIA-13.0% vs. ELISA-28.3%), high specificity (MIA-100.0% vs. ELISA-96.8%), and about the same levels of overall accuracy (MIA-63.0% vs. ELISA-67.6%).
They found no significant differences between diagnosis accuracy made using the MIA method compared to diagnosis made using ELISA, or between either of those against a combination of the two methods.
Compared to using either test alone, using both tests together made for a slight increase in overall test sensitivity where any one of the tests was positive, and an increase in specificity when all tests were positive.
The team determined that MIA testing for antibodies is as accurate as ELISA for celiac disease diagnosis and offers practical advantages over ELISA method. MIA testing measures multiple antibodies simultaneously, provides a complete antibody phenotype, and offers a quicker turnaround time and lower cost. They further noted that carefully targeted combination testing can help identify patients who require intestinal biopsy, which may reduce unnecessary biopsies.
Simple Saliva Test Offers Promise for Monitoring Celiac Disease
Celiac.com 11/03/2008 - Blood testing for radioimmunoassay (RIA) tissue transglutaminase auto-antibodies (tTG-Abs) has proven to be a sensitive test for celiac disease follow-up. Recent studies have shown that RIA can accurately detect tTG-Abs in human saliva. However, not much is known about reliability of this method for monitoring the progress of celiac disease over time in patients who are attempting to follow a gluten-free diet.
A team of researchers recently set out to assess salivary RIA tTG-Abs in celiac children on gluten-free diet. The research team included doctors M. Bonamico, R. Nenna, R.P.L. Luparia, C. Perricone, M. Montuori, F. Lucantoni, A. Castronovo, S. Mura; A. Turchetti, P. Strappini, and C. Tiberti.
The team evaluated blood and saliva samples taken from 109 children at the time of their diagnosis for celiac disease. The first group included 71 females, with an average age of 9.4 years. A second group included 58 people who were following a gluten-free diet. The second group was broken into two subgroups: group 2a with 36 patients assessed at 3-6 months; and group 2b with 34 patients at 9 months or more (group 2b).
The research team also included two control groups matched for age and sex. Group 3 included 89 gastroenterological patients, while group 4 included 49 healthy subjects. The team used RIA to detect tTG-Abs in saliva and blood, and compared the results against two other established tests: serum tTG-Abs ELISA and IgA anti-endomysium antibodies (EMA).
The team detected salivary RIA tTG-Abs in 94.5% of patients from group 1, 66.7% of celiac patients from group 2a, and 50.0% from 2b. They detected blood RIA tTG-Abs in 98.2% of patients from group 1, 72.2% of celiac patients from group 2a, and 50.0% from 2b. The longer patients were on a gluten-free diet, the more the tTG-Abs decreased. The research team also found a correlation between saliva and serum levels (r = 0.75, P = 0.0001). A celiac disease follow-up showed comparable salivary and serum RIA sensitivities, and higher levels for EMA and ELISA methods.
The research team concluded that it is possible to measure salivary tTG-Abs with a high level of accuracy; both at initial diagnosis for celiac disease, and also while patients are following a gluten-free diet.
This discovery means that doctors treating people with celiac disease might soon be able to use a simple saliva test to monitor the progress of their patients’ gluten-free diets. Such a development might take remove much of the guesswork for celiacs who are trying to follow a gluten-free diet, and would be particularly useful for patients who might be asymptomatic, or who are at risk for celiac-associated conditions.
A team of researchers recently set out to assess salivary RIA tTG-Abs in celiac children on gluten-free diet. The research team included doctors M. Bonamico, R. Nenna, R.P.L. Luparia, C. Perricone, M. Montuori, F. Lucantoni, A. Castronovo, S. Mura; A. Turchetti, P. Strappini, and C. Tiberti.
The team evaluated blood and saliva samples taken from 109 children at the time of their diagnosis for celiac disease. The first group included 71 females, with an average age of 9.4 years. A second group included 58 people who were following a gluten-free diet. The second group was broken into two subgroups: group 2a with 36 patients assessed at 3-6 months; and group 2b with 34 patients at 9 months or more (group 2b).
The research team also included two control groups matched for age and sex. Group 3 included 89 gastroenterological patients, while group 4 included 49 healthy subjects. The team used RIA to detect tTG-Abs in saliva and blood, and compared the results against two other established tests: serum tTG-Abs ELISA and IgA anti-endomysium antibodies (EMA).
The team detected salivary RIA tTG-Abs in 94.5% of patients from group 1, 66.7% of celiac patients from group 2a, and 50.0% from 2b. They detected blood RIA tTG-Abs in 98.2% of patients from group 1, 72.2% of celiac patients from group 2a, and 50.0% from 2b. The longer patients were on a gluten-free diet, the more the tTG-Abs decreased. The research team also found a correlation between saliva and serum levels (r = 0.75, P = 0.0001). A celiac disease follow-up showed comparable salivary and serum RIA sensitivities, and higher levels for EMA and ELISA methods.
The research team concluded that it is possible to measure salivary tTG-Abs with a high level of accuracy; both at initial diagnosis for celiac disease, and also while patients are following a gluten-free diet.
This discovery means that doctors treating people with celiac disease might soon be able to use a simple saliva test to monitor the progress of their patients’ gluten-free diets. Such a development might take remove much of the guesswork for celiacs who are trying to follow a gluten-free diet, and would be particularly useful for patients who might be asymptomatic, or who are at risk for celiac-associated conditions.
Stories of Celiac Disease Symptoms—Both Undiagnosed or Misdiagnosed
Celiac.com 12/12/2008 - The tales of diagnois for celiac disease are almost always dramatic: Some people go for years dealing with aches and pains and thinking that this is just the way their body was built. I remember feeling that way when my one-year-old was so crabby—walking around with her big old “Buddha” belly. Recently, I requested the top three symptoms from adult and child celiacs to put together a survey of the top symptoms on my blog. I didn’t ask for the diagnosis stories, but people offered some insight into the trials and tribulations of getting diagnosed with celiac disease—and eventually leading a new and healthier life!
It took a major virus, three doctors, x-rays, blood tests to get to Emma’s diagnosis.One doctor told me “kids throw up” (once every nine days? Really?), a second opinion recommended Milicon for her “gassy” tummy. Luckily, it all ended the way it should have, with a diagnosis of celiac disease that only took about 5 months—which is relatively little compared to some of the stories you’re about to hear.
One woman wrote me describing her daughter’s symptoms when she was diagnosed at age 15, but then she wrote back about the subsequent diagnoses of her sister and mother.Jean was diagnosed at age 70 but she and her family tell me her severe scoliosis at age 12 was a symptom! Can you believe being misdiagnosed for 58 years?Jean even had to be put in a back cast for a time.
Jean’s daughter, Vicky was diagnosed with Crohn’s disease at the age of 12—which included 3 major surgeries! Her celiac disease diagnosis didn’t come until the age of 51. By then major damage had been done to her body with the onsets of several health issues:rheumatoid and osteo arthritis, thyroid disease, severe osteoporosis (both hips have been replaced ...one twice) and severe scoliosis. It turns out: three generations of women in the same family all started showing their symptoms in those early teen years.
Kim wrote me and said she was diagnosed at 39 years old when she was hospitalized with stomach pain, vomiting and diarrhea.But she added at the end of her note, “[I] probably should have gotten tested at [age] 11 when I had the same severe cramping that put me in the hospital.” The bright spot in this story is that her eventual celiac diagnosis, led to the quicker diagnosis of her 5-year-old daughter who was just beginning her symptoms of low weight and anemia.
Another contributor said her 14-year-old son was diagnosed with celiac two years ago, but has also had a kidney issue for the last 9 years.But since he has been eating gluten free…his kidneys have also gotten better, last report was the best since before he was brought in at age 5!! Now I wonder which really came first?”It does make you wonder.
But there are some success stories:
One mom mentioned her son’s quick diagnosis. “[It] started with diarrhea. Thought it was a stomach bug.” Then it moved to constipation and two weeks later things still weren’t right.Then their doctor put two and two together, “[An] amazing pediatrician said ‘This sounds like Celiac’ and ran the blood tests. Andrew was only ‘sick’ about 1 month before diagnosis,” she said. However looking back on it all, he had a big belly and slow to grow.
Others talked about having celiac disease and not even feeling sick.
* “I only found out about the anemia through a blood test done as part of a complete physical; my general health to that point was excellent, including running marathons,” Danny wrote.
* “The only reason [my 3-year-old daughter] was diagnosed was her yearly blood draw came back positive so we had the biopsy,” said Monica, a mom of two celiac children.
* Anna’s dad, Tom, was diagnosed in his 40s after a family-round of blood testing. He is asymptomatic.
The last two points show how important it is to take part in preventative measures, by getting regular blood testing done for first-degree family members. The National Institute of diabetes, Digestive and Kidney Diseases says, “…because celiac disease is hereditary, family members of a person with the disease may wish to be tested. Four to 12 percent of an affected person’s first-degree relatives will also have the disease.”
The stories of diagnosing celiac disease may leave many of us angry, frustrated, and possibly grateful—all at the same time. The missed diagnoses and misdiagnoses of those who have this disease presents a roller-coaster ride of emotions. I hope this article helps you in knowing many others have gone through it and are likely going through it as we speak.We just need to make sure we’re spreading the word and getting as much awareness out there as possible to help others in similar situations.
It took a major virus, three doctors, x-rays, blood tests to get to Emma’s diagnosis.One doctor told me “kids throw up” (once every nine days? Really?), a second opinion recommended Milicon for her “gassy” tummy. Luckily, it all ended the way it should have, with a diagnosis of celiac disease that only took about 5 months—which is relatively little compared to some of the stories you’re about to hear.
One woman wrote me describing her daughter’s symptoms when she was diagnosed at age 15, but then she wrote back about the subsequent diagnoses of her sister and mother.Jean was diagnosed at age 70 but she and her family tell me her severe scoliosis at age 12 was a symptom! Can you believe being misdiagnosed for 58 years?Jean even had to be put in a back cast for a time.
Jean’s daughter, Vicky was diagnosed with Crohn’s disease at the age of 12—which included 3 major surgeries! Her celiac disease diagnosis didn’t come until the age of 51. By then major damage had been done to her body with the onsets of several health issues:rheumatoid and osteo arthritis, thyroid disease, severe osteoporosis (both hips have been replaced ...one twice) and severe scoliosis. It turns out: three generations of women in the same family all started showing their symptoms in those early teen years.
Kim wrote me and said she was diagnosed at 39 years old when she was hospitalized with stomach pain, vomiting and diarrhea.But she added at the end of her note, “[I] probably should have gotten tested at [age] 11 when I had the same severe cramping that put me in the hospital.” The bright spot in this story is that her eventual celiac diagnosis, led to the quicker diagnosis of her 5-year-old daughter who was just beginning her symptoms of low weight and anemia.
Another contributor said her 14-year-old son was diagnosed with celiac two years ago, but has also had a kidney issue for the last 9 years.But since he has been eating gluten free…his kidneys have also gotten better, last report was the best since before he was brought in at age 5!! Now I wonder which really came first?”It does make you wonder.
But there are some success stories:
One mom mentioned her son’s quick diagnosis. “[It] started with diarrhea. Thought it was a stomach bug.” Then it moved to constipation and two weeks later things still weren’t right.Then their doctor put two and two together, “[An] amazing pediatrician said ‘This sounds like Celiac’ and ran the blood tests. Andrew was only ‘sick’ about 1 month before diagnosis,” she said. However looking back on it all, he had a big belly and slow to grow.
Others talked about having celiac disease and not even feeling sick.
* “I only found out about the anemia through a blood test done as part of a complete physical; my general health to that point was excellent, including running marathons,” Danny wrote.
* “The only reason [my 3-year-old daughter] was diagnosed was her yearly blood draw came back positive so we had the biopsy,” said Monica, a mom of two celiac children.
* Anna’s dad, Tom, was diagnosed in his 40s after a family-round of blood testing. He is asymptomatic.
The last two points show how important it is to take part in preventative measures, by getting regular blood testing done for first-degree family members. The National Institute of diabetes, Digestive and Kidney Diseases says, “…because celiac disease is hereditary, family members of a person with the disease may wish to be tested. Four to 12 percent of an affected person’s first-degree relatives will also have the disease.”
The stories of diagnosing celiac disease may leave many of us angry, frustrated, and possibly grateful—all at the same time. The missed diagnoses and misdiagnoses of those who have this disease presents a roller-coaster ride of emotions. I hope this article helps you in knowing many others have gone through it and are likely going through it as we speak.We just need to make sure we’re spreading the word and getting as much awareness out there as possible to help others in similar situations.
Celiac Disease Vaccine Trials Slated for 2009
Celiac.com 12/18/2008 - Celiac disease is a life-long autoimmune disease. When people with celiac disease consume the gluten proteins found in wheat, rye and barley they damage the lining of the gut, which prevents normal digestion and absorption of food.
There is currently no cure for the celiac disease. The only treatment is life-long adherence to a strict gluten-free diet. If a gluten-free diet is not followed, the disease can ultimately lead to ill health and life-threatening conditions including malnutrition, osteoporosis, bowel cancer, and may cause infertility problems.
The charity group Coeliac UK, recently hosted a conference at the Royal Society of Arts in central London where, among the latest findings in celiac disease research, they announced progress on the development of a possible vaccine for the condition.
Dr. Bob Anderson of the Autoimmunity and Transplantation Division of Australia’s Walter and Eliza Hall Institute has led a research team that has isolated the toxic elements of gluten, paving the way for a possible vaccine that will suppress or prevent gluten toxicity. The research indicates that the toxic, autoimmune response in celiac patients exposed to wheat is triggered by just few dominant peptides in the gluten protein. This small number of offending peptides makes it exponentially easier for researchers to develop a vaccine.
Dr. Anderson is a joint founder and CEO of Nexpep, an Australian company that is actively working to develop a vaccine to treat celiac disease. Dr. Anderson’s team has created a peptide-based therapeutic vaccine to treat the main problem T-cell epitopes of gluten. The vaccine has the potential to treat at about 80% of people with celiac disease and having the appropriate genetic background. Similar to traditional desensitization therapy for allergies, the peptide-based vaccines are given in multiple small doses over a course of injections in an effort to create immune tolerance not only to the selected gluten fragments, but also lower the toxicity of related toxic gluten molecules.
Nexpep is currently raising capital for a clinical trial program for a peptide-based therapeutic vaccine and intends to commence a Phase 1 clinical trial in the first half of 2009.
There is currently no cure for the celiac disease. The only treatment is life-long adherence to a strict gluten-free diet. If a gluten-free diet is not followed, the disease can ultimately lead to ill health and life-threatening conditions including malnutrition, osteoporosis, bowel cancer, and may cause infertility problems.
The charity group Coeliac UK, recently hosted a conference at the Royal Society of Arts in central London where, among the latest findings in celiac disease research, they announced progress on the development of a possible vaccine for the condition.
Dr. Bob Anderson of the Autoimmunity and Transplantation Division of Australia’s Walter and Eliza Hall Institute has led a research team that has isolated the toxic elements of gluten, paving the way for a possible vaccine that will suppress or prevent gluten toxicity. The research indicates that the toxic, autoimmune response in celiac patients exposed to wheat is triggered by just few dominant peptides in the gluten protein. This small number of offending peptides makes it exponentially easier for researchers to develop a vaccine.
Dr. Anderson is a joint founder and CEO of Nexpep, an Australian company that is actively working to develop a vaccine to treat celiac disease. Dr. Anderson’s team has created a peptide-based therapeutic vaccine to treat the main problem T-cell epitopes of gluten. The vaccine has the potential to treat at about 80% of people with celiac disease and having the appropriate genetic background. Similar to traditional desensitization therapy for allergies, the peptide-based vaccines are given in multiple small doses over a course of injections in an effort to create immune tolerance not only to the selected gluten fragments, but also lower the toxicity of related toxic gluten molecules.
Nexpep is currently raising capital for a clinical trial program for a peptide-based therapeutic vaccine and intends to commence a Phase 1 clinical trial in the first half of 2009.
Metabonomic signature of celiac disease
Celiac.com 12/23/2008 - Metabolites are small–molecule products of biochemical processes in the body’s cells. Analysis of these metabolites can detect changes in the body caused by chemical toxicity, disease, gene mutations, or diet. bacteria in the gut also contribute to this “metabolic signature”, so it is also a way to understand changes in gut microbe populations.
Because metabolites are excreted from the cells into blood and urine, collecting these samples can be easy, noninvasive, and inexpensive. Chemical techniques like nuclear magnetic resonance (NMR) spectroscopy are used to analyze the samples. The results of NMR spectroscopy are chemical patterns, showing the simultaneous alterations of many compounds. The measurement and analysis of multiple metabolite changes in response to genetic changes or environmental stimuli is known as metabonomics.
Metabonomics has a number of potential applications. Ease of sample collection may enable researchers to develop a rapid screening tool for diseases like celiac disease. Using metabonomics, it is not necessary to know the specific metabolites that differ in people with a given disease (the disease biomarkers). Rather than looking for the presence or absence of a particular biomarker, the overall pattern of metabolite concentrations is compared to patterns of people known to have the disease (the metabolic signature of the disease) and patterns of people who do not have the disease. Large numbers of metabolites are analyzed simultaneously, instead of one by one, providing a snapshot into what is happening in the cells at a given time.
In this first study to investigate the metabonomic signature of celiac disease, blood and urine samples of 34 people with celiac disease were analyzed at the time of diagnosis, which was based on antibody tests and confirmed with biopsies of the small intestine. These patterns were compared to the metabolite patterns of 34 people without celiac disease. Using blood samples, researchers were able to predict celiac disease up to 83% of the time. Analysis of urine samples gave accuracy of about 70%.
These accuracy rates are lower than those achieved with antibody tests, but this is only the first small study and refining the techniques may significantly improve accuracy rates. In addition, analyzing the metabolic signature may lead to a greater understanding of celiac disease and the cause of its various symptoms. For example, results from this study included lower levels of some metabolites such as pyruvate (a product of glucose breakdown) coupled with elevated levels of other metabolites such as glucose and 3-hydroxybutyric acid (a by-product of fat breakdown) in people with celiac disease.
These results suggest a possible explanation for chronic fatigue experienced by up to 87% of patients with celiac disease—a possible impairment in the body’s ability to use glucose for energy. As expected, evidence of altered gut bacteria was also found, as were an increase in metabolites that indicate an increased intestinal permeability (“leaky gut”). After 12 months of a strict gluten-free diet, these altered metabolite patterns reverted to normal.
Metabonomics is an emerging field of study, which like genomics, holds great promise in the understanding, diagnosis, and treatment of diseases like celiac disease.
Because metabolites are excreted from the cells into blood and urine, collecting these samples can be easy, noninvasive, and inexpensive. Chemical techniques like nuclear magnetic resonance (NMR) spectroscopy are used to analyze the samples. The results of NMR spectroscopy are chemical patterns, showing the simultaneous alterations of many compounds. The measurement and analysis of multiple metabolite changes in response to genetic changes or environmental stimuli is known as metabonomics.
Metabonomics has a number of potential applications. Ease of sample collection may enable researchers to develop a rapid screening tool for diseases like celiac disease. Using metabonomics, it is not necessary to know the specific metabolites that differ in people with a given disease (the disease biomarkers). Rather than looking for the presence or absence of a particular biomarker, the overall pattern of metabolite concentrations is compared to patterns of people known to have the disease (the metabolic signature of the disease) and patterns of people who do not have the disease. Large numbers of metabolites are analyzed simultaneously, instead of one by one, providing a snapshot into what is happening in the cells at a given time.
In this first study to investigate the metabonomic signature of celiac disease, blood and urine samples of 34 people with celiac disease were analyzed at the time of diagnosis, which was based on antibody tests and confirmed with biopsies of the small intestine. These patterns were compared to the metabolite patterns of 34 people without celiac disease. Using blood samples, researchers were able to predict celiac disease up to 83% of the time. Analysis of urine samples gave accuracy of about 70%.
These accuracy rates are lower than those achieved with antibody tests, but this is only the first small study and refining the techniques may significantly improve accuracy rates. In addition, analyzing the metabolic signature may lead to a greater understanding of celiac disease and the cause of its various symptoms. For example, results from this study included lower levels of some metabolites such as pyruvate (a product of glucose breakdown) coupled with elevated levels of other metabolites such as glucose and 3-hydroxybutyric acid (a by-product of fat breakdown) in people with celiac disease.
These results suggest a possible explanation for chronic fatigue experienced by up to 87% of patients with celiac disease—a possible impairment in the body’s ability to use glucose for energy. As expected, evidence of altered gut bacteria was also found, as were an increase in metabolites that indicate an increased intestinal permeability (“leaky gut”). After 12 months of a strict gluten-free diet, these altered metabolite patterns reverted to normal.
Metabonomics is an emerging field of study, which like genomics, holds great promise in the understanding, diagnosis, and treatment of diseases like celiac disease.
More Doctors Advocate Long-term Management of Celiac Disease
Celiac.com 01/03/2009 - The development of reliable blood tests for celiac disease have shown the condition to be much more common than previously thought. In fact, the rate of diagnosis has increased sharply in recent years.
It’s been well documented that, for most people celiac disease, a gluten-free diet leads to healing of the small intestine, and brings about overall improvements in their quality of life. Current medical wisdom dictates that once a person is diagnosed with celiac disease and experiences an improvement in symptoms by adopting a gluten-free diet, there is little need to undergo follow-up screening unless they experience a clear recurrence of symptoms.
Some doctors are beginning to challenge that practice. However, it is also becoming clear that people with celiac disease face a higher risk of risk of developing a number of long-term complications and other autoimmune disorders.
The list of such complications and conditions associated with celiac disease is growing rapidly, in particular, autoimmune disease, malignancy, and bone disease. Can these be prevented and outcomes improved? Risk factors that can predict or shape long-term outcomes include genetic make-up, environmental factors, especially gluten consumption and exposure, persistent small intestinal inflammation⁄ damage and nutritional deficiencies.
The use of genotyping has yet to establish a clinical role in the long-term management of duodenal biopsy. Symptoms, blood tests, or other non-invasive methods are poor predictors of healing status, or the likelihood of associated complications. This means that long-term management of celiac care might benefit from strategies laying somewhere between regular biopsies for life and simple faith that one is successfully following a gluten-free diet.
A team of doctors based in Australia recently set out to conduct a systematic review of the complications and associations of celiac disease, to identify potential risk factors, to define ways of assessing risk factors and to provide a strategy for management. The team was made up of Dr. M. L. Haines, Dr. R. P. Anderson & Dr. P. R. Gibson, and they conducted a review of medical literature going back to 1975.
The doctors found that all people with celiac disease should have follow-up exams. They felt a reasonable minimum for all patients would be an initial consultation 1–2 weeks after biopsy diagnosis, review consultation 3–6 months later and subsequent annual reviews assessed on an individual basis.
As to whether the follow-up should be done by a specialist, such as a gastroenterologist, or by a general practitioner, a nurse practitioner, or a dietitian, the research team noted that most celiac patients prefer to see a dietitian for follow-up, with a doctor available as needed.
The team felt that special attention should be paid to patient adherence to a gluten free diet.
The doctors noted the ease of gluten ingestion and pointed out that 6 in 10 patients experience persistent histological changes within an average of two years of undetected gluten exposure. They also noted there are a large number of associated conditions that can be averted by keeping celiac disease under control. They also note that symptoms and blood tests are poor indicators of intestinal damage levels on a cellular level.
Such damage can spread from the cellular level to the systemic level over time, leaving people with untreated celiac disease face an elevated risk of developing infection. The researchers noted that people untreated celiac disease have significantly reduced levels of leucocytes, total lymphocytes, and CD3+, CD4+ and CD8+ lymphocytes compared to those with treated celiac disease and to the general population.
With so many associated conditions tied to celiac-related intestinal damage, controlling or preventing that damage becomes crucial. They also note that proper monitoring of celiac disease can help to prevent celiac-associated neuro-psychiatric conditions such as anxiety, headaches, behavioral symptoms and depression, which, it is thought may be triggered by impaired availability of tryptophan and disturbances in central serotonergic function.
The proper control of celiac disease can help to prevent the development of, or improve, numerous celiac-associated conditions. That proper control means a reliable means to assess patients for follow-up, and the study presents several aspects of a new protocol for treating celiac disease over the course of the patient’s lifetime.
It’s been well documented that, for most people celiac disease, a gluten-free diet leads to healing of the small intestine, and brings about overall improvements in their quality of life. Current medical wisdom dictates that once a person is diagnosed with celiac disease and experiences an improvement in symptoms by adopting a gluten-free diet, there is little need to undergo follow-up screening unless they experience a clear recurrence of symptoms.
Some doctors are beginning to challenge that practice. However, it is also becoming clear that people with celiac disease face a higher risk of risk of developing a number of long-term complications and other autoimmune disorders.
The list of such complications and conditions associated with celiac disease is growing rapidly, in particular, autoimmune disease, malignancy, and bone disease. Can these be prevented and outcomes improved? Risk factors that can predict or shape long-term outcomes include genetic make-up, environmental factors, especially gluten consumption and exposure, persistent small intestinal inflammation⁄ damage and nutritional deficiencies.
The use of genotyping has yet to establish a clinical role in the long-term management of duodenal biopsy. Symptoms, blood tests, or other non-invasive methods are poor predictors of healing status, or the likelihood of associated complications. This means that long-term management of celiac care might benefit from strategies laying somewhere between regular biopsies for life and simple faith that one is successfully following a gluten-free diet.
A team of doctors based in Australia recently set out to conduct a systematic review of the complications and associations of celiac disease, to identify potential risk factors, to define ways of assessing risk factors and to provide a strategy for management. The team was made up of Dr. M. L. Haines, Dr. R. P. Anderson & Dr. P. R. Gibson, and they conducted a review of medical literature going back to 1975.
The doctors found that all people with celiac disease should have follow-up exams. They felt a reasonable minimum for all patients would be an initial consultation 1–2 weeks after biopsy diagnosis, review consultation 3–6 months later and subsequent annual reviews assessed on an individual basis.
As to whether the follow-up should be done by a specialist, such as a gastroenterologist, or by a general practitioner, a nurse practitioner, or a dietitian, the research team noted that most celiac patients prefer to see a dietitian for follow-up, with a doctor available as needed.
The team felt that special attention should be paid to patient adherence to a gluten free diet.
The doctors noted the ease of gluten ingestion and pointed out that 6 in 10 patients experience persistent histological changes within an average of two years of undetected gluten exposure. They also noted there are a large number of associated conditions that can be averted by keeping celiac disease under control. They also note that symptoms and blood tests are poor indicators of intestinal damage levels on a cellular level.
Such damage can spread from the cellular level to the systemic level over time, leaving people with untreated celiac disease face an elevated risk of developing infection. The researchers noted that people untreated celiac disease have significantly reduced levels of leucocytes, total lymphocytes, and CD3+, CD4+ and CD8+ lymphocytes compared to those with treated celiac disease and to the general population.
With so many associated conditions tied to celiac-related intestinal damage, controlling or preventing that damage becomes crucial. They also note that proper monitoring of celiac disease can help to prevent celiac-associated neuro-psychiatric conditions such as anxiety, headaches, behavioral symptoms and depression, which, it is thought may be triggered by impaired availability of tryptophan and disturbances in central serotonergic function.
The proper control of celiac disease can help to prevent the development of, or improve, numerous celiac-associated conditions. That proper control means a reliable means to assess patients for follow-up, and the study presents several aspects of a new protocol for treating celiac disease over the course of the patient’s lifetime.
Quick Home Celiac Disease Test Debuts in Canada
Celiac.com 02/27/2009 - A simple, reliable low-cost home screening test for celiac disease recently made its Canadian debut.
According to health officials, about 1% of the population, or one out of every 100 Americans suffers from celiac disease. Currently, that total number of Americans with celiac disease stands somewhere near 3 million. Sadly, upwards of 97% of those affected remain undiagnosed.
For people with celiac disease, eating gluten—a protein found in wheat, rye and barley—causes damage to the lining of the small intestine, preventing the uptake of nutrients.
Delayed diagnosis can put people at risk for certain types of cancer and many other associated conditions, including infertility. Early diagnosis of celiac disease is actually quite easy and carries many advantages.
Still, the average time for a correct diagnosis of celiac disease is 10 years from the first onset of symptoms. That figure is 12 years for Canadians, according to a 2007 survey of the 5000 member Canadian Celiac Association. Checking for celiac disease involves a simple blood test and usually a biopsy to follow up on positive results. Until now, that blood test was available solely through a doctor. Often, believing celiac to be rare, doctors are reluctant to order the blood test without overwhelming evidence. This can be problematical, as most people being diagnosed these days do not have classical symptoms, and are often asymptomatic. Numerous people have been forced to visit multiple doctors before confirming their diagnosis.
Recently, the Finnish firm AniBiotech developed a unique, patient-friendly celiac disease test kit that can be used to provide quick, accurate results at home. Marketed in Canada by 2G Pharma, the Biocard™ Celiac Test Kit works by metering gluten antibody levels from a tiny fingertip blood sample, and is the currently the only point-of-care celiac disease test kit approved by Health Canada.
The test tells users with a high degree of accuracy that they are either negative, developing celiac disease, or already have celiac disease. In the last two cases, the specially formulated Canadian kit encourages people to consult a physician for confirmation, which usually involves a biopsy of the small bowel.
The Biocard™ Celiac Test Kit is currently available in Canada at London Drugs, Rexall Pharma Plus, and other major Canadian retail chains. More information can be found at www.celiachometest.com.
The test kit is currently awaiting approval for U.S. distribution.
According to health officials, about 1% of the population, or one out of every 100 Americans suffers from celiac disease. Currently, that total number of Americans with celiac disease stands somewhere near 3 million. Sadly, upwards of 97% of those affected remain undiagnosed.
For people with celiac disease, eating gluten—a protein found in wheat, rye and barley—causes damage to the lining of the small intestine, preventing the uptake of nutrients.
Delayed diagnosis can put people at risk for certain types of cancer and many other associated conditions, including infertility. Early diagnosis of celiac disease is actually quite easy and carries many advantages.
Still, the average time for a correct diagnosis of celiac disease is 10 years from the first onset of symptoms. That figure is 12 years for Canadians, according to a 2007 survey of the 5000 member Canadian Celiac Association. Checking for celiac disease involves a simple blood test and usually a biopsy to follow up on positive results. Until now, that blood test was available solely through a doctor. Often, believing celiac to be rare, doctors are reluctant to order the blood test without overwhelming evidence. This can be problematical, as most people being diagnosed these days do not have classical symptoms, and are often asymptomatic. Numerous people have been forced to visit multiple doctors before confirming their diagnosis.
Recently, the Finnish firm AniBiotech developed a unique, patient-friendly celiac disease test kit that can be used to provide quick, accurate results at home. Marketed in Canada by 2G Pharma, the Biocard™ Celiac Test Kit works by metering gluten antibody levels from a tiny fingertip blood sample, and is the currently the only point-of-care celiac disease test kit approved by Health Canada.
The test tells users with a high degree of accuracy that they are either negative, developing celiac disease, or already have celiac disease. In the last two cases, the specially formulated Canadian kit encourages people to consult a physician for confirmation, which usually involves a biopsy of the small bowel.
The Biocard™ Celiac Test Kit is currently available in Canada at London Drugs, Rexall Pharma Plus, and other major Canadian retail chains. More information can be found at www.celiachometest.com.
The test kit is currently awaiting approval for U.S. distribution.
Celiac Disease Treatment
Celiac.com 02/08/2007 - There is presently no cure for celiac disease. Celiac patients can vary greatly in their tolerance to gluten. Some patients may not notice any symptoms when they ingest tiny amounts of gluten, for example if something they ingest has been cross-contaminated, while others suffer pronounced symptoms after ingesting even the slightest amount of gluten.
Avoiding gluten is crucial
A life-long diet free of gluten is the standard treatment for celiac disease. To manage the disease and prevent complications, its essential to avoid all foods that contain gluten. That means it is crucial to:
* Avoid all foods made with wheat, rye, or barley. Including types of wheat like durum, farina, graham flour, and semolina. Also, bulgur, kamut, kasha, matzo meal, spelt and triticale. Examples of products that commonly contain these include breads, breading, batter, cereals, cooking and baking mixes, pasta, crackers, cookies, cakes, pies and gravies, among others.
* Avoid oats, at least during initial treatment stages, as the effects of oats on celiac patients are not fully understood, and contamination with wheat in processing is common. So, its best to eliminate oats at least until symptoms subside and their reintroduction into the diet can be fairly monitored and evaluated.
* Avoid processed foods that may contain hidden gluten. Wheat is commonly used in many processed foods that one might never suspect. A few examples include:
o candy bars
o canned soup
o canned meat
o energy bars
o ketchup
o ice cream
o instant coffee
o lunch meat
o mustard
o pastas
o processed meat
o sausages
* Avoid capsules and tablets that contain wheat starch, which is a common used binding agent in their production. Gluten is also commonly found in many vitamins and cosmetics, such as lipstick.
* Avoid beer (wine, brandy, whiskey and other non-wheat or barley alcohols are okay).
* Eat a diet rich in fish, fresh meats, rice, corn, soybean, potato, poultry, fruits and vegetables.
* Avoid milk and other dairy products, as it is common for patients with untreated celiac disease to be lactose intolerant. Successful treatment often means dairy products can be slowly reintroduced into the diet over time.
* Identify gluten-free foods. Because a gluten-free diet needs to be strictly followed, and because food ingredients may vary from place to place and even over time for a given product, it is important to always read the label. Consider purchasing commercial listings of gluten-free foods and products. For specific advice on adopting, shaping and maintaining the gluten-free diet that is right for you, you may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet.
* Always read labels, as ingredients often change over time and products that that were once gluten-free may be reformulated and now include gluten in some form. Products that are gluten-free in one country are sometimes not gluten-free in another.
Most patients who remove gluten from their diets find that their symptoms improve as inflammation of the small intestine begins to subside, usually within several weeks. Many patients who adopt a gluten-free diet report an improvement within 48 hours.
Results of a gluten-free diet can be especially dramatic in children with celiac disease. Not only does their diarrhea and abdominal distress usually subside but, frequently, their behavior and growth rate are often markedly improved.
A reappearance of intestinal villi nearly always follows an improvement in symptoms.
In younger people, the villi may complete healing and regrowth in several months, while in older people, the process may take as long as two to three years.
In cases where nutritional deficiencies are severe, celiac patients may require vitamin and mineral supplements to help bring about a healthier vitamin profile: folic acid and B12 for patients with anemia due to folate or B12 deficiency; vitamin K for patients with an abnormal ProTime; calcium and vitamin D supplements for patients with low blood calcium levels or with osteoporosis. For all such cases, individuals should consult their health professional.
Skin lesions common in patients with dermatitis herpetiformis often improve with adherence to a gluten-free diet.
For patients with celiac disease, the importance of maintaining a life-long diet free of gluten can hardly be over-stressed. Research indicates that only half of those patients who have had celiac disease for at least 20 years were following a strict gluten-free diet. Up to 30% of those patients showed evidence of bone loss and iron deficiency. These are but a few of the long-term consequences for celiac patients failing to follow a gluten-free diet.
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
Avoiding gluten is crucial
A life-long diet free of gluten is the standard treatment for celiac disease. To manage the disease and prevent complications, its essential to avoid all foods that contain gluten. That means it is crucial to:
* Avoid all foods made with wheat, rye, or barley. Including types of wheat like durum, farina, graham flour, and semolina. Also, bulgur, kamut, kasha, matzo meal, spelt and triticale. Examples of products that commonly contain these include breads, breading, batter, cereals, cooking and baking mixes, pasta, crackers, cookies, cakes, pies and gravies, among others.
* Avoid oats, at least during initial treatment stages, as the effects of oats on celiac patients are not fully understood, and contamination with wheat in processing is common. So, its best to eliminate oats at least until symptoms subside and their reintroduction into the diet can be fairly monitored and evaluated.
* Avoid processed foods that may contain hidden gluten. Wheat is commonly used in many processed foods that one might never suspect. A few examples include:
o candy bars
o canned soup
o canned meat
o energy bars
o ketchup
o ice cream
o instant coffee
o lunch meat
o mustard
o pastas
o processed meat
o sausages
* Avoid capsules and tablets that contain wheat starch, which is a common used binding agent in their production. Gluten is also commonly found in many vitamins and cosmetics, such as lipstick.
* Avoid beer (wine, brandy, whiskey and other non-wheat or barley alcohols are okay).
* Eat a diet rich in fish, fresh meats, rice, corn, soybean, potato, poultry, fruits and vegetables.
* Avoid milk and other dairy products, as it is common for patients with untreated celiac disease to be lactose intolerant. Successful treatment often means dairy products can be slowly reintroduced into the diet over time.
* Identify gluten-free foods. Because a gluten-free diet needs to be strictly followed, and because food ingredients may vary from place to place and even over time for a given product, it is important to always read the label. Consider purchasing commercial listings of gluten-free foods and products. For specific advice on adopting, shaping and maintaining the gluten-free diet that is right for you, you may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet.
* Always read labels, as ingredients often change over time and products that that were once gluten-free may be reformulated and now include gluten in some form. Products that are gluten-free in one country are sometimes not gluten-free in another.
Most patients who remove gluten from their diets find that their symptoms improve as inflammation of the small intestine begins to subside, usually within several weeks. Many patients who adopt a gluten-free diet report an improvement within 48 hours.
Results of a gluten-free diet can be especially dramatic in children with celiac disease. Not only does their diarrhea and abdominal distress usually subside but, frequently, their behavior and growth rate are often markedly improved.
A reappearance of intestinal villi nearly always follows an improvement in symptoms.
In younger people, the villi may complete healing and regrowth in several months, while in older people, the process may take as long as two to three years.
In cases where nutritional deficiencies are severe, celiac patients may require vitamin and mineral supplements to help bring about a healthier vitamin profile: folic acid and B12 for patients with anemia due to folate or B12 deficiency; vitamin K for patients with an abnormal ProTime; calcium and vitamin D supplements for patients with low blood calcium levels or with osteoporosis. For all such cases, individuals should consult their health professional.
Skin lesions common in patients with dermatitis herpetiformis often improve with adherence to a gluten-free diet.
For patients with celiac disease, the importance of maintaining a life-long diet free of gluten can hardly be over-stressed. Research indicates that only half of those patients who have had celiac disease for at least 20 years were following a strict gluten-free diet. Up to 30% of those patients showed evidence of bone loss and iron deficiency. These are but a few of the long-term consequences for celiac patients failing to follow a gluten-free diet.
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
Celiac Disease Symptoms
Celiac.com 02/08/2007 - There are no signs or symptoms typical for all people with celiac disease. Signs and symptoms and can vary greatly from person to person.
People with celiac disease often have general gastric complaints, such as intermittent diarrhea, abdominal pain and bloating. Some people with celiac disease, however, suffer no gastrointestinal discomfort at all.
To make matters of diagnosing celiac disease even more challenging, celiac symptoms can also mimic symptoms of other conditions, such as anemia, Crohns disease, gastric ulcers, irritable bowel, parasitic infection, even various skin disorders or nervous conditions.
It is not uncommon for celiac disease to present itself with symptoms that are far more vague. Such symptoms can include: dental and bone disorders (such as osteoporosis), depression, irritability, joint pain, mouth sores, muscle cramps, skin rash, stomach discomfort, and even tingling in the legs and feet (neuropathy).
Celiac disease results in malabsorption of nutrients.
Depending on the degree of malabsorption, the signs and symptoms of celiac disease vary among individuals, ranging from no symptoms, few or mild signs and symptoms, to many or severe signs and symptoms. There are two categories of signs and symptoms:
Signs and symptoms due to malabsorption. Some signs of malabsorption associated with celiac disease include:
• Abdominal cramps, gas and bloating
• Diarrhea
• Fatigue or general weakness
• Foul-smelling or grayish stools that are often fatty or oily
• Osteoporosis
• Stunted growth in children
• Weight loss
• Obesity
Signs and symptoms of malnutrition and vitamin or mineral deficiencies due to celiac disease:
• Anemia
• Easy bruising
• Fluid retention
• Infertility
• Muscle weakness
• Osteoporosis
• Peripheral neuropathy (nerve damage)
• Weight loss
People with celiac disease often have general gastric complaints, such as intermittent diarrhea, abdominal pain and bloating. Some people with celiac disease, however, suffer no gastrointestinal discomfort at all.
To make matters of diagnosing celiac disease even more challenging, celiac symptoms can also mimic symptoms of other conditions, such as anemia, Crohns disease, gastric ulcers, irritable bowel, parasitic infection, even various skin disorders or nervous conditions.
It is not uncommon for celiac disease to present itself with symptoms that are far more vague. Such symptoms can include: dental and bone disorders (such as osteoporosis), depression, irritability, joint pain, mouth sores, muscle cramps, skin rash, stomach discomfort, and even tingling in the legs and feet (neuropathy).
Celiac disease results in malabsorption of nutrients.
Depending on the degree of malabsorption, the signs and symptoms of celiac disease vary among individuals, ranging from no symptoms, few or mild signs and symptoms, to many or severe signs and symptoms. There are two categories of signs and symptoms:
Signs and symptoms due to malabsorption. Some signs of malabsorption associated with celiac disease include:
• Abdominal cramps, gas and bloating
• Diarrhea
• Fatigue or general weakness
• Foul-smelling or grayish stools that are often fatty or oily
• Osteoporosis
• Stunted growth in children
• Weight loss
• Obesity
Signs and symptoms of malnutrition and vitamin or mineral deficiencies due to celiac disease:
• Anemia
• Easy bruising
• Fluid retention
• Infertility
• Muscle weakness
• Osteoporosis
• Peripheral neuropathy (nerve damage)
• Weight loss
Celiac Disease Causes/Risk Factors
Celiac.com 02/08/2007 - While celiac disease can affect anyone, it is more rare in Africans and Asians, and occurs most frequently in whites of Northern European ancestry, and in people with autoimmune disorders, such as:
* Autoimmune thyroid disease
* Lupus erythematosus
* Microscopic colitis
* Rheumatoid arthritis
* Type 1 diabetes
Also, celiac disease and the tendency to get celiac disease runs in families. If one member of a family has celiac disease, the odds are that about one in ten of their first-degree relatives will also have it. People may harbor this tendency for years or even decades without showing signs or getting sick. Then, some kind of severe stress, like childbirth, infection, physical injury, or surgery can "activate" celiac disease.
While the precise mechanism of this activation, and of the intestinal damage is unclear, removal of gluten from the diet usually brings about quick relief of symptoms and promotes intestinal healing in most patients.
* Autoimmune thyroid disease
* Lupus erythematosus
* Microscopic colitis
* Rheumatoid arthritis
* Type 1 diabetes
Also, celiac disease and the tendency to get celiac disease runs in families. If one member of a family has celiac disease, the odds are that about one in ten of their first-degree relatives will also have it. People may harbor this tendency for years or even decades without showing signs or getting sick. Then, some kind of severe stress, like childbirth, infection, physical injury, or surgery can "activate" celiac disease.
While the precise mechanism of this activation, and of the intestinal damage is unclear, removal of gluten from the diet usually brings about quick relief of symptoms and promotes intestinal healing in most patients.
Celiac Disease Screening
Celiac.com 02/08/2007 - For anyone with a family history of celiac disease or of disorders such as thyroid disease, anemia of unknown cause, type I diabetes or other immune disorders or Downs syndrome, doctors may suggest routine screening. Otherwise, patients are generally screened on a case by case basis according to individual symptoms.
People with celiac disease have abnormally high levels of associated antibodies, including one or more of the following: anti-gliadin, anti-endomysium and anti-tissue transglutaminase, and damage to the villi (shortening and villous flattening) in the lamina propria and crypt regions of their intestines when they eat specific food-grain antigens (toxic amino acid sequences) that are found in wheat, rye, and barley.
Antibodies are the specialized proteins the immune system uses to break down and eliminate foreign substances from the body. In people with celiac disease, the immune system treats gluten as a foreign invader and produces elevated levels of antibodies to get rid of it, causing symptoms and associated discomfort.
Testing & Diagnosis
A blood test, such as anti-tissue transglutaminase and anti-endomysial antibodies, can detect abnormally high antibody levels, and is often used in the initial detection of celiac in people who are most likely to have the disease, and for those who may need further testing.
Since the immune system of a person with celiac treats gluten as a foreign substance and increases the number of antibodies, elevated levels of these antibodies are a sign of celiac disease.
To confirm the diagnosis, your doctor may need to do a biopsy, that is, microscopically examine a small portion of intestinal tissue to check for celiac associated damage to the small intestine. To do this, your doctor inserts a thin, flexible tube (endoscope) through your mouth, esophagus and stomach into your small intestine and takes a sample of intestinal tissue to look for damage to the villi (tiny, hair-like projections in the walls the small intestine that absorb vitamins, minerals and other nutrients).
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
People with celiac disease have abnormally high levels of associated antibodies, including one or more of the following: anti-gliadin, anti-endomysium and anti-tissue transglutaminase, and damage to the villi (shortening and villous flattening) in the lamina propria and crypt regions of their intestines when they eat specific food-grain antigens (toxic amino acid sequences) that are found in wheat, rye, and barley.
Antibodies are the specialized proteins the immune system uses to break down and eliminate foreign substances from the body. In people with celiac disease, the immune system treats gluten as a foreign invader and produces elevated levels of antibodies to get rid of it, causing symptoms and associated discomfort.
Testing & Diagnosis
A blood test, such as anti-tissue transglutaminase and anti-endomysial antibodies, can detect abnormally high antibody levels, and is often used in the initial detection of celiac in people who are most likely to have the disease, and for those who may need further testing.
Since the immune system of a person with celiac treats gluten as a foreign substance and increases the number of antibodies, elevated levels of these antibodies are a sign of celiac disease.
To confirm the diagnosis, your doctor may need to do a biopsy, that is, microscopically examine a small portion of intestinal tissue to check for celiac associated damage to the small intestine. To do this, your doctor inserts a thin, flexible tube (endoscope) through your mouth, esophagus and stomach into your small intestine and takes a sample of intestinal tissue to look for damage to the villi (tiny, hair-like projections in the walls the small intestine that absorb vitamins, minerals and other nutrients).
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
Celiac Disease Alternative Medicine
Celiac.com 02/12/2007 - Before they are diagnosed, people with celiac disease often find themselves in an unenviable position. They may go out of their way to eat a wholesome, balanced diet including plenty of fruits and vegetables, a good variety of whole-grain foods, and a modest amount of meat and dairy, yet still find themselves suffering a whole range of bothersome stomach and digestive complaints including indigestion, gas, stomach cramps and diarrhea, alternating with constipation.
Thats because people with celiac disease are intolerant of the protein gluten. Gluten is found in wheat, rye, and barley (oats contain a type of gluten that may be safe for most celiacs), and is found in the soft, white inside of the grain, its what makes dough, and flour and water paste, sticky and gooey.
When people with celiac disease eat food made from these grains, even in small amounts, their immune systems seem to treat the gluten as foreign invader, and basically create a massive defensive action against what might be, for most people, part of a good healthy diet. The immune reaction that is triggered by gluten causes inflammation of the intestines, which leads to many problems that are associated with malabsorption, and ultimately to the general gastrointestinal malaise associated with undiagnosed celiac disease, or with gluten contamination in otherwise mindful celiac patients on a gluten-free diet.
Diagnosis and Treatment of Celiac Disease are Important
Unless celiac is treated, it becomes difficult for the digestive system to absorb enough nutrients from food to carry on proper body functions, and resulting vitamin deficiencies can cause a wide range of symptoms, including a condition known as malabsorption. Weight-loss, listlessness, feeling or looking malnourished, are all signs of the nutritional malabsorption associated with untreated celiac disease.
Left untreated, celiac disease can become life-threatening. People can waste away. More likely though are higher instances of certain cancers, particularly of the intestines, and other diseases associated with untreated celiac disease. Thats why its advisable for people with any of these symptoms to check with their doctor to ensure a proper diagnosis, and to have follow up wellness checks.
Even a negative blood test for celiac disease doesnt mean youre fully out of the woods. For a long time, research put the number of celiac patients at around 0.5% of the worlds population, or around 1 in 200 people. Recent studies however, have shown that to be a low estimate, and incidence is more likely around 1% of the population, or 1 in 133 people. Celiac Disease, however, is looking more and more like a very small part of the much larger Gluten sensitive picture.
More ominous still, new evidence shows Non-Celiac Gluten intolerance to be around 30 times more prevalent than celiac disease, and if could affect up to 15% of people worldwide. 1 in 7 people are gluten-sensitive or gluten-intolerant. These people test negative or inconclusive for Celiac Disease, but suffer most of the same symptoms and long-term problems associated with celiac disease when they ingest wheat. This group of people are sometimes referred to as Non-Celiac Gluten Sensitive.
Because the symptoms overlap with many other ailments, Gluten intolerance can easily be missed or misdiagnosed; especially in light of negative blood or biopsy tests--and this may lead many to miss out on discovering the simple and drug-free remedy of a Gluten-free diet for a dramatic recovery. If classic screening techniques for celiac disease do not identify the disease in someone who is in the Non-Celiac Gluten Sensitive category, or if the test results are borderline or inconclusive, often the only other approach to discover the problem is via the Elimination Diet.
Once the cause is understood, and the necessary adjustments are made to the diet, celiac disease and gluten sensitivity are easily treated. A diet free of gluten usually brings both short and long-term improvement. This isnt always quite as easy as it sounds, as so many processed foods contain hidden forms of wheat that are used as binding or flavoring agents.
Once you become aware of damaging foods and avoid them, a gluten-free diet can restore small intestine function within a few weeks to a few months. Once the mucosa of the intestine is no longer inflamed, most absorption issues will usually subside. The inflammation in the intestine will subside as gluten is eliminated.
Echinacea and goldenseal may help to speed this process along. These two immune system boosters are often packaged together in capsule form. You may also find Echinacea and goldenseal in combination with slippery elm, marshmallow, geranium, and other herbs. This combination goes by the generic name of Roberts Formula, and is made by a number of manufacturers. Roberts formula treats the digestive tract by creating a beneficial layer of slime that is healing to digestive tissues. Check your local health food store.
Echinacea and goldenseal are important healers because they have anti-inflammatory and antibacterial properties. One cautionary note, however: Dont take these herbs continuously. Generally, two weeks on and two weeks off for a period of up to two months.
How to Replace Lost Nutrients Caused by Untreated Celiac Disease
At the very least, most celiacs will benefit from a daily multivitamin/mineral supplement that includes calcium, 1,000 milligrams, along with 400 milligrams of magnesium (note that too much magnesium can cause diarrhea). Lack of vitamin B6 is partly to blame for symptoms of celiac disease, Pyridoxal-5-Phosphate (P-5-P) is often a good choice, as it requires no conversion to make vitamin B6, and can be easier on the stomach.
Vitamins can also speed healing. Because the absorption of fats is particularly poor in celiacs, many celiac patients commonly suffer deficiencies of vitamins A, C, D, E, and benefit from taking these in supplemental form, along with a chelated form of zinc supplement. As with any supplement, read the directions and keep your doctor fully informed about what you are taking and how much.
A typical dose, for example, is 1,000 to 2,000 international units (IU) of vitamin A in the form of fish oil (too much can have toxic effects so discuss this with your doctor), 100 to 200 IU of vitamin D also in fish oil, 500 to 1000 milligrams of vitamin C, 100 to 400 IU of vitamin E, and 15 to 30 milligrams of chelated zinc.
Check with your doctor before taking more than 20 milligrams of zinc. Beta-carotene, 10,000 I.U. daily, can also be helpful, as can Iron, 60 mg. daily, if a blood test indicates iron deficiency.
In addition to a good multivitamin/mineral for support, and other vitamins, digestive enzymes, which digest gluten, may also be helpful. To improve nutrient absorption and assimilation, these should be supplemented.
Celiac patients also often suffer a deficiency of vitamin K., which can be supplemented through green foods, especially alfalfa. Green food supplements contain many essential nutrients, including trace minerals. Evening primrose oil is a good source of the omega-6 essential fatty acids that celiac patients often lack.
Silica soothes inflammations in the gastrointestinal tract. It is available in both capsules and gel form.
Medicinal clay is excellent in promoting healing of the walls of the colon and protecting it from irritation by toxins and dry, abrasive matter.
Daily Dosages of Supplements for Celiacs:
* Green food supplements, 1 tbsp.
* Evening primrose oil, two 500 mg capsules three times daily
* Multivitamin supplement, as directed on the label
* Medicinal clay, dissolve 1 tsp. of clay in ½cup of water at room temperature and drink twice daily.
* Papain, 500 mg three times daily
* Pyridoxal-5-Phosphate, 50 mg daily
* Silica, 3-6 capsules; in the gel form, follow the directions on the label
* Vitamin B complex, 50 mg twice daily
* Vitamin B12, 100 mcg
* Vitamin C, with bioflavonoids, 5,000 mg one to three times daily
Herbal Remedies in the Treatment of Celiac Disease
Herbal remedies can help soothe intestinal irritation and inflammation and heal damaged mucous membranes.
* Roberts Formula
* Take 4 drops of agrimony tincture in water, three times daily.
* Sufficient silica in the intestines will reduce inflammation, and strengthen and rebuild connective tissue. Take 3 cups of silica-rich horsetail tea or 15 drops of tincture in liquid three times daily.
* A combination of burdock, slippery elm, sheep sorrel and Turkish rhubarb tea helps different types of inflammations in the gastrointestinal tract.
* Use dandelion, saffron and yellow dock herbal teas to that purify and nourish the blood.
* Pickled ginger can be eaten for anti-inflammation properties.
Thats because people with celiac disease are intolerant of the protein gluten. Gluten is found in wheat, rye, and barley (oats contain a type of gluten that may be safe for most celiacs), and is found in the soft, white inside of the grain, its what makes dough, and flour and water paste, sticky and gooey.
When people with celiac disease eat food made from these grains, even in small amounts, their immune systems seem to treat the gluten as foreign invader, and basically create a massive defensive action against what might be, for most people, part of a good healthy diet. The immune reaction that is triggered by gluten causes inflammation of the intestines, which leads to many problems that are associated with malabsorption, and ultimately to the general gastrointestinal malaise associated with undiagnosed celiac disease, or with gluten contamination in otherwise mindful celiac patients on a gluten-free diet.
Diagnosis and Treatment of Celiac Disease are Important
Unless celiac is treated, it becomes difficult for the digestive system to absorb enough nutrients from food to carry on proper body functions, and resulting vitamin deficiencies can cause a wide range of symptoms, including a condition known as malabsorption. Weight-loss, listlessness, feeling or looking malnourished, are all signs of the nutritional malabsorption associated with untreated celiac disease.
Left untreated, celiac disease can become life-threatening. People can waste away. More likely though are higher instances of certain cancers, particularly of the intestines, and other diseases associated with untreated celiac disease. Thats why its advisable for people with any of these symptoms to check with their doctor to ensure a proper diagnosis, and to have follow up wellness checks.
Even a negative blood test for celiac disease doesnt mean youre fully out of the woods. For a long time, research put the number of celiac patients at around 0.5% of the worlds population, or around 1 in 200 people. Recent studies however, have shown that to be a low estimate, and incidence is more likely around 1% of the population, or 1 in 133 people. Celiac Disease, however, is looking more and more like a very small part of the much larger Gluten sensitive picture.
More ominous still, new evidence shows Non-Celiac Gluten intolerance to be around 30 times more prevalent than celiac disease, and if could affect up to 15% of people worldwide. 1 in 7 people are gluten-sensitive or gluten-intolerant. These people test negative or inconclusive for Celiac Disease, but suffer most of the same symptoms and long-term problems associated with celiac disease when they ingest wheat. This group of people are sometimes referred to as Non-Celiac Gluten Sensitive.
Because the symptoms overlap with many other ailments, Gluten intolerance can easily be missed or misdiagnosed; especially in light of negative blood or biopsy tests--and this may lead many to miss out on discovering the simple and drug-free remedy of a Gluten-free diet for a dramatic recovery. If classic screening techniques for celiac disease do not identify the disease in someone who is in the Non-Celiac Gluten Sensitive category, or if the test results are borderline or inconclusive, often the only other approach to discover the problem is via the Elimination Diet.
Once the cause is understood, and the necessary adjustments are made to the diet, celiac disease and gluten sensitivity are easily treated. A diet free of gluten usually brings both short and long-term improvement. This isnt always quite as easy as it sounds, as so many processed foods contain hidden forms of wheat that are used as binding or flavoring agents.
Once you become aware of damaging foods and avoid them, a gluten-free diet can restore small intestine function within a few weeks to a few months. Once the mucosa of the intestine is no longer inflamed, most absorption issues will usually subside. The inflammation in the intestine will subside as gluten is eliminated.
Echinacea and goldenseal may help to speed this process along. These two immune system boosters are often packaged together in capsule form. You may also find Echinacea and goldenseal in combination with slippery elm, marshmallow, geranium, and other herbs. This combination goes by the generic name of Roberts Formula, and is made by a number of manufacturers. Roberts formula treats the digestive tract by creating a beneficial layer of slime that is healing to digestive tissues. Check your local health food store.
Echinacea and goldenseal are important healers because they have anti-inflammatory and antibacterial properties. One cautionary note, however: Dont take these herbs continuously. Generally, two weeks on and two weeks off for a period of up to two months.
How to Replace Lost Nutrients Caused by Untreated Celiac Disease
At the very least, most celiacs will benefit from a daily multivitamin/mineral supplement that includes calcium, 1,000 milligrams, along with 400 milligrams of magnesium (note that too much magnesium can cause diarrhea). Lack of vitamin B6 is partly to blame for symptoms of celiac disease, Pyridoxal-5-Phosphate (P-5-P) is often a good choice, as it requires no conversion to make vitamin B6, and can be easier on the stomach.
Vitamins can also speed healing. Because the absorption of fats is particularly poor in celiacs, many celiac patients commonly suffer deficiencies of vitamins A, C, D, E, and benefit from taking these in supplemental form, along with a chelated form of zinc supplement. As with any supplement, read the directions and keep your doctor fully informed about what you are taking and how much.
A typical dose, for example, is 1,000 to 2,000 international units (IU) of vitamin A in the form of fish oil (too much can have toxic effects so discuss this with your doctor), 100 to 200 IU of vitamin D also in fish oil, 500 to 1000 milligrams of vitamin C, 100 to 400 IU of vitamin E, and 15 to 30 milligrams of chelated zinc.
Check with your doctor before taking more than 20 milligrams of zinc. Beta-carotene, 10,000 I.U. daily, can also be helpful, as can Iron, 60 mg. daily, if a blood test indicates iron deficiency.
In addition to a good multivitamin/mineral for support, and other vitamins, digestive enzymes, which digest gluten, may also be helpful. To improve nutrient absorption and assimilation, these should be supplemented.
Celiac patients also often suffer a deficiency of vitamin K., which can be supplemented through green foods, especially alfalfa. Green food supplements contain many essential nutrients, including trace minerals. Evening primrose oil is a good source of the omega-6 essential fatty acids that celiac patients often lack.
Silica soothes inflammations in the gastrointestinal tract. It is available in both capsules and gel form.
Medicinal clay is excellent in promoting healing of the walls of the colon and protecting it from irritation by toxins and dry, abrasive matter.
Daily Dosages of Supplements for Celiacs:
* Green food supplements, 1 tbsp.
* Evening primrose oil, two 500 mg capsules three times daily
* Multivitamin supplement, as directed on the label
* Medicinal clay, dissolve 1 tsp. of clay in ½cup of water at room temperature and drink twice daily.
* Papain, 500 mg three times daily
* Pyridoxal-5-Phosphate, 50 mg daily
* Silica, 3-6 capsules; in the gel form, follow the directions on the label
* Vitamin B complex, 50 mg twice daily
* Vitamin B12, 100 mcg
* Vitamin C, with bioflavonoids, 5,000 mg one to three times daily
Herbal Remedies in the Treatment of Celiac Disease
Herbal remedies can help soothe intestinal irritation and inflammation and heal damaged mucous membranes.
* Roberts Formula
* Take 4 drops of agrimony tincture in water, three times daily.
* Sufficient silica in the intestines will reduce inflammation, and strengthen and rebuild connective tissue. Take 3 cups of silica-rich horsetail tea or 15 drops of tincture in liquid three times daily.
* A combination of burdock, slippery elm, sheep sorrel and Turkish rhubarb tea helps different types of inflammations in the gastrointestinal tract.
* Use dandelion, saffron and yellow dock herbal teas to that purify and nourish the blood.
* Pickled ginger can be eaten for anti-inflammation properties.
Celiac Disease From Medical Authorities
Celiac.com 02/26/2007 - Celiac disease is an inherited autoimmune disorder. Even though celiac disease is genetic, and generally runs in families, it can sometimes be triggered by, or become active for the first time after, surgery, pregnancy, childbirth, viral infection, or severe emotional stress.
People with untreated celiac disease typically have abnormally high levels of associated antibodies including anti-gliadin, anti-endomysium and anti-tissue transglutaminase. The presence of these antibodies is caused by an immune system reaction to the presence of gluten in the body.
When people with celiac disease eat foods or use products containing gluten, the response from their immune system damages the tiny, fingerlike protrusions lining the small intestine, called villi. Properly working villi allow nutrients from food to be absorbed into the bloodstream. When villi are damaged, vital nutrients go unabsorbed. In addition to vitamin deficiencies and their associated maladies, left untreated, villi damage can result in full-blown malabsorption, accompanied by nerve damage, wasting, and organ distress and failure.
Until fairly recently doctors believed celiac disease was quite rare, and only affected about 1 in 5,000 people. It was also thought of a disease that mostly affected babies and very young children. Recent studies, however, put the estimate of celiac sufferers at 1 in 133 people in the United States. Most people with celiac disease still dont know that they have it.
More alarmingly, many experts believe that Non-Celiac gluten intolerance could be upwards of 15 times more prevalent than full-blown celiac disease. According to some experts up to 15% of people worldwide—a full 1 in 7—are gluten-sensitive or gluten-intolerant. These people often test negative or inconclusive for Celiac Disease, but can still suffer the same symptoms and long-term problems when they ingest gluten.
Signs and Symptoms of Celiac Disease
Its very important to diagnose both celiac disease and Non-Celiac gluten intolerance early before any serious damage to the intestine occurs. However, both can be difficult to diagnose because their symptoms are easily confused with other intestinal disorders, such as irritable bowel syndrome or lactose intolerance, thus many people may never discover that they have some level of gluten sensitivity.
Some common general symptoms of celiac disease are diarrhea, abdominal pain and bloating, and weight loss. People with the disease may feel overly tired, and they may also be irritable or depressed. Some have skin rashes and mouth sores. Teens with undiagnosed celiac disease may go through puberty late.
Symptoms of Celiac Disease can vary greatly from individual to individual, and even among family members. Symptoms may occur in the digestive system, or in other parts of the body. For example, one person might have diarrhea and abdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the most common symptoms in children.
Obviously, since so much growth and development crucial to human well being takes place in infancy and childhood, and since so much of that development hinges on proper nutritional absorption, any condition which hinders absorption is especially important diagnose and treat in the earliest possible stages.
People with untreated celiac disease typically have abnormally high levels of associated antibodies including anti-gliadin, anti-endomysium and anti-tissue transglutaminase. The presence of these antibodies is caused by an immune system reaction to the presence of gluten in the body.
When people with celiac disease eat foods or use products containing gluten, the response from their immune system damages the tiny, fingerlike protrusions lining the small intestine, called villi. Properly working villi allow nutrients from food to be absorbed into the bloodstream. When villi are damaged, vital nutrients go unabsorbed. In addition to vitamin deficiencies and their associated maladies, left untreated, villi damage can result in full-blown malabsorption, accompanied by nerve damage, wasting, and organ distress and failure.
Until fairly recently doctors believed celiac disease was quite rare, and only affected about 1 in 5,000 people. It was also thought of a disease that mostly affected babies and very young children. Recent studies, however, put the estimate of celiac sufferers at 1 in 133 people in the United States. Most people with celiac disease still dont know that they have it.
More alarmingly, many experts believe that Non-Celiac gluten intolerance could be upwards of 15 times more prevalent than full-blown celiac disease. According to some experts up to 15% of people worldwide—a full 1 in 7—are gluten-sensitive or gluten-intolerant. These people often test negative or inconclusive for Celiac Disease, but can still suffer the same symptoms and long-term problems when they ingest gluten.
Signs and Symptoms of Celiac Disease
Its very important to diagnose both celiac disease and Non-Celiac gluten intolerance early before any serious damage to the intestine occurs. However, both can be difficult to diagnose because their symptoms are easily confused with other intestinal disorders, such as irritable bowel syndrome or lactose intolerance, thus many people may never discover that they have some level of gluten sensitivity.
Some common general symptoms of celiac disease are diarrhea, abdominal pain and bloating, and weight loss. People with the disease may feel overly tired, and they may also be irritable or depressed. Some have skin rashes and mouth sores. Teens with undiagnosed celiac disease may go through puberty late.
Symptoms of Celiac Disease can vary greatly from individual to individual, and even among family members. Symptoms may occur in the digestive system, or in other parts of the body. For example, one person might have diarrhea and abdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the most common symptoms in children.
Obviously, since so much growth and development crucial to human well being takes place in infancy and childhood, and since so much of that development hinges on proper nutritional absorption, any condition which hinders absorption is especially important diagnose and treat in the earliest possible stages.
Celiac Disease From Medical Authorities
Celiac.com 02/26/2007 - Celiac disease is an inherited autoimmune disorder. Even though celiac disease is genetic, and generally runs in families, it can sometimes be triggered by, or become active for the first time after, surgery, pregnancy, childbirth, viral infection, or severe emotional stress.
People with untreated celiac disease typically have abnormally high levels of associated antibodies including anti-gliadin, anti-endomysium and anti-tissue transglutaminase. The presence of these antibodies is caused by an immune system reaction to the presence of gluten in the body.
When people with celiac disease eat foods or use products containing gluten, the response from their immune system damages the tiny, fingerlike protrusions lining the small intestine, called villi. Properly working villi allow nutrients from food to be absorbed into the bloodstream. When villi are damaged, vital nutrients go unabsorbed. In addition to vitamin deficiencies and their associated maladies, left untreated, villi damage can result in full-blown malabsorption, accompanied by nerve damage, wasting, and organ distress and failure.
Until fairly recently doctors believed celiac disease was quite rare, and only affected about 1 in 5,000 people. It was also thought of a disease that mostly affected babies and very young children. Recent studies, however, put the estimate of celiac sufferers at 1 in 133 people in the United States. Most people with celiac disease still dont know that they have it.
More alarmingly, many experts believe that Non-Celiac gluten intolerance could be upwards of 15 times more prevalent than full-blown celiac disease. According to some experts up to 15% of people worldwide—a full 1 in 7—are gluten-sensitive or gluten-intolerant. These people often test negative or inconclusive for Celiac Disease, but can still suffer the same symptoms and long-term problems when they ingest gluten.
Signs and Symptoms of Celiac Disease
Its very important to diagnose both celiac disease and Non-Celiac gluten intolerance early before any serious damage to the intestine occurs. However, both can be difficult to diagnose because their symptoms are easily confused with other intestinal disorders, such as irritable bowel syndrome or lactose intolerance, thus many people may never discover that they have some level of gluten sensitivity.
Some common general symptoms of celiac disease are diarrhea, abdominal pain and bloating, and weight loss. People with the disease may feel overly tired, and they may also be irritable or depressed. Some have skin rashes and mouth sores. Teens with undiagnosed celiac disease may go through puberty late.
Symptoms of Celiac Disease can vary greatly from individual to individual, and even among family members. Symptoms may occur in the digestive system, or in other parts of the body. For example, one person might have diarrhea and abdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the most common symptoms in children.
Obviously, since so much growth and development crucial to human well being takes place in infancy and childhood, and since so much of that development hinges on proper nutritional absorption, any condition which hinders absorption is especially important diagnose and treat in the earliest possible stages.
People with untreated celiac disease typically have abnormally high levels of associated antibodies including anti-gliadin, anti-endomysium and anti-tissue transglutaminase. The presence of these antibodies is caused by an immune system reaction to the presence of gluten in the body.
When people with celiac disease eat foods or use products containing gluten, the response from their immune system damages the tiny, fingerlike protrusions lining the small intestine, called villi. Properly working villi allow nutrients from food to be absorbed into the bloodstream. When villi are damaged, vital nutrients go unabsorbed. In addition to vitamin deficiencies and their associated maladies, left untreated, villi damage can result in full-blown malabsorption, accompanied by nerve damage, wasting, and organ distress and failure.
Until fairly recently doctors believed celiac disease was quite rare, and only affected about 1 in 5,000 people. It was also thought of a disease that mostly affected babies and very young children. Recent studies, however, put the estimate of celiac sufferers at 1 in 133 people in the United States. Most people with celiac disease still dont know that they have it.
More alarmingly, many experts believe that Non-Celiac gluten intolerance could be upwards of 15 times more prevalent than full-blown celiac disease. According to some experts up to 15% of people worldwide—a full 1 in 7—are gluten-sensitive or gluten-intolerant. These people often test negative or inconclusive for Celiac Disease, but can still suffer the same symptoms and long-term problems when they ingest gluten.
Signs and Symptoms of Celiac Disease
Its very important to diagnose both celiac disease and Non-Celiac gluten intolerance early before any serious damage to the intestine occurs. However, both can be difficult to diagnose because their symptoms are easily confused with other intestinal disorders, such as irritable bowel syndrome or lactose intolerance, thus many people may never discover that they have some level of gluten sensitivity.
Some common general symptoms of celiac disease are diarrhea, abdominal pain and bloating, and weight loss. People with the disease may feel overly tired, and they may also be irritable or depressed. Some have skin rashes and mouth sores. Teens with undiagnosed celiac disease may go through puberty late.
Symptoms of Celiac Disease can vary greatly from individual to individual, and even among family members. Symptoms may occur in the digestive system, or in other parts of the body. For example, one person might have diarrhea and abdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the most common symptoms in children.
Obviously, since so much growth and development crucial to human well being takes place in infancy and childhood, and since so much of that development hinges on proper nutritional absorption, any condition which hinders absorption is especially important diagnose and treat in the earliest possible stages.
Celiac Disease Practice Guidelines
Celiac.com 02/27/2007 - Celiac disease is an inherited autoimmune enteropathy caused by an adverse reaction to gluten in people who are genetically susceptible. Symptomatic celiac disease usually occurs in children and adolescents, who generally present gastrointestinal and other symptoms including: Abdominal cramps; gas and bloating; diarrhea; fatigue or general weakness; foul-smelling or grayish stools that are often fatty or oily; osteoporosis; stunted growth in children; weight loss.
Celiac disease can also occur in asymptomatic individuals who have associated conditions. Recent studies show the prevalence of celiac in children under 15 years in the general population is 3 to 13 per 1,000 children, or approximately 1:300 to 1:80 children. A figure of 1 in 133 people is commonly used as an average for rates of celiac disease in the general population.
Diagnosis of Celiac Disease
Celiac disease can be challenging to diagnose, because its symptoms are often similar to those of other diseases. Celiac disease is easily taken for other diseases such as Crohns disease, chronic fatigue syndrome, diverticulitis, various intestinal infections, irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss. Thus, celiac disease is often misdiagnosed, and generally under-diagnosed.
Celiac practice guidelines call for routine screening of anyone with a family history of celiac disease or of disorders such as thyroid disease, anemia of unknown cause, type I diabetes or other immune disorders or Downs syndrome. Otherwise, patients are generally screened case by case according to individual symptoms.
Likely Signs of Celiac Disease
As a general practice, celiac disease should be considered in the earliest stages of differential diagnosis of children with persistent diarrhea, especially with failure to thrive.
Celiac disease should also be considered in the differential diagnosis of children with persistent GI symptoms, including recurrent abdominal pain, constipation and vomiting, and any other GI issues commonly associated with celiac disease.
Testing is recommended for children with celiac-associated non-gastrointestinal symptoms, such as delayed puberty, dental enamel hypoplasia of permanent teeth, dermatitis herpetiformis, iron-deficient anemia resistant to oral iron, osteoporosis, and short stature.
Testing is also recommended for asymptomatic children whose relatives have celiac, and those who have celiac-associated conditions, such as autoimmune thyroiditis, Down syndrome, selective IgA deficiency, Turner syndrome, type 1 diabetes mellitus, or Williams syndrome.
Celiac practice guidelines call for testing asymptomatic children who belong to at-risk groups at around three years of age, as long as they have eaten gluten regularly for at least one year before testing.
Therefore, guidelines call for testing asymptomatic individuals with negative serological tests, and who belong to at-risk groups at regular intervals. Treatment guidelines do not presently call for routinely testing autistic children for celiac disease, as there is currently no peer reviewed scientific evidence that celiac disease is more common in autistic children than in the general population (although more research needs to be done in this area because many parents report a vast improvement in their childrens symptoms by eliminating gluten and casein from their diets).
Testing for Celiac Disease
A blood test, such as anti-tissue transglutaminase and anti-endomysial antibodies, can detect abnormally high antibody levels, and is often used to screen people who are most likely to have the disease, and for those who may need further testing.
Based on the current evidence and practical considerations, including accuracy, reliability, and cost, measurement of IgA antibody to human recombinant tissue transglutaminase (TTG) is recommended for initial testing for celiac disease. Although it is nearly as accurate as TTG, measurement of IgA antibody to endomysium (EMA) is observer dependent and therefore more subject to interpretation error and added cost. Because of the inferior accuracy of the antigliadin antibody tests (AGA), the use of AGA IgA and AGA IgG tests is no longer recommended for detecting celiac disease.
More than 90% of patients with celiac disease have genetic markers HLA DQalpha *0501, and HLA DQbeta *0201. Negative tests for these markers in conjunction with negative serum antibody tests suggest an absence of celiac disease. However, positive tests for the genetic markers do not necessarily mean that the patient has celiac disease. In conclusion, genetic markers can generally be used as a test to exclude celiac disease as a diagnosis, although there have been reported cases of the disease absent these markers--it is a scenario that is rare.
Celiac Disease biopsy
To confirm a diagnosis of celiac disease, your doctor may need to do a biopsy, that is, microscopically examine a small portion of intestinal tissue, looking for celiac associated damage to the small intestine. To do this, your doctor inserts a thin, flexible tube (endoscope) through your mouth, esophagus and stomach into your small intestine and takes a sample of intestinal tissue to look for damage to the villi (tiny, hair-like projections in the walls the small intestine that absorb vitamins, minerals and other nutrients).
Practice Guidelines for Treatment of Celiac Disease with an Aggressive Life-long Gluten-free Diet
As there is presently no cure for celiac disease, avoiding gluten is crucial. Practice guidelines call for a life-long diet free of gluten as the standard treatment for celiac disease. To manage the disease and prevent complications, its essential that patients avoid all foods that contain gluten. That means it is crucial for the patient to avoid all foods made with wheat, rye, or barley. This includes types of wheat like durum, farina, graham flour, and semolina. Also, bulgur, kamut, kasha, matzo meal, spelt and triticale. Examples of products that commonly contain these include breads, breading, batter, cereals, cooking and baking mixes, pasta, crackers, cookies, cakes, pies and gravies, among others.
It is also good practice in treating celiac disease for patients to avoid oats, at least during initial treatment stages, as the effects of oats on celiac patients are not fully understood, and contamination with wheat in processing is common. So, its a good practice when first adopting a gluten-free diet to eliminate oats, at least until symptoms subside, and their reintroduction into the diet can be fairly monitored and evaluated.
Another good practice is coaching celiac patients to avoid processed foods that may contain hidden gluten. Wheat flour is commonly used in many processed foods that one might never suspect. A few examples include candy bars, canned soup, canned meat, energy bars, ketchup, ice cream, instant coffee, lunch meat, mustard, pastas, processed meat and sausages.
Also, gluten is also commonly found in many vitamins and cosmetics, such as lipstick, and in the production of many capsules and tablets, where wheat starch is a commonly used binding agent. Obviously, patients must avoid beer (most is made using barely, although there are gluten-free beers on the market), though wine, brandy, whiskey and other distilled and non-wheat or non-barley alcohols are okay.
Celiac patients are encouraged to eat a diet rich in fish, fresh meats, rice, corn, soybean, potato, poultry, fruits and vegetables. Initially celiac patients should also avoid milk and other dairy products, as it is common for patients with celiac disease to be lactose intolerant. Dairy products can often be slowly reintroduced into the diet over time with successful treatment.
It is also important for patients to learn to identify gluten-free foods. Because a gluten-free diet needs to be strictly followed, and because food ingredients may vary from place to place and even over time for a given product, it is important to always read ingredient labels.
For lists of gluten-free foods and products, and for specific advice on adopting, shaping and maintaining the gluten-free diet that is right for them, patients may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet, or purchase a commercial gluten-free product listing.
Most patients who remove gluten from their diets find that their symptoms improve as inflammation of the small intestine begins to subside, usually within several weeks to several months. Many patients who adopt a gluten-free diet report an improvement within 48 hours. Results of a gluten-free diet can be especially dramatic in children with celiac disease. Not only does their diarrhea and abdominal distress usually subside but, frequently, their behavior and growth rate are often markedly improved.
A reappearance of intestinal villi nearly always follows an improvement in symptoms. In younger people, the villi may complete healing and re-growth in several months, while in older people, the process may take as long as two to three years.
In cases where nutritional deficiencies are severe, celiac patients may require vitamin and mineral supplements to help bring about a healthier vitamin profile: folic acid and B12 for patients with anemia due to folate or B12 deficiency; vitamin K for patients with an abnormal ProTime; calcium and vitamin D supplements for patients with low blood calcium levels or with osteoporosis. For all such cases, individuals should consult their health professional.
Skin lesions common in patients with dermatitis herpetiformis often improve with adherence to a gluten-free diet.
The Importance of Follow-up Testing for Celiac Patients on a Gluten-free Diet
Research indicates that only half of those patients who have had celiac disease for at least 20 years were following a strict gluten-free diet. Up to 30% of those patients showed evidence of bone loss and iron deficiency. These are but a few of the long-term consequences for celiac patients failing to follow a gluten-free diet.
Thus, it is important to conduct follow-up testing of celiac patients to determine the success of their gluten-free diets, and the progress of their treatment, and to make any necessary adjustments to each.
Even done properly, with no accidental consumption of gluten, the elimination of gluten antibodies from the blood takes months. To estimate the treatments effectiveness, current guidelines call for a single serological testing after 3-6 months on a gluten-free diet. In addition many doctors recommend an annual serological screening and biopsy to make certain that the disease is properly controlled.
For patients who are free of antibodies, and actively following a gluten-free diet, it is wise to consult a doctor if there is any recurrence of celiac-associated symptoms. First degree relatives of celiac patients should have a repeat blood test every 2-3 years.
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
Celiac disease can also occur in asymptomatic individuals who have associated conditions. Recent studies show the prevalence of celiac in children under 15 years in the general population is 3 to 13 per 1,000 children, or approximately 1:300 to 1:80 children. A figure of 1 in 133 people is commonly used as an average for rates of celiac disease in the general population.
Diagnosis of Celiac Disease
Celiac disease can be challenging to diagnose, because its symptoms are often similar to those of other diseases. Celiac disease is easily taken for other diseases such as Crohns disease, chronic fatigue syndrome, diverticulitis, various intestinal infections, irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss. Thus, celiac disease is often misdiagnosed, and generally under-diagnosed.
Celiac practice guidelines call for routine screening of anyone with a family history of celiac disease or of disorders such as thyroid disease, anemia of unknown cause, type I diabetes or other immune disorders or Downs syndrome. Otherwise, patients are generally screened case by case according to individual symptoms.
Likely Signs of Celiac Disease
As a general practice, celiac disease should be considered in the earliest stages of differential diagnosis of children with persistent diarrhea, especially with failure to thrive.
Celiac disease should also be considered in the differential diagnosis of children with persistent GI symptoms, including recurrent abdominal pain, constipation and vomiting, and any other GI issues commonly associated with celiac disease.
Testing is recommended for children with celiac-associated non-gastrointestinal symptoms, such as delayed puberty, dental enamel hypoplasia of permanent teeth, dermatitis herpetiformis, iron-deficient anemia resistant to oral iron, osteoporosis, and short stature.
Testing is also recommended for asymptomatic children whose relatives have celiac, and those who have celiac-associated conditions, such as autoimmune thyroiditis, Down syndrome, selective IgA deficiency, Turner syndrome, type 1 diabetes mellitus, or Williams syndrome.
Celiac practice guidelines call for testing asymptomatic children who belong to at-risk groups at around three years of age, as long as they have eaten gluten regularly for at least one year before testing.
Therefore, guidelines call for testing asymptomatic individuals with negative serological tests, and who belong to at-risk groups at regular intervals. Treatment guidelines do not presently call for routinely testing autistic children for celiac disease, as there is currently no peer reviewed scientific evidence that celiac disease is more common in autistic children than in the general population (although more research needs to be done in this area because many parents report a vast improvement in their childrens symptoms by eliminating gluten and casein from their diets).
Testing for Celiac Disease
A blood test, such as anti-tissue transglutaminase and anti-endomysial antibodies, can detect abnormally high antibody levels, and is often used to screen people who are most likely to have the disease, and for those who may need further testing.
Based on the current evidence and practical considerations, including accuracy, reliability, and cost, measurement of IgA antibody to human recombinant tissue transglutaminase (TTG) is recommended for initial testing for celiac disease. Although it is nearly as accurate as TTG, measurement of IgA antibody to endomysium (EMA) is observer dependent and therefore more subject to interpretation error and added cost. Because of the inferior accuracy of the antigliadin antibody tests (AGA), the use of AGA IgA and AGA IgG tests is no longer recommended for detecting celiac disease.
More than 90% of patients with celiac disease have genetic markers HLA DQalpha *0501, and HLA DQbeta *0201. Negative tests for these markers in conjunction with negative serum antibody tests suggest an absence of celiac disease. However, positive tests for the genetic markers do not necessarily mean that the patient has celiac disease. In conclusion, genetic markers can generally be used as a test to exclude celiac disease as a diagnosis, although there have been reported cases of the disease absent these markers--it is a scenario that is rare.
Celiac Disease biopsy
To confirm a diagnosis of celiac disease, your doctor may need to do a biopsy, that is, microscopically examine a small portion of intestinal tissue, looking for celiac associated damage to the small intestine. To do this, your doctor inserts a thin, flexible tube (endoscope) through your mouth, esophagus and stomach into your small intestine and takes a sample of intestinal tissue to look for damage to the villi (tiny, hair-like projections in the walls the small intestine that absorb vitamins, minerals and other nutrients).
Practice Guidelines for Treatment of Celiac Disease with an Aggressive Life-long Gluten-free Diet
As there is presently no cure for celiac disease, avoiding gluten is crucial. Practice guidelines call for a life-long diet free of gluten as the standard treatment for celiac disease. To manage the disease and prevent complications, its essential that patients avoid all foods that contain gluten. That means it is crucial for the patient to avoid all foods made with wheat, rye, or barley. This includes types of wheat like durum, farina, graham flour, and semolina. Also, bulgur, kamut, kasha, matzo meal, spelt and triticale. Examples of products that commonly contain these include breads, breading, batter, cereals, cooking and baking mixes, pasta, crackers, cookies, cakes, pies and gravies, among others.
It is also good practice in treating celiac disease for patients to avoid oats, at least during initial treatment stages, as the effects of oats on celiac patients are not fully understood, and contamination with wheat in processing is common. So, its a good practice when first adopting a gluten-free diet to eliminate oats, at least until symptoms subside, and their reintroduction into the diet can be fairly monitored and evaluated.
Another good practice is coaching celiac patients to avoid processed foods that may contain hidden gluten. Wheat flour is commonly used in many processed foods that one might never suspect. A few examples include candy bars, canned soup, canned meat, energy bars, ketchup, ice cream, instant coffee, lunch meat, mustard, pastas, processed meat and sausages.
Also, gluten is also commonly found in many vitamins and cosmetics, such as lipstick, and in the production of many capsules and tablets, where wheat starch is a commonly used binding agent. Obviously, patients must avoid beer (most is made using barely, although there are gluten-free beers on the market), though wine, brandy, whiskey and other distilled and non-wheat or non-barley alcohols are okay.
Celiac patients are encouraged to eat a diet rich in fish, fresh meats, rice, corn, soybean, potato, poultry, fruits and vegetables. Initially celiac patients should also avoid milk and other dairy products, as it is common for patients with celiac disease to be lactose intolerant. Dairy products can often be slowly reintroduced into the diet over time with successful treatment.
It is also important for patients to learn to identify gluten-free foods. Because a gluten-free diet needs to be strictly followed, and because food ingredients may vary from place to place and even over time for a given product, it is important to always read ingredient labels.
For lists of gluten-free foods and products, and for specific advice on adopting, shaping and maintaining the gluten-free diet that is right for them, patients may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet, or purchase a commercial gluten-free product listing.
Most patients who remove gluten from their diets find that their symptoms improve as inflammation of the small intestine begins to subside, usually within several weeks to several months. Many patients who adopt a gluten-free diet report an improvement within 48 hours. Results of a gluten-free diet can be especially dramatic in children with celiac disease. Not only does their diarrhea and abdominal distress usually subside but, frequently, their behavior and growth rate are often markedly improved.
A reappearance of intestinal villi nearly always follows an improvement in symptoms. In younger people, the villi may complete healing and re-growth in several months, while in older people, the process may take as long as two to three years.
In cases where nutritional deficiencies are severe, celiac patients may require vitamin and mineral supplements to help bring about a healthier vitamin profile: folic acid and B12 for patients with anemia due to folate or B12 deficiency; vitamin K for patients with an abnormal ProTime; calcium and vitamin D supplements for patients with low blood calcium levels or with osteoporosis. For all such cases, individuals should consult their health professional.
Skin lesions common in patients with dermatitis herpetiformis often improve with adherence to a gluten-free diet.
The Importance of Follow-up Testing for Celiac Patients on a Gluten-free Diet
Research indicates that only half of those patients who have had celiac disease for at least 20 years were following a strict gluten-free diet. Up to 30% of those patients showed evidence of bone loss and iron deficiency. These are but a few of the long-term consequences for celiac patients failing to follow a gluten-free diet.
Thus, it is important to conduct follow-up testing of celiac patients to determine the success of their gluten-free diets, and the progress of their treatment, and to make any necessary adjustments to each.
Even done properly, with no accidental consumption of gluten, the elimination of gluten antibodies from the blood takes months. To estimate the treatments effectiveness, current guidelines call for a single serological testing after 3-6 months on a gluten-free diet. In addition many doctors recommend an annual serological screening and biopsy to make certain that the disease is properly controlled.
For patients who are free of antibodies, and actively following a gluten-free diet, it is wise to consult a doctor if there is any recurrence of celiac-associated symptoms. First degree relatives of celiac patients should have a repeat blood test every 2-3 years.
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
Celiac.com 04/24/2008 - Genetic tests for celiac disease and gluten sensitivity are readily available. Testing can be performed on either blood and mo
Celiac.com 03/21/2007 - Celiac disease is an inherited autoimmune disorder marked by an inflammatory condition in the small intestine that triggers when genetically susceptible individuals consume wheat. Symptoms of celiac most commonly begin around age two, after wheat has been introduced into the diet, or in the third and fourth decades of adult life.
In genetically susceptible people, the ingestion of wheat gluten protein triggers an inflammatory reaction in the small bowel that causes a collapse of the villi, the small finger-like projections responsible for nutrient absorption. This greatly reduces the amount of surface area available for nutrient, fluid and electrolyte absorption. The extent of this intestinal damage generally correlates to the severity of the symptoms.
Celiac generally presents gastrointestinal and other symptoms including: abdominal cramps; gas and bloating; diarrhea; fatigue or general weakness; foul-smelling or grayish stools that are often fatty or oily; osteoporosis; stunted growth in children; weight loss, however many individuals have little or no symptoms at all.
Celiac disease can also occur in asymptomatic individuals who have associated conditions. Recent studies show the prevalence of celiac in children under 15 years in the general population to be 3 to 13 per 1,000 children, or approximately 1:300 to 1:80 children. A figure of 1 in 133 people is commonly used as an average for rates of celiac disease in the general population.
Celiac Disease Diagnosis
Celiac disease can be challenging to diagnose, because its symptoms are often similar to those of other diseases. Celiac disease is easily taken for other diseases such as Crohns disease, chronic fatigue syndrome, diverticulitis, various intestinal infections, irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss. Thus, celiac disease is often misdiagnosed, and greatly under-diagnosed.
Celiac practice guidelines call for routine screening of anyone with a family history of celiac disease or of disorders such as thyroid disease, anemia of unknown cause, type 1 diabetes or other immune disorders or Downs syndrome. Otherwise, patients are generally screened case by case according to individual symptoms.
Considerations for Celiac Disease
As a general practice, celiac disease should be considered in the earliest stages of differential diagnosis of children with persistent diarrhea, especially with failure to thrive. Celiac disease should also be considered in the differential diagnosis of children with persistent GI symptoms, including recurrent abdominal pain, constipation and vomiting, and any other GI issues commonly associated with celiac disease.
Testing is recommended for children with celiac-associated non-gastrointestinal symptoms, such as delayed puberty, dental enamel hypoplasia of permanent teeth, dermatitis herpetiformis, iron-deficient anemia resistant to oral iron, osteoporosis, and short stature. Testing is also recommended for asymptomatic children whose relatives have celiac, and those who have celiac-associated conditions, such as autoimmune thyroiditis, Down syndrome, selective IgA deficiency, Turner syndrome, type 1 diabetes mellitus, or Williams syndrome.
Celiac practice guidelines call for testing asymptomatic children who belong to at-risk groups at around 3 years of age, as long as they have eaten gluten regularly for at least 1 year before testing.
First-degree relatives of individuals with celiac disease may or may not manifest symptoms of the disease.
Predisposition to gluten sensitivity has been mapped to the major histocompatibility (MHC) D region on chromosome 6. The most important HLA haplotype is DQw2, which is often in linkage with DR3. Other important HLA haplotypes identified are DR7 and DPB 1, 3, 4.1 and 4.2.
The sites on these MHC class 2 expressed proteins responsible for interacting with gliadin and host T cell receptors thereby sensitizing the intestine to gluten have not been identified.
Therefore, guidelines call for regular testing of asymptomatic individuals with negative serological tests, and who belong to at-risk groups. Treatment guidelines do not presently call for routinely testing autistic children for celiac disease, as there is no evidence that celiac is more in autistic children than in the general population.
Celiac Disease Testing
There is currently no test for diagnosing celiac disease with 100% certainty. For most people, the disappearance of symptoms, and/or the appearance of a "normal" biopsy following the adoption of a gluten-free diet provide the strongest evidence for celiac disease or gluten intolerance.
A blood test, such as anti-tissue transglutaminase and anti-endomysial antibodies, can detect abnormally levels of antibodies, and is often used in the initial detection of celiac in people who are most likely to have the disease, and for those who may need further testing.
Based on the current evidence and practical considerations, including accuracy, reliability, and cost, measurement of IgA antibody to human recombinant tissue transglutaminase (TTG) is recommended for initial testing for CD. Although as accurate as TTG, measurement of IgA antibody to endomysium (EMA) is observer dependent and therefore more subject to interpretation error and added cost. Because of the inferior accuracy of the antigliadin antibody tests (AGA), the use of AGA IgA and AGA IgG tests alone is no longer recommended for detecting CD.
Several serological markers are useful in diagnosing celiac disease. The first of these is IgG class antigliadin antibody (AGA). This antibody is sensitive to gluten, but it is also found in other diseases and thus is not a good a specific indicator of celiac.
Generally, IgA class AGA is more specific, but about 2% of celiac patients show selective IgA deficiency, and thus show negative results, even though they have celiac.
A positive IgG and IgA AGA gives a reported sensitivity of 96% to100% and specificity of 96% to 97%. Recent studies show Anti-reticulin antibodies (ARA) in people with celiac disease, but these appear to be nonspecific. In fact, taken alone, IgG ARA is largely ineffective. However, IgA ARA has sensitivity of 97% and a specificity of 98% in adults. These figures are much lower in children.
IgA class anti-endomysial antibody (EMA) and human jejunal antibody (JAB) have recently been identified as both sensitive and specific for celiac disease.
The antibody EMA, which reacts against endomysium reticulin fibers, has been found only in people with active celiac and not other diseases. As EMAs are associated with other diseases in children, they are a less accurate indicator of celiac in children than in adults.
Studies in children less than 2 years old with celiac disease have shown a steep fall in EMA sensitivity, so EMA appears even less useful than in children over 2 years of age.
Finally, since the EMA and JAB antibody tests may be negative in adults with celiac disease and IgA deficiency, they cannot be considered definitive for diagnosis of celiac disease.
A complete panel of antibody tests seems to be most accurate method of diagnosing celiac disease.
Taken together, a positive panel of IgG AGA, IgA AGA and EMA can predict the presence of celiac disease in 99.3% of patients. A negative panel of IgG AGA, IgA AGA and EMA can predict the absence of celiac in 99.6% of patients.
These antibodies tend to diminish or disappear when individuals maintain a gluten-free diet.
More than 90% of patients with celiac disease have genetic markers HLA DQalpha *0501, and HLA DQbeta *0201. Negative tests for these markers in conjunction with negative serum antibody tests suggest an absence of celiac disease. However, positive tests for the genetic markers do not necessarily mean that the patient has celiac disease. In conclusion, genetic markers can be used as a test to exclude celiac disease as a diagnosis.
Celiac Disease Biopsy
A diagnosis of celiac disease is generally confirmed through a biopsy, by looking for celiac associated damage to the small intestine.
One important fact is that intestinal biopsies are regularly obtained endoscopically from the duodenum and therefore provide no information regarding the extent of disease along the jejunum.
Flattening of the villi usually occurs first, and most severely, in the duodenum, as it the duodenum is the first part of the intestine to be exposed to gluten. Conversely, the villi of the jejunum, which receives much less exposure, are often asymptomatic, and nearly normal.
In most of these individuals, treatment with a gluten-free diet results in the return of all villous and crypt structures to normal or near normal.
Certain conditions, especially infection, can yield intestinal biopsy results that are similar to those of celiac disease, and it is important to consider and/or exclude these conditions when celiac disease is suspected.
Practice Guidelines for Treatment of Celiac Disease with an Aggressive Life-long Gluten-free Diet
As there is presently no cure for celiac disease, avoiding gluten is crucial. Practice guidelines call for a life-long gluten-free diet as the standard treatment for celiac disease. To manage the disease and prevent complications, its essential that patients avoid all foods that contain gluten. That means it is crucial for the patient to avoid all foods made with wheat, rye, or barley. This includes types of wheat like durum, farina, graham flour, and semolina. Also, bulgur, kamut, kasha, matzo meal, spelt and triticale. Examples of products that commonly contain these include breads, breading, batter, cereals, cooking and baking mixes, pasta, crackers, cookies, cakes, pies and gravies, among others.
It is also good practice for patients to avoid oats, at least during initial treatment stages, as the effects of oats on celiac patients are not fully understood, and contamination with wheat in processing is common. So, its a good practice when first adopting a gluten-free diet to eliminate oats, at least until symptoms subside, and their reintroduction into the diet can be fairly monitored and evaluated.
Another good practice is coaching celiac patients to avoid processed foods that may contain hidden gluten. Wheat flour is commonly used in many processed foods that one might never suspect. A few examples include candy bars, canned soup, canned meat, energy bars, ketchup, ice cream, instant coffee, lunchmeat, mustard, pastas, processed meat, sausages, and yogurt.
Also, gluten is also commonly found in many vitamins and cosmetics, such as lipstick, and in the production of many capsules and tablets, where wheat starch is a commonly used binding agent.
Obviously, patients must avoid beer made with barley or wheat (there are gluten-free beers), though wine, brandy, whiskey and other non-wheat or non-barley alcohols are okay.
Encourage patients to eat a diet rich in fish, fresh meats, rice, corn, soybean, potato, poultry, fruits and vegetables. Patients should also avoid milk and other dairy products, as it is common for patients with celiac disease to be lactose intolerant. Dairy products can often be slowly reintroduced into the diet over time with successful treatment.
It is also important for patients to learn to identify gluten-free foods. Because a gluten-free diet needs to be strictly followed, and because food ingredients may vary from place to place and even over time for a given product, it is important to always read the label.
For lists of gluten-free foods and products, and for specific advice on adopting, shaping and maintaining the gluten-free diet that is right for them, patients may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet.
Most patients who remove gluten from their diets find that their symptoms improve as inflammation of the small intestine begins to subside, usually within several weeks. Many patients who adopt a gluten-free diet report an improvement within 48 hours.
Results of a gluten-free diet can be especially dramatic in children with celiac disease. Not only does their diarrhea and abdominal distress usually subside but, frequently, their behavior and growth rate are often markedly improved.
A reappearance of intestinal villi nearly always follows an improvement in symptoms.
In younger people, the villi may complete healing and re-growth in several months, while in older people, the process may take as long as two to three years.
In cases where nutritional deficiencies are severe, celiac patients may require vitamin and mineral supplements to help bring about a healthier vitamin profile: folic acid and B12 for patients with anemia due to folate or B12 deficiency; vitamin K for patients with an abnormal ProTime; calcium and vitamin D supplements for patients with low blood calcium levels or with osteoporosis. For all such cases, individuals should consult their health professional.
Skin lesions common in patients with dermatitis herpetiformis often improve with adherence to a gluten-free diet.
The Importance of Follow-up Testing for Celiac Patients on a Gluten-free Diet
Research indicates that only half of those patients who have had celiac disease for at least 20 years were following a strict gluten-free diet. Up to 30% of those patients showed evidence of bone loss and iron deficiency. These are but a few of the long-term consequences for celiac patients failing to follow a gluten-free diet.
Thus, it is important to conduct follow-up testing of celiac patients to determine the success of their gluten-free diets, and the progress of their treatment, and to make any necessary adjustments to each. Even done properly, with no accidental consumption of gluten, the elimination of gluten antibodies from the blood takes months. To estimate the treatments effectiveness, current guidelines call for a single serological testing after 3-6 months on a gluten-free diet.
For patients who are free of antibodies, and actively following a gluten-free diet, it is wise to consult a doctor if there is any recurrence of celiac-associated symptoms. First-degree relatives of celiac patients should have a repeat blood test every 2-3 years.
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
In genetically susceptible people, the ingestion of wheat gluten protein triggers an inflammatory reaction in the small bowel that causes a collapse of the villi, the small finger-like projections responsible for nutrient absorption. This greatly reduces the amount of surface area available for nutrient, fluid and electrolyte absorption. The extent of this intestinal damage generally correlates to the severity of the symptoms.
Celiac generally presents gastrointestinal and other symptoms including: abdominal cramps; gas and bloating; diarrhea; fatigue or general weakness; foul-smelling or grayish stools that are often fatty or oily; osteoporosis; stunted growth in children; weight loss, however many individuals have little or no symptoms at all.
Celiac disease can also occur in asymptomatic individuals who have associated conditions. Recent studies show the prevalence of celiac in children under 15 years in the general population to be 3 to 13 per 1,000 children, or approximately 1:300 to 1:80 children. A figure of 1 in 133 people is commonly used as an average for rates of celiac disease in the general population.
Celiac Disease Diagnosis
Celiac disease can be challenging to diagnose, because its symptoms are often similar to those of other diseases. Celiac disease is easily taken for other diseases such as Crohns disease, chronic fatigue syndrome, diverticulitis, various intestinal infections, irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss. Thus, celiac disease is often misdiagnosed, and greatly under-diagnosed.
Celiac practice guidelines call for routine screening of anyone with a family history of celiac disease or of disorders such as thyroid disease, anemia of unknown cause, type 1 diabetes or other immune disorders or Downs syndrome. Otherwise, patients are generally screened case by case according to individual symptoms.
Considerations for Celiac Disease
As a general practice, celiac disease should be considered in the earliest stages of differential diagnosis of children with persistent diarrhea, especially with failure to thrive. Celiac disease should also be considered in the differential diagnosis of children with persistent GI symptoms, including recurrent abdominal pain, constipation and vomiting, and any other GI issues commonly associated with celiac disease.
Testing is recommended for children with celiac-associated non-gastrointestinal symptoms, such as delayed puberty, dental enamel hypoplasia of permanent teeth, dermatitis herpetiformis, iron-deficient anemia resistant to oral iron, osteoporosis, and short stature. Testing is also recommended for asymptomatic children whose relatives have celiac, and those who have celiac-associated conditions, such as autoimmune thyroiditis, Down syndrome, selective IgA deficiency, Turner syndrome, type 1 diabetes mellitus, or Williams syndrome.
Celiac practice guidelines call for testing asymptomatic children who belong to at-risk groups at around 3 years of age, as long as they have eaten gluten regularly for at least 1 year before testing.
First-degree relatives of individuals with celiac disease may or may not manifest symptoms of the disease.
Predisposition to gluten sensitivity has been mapped to the major histocompatibility (MHC) D region on chromosome 6. The most important HLA haplotype is DQw2, which is often in linkage with DR3. Other important HLA haplotypes identified are DR7 and DPB 1, 3, 4.1 and 4.2.
The sites on these MHC class 2 expressed proteins responsible for interacting with gliadin and host T cell receptors thereby sensitizing the intestine to gluten have not been identified.
Therefore, guidelines call for regular testing of asymptomatic individuals with negative serological tests, and who belong to at-risk groups. Treatment guidelines do not presently call for routinely testing autistic children for celiac disease, as there is no evidence that celiac is more in autistic children than in the general population.
Celiac Disease Testing
There is currently no test for diagnosing celiac disease with 100% certainty. For most people, the disappearance of symptoms, and/or the appearance of a "normal" biopsy following the adoption of a gluten-free diet provide the strongest evidence for celiac disease or gluten intolerance.
A blood test, such as anti-tissue transglutaminase and anti-endomysial antibodies, can detect abnormally levels of antibodies, and is often used in the initial detection of celiac in people who are most likely to have the disease, and for those who may need further testing.
Based on the current evidence and practical considerations, including accuracy, reliability, and cost, measurement of IgA antibody to human recombinant tissue transglutaminase (TTG) is recommended for initial testing for CD. Although as accurate as TTG, measurement of IgA antibody to endomysium (EMA) is observer dependent and therefore more subject to interpretation error and added cost. Because of the inferior accuracy of the antigliadin antibody tests (AGA), the use of AGA IgA and AGA IgG tests alone is no longer recommended for detecting CD.
Several serological markers are useful in diagnosing celiac disease. The first of these is IgG class antigliadin antibody (AGA). This antibody is sensitive to gluten, but it is also found in other diseases and thus is not a good a specific indicator of celiac.
Generally, IgA class AGA is more specific, but about 2% of celiac patients show selective IgA deficiency, and thus show negative results, even though they have celiac.
A positive IgG and IgA AGA gives a reported sensitivity of 96% to100% and specificity of 96% to 97%. Recent studies show Anti-reticulin antibodies (ARA) in people with celiac disease, but these appear to be nonspecific. In fact, taken alone, IgG ARA is largely ineffective. However, IgA ARA has sensitivity of 97% and a specificity of 98% in adults. These figures are much lower in children.
IgA class anti-endomysial antibody (EMA) and human jejunal antibody (JAB) have recently been identified as both sensitive and specific for celiac disease.
The antibody EMA, which reacts against endomysium reticulin fibers, has been found only in people with active celiac and not other diseases. As EMAs are associated with other diseases in children, they are a less accurate indicator of celiac in children than in adults.
Studies in children less than 2 years old with celiac disease have shown a steep fall in EMA sensitivity, so EMA appears even less useful than in children over 2 years of age.
Finally, since the EMA and JAB antibody tests may be negative in adults with celiac disease and IgA deficiency, they cannot be considered definitive for diagnosis of celiac disease.
A complete panel of antibody tests seems to be most accurate method of diagnosing celiac disease.
Taken together, a positive panel of IgG AGA, IgA AGA and EMA can predict the presence of celiac disease in 99.3% of patients. A negative panel of IgG AGA, IgA AGA and EMA can predict the absence of celiac in 99.6% of patients.
These antibodies tend to diminish or disappear when individuals maintain a gluten-free diet.
More than 90% of patients with celiac disease have genetic markers HLA DQalpha *0501, and HLA DQbeta *0201. Negative tests for these markers in conjunction with negative serum antibody tests suggest an absence of celiac disease. However, positive tests for the genetic markers do not necessarily mean that the patient has celiac disease. In conclusion, genetic markers can be used as a test to exclude celiac disease as a diagnosis.
Celiac Disease Biopsy
A diagnosis of celiac disease is generally confirmed through a biopsy, by looking for celiac associated damage to the small intestine.
One important fact is that intestinal biopsies are regularly obtained endoscopically from the duodenum and therefore provide no information regarding the extent of disease along the jejunum.
Flattening of the villi usually occurs first, and most severely, in the duodenum, as it the duodenum is the first part of the intestine to be exposed to gluten. Conversely, the villi of the jejunum, which receives much less exposure, are often asymptomatic, and nearly normal.
In most of these individuals, treatment with a gluten-free diet results in the return of all villous and crypt structures to normal or near normal.
Certain conditions, especially infection, can yield intestinal biopsy results that are similar to those of celiac disease, and it is important to consider and/or exclude these conditions when celiac disease is suspected.
Practice Guidelines for Treatment of Celiac Disease with an Aggressive Life-long Gluten-free Diet
As there is presently no cure for celiac disease, avoiding gluten is crucial. Practice guidelines call for a life-long gluten-free diet as the standard treatment for celiac disease. To manage the disease and prevent complications, its essential that patients avoid all foods that contain gluten. That means it is crucial for the patient to avoid all foods made with wheat, rye, or barley. This includes types of wheat like durum, farina, graham flour, and semolina. Also, bulgur, kamut, kasha, matzo meal, spelt and triticale. Examples of products that commonly contain these include breads, breading, batter, cereals, cooking and baking mixes, pasta, crackers, cookies, cakes, pies and gravies, among others.
It is also good practice for patients to avoid oats, at least during initial treatment stages, as the effects of oats on celiac patients are not fully understood, and contamination with wheat in processing is common. So, its a good practice when first adopting a gluten-free diet to eliminate oats, at least until symptoms subside, and their reintroduction into the diet can be fairly monitored and evaluated.
Another good practice is coaching celiac patients to avoid processed foods that may contain hidden gluten. Wheat flour is commonly used in many processed foods that one might never suspect. A few examples include candy bars, canned soup, canned meat, energy bars, ketchup, ice cream, instant coffee, lunchmeat, mustard, pastas, processed meat, sausages, and yogurt.
Also, gluten is also commonly found in many vitamins and cosmetics, such as lipstick, and in the production of many capsules and tablets, where wheat starch is a commonly used binding agent.
Obviously, patients must avoid beer made with barley or wheat (there are gluten-free beers), though wine, brandy, whiskey and other non-wheat or non-barley alcohols are okay.
Encourage patients to eat a diet rich in fish, fresh meats, rice, corn, soybean, potato, poultry, fruits and vegetables. Patients should also avoid milk and other dairy products, as it is common for patients with celiac disease to be lactose intolerant. Dairy products can often be slowly reintroduced into the diet over time with successful treatment.
It is also important for patients to learn to identify gluten-free foods. Because a gluten-free diet needs to be strictly followed, and because food ingredients may vary from place to place and even over time for a given product, it is important to always read the label.
For lists of gluten-free foods and products, and for specific advice on adopting, shaping and maintaining the gluten-free diet that is right for them, patients may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet.
Most patients who remove gluten from their diets find that their symptoms improve as inflammation of the small intestine begins to subside, usually within several weeks. Many patients who adopt a gluten-free diet report an improvement within 48 hours.
Results of a gluten-free diet can be especially dramatic in children with celiac disease. Not only does their diarrhea and abdominal distress usually subside but, frequently, their behavior and growth rate are often markedly improved.
A reappearance of intestinal villi nearly always follows an improvement in symptoms.
In younger people, the villi may complete healing and re-growth in several months, while in older people, the process may take as long as two to three years.
In cases where nutritional deficiencies are severe, celiac patients may require vitamin and mineral supplements to help bring about a healthier vitamin profile: folic acid and B12 for patients with anemia due to folate or B12 deficiency; vitamin K for patients with an abnormal ProTime; calcium and vitamin D supplements for patients with low blood calcium levels or with osteoporosis. For all such cases, individuals should consult their health professional.
Skin lesions common in patients with dermatitis herpetiformis often improve with adherence to a gluten-free diet.
The Importance of Follow-up Testing for Celiac Patients on a Gluten-free Diet
Research indicates that only half of those patients who have had celiac disease for at least 20 years were following a strict gluten-free diet. Up to 30% of those patients showed evidence of bone loss and iron deficiency. These are but a few of the long-term consequences for celiac patients failing to follow a gluten-free diet.
Thus, it is important to conduct follow-up testing of celiac patients to determine the success of their gluten-free diets, and the progress of their treatment, and to make any necessary adjustments to each. Even done properly, with no accidental consumption of gluten, the elimination of gluten antibodies from the blood takes months. To estimate the treatments effectiveness, current guidelines call for a single serological testing after 3-6 months on a gluten-free diet.
For patients who are free of antibodies, and actively following a gluten-free diet, it is wise to consult a doctor if there is any recurrence of celiac-associated symptoms. First-degree relatives of celiac patients should have a repeat blood test every 2-3 years.
health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
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