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Celiac Disease & Gluten-Free Diet Blogs

  • kareng's Blog
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  • Research on South African Celiac Tours
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  • Keating's Not-so-Glutenfree life
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  • Coeliac, or just plain unlucky?
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  • Searchin for a Primary Care Dr. In Redlands That is Knowledgeable about Celiac disease
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  • Living in Japan with Ceoliac Disease
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  • MJ
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  • HONG KONG GLUTEN, WHEAT FREE PRODUCTS
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  • Healthy Food Healthy You
  • SydneyT1D - Diabetic and Celiac YouTuber!
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  • SMAS: www.celiac.com
  • gardener1's Blog
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  • JillianC
  • Sugar's Blog
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  • Gluten-Free Sisters :)
  • Eab12's Celiac Blog
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  • Newly Self Diagnosed?
  • misscorpiothing's Blog
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  • Petroguy
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  • Soap Opera Central
  • nurcan's Blog
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  • Mr J's Blog
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  • CAC's Blog
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  • Teri Kiefer's Blog
  • happyasabeewithceliac's Blog
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  • Cheryl
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  • donna mae's Blog
  • Colleen's blog
  • DawnJ's Blog
  • Gluten Challenge
  • twins2's Blog
  • just trying to feel better's Blog
  • Celiac Teen
  • MNBelle blog
  • Gabe351's Blog
  • moosemalibu's Blog
  • Coeliac Disease or Coeliac Sprue or Non Tropical Sprue
  • karalto's Blog
  • deacon11's Blog
  • Nyxie's Blog
  • Swpocket's Blog
  • threeringfilly's Blog
  • Madison Papers: Living Gluten-Free in a Gluten-Full World
  • babinsky's Blog
  • prettycat's Blog
  • Celiac Diagnosis at Age 24 months in 1939
  • Sandy R's Blog
  • mary m's Blog
  • Jkrupp's Blog
  • Oreo1964's Blog
  • keyboard
  • Louisa's Blog
  • Guts & Brains
  • Gluten Free Betty
  • Jesse'sGirl's Blog
  • NewMom's Blog
  • Connie C.'s Blog
  • garden girl's Blog
  • april anne's Blog
  • 4xmom's Blog
  • benalexander60's Blog
  • missmyrtle's Blog
  • Jersey Shore wheat no more's Blog
  • swezzan's Blog
  • aheartsj's Blog
  • MeltheBrit's Blog
  • glutenfreecosmeticcounter
  • Reasons Why Tummy tuck is considered best to remove unwanted belly fat?
  • alfgarrie's Blog
  • SmidginMama's Blog
  • lws' Blog
  • KMBC2014's Blog
  • Musings and Lessons Learned
  • txwildflower65's Blog
  • Uncertain
  • jess4736's Blog
  • deedo's Blog
  • persistent~Tami's Blog
  • Posterboy's Blog
  • jferguson
  • tiffjake's Blog
  • KCG91's Blog
  • Yolo's Herbs & Other Healing Strategies
  • scrockwell's Blog
  • Sandra45's Blog
  • Theresa Marie's Blog
  • Skylark's Blog
  • JessicaB's Blog
  • Anna'sMommy's Blog
  • Skylark's Oops
  • Jehovah witnesses
  • Celiac in Seattle's Blog
  • March On
  • honeybeez's Blog
  • The Liberated Kitchen, redux
  • onceandagain's Blog
  • JoyfulM's Blog
  • keepingmybabysafe's Blog
  • To beer, with love...
  • nana b's Blog
  • kookooto's Blog
  • SunnyJ's Blog
  • Mia'smommy's Blog
  • Amanda's Blog
  • jldurrani's Blog
  • Why choosing Medical bracelets for women online is the true possible?
  • Carriefaith's Blog
  • acook's Blog
  • REAGS' Blog
  • gfreegirl0125's Blog
  • Gluten Free Recipes - Blog
  • avlocken's Blog
  • Thiamine Thiamine Thiamine
  • wilbragirl's Blog
  • Gluten and Maize-Free (gluten-free-MF)
  • Elimination Diet Challenge
  • DJ 14150
  • mnsny's Blog
  • Linda03's Blog
  • GFinDC's Blog
  • Kim UPST NY's Blog
  • cmc's Blog
  • blog comppergastta1986
  • JesikaBeth's Blog
  • Melissa
  • G-Free's Blog
  • miloandotis' Blog
  • Confessions of a Celiac
  • Know the significance of clean engine oil
  • bobhayes1's Blog
  • Robinbird's Blog
  • skurtz's Blog
  • Olivia's Blog
  • Jazzdncr222's Blog
  • Lemonade's Blog
  • k8k's Blog
  • celiaccoach&triathlete's Blog
  • Gluten Free Goodies
  • cherbourgbakes.blogspot.com
  • snow dogs' Blog
  • Rikki Tikki's Blog
  • lthurman1979's Blog
  • Sprue that :)'s Blog
  • twinkletoes' Blog
  • Ranking the best gluten free pizzas
  • Gluten Free Product
  • Wildcat Golfer's Blog
  • Becci's Blog
  • sillyker0nian's Blog
  • txplowgirl's Blog
  • Gluten Free Bread Blog
  • babygoose78's Blog
  • G-freegal12's Blog
  • kelcat's Blog
  • Heavy duty 0verhead crane
  • beckyk's Blog
  • pchick's Blog
  • NOT-IN-2gluten's Blog
  • PeachPie's Blog
  • Johny
  • Breezy32600's Blog
  • Edgymama's Gluten Free Journey
  • Geoff
  • audra's Blog
  • mfrklr's Blog
  • 2 chicks
  • I Need Help With Bread
  • the strong one has returned!
  • sabrina_B_Celiac's Blog
  • Gluten Free Pioneer's Blog
  • Theanine.
  • The Search of Hay
  • Vanessa
  • racecar16's Blog
  • JCH13's Blog
  • b&kmom's Blog
  • Gluten Free Foodies
  • NanaRobin's Blog
  • mdrumr8030's Blog
  • Sharon LaCouture's Blog
  • Zinc, Magnesium, and Selenium
  • sao155's Blog
  • Tabasco's Blog
  • Amanda Smith
  • mmc's Blog
  • xphile1121's Blog
  • golden exch
  • kerrih's Blog
  • jleb's Blog
  • RUGR8FUL's Blog
  • Brynja's Grain Free Kitchen
  • schneides123's Blog
  • Greenville, SC Gluten-Free Blog
  • ramiaha's Blog
  • Kathy P's Blogs
  • rock on!'s Blog
  • Carri Ninja's Blog
  • jerseygirl221's Blog
  • Pkhaselton's Blog
  • Hyperceliac Blog
  • abbiekir's Blog
  • Lasister's Thoughts
  • bashalove's Blog
  • Steph1's Blog
  • Etboces
  • Rantings of Tiffany
  • GlutenWrangler's Blog
  • kalie's Blog
  • Mommy Of A Gluten Free Child
  • ready2go's Blog
  • Maureen
  • Floridian's Blog
  • Bobbie41972's Blog
  • Everyday Victories
  • Intolerance issue? Helpppp!
  • Feisty
  • In the Beginning...
  • Cheri46's Blog
  • Acne after going gluten free
  • sissSTL's Blog
  • Elizabeth19's Blog
  • LindseyR's Blog
  • sue wiesbrook's Blog
  • I'm Hungry's Blog
  • badcasper's Blog
  • M L Graham's Blog
  • Wolicki's Blog
  • katiesalmons' Blog
  • CBC and celiac
  • Kaycee's Blog
  • wheatisbad's Blog
  • beamishmom's Blog
  • Celiac Ninja's Blog
  • scarlett54's Blog
  • GloriaZ's Blog
  • Holly F's Blog
  • Jackie's Blog
  • lbradley's Blog
  • TheSandWitch's Blog
  • Ginger Sturm's Blog
  • The Struggle is Real
  • whataboutmary's Blog
  • JABBER's Blog
  • morningstar38's Blog
  • Musings of a Celiac
  • Celiacchef's Blog
  • healthygirl's Blog
  • allybaby's Blog
  • MGrinter's Blog
  • LookingforAnswers15's Blog
  • Lis
  • Alilbratty's Blog
  • 3sisters' Blog
  • MGrinter's Blog
  • Amanda
  • felise's Blog
  • rochesterlynn's Blog
  • mle_ii's Blog
  • GlamourGetaways' Blog
  • greendog's Blog
  • Tabz's Blog
  • Smiller's Blog
  • my vent
  • newby to celiac?'s Blog
  • siren's Blog
  • myraljo's Blog
  • Relieved and confused
  • carb bingeing
  • scottish's Blog
  • maggiemay832's Blog
  • Cristina Barbara
  • ~~~AnnaBelle~~~'s Blog
  • nikky's Blog
  • Suzy-Q's Blog
  • mfarrell's Blog
  • Kat-Kat's Blog
  • Kelcie's Blog
  • cyoshimit's Blog
  • pasqualeb's Blog
  • My girlfriend has celiacs and she refuses to see a doctor
  • Ki-Ki29's Blog
  • mailmanrol's Blog
  • Sal Gal
  • WildBillCODY's Blog
  • Ann Messenger
  • aprilz's Blog
  • the gluten-free guy
  • gluten-free-wifey's Blog
  • Lynda MEADOWS's Blog
  • mellajane's Blog
  • Jaded's Celiac adventures in a non-celiac world.
  • booboobelly18's Blog
  • Dope show
  • Classic Celiac Blog
  • Keishalei's Blog
  • Bada
  • Sherry's blurbs
  • addict697's Blog
  • MIchael530btr's Blog
  • Shawn C
  • antono's Blog
  • Undiagnosed
  • little_d's Blog
  • Gluten, dairy, pineapple
  • The Fat (Celiac) Lady Sings
  • Periomike
  • Sue Mc's Blog
  • BloatusMaximus' Blog
  • It's just one cookie!
  • Kimmy
  • jacobsmom44's Blog
  • mjhere's Blog
  • tlipasek's Blog
  • You're Prescribing Me WHAT!?!
  • Kimmy
  • nybbles's Blog
  • Karla T.'s Blog
  • Young and dealing with celiacs
  • Celiac.com Podcast Edition
  • LCcrisp's Blog
  • ghfphd's allergy blog
  • https://www.bendglutenfree.com/
  • Costume's and GF Life
  • mjhere69's Blog
  • dedeadge's Blog
  • CeliacChoplin
  • Ravenworks' Blog
  • ahubbard83's Blog
  • celiac<3'sme!'s Blog
  • William Parsons
  • Gluten Free Breeze (formerly Brendygirl) Blog
  • Ivanna44's Blog
  • Daily Life and Compromising
  • Vonnie Mostat
  • Aly'smom's Blog
  • ar8's Blog
  • farid's Blog
  • Sandra Lee's Blog
  • Demertitis hepaformis no Celac
  • Vonnie Mostat, R.N.
  • beetle's Blog
  • Sandra Lee's Blog
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  • totalallergyman's Blog
  • Kim
  • Vhips
  • twinsmom's Blog
  • Newbyliz's Blog
  • collgwg's Blog
  • Living in the Gluten Free World
  • lisajs38's Blog
  • Mary07's Blog
  • Treg immune celsl, short chain fatty acids, gut bacteria etc.
  • questions
  • A Blog by Yvonne (Vonnie) Mostat, RN
  • ROBIN
  • covsooze's Blog
  • HeartMagic's Blog
  • electromobileplace's Blog
  • Adventures of a Gluten Free Mom
  • Fiona S
  • bluff wallace's Blog
  • sweetbroadway's Blog
  • happybingf's Blog
  • Carla
  • jaru24's Blog
  • AngelaMH's Blog
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  • SimplyGF Blog
  • Jim L Christie
  • Debbie65's Blog
  • Alcohol, jaundice, and celiac
  • kmh6leh's Blog
  • Gluten Free Mastery
  • james
  • danandbetty1's Blog
  • Feline's Blog
  • Linda Atkinson
  • Auntie Lur: The Blog of a Young Girl
  • KathyNapoleone's Blog
  • Gluten Free and Specialty Diet Recipes
  • Why are people ignoring Celiac Disease, and not understanding how serious it actually is?
  • miasuziegirl's Blog
  • KikiUSA's Blog
  • Amyy's Blog
  • Pete Dixon
  • abigail's Blog
  • CHA's Blog
  • Eczema or Celiac Mom?'s Blog
  • Thoughts
  • International Conference on Gastroenterology
  • Deedle's Blog
  • krackers' Blog
  • cliniclfortin's Blog
  • Mike Menkes' Blog
  • Juanita's Blog
  • BARB OTTUM
  • holman's Blog
  • It's EVERYWHERE!
  • life's Blog
  • writer ann's Blog
  • Ally7's Blog
  • Gluten Busters: Gluten-Free Product Alerts by Celiac.com
  • K Espinoza
  • klc's Blog
  • Pizza&beer's Blog
  • CDiseaseMom's Blog
  • sidinator's Blog
  • Dr Rodney Ford's Blog
  • How and where is it safe to buy cryptocurrency?
  • lucedith's Blog
  • Random Thoughts
  • Kate
  • twin#1's Blog
  • myadrienne's Blog
  • Nampa-Boise Idaho
  • Ursa Major's Blog
  • bakingbarb's Blog
  • Does Celiac Cause Sensitivites To Rx's?
  • delana6303's Blog
  • psychologygrl25's Blog
  • Alcohol and Celiac Disease
  • How do we get it???
  • cooliactic_BOOM's Blog
  • GREAT GF eating in Toronto
  • Gluten-free Food Recommendations!
  • YAY! READ THIS!!
  • BROW-FREE DIET BLOG
  • carib168's Blog
  • A Healing Kitchen
  • Shawn s
  • AZ Gal's Blog
  • mom1's Blog
  • The Beginning - The Diagnosis
  • PeweeValleyKY's Blog
  • solange's Blog
  • Cate K's Blog
  • Layered Vegetable Baked Pasta (gluten-free Vegetarian Lasagna)
  • Gluten Free Teen by Ava
  • mtdawber's Blog
  • sweeet_pea's Blog
  • DCE's Blog
  • Infertility and Celiac Disease
  • What to do in the Mekong Delta in 1 Day?
  • glutenfreenew's Blog
  • Living in the Garden of Eden
  • toddzgrrl02's Blog
  • redface's Blog
  • Gluten Free High Protein
  • Ari
  • Great Harvest Chattanooga's Blog
  • CeliBelli's Blog
  • Aboluk's Blog
  • redface's Blog
  • Being in Control of Your Gluten-Free Diet on a Cruise Ship
  • jayshunee's Blog
  • lilactorgirl's Blog
  • Yummy or Yucky Gluten-Free Foods
  • Electra's Blog
  • Cocerned husband's Blog
  • lilactorgirl's Blog
  • A Little History - My Celiac Disease Diagnosis
  • How to line my stomach
  • sewfunky's Blog
  • Oscar's Blog
  • Chey's Blog
  • The Fun of Gluten-free Breastfeeding
  • Dawnie's Blog
  • Sneaky gluten free goodness!
  • Chicago cubs shirts- A perfect way of showing love towards the baseball team!
  • Granny Garbonzo's Blog
  • GFzinks09's Blog
  • How do I get the Celiac.com podcast on my mp3 player?
  • quantumsugar's Blog
  • Littlebit's Blog
  • Kimberly's Blog
  • Dayz's Blog
  • Swimming Breadcrumbs and Other Issues
  • Helen Burdass
  • celiacsupportnancy's Blog
  • Life of an Aggie Celiac
  • kyleandjra.jacobson's Blog
  • Hey! I'm Not "Allergic" to Wheat!
  • FoOdFaNaTic's Blog
  • Wendy Cohan, RN's Gluten-Free and Dairy-Free Cooking Classes
  • Lora Derry
  • Dr. Joel Goldman's Blog
  • The Ultimate Irony
  • Lora Derry
  • ACK514's Blog
  • katinagj's Blog
  • What Goes On, Goes In (Gluten in Skin Care Products)
  • What’s new in hydraulic fittings?
  • cannona3's Blog
  • citykatmm's Blog
  • Adventures in Gluten-Free Toddling
  • tahenderson67's Blog
  • The Dinner Party Drama—Two Guidelines to Assure a Pleasant Gluten-Free Experience
  • What’s new in hydraulic fittings?
  • sparkybear's Blog
  • justbikeit77's Blog
  • To "App" or Not to "App": The Use of Gluten Free Product List Computer Applications
  • Onangwatgo
  • Raine's Blog
  • lalla's Blog
  • To die for Cookie Crumb Gluten-Free Pie Crust
  • DeeTee33's Blog
  • http://glutenfreegroove.com/blog/
  • David2055's Blog
  • Gluten-Free at the Fancy Food Show in San Francisco
  • Kup wysokiej jakości paszporty, prawa jazdy, dowody osobiste
  • Janie's Blog
  • Managing Hives & Gluten Allergies
  • User Is it safe to use GB WhatsApp pro in 2024?
  • Bogaert's Blog
  • Janie's Blog
  • RaeD's Blog
  • Dizzying Disclaimers!
  • Dream Catcher's Blog
  • PinkZebra's Blog
  • Hibachi Food and Hidden Gluten Hazards (How to Celebrate Gluten-Free)
  • jktenner's Blog
  • OhSoTired's Blog
  • PinkZebra's Blog
  • gluten-free Lover's Blog
  • Gluen Free Health Australia
  • Melissamb21's Blog
  • Andy C's Blog
  • halabackgirl9129's Blog
  • Liam Edwards' Blog
  • Celiac Disease in Africa?
  • Suz's Blog
  • Gluten-Free Fast Food
  • mis_chiff's Blog
  • gatakat's Blog
  • macocha's Blog
  • Newly Diagnosed Celiacs Needed for Study in Chicago
  • Poor Baby's Blog
  • the loonie celiac's Blog
  • jenlex's Blog
  • Sex Drive/Testosterone can be Depleted by Certain Foods
  • samantha79's Blog
  • 21 Months into the Gluten-free Diet
  • WashingtonLady's Blog-a-log
  • James S. Reid's Blog
  • Living with a Gluten-Free Husband
  • runner girl's Blog
  • kp3972's Blog
  • ellie_lynn's Blog
  • trayne91's Blog
  • Gluten-free Lipstick!
  • Nonna2's Blog
  • Schar Chocolate Hazelnut Bar (Gluten-Free)
  • pnltbox27's Blog
  • Live2BWell's Blog
  • melissajohnson's Blog
  • nvsmom's Blog
  • Diagnosed with Celiac Disease and Still Sick
  • snowcoveredheart's Blog
  • Gluten Free Nurse
  • Gluten-Free Frustration!
  • Melody A's Blog
  • novelgutfeeling's Blog
  • Trouble Eating Out Gluten-Free...Good or Bad?!
  • dilsmom's Blog
  • theceliachusband's Blog
  • amanda2610's Blog
  • Pancreas and Celiac Disease Link?
  • epiphany's Blog
  • Patty55's Blog
  • The Latest Gluten-Free Food Recalls
  • kenzie's blog
  • CVRupp's Blog
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  1. Celiac.com 11/15/2023 - Imagine enjoying your favorite pasta dish one day, and the next day, experiencing mysterious and uncomfortable symptoms like stomach pain, vomiting, fatigue, or skin rashes. What could be causing these problems? One possibility might be celiac disease. Celiac disease is a relatively common autoimmune disorder that affects the small intestine. It's triggered by the consumption of gluten, a protein found in wheat, barley, and rye. When someone with celiac disease eats gluten, their immune system reacts by damaging the lining of the small intestine, which can lead to a wide range of symptoms and complications. Getting the diagnosis correct is important, because celiac disease is often misdiagnosed. Symptoms of Celiac Disease The symptoms of celiac disease can vary greatly from person to person, and some individuals may not experience any symptoms at all. Here are some common signs to watch out for: Digestive Troubles: Symptoms often involve the digestive system, such as diarrhea, constipation, bloating, gas, and abdominal pain. Fatigue: Many people with celiac disease report feeling excessively tired, even after a full night's sleep. Weight Loss: Unintended weight loss can occur due to malabsorption of nutrients caused by intestinal damage. Skin Issues: Some individuals develop skin conditions, itchy rashes, like dermatitis herpetiformis, which is closely linked to celiac disease. Joint Pain: Joint pain and inflammation may affect those with celiac disease. Mood Changes: Mood swings, depression, or anxiety can be related to the condition. Delayed Growth in Children: Celiac disease can hinder proper growth and development in children. Diagnosis of Celiac Disease Getting a proper diagnosis is crucial for managing celiac disease effectively. Here's how doctors typically diagnose it: Blood Tests: Initially, blood tests are done to check for elevated levels of certain antibodies, such as anti-tissue transglutaminase (tTG) and anti-endomysial antibodies (EMA). Higher levels of these antibodies can be a sign of celiac disease. Biopsy: If blood tests indicate celiac disease, a small intestine biopsy may be performed. During this procedure, a tiny sample of the intestinal lining is taken and examined under a microscope. Damage to the lining is a key indicator of the disease. In more and more cases, celiac disease can be diagnosed without biopsy. Treatment of Celiac Disease The primary treatment for celiac disease is a strict gluten-free diet. Once diagnosed, individuals need to eliminate all sources of gluten from their diet, including bread, pasta, cakes, and even certain sauces. This can be challenging, as gluten can hide in unexpected places, so reading food labels and avoiding gluten ingredients is a must. Most people with celiac disease notice significant improvements in their symptoms once they adopt a gluten-free lifestyle. Over time, the intestinal lining often heals, allowing for better nutrient absorption. In some cases, complications of celiac disease may require additional medical attention. For instance, individuals with severe malabsorption may need vitamin and mineral supplements. Dermatitis herpetiformis may be treated with medications. Living with Celiac Disease While a gluten-free diet is the cornerstone of managing celiac disease, it's also essential to be vigilant about cross-contamination. This means avoiding utensils, kitchen appliances, and cooking surfaces that have come into contact with gluten-containing foods. Celiac.com offers numerous forums for discussing celiac disease and gluten-free challenges with other celiacs who can share experience and help guide your celiac and gluten-free journey. Support groups and dietary counselors can be incredibly helpful for those newly diagnosed with celiac disease. They provide practical tips for maintaining a gluten-free lifestyle and offer emotional support during the transition. In conclusion, celiac disease is a common but manageable condition. By recognizing its symptoms, seeking a proper diagnosis, and committing to a gluten-free diet, individuals with celiac disease can lead healthy and fulfilling lives. If you suspect you have celiac disease, don't hesitate to consult a healthcare professional for guidance and testing. Your well-being is worth it!
  2. Celiac.com 10/23/2023 - A recent study conducted by a team of US investigators is shedding light on the use of European thresholds for diagnosing celiac disease in North America. This study seeks to determine how often biopsies are performed on children who are considered at high risk for celiac disease based on common diagnostic tests, yet meet the criteria for non-biopsy diagnoses according to European standards. Dr. Denis Chang, the study's lead author, discussed the trial's design and its implications for celiac disease diagnostics in North America during an interview with HCPLive at the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) 2023 Annual Meeting in San Diego. Celiac disease is an autoimmune disorder that affects the small intestine and is triggered by the consumption of gluten, a protein found in wheat, rye, and barley. The gold standard for diagnosing celiac disease is through an endoscopy, which involves taking biopsies to confirm the damage caused by gluten. However, serology, or blood testing, has become a game-changer in the diagnostic process. It helps identify individuals who require an endoscopy based on a positive blood test, typically the tissue transglutaminase (tTG-IgA) test. While tTG-IgA is a reliable biomarker, it is not infallible and can yield false positives or negatives. In 2012, European colleagues established guidelines that allow for a celiac disease diagnosis in some cases where a highly positive tTG-IgA result is combined with another positive blood marker, EMA IgA. These guidelines initially included genetic risk and symptoms but no longer do. In contrast, North American guidelines have not incorporated these standards, partially due to the wide array of diagnostic assays used to identify celiac disease, each with its own methodology. Dr. Chang also emphasizes the concern of potentially overlooking other diagnoses by not conducting an endoscopy, such as eosinophilic esophagitis, which is commonly seen in celiac patients. In an ideal world, a standardized and widely accepted diagnostic assay strategy would simplify the diagnostic process and potentially pave the way for developing new clinical therapies for celiac disease. Currently, there are no FDA-approved drugs for treating celiac disease, and the most promising agents in development are primarily intended for adult patients. Dr. Chang explained that an alternative diagnosis method could help expand the pool of individuals, both providers and patients, who can collaborate to advance celiac disease research and treatment options. Additionally, it could offer clarity for patients who have received a presumed celiac disease diagnosis based solely on high blood markers, without undergoing a biopsy. This investigation into the use of European diagnostic thresholds in North America is a significant step toward streamlining the diagnosis of celiac disease. See more at the Conference|North American Society For Pediatric Gastroenterology, Hepatology & Nutrition

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  4. Celiac.com 07/13/2017 - Until recently, duodenal biopsy was considered the gold standard for diagnosing celiac disease, but that is changing. A number of studies have shown that celiac disease can be diagnosed using serological tests alone, but many clinicians have yet to embrace this approach. In both retrospective and prospective studies, one research team showed that certain IgA-tissue transglutaminase antibodies levels can predict celiac disease in adults 100% of the time. After making some adjustments to the analytical method for measuring the antibody, a team of researchers recently set out to to determine whether such serum tests can reliably diagnose celiac disease in large numbers adult patients without the need for small bowel biopsy. The research team included GKT Holmes, JM Forsyth, S Knowles, H Seddon, PG Hill, and AS Austin. They are variously associated with the Royal Derby Hospital, the Department of Pathology, and the Derby Digestive Diseases Centre at the Royal Derby Hospital in Derby, UK. For their study, the team conducted a retrospective analysis in an unselected series of 270 adult patients who underwent small bowel biopsies and the measurement of serum IgA-tissue transglutaminase antibody levels from 2009 to 2014. At an IgA-tissue transglutaminase antibody cut-off greater than 45 U/ml (>8×upper limit of normal+2SDs) the positive predictive value for celiac disease in this cohort was 100%; 40% of cases were above this cut-off. The team found that they could use IgA-tissue transglutaminase antibody levels to reliably diagnose celiac disease in a high proportion of these adult patients. This study adds to the growing body of evidence that supports the diagnosis of celiac disease without a mandatory small bowel biopsy. As a realist of these findings, the study team has changed the diagnostic guidelines for their center, and will now make celiac diagnosis based on cut-off levels of IgA-tissue transglutaminase. This is exciting news. For many, many years, the biopsy was considered the gold standard for diagnosing celiac disease. By eliminating biopsies in favor of IgA-tissue transglutaminase levels, diagnosing celiac disease could become much easier and even cheaper. Do you have celiac disease? Did you receive a biopsy for diagnosis? How do you feel about celiac diagnosis without biopsy? Share your thoughts below. Source: Eur J Gastroenterol Hepatol. 2017 Jun;29(6):640-645. doi: 10.1097/MEG.0000000000000841.
  5. hi guys, i have recently (July) been diagnosed with celiac disease however via blood results my ttg iga was 128 which is ten times over normal and endomysial was a strong positive. I also had high lymphocytes and low vitamin B12. My GP advised due to how high to start a gluten free diet immediately which i did, my bloating, brain fog, bowels etc got how they should be and anxiety also. The Gastro dept have contacted me asking for me to go onto a gluten diet for 8 weeks for a biopsy which i have been glutened and has caused me utter hell in past. My concern is why on celiac foundation website are we told if it is ten times over normal count that pt should not necessarily need an Endoscopy. I have had a MRI due to brain fog, and they had found white matter on my brain that is linked to celiac. PLEASE HELP I HAVE NO IDEA WHAT TO DO, HE JUST TOLD ME TO GO ON GLUTEN DIET NO ADVISORIES NOTHING, EVEN WHEN I AM A STRONG POSITIVE!!!! and i really do not know if it is worth the trauma.
  6. Hi everyone, I have had bowel trouble for about 12 years. It first started with a case of acute diarrhea during jogging. After that the main complaints are bloating and flatulence/burping. It is worse after meals. I had acute diarrhea on a few occasions after eating very buttery/oily food. Twelve years ago my general doctor diagnosed it as IBS (after not founding anything specific). Recently I have revisited the problem in the hope to solve it as it is something I can live with but it still affects your life quite a bit. So I went to a gastro-enterologist. First I had a breath test for lactose which was negative. Then I was checked for celiac disease: As far as I know to diagnose celiac disease you do blood test which give you an indication. This then needs to be confirmed by an endoscopic biopsy. My blood test came back with the following results: Deamidated Gliadin Antibody was positive (6.2 kU/L range 0-3.9) Transglutaminase (IgA) was negative (0.6 kUA/L range < 8.0) I read that the transglutaminase test is more reliable, but we still did the endoscopic biopsy which came out negative. Then a week after telling me I do not have celiac disease because of the biopsy my gastro-enterologist emails me writing; "the lab antibody test for gluten is positive so your condition seems celiac disease". Of course I was surprised as I thought the biopsy should have been the gold standard (and the antibody test was quite uncertain). I asked her, but unfortunately I did not get a reply anymore. So my first question is if I am correct in my conclusion that it is highly unlikely that I have celiac disease? I do have the feeling I react to some products that contain gluten (croissant/pizza/cake/pasta/soy sauce), but others not (e.g. bread).I have tried going gluten free for a week, but there was no impact. I thought that the issue might be fat content as at least croissant/pizza/cake have a higher fat content than bread, so I tried a low fat diet for about a week, but also that did not improve my symptoms. For completeness other deviating blood values are: Bilirubine indirect (1.48 mg/dL range 0-1.10) This is due to a biliary cyste. Cholestrol LDL (185 mg/dL range < 115) Ferritine (378 ug/L range 20-250) Vitamine D (11.2 ng/mL range 30-100) So if my condition is not celiac disease all ideas and advise of what it could be are welcome. Thank you all in advance, Steve
  7. Hi Guys, I am new here and i just wanted to say hello to everybody and to say thanks to all admins and people who are sharing info so they can help each-other! Today i need help for peace and mind I am male 39y old and Recently, couple months ago 6-8 i started to have more and more symptoms and problems for example like: constant bloating, constant discomfort, fatigue, weight loss and abdominal pain. I have hemmies and occasional blood in stool. I do not have D, sometimes i have C but normal stool. I went to my GI and he did upper and lower endoscopy with biopsy. Pathologists found increased IEL and moderate villious blunting Marsh 3a/b. My serology was negative for complete celiac panel. I did not do yet the gene testing. I was positive for SIBO (methane)and now i am on antibiotics. My other examinations are ok, (ultrasound, blood cbc, h.pylori stool, and so on). My questions are: 1. Does anybody here have positive biopsy and negative celiac panel even gene testing? 2. Does andbody have increased IEl and villious blunting with SIBO? Thank You and kind regards!

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  9. Hello everyone. Brand new to the Celiac scene personally and this is my first post here. I just recently had my tTg-IgA drawn and it came back at 11 U/mL. Standard range 0-3, weak positive 4-10 and 11 or greater positive. A little background: My grandfather was diagnosed late in life (in his 70's) with Dermatitis Herpetiformis via skin biopsy. His physician put him on Dapsone and told him to try to avoid gluten. My grandfather wasn't ever told he had to be strictly gluten free for life. He tried to avoid gluten for a period of time, along with the Dapsone and his DH got better. It sounds like things had calmed down and he was "avoiding" gluten so his doctor took him off Dapsone. Turns out my grandfather didn't realize how important it was for him to be strictly gluten free because he was never educated properly. According to my grandmother, (which is where I got all of this information) he was told he did not have Celiac disease but he was just allergic to wheat. After this, my grandfather decided it was too difficult to avoid gluten in his diet and the doctor agreed to just put him back on Dapsone so he could consume gluten without having all of the DH flare-ups. Eventually this downward spiral led to him having emergency surgical exploration ending up with small-bowel resection due to complications with his small intestines (I'm speculating this is Celiac related but not 100% positive). Throughout the next several years his health continued to rapidly deteriorate to the point he became extremely frail and was using a walker. Fast forward to the day before he passed away. He had fallen and sustained a fractured hip. He had surgical repair that night which eventually led to him being admitted to the ICU due to inability to keep his blood pressure stable. That night, despite all of the ICU IV blood pressure support medications they had him on he passed away. Since it was such a sudden and unexplained death they offered my grandmother an autopsy and she agreed. In the report, according to my grandmother, they put that he had a chronic adrenal gland issue which ended up causing his death. I investigated this some online and I found there was a link between Addison's Disease and Celiac Disease. From what it sounds like to me he went into an Addisonian crisis and led to his death. I started with that story because I am utterly shocked at how little education my grandfather received regarding his diagnosis of DH and to be told he just has a wheat allergy and needs to avoid gluten if possible. I found this website after I tested on the positive scale for tTg-IgA and started reading post after post absorbing as much information as possible. I came to be tested after my younger brother mentioned to me he had been tested for Celiac disease and had a "weak positive" test result on tTg-IgA and was told to go gluten free immediately after that test. He was not given a diagnosis or recommended GI consultation for EGD biopsy. (I have since shared the information I have learned but he already went gluten free and had resolution to most of his symptoms and is not interested in EGD with biopsy or going back on gluten for that matter!). I started to put the pieces together after he told me about his "weak positive" result and started thinking about all of the weird symptoms I had experienced off and on throughout my 33 years of life. As a child I oftentimes would throw up for no reason after eating breakfast or have diarrhea before school. My mom always attributed it to nerves about going to school. She also told me that I threw up at school a lot early on and would be sent to the nurses office but again it was attributed to nerves and apparently I would say things like "I'm afraid my parents won't pick me up after school." I had a lot of childhood anxieties and worries that other children didn't have and my parents thought I was just a sensitive child. Eventually, all of the gastric concerns triggered a pediatric GI consultation. I had an EGD and some form of barium study (as I remember the distinct white poo it produced later). I was just a small child at the time this was happening and now that I'm older I asked my mom if she remembers what they were looking for or what they told her and she can't remember any of the test results. She said they thought it was just stress related. As a child I also developed this strange rash on my hands that presented as small, clear blister-like bumps with a tiny dot in the middle of them and would be on my palms and in between my fingers. The inside of the finger bumps I remember would get kind of raw, itchy and would crust over and the bumps on my palms would just itch a lot. Eventually it just went away and would come and go randomly up until early adulthood. I remember distinctly the last time I had this rash on my hands. I was in California at the beach in my early 20's and I picked up a large bull kelp seaweed and was swinging it around. Later that night I had that rash randomly appear after not having that rash on my hands for years and years. In my early adult life I had 4 different occasions of kidney stones. I know this is a very common thing to happen to people but also found information that said Celiac individuals have a higher incidence of these due to malabsorption issues (correct me if I'm wrong). The biggest symptoms I have been experiencing since 2017, after I just finished up a year long divorce. I started having the most intense anal irritation....I mean this was bad. It was itchy, raw, burning and there was blood whenever I would wipe. This went on for a year until 2018 when I started having other symptoms. I went to my primary doctor and told him I am completely wiped out and feeling fatigued to the point it was very noticeable to me (told me it was stress from going through divorce). I had this "fuzzy" feeling like I was walking around kind of dazed all the time. I also reported having joint pain in my thumb, hip, knee and ankle. They weren't all painful at the same time and the pain would sometimes be there and sometimes be fine. I reported that I had developed a red, bumpy and very itchy rash on my arm that eventually went away and then went to my back. After my back rash went away it moved to my abdomen where it stayed for months and was present at the time of my appointment. I also told him about the severe anal discomfort. He said I had anal fissures and gave me some steroid suppositories. He checked labs for rheumatoid arthritis and lupus which were both negative. He also tested my testosterone which was slightly elevated and checked my leutinizing hormone and follicle stimulating hormone, which were both high. Nothing ever came of these symptoms or tests and I kind of just internalized everything and thought this must just be how I am and I am getting a little bit older now. I continued to have these symptoms off and on until the present time just thinking this is the way I was built. I also always wondered what those bright white areas on four of my teeth were (enamel defects!). My last primary care check up (May 2022) I told the doctor I was feeling really weird and that I felt like the normal everyday things that didn't stress me out before are now stressing me out a lot and getting me down. I told him I was very irritable all of the time for no reason at all. I could have all kinds of great things happening in my life and I was just irritated and moody all of the time (to the point my new wife was noticing a change in character for me and mentioned it). He asked if I wanted to be put on some meds and I told him I didn't want them. I have also been having almost daily minor, annoying headaches almost every single day for several months now. Fast forward to September 2022 and this is the point I put the pieces together and asked my doctor to be screened for Celiac disease. I was given a formal GI referral after my positive test and I am set to go to that appointment today at 3:00 pm. I am seeing a nurse practitioner for the consult due to long wait time to see a doctor. I was assured the NP will be able to order the EGD and will take my history, etc. I'm very apprehensive about the coming EGD because I'm worried they won't be able to see what they need to see or won't biopsy enough sites to give an actual diagnosis. I guess I'm so worried about that because my tTg-IgA was only an 11 U/mL and was just on the cusp of being positive but still considered positive. If my result was much higher I would be less apprehensive I guess. Technically my tTg-IgA is close to 4 times the upper normal level for my lab. I only had my tTg-IgA drawn and didn't know at the time I asked for testing about all of the other things I should have asked for. Should I ask for more celiac tests i.e DGP IGA/IGG, total IGA at my GI consultation today or is the tTg-IgA enough since it was positive? Should I ask to be screened for vitamin deficiencies and what are the most important ones to ask for? Is it rude to ask them how many biopsies they take and is it okay to be pushy and tell them I want 4-6 biopsies?? Thank you for allowing me to tell my story! Sorry it ended up being so long and I would greatly appreciate any feedback, recommendations, etc. if you have time to get through to the end of my novel!! Take care.
  10. My main symptom has been absolutely crippling fatigue. I've been back and forth to the GP and had to beg them for blood tests. GP kept saying it was long covid despite never testing positive. To cut some long stories short he eventually checked my TTG levels which came back as 11.0u/ml (< 5 negative, 5-10 equivocal, >10 positive). My EMA also came back positive. GP just told me to cut out gluten for 3 months then phone him back. I challenged this as I know the guidance states you need a biopsy and not to cut out gluten. I argued and argued and got sick of arguing and paid for a private biopsy. The gastroenterologist basically said they disregard the EMA and because my ttg was 11 it's highly unlikely I'm coeliac. Had the biopsies today and he said everything looks normal and he thinks the biopsies will be negative. Thoughts??
  11. Celiac.com 08/15/2022 - In a significant finding, a celiac disease registry at University of Alabama reveals significant issues in accurately testing Black people for celiac disease using the TTG antibody test. The new registry of celiac disease patients at the University of Alabama at Birmingham is the work gastroenterologist Dr. Amanda Cartee, MD, and fellow colleagues at UAB. Among the most important findings, the registry reveals that Black people with biopsy confirmed celiac disease are exponentially more likely than non-Hispanic whites to show negative results on the most common diagnostic celiac disease blood test. For people with celiac disease, a positive TTG antibody test is the most common path to an endoscopy and biopsy to confirm or negate celiac disease. For most people with celiac disease, especially non-Hispanic whites, a positive TTG test is highly predictive of celiac disease, hence the routine endoscopy and biopsy to follow-up a positive test. In fact, less than ten percent of non-Hispanic whites with biopsy-proven celiac disease have a "negative" TTG test. However, according to the registry data, high percentages of Black people with celiac disease are testing negative for TTG antibodies, and so being denied a swift and properly diagnosis, simply because they never meet themes common threshold for biopsy. It's the TTG threshold currently used to determine the definition of positive and negative TTG that might just be at the heart of the problem. That's because the numbers are nearly reversed for Black people. While less than ten percent of non-Hispanic whites with celiac disease show negative TTG results, the registry data shows that a whopping eighty percent of Black people with biopsy-proven celiac disease have a "negative" TTG test. The means that these folks were unlikely to have gotten a biopsy as quickly as someone with a positive TTG test. It also means they may have had to suffer longer, and/or self diagnose. And those facts are also borne out by the registry data, which point to longer times to diagnosis and less biopsy-driven diagnoses for Black celiac patients. Black patients were also much less likely to have received genetic testing for celiac-associated genes. There is limited data on celiac disease and Black people, said Dr. Cartee, noting that only a single study with the primary goal of investigating the clinical characteristics of celiac disease and Black people has been done. While the registry revealed differences in TTG test results and BMI, it showed similarities in celiac disease diagnosis for non-Hispanic white and Black patients. These included symptoms as the primary cause for testing, length of time to diagnosis, and a diagnosis that did not include recommended blood tests and a biopsy. Basically, the data show that TTG tests will be negative in the vast majority of Black patients with biopsy-proven celiac disease. That means further study is needed to determine whether the TTG test is useful for Black patients, and more research needs to be done to figure out how to make sure they can get quickly and properly diagnosed. Stat tuned for more on this and related stories regarding celiac disease testing, screening, and diagnosis in Black people, and in other ethnic populations. Read more about the celiac registry data and findings presented by UAB gastroenterologist Dr. Amanda Cartee, MD, at Digestive Disease Week.
  12. I was diagnosed with celiac disease four years ago (through a biopsy and blood test). I immediately stopped eating gluten and have followed a rigid gluten-free diet ever since (I sometimes eat at restaurants and cafés but am always careful when I do). Around the same time (i.e. four years ago) I started having occasional rashes on my tush. I had previously had rashes on my elbows and knees that were thought to be eczema. The progression usually goes like this: an itchy red bump, followed by a raised yellowish blister (also itchy), spreading to a more diffuse pink splotch, finishing with a dark red scab, and then healing. I have always noticed that this usually occurs symmetrically on my body. Eventually it started appearing on my knuckles and fingers, and occasionally on my back and stomach. About a year ago it started to appear fairly intensely on my scalp. At night the itching (especially on my backside) wakes me up. I went to the GP several times and received a variety of possible diagnoses (rarely with any degree of certainty): eczema, fungus, scabies, herpes. I was swabbed for herpes three times with negative results each time. I was prescribed a variety of creams and topical steroids, none of which really worked, except that the steroid (Eumovate) does reduce the itching. More recently I've been using an essential oil mixture that also seems to help the itching. I occasionally get periods of remission, often when I travel, and most recently when I had the flu and my skin cleared up completely for a week. I'm never able to really identify anything different in my diet during these periods of remission. At one point the herbalist put me on the Gaps diet, which I did for a couple months with limited success. My questions are these: 1) are there other people here who have adopted a strict gluten-free diet but still have DH? 2) my GP told me that even though I have been gluten-free for a long time, a biopsy of my skin would still give good results, because I have active symptoms. Does anyone have experience with this? I'm open to any other advice and information people would like to add. I've been reading this part of the forum and have already learned a lot. Thanks
  13. Celiac.com 06/13/2022 - In 1992 Dr. Michael Marsh developed his "Marsh Classification" system to describe the various stages of microscopic damage to the small intestine (histological changes) seen in those with celiac disease. The original system ranged from 0 - 4, and 3 or higher meant celiac disease, but his system was modified for consistency and reproducibility between pathologists. Today, anyone who has been diagnosed with celiac disease has likely heard about the Marsh classification system. Using the Marsh Classification allows clinicians to accurately measure the full extent of the damage to the villi that line the small intestine, to determine the extent of celiac disease progress and damage. Modified Marsh Classification of histologic findings in celiac disease (Oberhuber) are measured in units of IEL/100 enterocytes, intraepithelial lymphocytes per 100 enterocytes. Current Marsh Classification Marsh Type 0 - Normal; celiac disease highly unlikely. IEL / 100 enterocytes – jejunum <40 IEL / 100 enterocytes - duodenum <30 Normal crypt hyperplasia Normal villi Marsh Type 1 - Seen in patients on gluten free diet (suggesting minimal amounts of gluten or gliadin are being ingested); patients with dermatitis herpetiformis; family members of celiac disease patients, not specific, may be seen in infections. IEL / 100 enterocytes – jejunum >40 IEL / 100 enterocytes - duodenum >30 Normal crypt hyperplasia Normal villi Marsh Type 2 - Very rare, seen occasionally in dermatitis herpetiformis. IEL / 100 enterocytes – jejunum >40 IEL / 100 enterocytes - duodenum >30 Increased crypt hyperplasia Normal villi Marsh Type 3 - Spectrum of changes seen in symptomatic celiac disease. Marsh Type 3a IEL / 100 enterocytes – jejunum >40 IEL / 100 enterocytes - duodenum >30 Increased crypt hyperplasia Mild villous atrophy Marsh Type 3b IEL / 100 enterocytes – jejunum >40 IEL / 100 enterocytes - duodenum >30 Increased crypt hyperplasia Marked villous atrophy Marsh Type 3c IEL / 100 enterocytes – jejunum >40 IEL / 100 enterocytes - duodenum >30 Increased crypt hyperplasia Complete villous atrophy In an effort to simply the Marsh Classification system, the following Simplified Celiac Classification System has been proposed by researchers Corazza, Roberts, and Ensari, which may be much easier and more reproducible. Simplified Celiac Classification System Grade A/Type 1: increased intraepithelial lymphocytes but no villous atrophy. This occurs in those on a gluten-free diet and is likely caused by patients who consume small amounts of gluten due to cross-contamination or in those who cheat on their diets, and in patients with dermatitis herpetiformis, family members of celiacs, and can also be seen in certain infections. Grade B1/Type 2: villi still present but shortened. This level of damage is accompanied by many symptoms associated with celiac disease. Grade B2/Type 3: complete villous atrophy. This level of damage is accompanied by many symptoms associated with celiac disease. To date, there has been no good study data comparing the two systems. Certainly, a simpler, more reproducible Marsh system would make the job of measuring the progress of celiac disease and the gluten-free diet in celiac patients much easier. Stay tuned for more on this and related stories. Read more at stanford.edu.
  14. Celiac.com 05/27/2022 - Among the many symptoms associated with celiac disease, some of the commonest fall into the broad category of “dyspepsia”. These are symptoms more usually attributed to acid reflux from the stomach into the esophagus (heartburn, regurgitation, even difficulty swallowing a.k.a. dysphagia) or to peptic ulcer disease (upper abdominal pain, indigestion, fullness). While we are not entirely sure why celiac disease causes these, often in the absence of typical “bowel” symptoms, we do know how(1) . Studies of the upper gut in celiac disease patients frequently show abnormal motility and peristalsis: the conveyor belt isn’t working properly (The constipation that is often paradoxically a symptom of celiac disease probably has the same basis). So many celiac patients are going to be referred not for small bowel investigation but for upper GI endoscopy, and the gastroenterologist is expecting not celiac disease, but reflux esophagitis, hiatus hernia, gastritis or peptic ulcer disease. Wouldn’t it be nice—and wouldn’t it make life a lot simpler for the so far undiagnosed celiac patient—if the gastroenterologist could spot villous atrophy like these other conditions? The good news is that you can see villous atrophy down an endoscope. Well, some of the time (but more of that later). One of the most exciting developments in my career as a celiac diagnostician was when our museum piece fiberoptic endoscopes were replaced by full color videoscopes. Endoscopy was no longer an uncomfortable (for the endoscopist!) and hurried foray into the upper gut, hunched over with one eye peering down a clouded eyepiece, frantically trying to see everything and get the heck out before the disinfectant fumes wafting up the scope dissolved the glue holding my spectacles together. Instead it became a civilized stroll which ended in a duodenum filling a ten inch TV picture in glorious color. And it became clear to me and many other celiac specialists that the duodenums of celiac patients didn’t look quite right when they were up close and magnified in this way. Abnormalities seen in our patients with villous atrophy(2) include mosaic mucosa (53%), scalloped folds (50%), fold loss (15%) and nodular mucosa (6%) and erosions (small ulcers) in the second part of duodenum in 7%. Occasionally the mucosa is so thin that blood vessels can be seen through it. Although uncommon in celiac disease, the finding of erosions in the second part of duodenum is of particular interest as clinicians may simply flag it up as peptic ulcer disease, even though peptic ulcers usually only affect the first part of duodenum. I’ve seen a few patients who had previously been wrongly diagnosed “peptic” because of this endoscopic feature. So how have these endoscopic markers changed my practice? Around half of my new celiac patients present with dyspepsia and are recognized at endoscopy(3) . One in 60 (twice the background prevalence of celiac disease) patients referred for endoscopy from primary care with dyspepsia are diagnosed celiac because of these markers(4). Often the story is of dyspeptic symptoms which have not responded to ulcer healing drugs—while on a gluten-free diet they disappear magically. There are two caveats regarding endoscopic markers. While villous atrophy in adults is pretty much synonymous with celiac disease in Western Europe, elsewhere it may sometimes indicate other disease, as reported by the New York Group(5) . Secondly, the bad news is that villous atrophy can’t always be spotted. We found that only 74% of villous atrophy cases had endoscopic markers(2) , and as many patients had endoscopy for biopsy because we were expecting to find celiac disease, that figure may be an overestimate of routine practice. The Mayo Clinic found markers in only 59% of celiac patients from a group of anemic patients having endoscopy(6). While 82% of our patients with subtotal or total villous atrophy had one or more endoscopic markers, the yield fell to 58% for partial villous atrophy(7). And as you might expect, I have never seen endoscopic markers in gluten-sensitive patients with milder (Marsh I, Marsh II) histologic abnormalities which have not yet progressed to villous atrophy. So lack of markers does not mean that there is no need to biopsy, particularly in high risk groups like patients with anemia and insulin dependent diabetes. In an ideal world, duodenal biopsy would be a routine part of every upper GI endoscopy, as already proposed by Peter Green and Joe Murray(8). In practice, particularly in the good ol’ underfunded UK National Health Service that I work for, this would have very significant resource implications. I suspect such a policy—duodenal biopsies taken at every endoscopy— implemented without a major funding initiative on my side of the Atlantic might find our already overworked and undervalued histopathologists under the cars of gastroenterologists furiously cutting through their brake lines. In the meantime, and until the New Jerusalem of routine duodenal biopsy during endoscopy is constructed, recognition of the endoscopic markers of celiac disease, while not foolproof, represents a pragmatic way of diagnosing celiac patients who present with dyspepsia. References: Bassotti G, Castellucci G, Betti C et al. Abnormal gastrointestinal motility in patients with celiac sprue. Dig Dis Sci 1994; 39: 1947-54. Dickey W, Hughes DF. Erosions of the second part of duodenum in patients with villous atrophy. Gastrointestinal Endoscopy 2004; 59: 116-118. Dickey W. Diagnosis of coeliac disease at open access endoscopy. Scandinavian Journal of Gastroenterology 1998; 33: 612- 5. Dickey W, Hughes DF. Prevalence of celiac disease and its endoscopic markers among patients undergoing routine endoscopy. American Journal of Gastroenterology: 1999; 94: 2182-6. Shah VH, Rotterdam H, Kotler DP, Fasano A, Green PHR. All that scallops is not celiac disease. Gastrointest Endosc 2000; 51: 717-20. Oxentenko AS, Grisolano SW, Murray JA et al. The insensitivity of endoscopic markers in celiac disease. Am J Gastroenterol 2002; 97: 933-8. Dickey W, Hughes DF. Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: implications for celiac disease diagnosis during routine endoscopy. Am J Gastroenterol 2001; 96: 2126-8. Green PHR, Murray JA. Routine duodenal biopsies to exclude celiac disease? Am J Gastroenterol 2003; 58: 92-5.
  15. Celiac.com 04/04/2022 - Consensus is building among researchers and clinicians for skipping biopsy, and diagnosing celiac disease in both children and adults using antibody tests alone. A team of researchers recently set out to assess the diagnostic accuracy of serological tests for celiac disease in adults and children. The research team included Athena L. Sheppard; Martha M. C. Elwenspoek; Lauren J. Scott; Victoria Corfield; Hazel Everitt; Peter M. Gillett; Alastair D. Hay; Hayley E. Jones; Susan Mallett; Jessica Watson; and Penny F. Whiting. They are variously affiliated with the The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK; the Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; the Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK; the Paediatric Gastroenterology Department, Royal Hospital for Children and Young People, Edinburgh, UK; and the Centre for Medical Imaging, University College London, London, UK. The team searched seven electronic databases between January 1990 and August 2020 and looked for diagnostic studies that assessed the accuracy of serological tests for celiac disease against duodenal biopsy. They used QUADAS-2 to determine bias risk, along with bivariate random-effects meta-analyses to estimate serology sensitivity and specificity at the most commonly reported thresholds. They included over one-hundred and ten studies covering nearly thirty thousand patients, all in secondary care populations. Due to variations in diagnostic thresholds, they included a subset of studies in meta-analyses. Overall sensitivity and specificity of immunoglobulin A (IgA) anti-tissue transglutaminase were 90.7% and 87.4%, respectively, in adults, and 97.7% and 70.2% respectively in children. Overall sensitivity and specificity of IgA endomysial antibodies were 88.0% and 99.6% in adults, and 94.5% and 93.8% in children. Anti-tissue transglutaminase sensitivity appears to be sufficient to rule out celiac disease in children. The high specificity of endomysial antibody in adults supports clinical use to rule in celiac disease. This evidence supports the serological diagnosis of celiac disease without biopsy. The research team calls for additional studies in primary care to assess serological testing strategies. This news will come as a relief to anyone who has been made to eat gluten for a few weeks, and suffer a biopsy to get a celiac diagnosis. We truly are on a new threshold of celiac diagnosis, where biopsy will soon be a rare tool, and serological testing will deliver an accurate diagnosis. Stay tuned for more on this and related stories. Read more in Alimentary Pharmacology & Therapeutics
  16. Celiac.com 03/14/2022 - Levels of antitissue transglutaminase titres at or above five times the upper limit of normal in children indicates celiac disease in nearly every case. Currently, guidelines on celiac disease by the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) recommend that children who have IgA-based antitissue transglutaminase (TGA-IgA) titre at or above ten times the upper limit of normal (≥10x ULN), along with positive antiendomysial antibody, can be reliably diagnosed with celiac disease with no-biopsy required. A team of researchers recently set out to examine the relationship between TGA-IgA ≥5×ULN and histologically confirmed diagnosis of celiac disease. The research team included Siba Prosad Paul; Daniyal Isam Raja; Bhupinder Kaur Sandhu; Srinivasa R Rao; Christine H Spray; Anthony Edward Wiskin; Lakshmipriya Selvarajan; Eleni Volonaki; Pramila Ramani; Lina Bourhan Tashtoush and Dharamveer Basude. They are variously affiliated with the Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK Paediatrics, Yeovil District Hospital in Yeovil, UK; the Medical School at the University of Exeter in Exeter, Devon, UK; the Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK; and the Paediatric Histopathology, Bristol Royal Hospital for Children, Bristol, UK The team reviewed and assessed data, including TGA-IgA levels at upper gastrointestinal endoscopy and histological findings, from children diagnosed with celiac disease following endoscopy from 2006 to 2021. They confirmed celiac disease cases using Marsh-Oberhuber histological grading 2 to 3, and conducted statistical analysis using χ² analysis. The team histologically confirmed celiac disease in a total of 722 of 758 children, along with 455 of 457 children with TGA-IgA at or above five times ULN (the two outliers were eventually received celiac diagnosis based on clinico-pathological features. A total of 114 of the 457 had between TGA-IgA at or above five times ULN and below ten times ULN; all of whom were confirmed with celiac disease. Patients with TGA-IgA at or above five times ULN had a ninety-nine percent likelihood of a positive biopsy, compared with eighty-eight percent of those with TGA-IgA below five times ULN, which is statistically significant. The team determined the best TGA-IgA cut-off point to be below 5×ULN for the two screens used. Nearly one-hundred percent of children (99.5%) with TGA-IgA levels at or above five times ULN had histological confirmation of celiac disease, and can be confidently diagnosed without biopsy. Confirmation of these findings by additional studies would present strong evidence for changing the ESPGHAN guidelines to a lower threshold of TGA-IgA for serological diagnosis of celiac disease. This is extremely encouraging for children whose celiac screening falls within these levels. Ideally, we'll be able to move toward quick, confident celiac disease diagnoses for these patients, without going through the hassle of eating gluten and getting a biopsy. Read more in Archives of Disease in Childhood
  17. Celiac.com 12/15/2021 - The journey from symptoms to questions, to the search for a proper celiac disease diagnosis can be long, confusing, and frustrating. For many people with celiac disease, the pre-diagnosis phase is the most challenging part of the journey. A glance at our popular online forum shows that questions about pre-diagnosis, testing and symptoms of celiac disease abound among celiac sufferers. To help make the journey a bit easier, we've put together this list of helpful things to know about per-diagnosis and testing for celiac disease. Celiac Disease Pre-Diagnosis & Testing Celiac Symptoms We'll start first with symptoms, because, for most patients, celiac symptoms are often what get the ball rolling toward testing and diagnosis. Classic celiac-associated gastrointestinal symptoms include malnutrition, diarrhea, abdominal pain, and bloating, weight-loss, or low body weight, among others. Interestingly, most people with celiac disease show no symptoms, but are diagnosed on the basis of referral for elevated risk factors. For people who do show symptoms, it is increasingly common to find atypical symptoms, such as being overweight, especially in children. In fact, most children with celiac disease now show atypical symptoms. An absence of symptoms, or the presence of atypical symptoms can make diagnosing celiac disease even more difficult, as patients often need a referral from a physician, who may have trouble justifying one if she can't point to clear symptoms. To make matters worse, celiac disease is often confused with numerous other diseases, which can cause delayed diagnosis, or even misdiagnosis. Celiac Disease Pre-Diagnosis When people talk about "pre-diagnosis" of celiac disease, they are usually talking about the testing phase. Usually, a person will have symptoms of one sort or another that will lead them to a physician, who will then request testing for celiac disease antibodies. In some cases, confirmation by biopsy is still the go-to procedure for officially confirming celiac disease, however, in Europe they are now diagnosing celiac disease via a blood test only when it detects a 10-fold increase in IgA antitissue transglutaminase (tTG) antibody levels above the reference range, in combination with EMA positivity, without the need for a duodenal biopsy. So in many cases, celiac disease can now be diagnosed by blood test alone, without the need for a follow-up biopsy, especially in children, first-degree family relatives, and even in many adults. Celiac Disease Blood Antibody Testing Traditionally, doctors will order a test to measure blood levels of anti-transglutaminase antibodies, or tTG2, which are higher in people with celiac disease. tTG2 proteins are among the proteins that trigger the immune reaction the causes inflammation when celiac eat wheat, rye, or barley. Celiacs have hundreds times more tTG proteins than non-celiacs. Testing begins with a test called Immunoglobulin A (IgA). If the results are normal, then a Tissue transglutaminase, antibody, IgA test is given. A weak positive should lead to the following tests: Endomysial antibodies (IgA) and; Gliadin (deamidated) antibody, IgA. If the initial Immunoglobulin A (IgA) test is low, then these two tests should be done: Tissue transglutaminase antibodies, IgA and IgG profle. Gliadin (deamidated) antibodies evaluation, IgG and IgA. If the initial Immunoglobulin A (IgA) test is deficient then these two tests should be done: Tissue transglutaminase (tTG) antibody, IgG. Gliadin (deamidated) antibody, IgG. In fact, trials show the tTG blood test to be 95 percent sensitive (meaning it detects celiac disease 95 times out of 100), and 95 percent specific (meaning it gives a false positive result just 5 times out of 100). A Possible Future for Celiac Blood Tests One Blood Test Can Now Diagnose Celiac Disease without Biopsy New Screening Method Offers Faster and Easier Detection of Celiac Antibodies FDA Approves New Test for Celiac Disease A New York startup company, Aesku NY, has received FDA approval for tests to detect celiac disease. Patients who screen positive would require further testing for a specific diagnosis. However, the tests are designed to be cost effective, and efficient, potentially increasing the availability of a reliable screening method for diseases that are best caught and treated early. Blood Test Results Normally the results you get will be either negative, weak positive, or positive. Any positive blood test, even if others are negative, could indicate celiac disease. Read more about the Interpretation of Celiac Disease Blood Test Results Confirmation In some cases, biopsy is still the go-to procedure for officially confirming celiac disease. This is the case even in Europe when tTG levels are below 10x the reference range for celiac disease. There is some research to indicate that children, on average, may have less villi damage than adults, which is why blood test results are so important. Genetic Testing Genetic tests for celiac disease and gluten sensitivity are readily available. Testing can be performed on either blood or mouth swab samples. Tests can be done at home and mailed to the lab for analysis. A good testing laboratory will provide an accurate prediction of celiac disease risk, and will also provide information about the statistical risk to your children, your likelihood of developing more severe celiac disease, whether one or both of your parents had the risk gene, and for some laboratories, you may determine your risk of gluten sensitivity without celiac disease. Get the Facts About Celiac Disease Genetic Testing Genetic Test Results No DQ2 & DQ8 Can Still Mean Non-Celiac Gluten Sensitivity (NCGS) Data collected by Dr. Ken Fine of Enterolab supports the fact that the absence of DQ2 and DQ8 does not exclude the risk of gluten intolerance or gluten sensitivity, though it now looks likely that one or both of those genetic white blood cell patterns are required for celiac disease to develop. DQ Type Can Influence Celiac Risk and Severity Both the DQ type, and number of copies you have, help to determine the risk, and also the potential severity of celiac disease. Two copies of DQ2 carries more risk than one copy of DQ8 or only partial DQ2. Even a single copy of DQ2 alpha subunit ("half DQ2 positive") carries risk for celiac disease, but most of the commonly used laboratories for Celiac genetics do not test for or report the presence of this component of the celiac genes. The odds of developing celiac disease based on HLA-DQA/DQB genotypes is as follows: DQ2+DQ8 1:7 (14.3%) DQ2+DQ2 OR DQ2 Homozygous DQB1*02 1:10 (10%) DQ8+DQ8 1:12 (8.42%) DQ8+DQ8*02 1:24 (4.2%) Homozygous DQB1*02 1:26 (3.8%) DQ2 only 1:35 (2.9%) DQ8 only 1:89 (1.1%) General Population - Genotypes unknown 1:100 (1%) ½ DQ2*DQB1*02 1:210 (0.5%) ½ DQ2*DQA1*05 1:842 (0.05%) No HLA-DQA/DQB susceptible alleles 1:2518 (0.04%) Testing for celiac disease should be done using FDA-approved HLA test kits. HLA-DQA/DQB genotyping typically provides detection of DQ2 (DQA1*0501, DQA1*0505, and DQB1*0201/*0202) and DQ8 (DQB1*0302) For example: HLA-DQ2(DQA1*05/DQB1*02) Positive or Negative HLA-DQ8(DQA1*03/DQB1*0302) Positive or Negative Conclusion For anyone in the pre-diagnosis phase of suspected celiac disease, the keys to effective screening and diagnosis lie in testing and diagnosis, with or without biopsy. If you have questions about specific issues, be sure to check into our celiac disease forum.
  18. Hello! Today I was met with stress because of dealing with a doctor who seemed like he knew nothing about celiac or similar diseases. a couple months ago, I started to lose a lot of weight. About 30lbs and then after I lost the weight, I began to get extreme stomach pains and bloating whenever I consumed gluten. I now get extreme nausea to the point of almost throwing up, migraines, acne (could be unrelated), bloating, sickness like stuffy nose and bloated face, the list goes on. I contacted my doctor when I realized this was an issue and began to change my diet immediately so I could attend classes and function as consuming gluten would prevent me from being healthy. my doctor signed me up for many exams including a blood attg test. He told me to continue being on a gluten free diet and not to consume gluten if it hurt. What he didn’t tell me is that not consuming gluten for about two months prior to the test would result in my test being negative. Because he told me to go gluten free before the blood test, I was unable to find any antibodies. after discussing things with him today, he told me that I “probably have something like celiac” so I shouldn’t eat gluten but since my tests came back negative (because I didn’t eat gluten, so my antibodies didn’t show up), he didn’t want to give me the biopsy to confirm the disease. Further, I asked for vitamin supplements or other things to help with coping with my new lifestyle and all he said was to not eat gluten since it was helping me already. Has anyone else had this issue? I feel like my doctor won’t even help me. I have no clue what to do and I really want a diagnosis of something. I do not know if I have gluten intolerance, sensitivity, celiac or something else because he refused to guide me in what to do or even have a referral to a biopsy so I can get an official diagnosis.
  19. Hi! So I went to a GI doctor due to having terrible digestive issues, bloating, and acid reflux. I got a celiac blood panel test done and only one part came back positive, the Deamidated Gliadin Abs, IgG. my doctor then told me that an endoscopy needs to be performed next so i got one done. (Both blood test and endoscopy were performed while i was eating gluten) The biopsy results were “ increased intraepithelial lymphocytes with normal villous structure”. I met with my doctor and she stated with the blood results combined with the biopsy results that it was celiac disease. she told me to go gluten-free and come back in two months to get another blood test. so I went gluten free and it’s been one month since, and I have seen a big difference in symptoms, with me almost having no digestive issues now. i’m just confused because I’m trying to understand the results more and I looked stuff up and I’m reading stuff about latent Celiac, only gluten intolerant, etc. i’m just questioning it because I have no intestinal damage, but I do know that not every part of the intestines can be biopsied to see. and the only one positive part blood test is confusing to me, because some sources say only one antibody needs to be positive and some don’t. I don’t want to be diagnosed celiac if I don’t have it, but on the other hand I do want to be diagnosed if I do have it because I don’t want to make it worse if i don’t do gluten free. obviously I trust my doctor and she has been really great at listening to me, and i’m going to meet with her soon to ask for clarification. I’m not asking for a diagnosis, but I’m just trying to see if anybody else has had the same experience or results? Or if anybody can help explain the results more? I know I’m probably overthinking it😅
  20. Hey Guys, I'll post the question first in case you don't have time to read my story. Does/can gluten expose cause burning pain in the gut area? It seems when I MIGHT have a gluten exposure I get a "flare" of burning pain in my gut - mostly my left upper area. If I KNOW I've eaten gluten I get the burning plus the awful cramps and like I have constipation and diarrhea at the same time, my joints hurt like crazy and feel a little dizzy and this goes on strong for at least two days and takes what seems two to three weeks to go away. Backstory: My gut has been sick for 5 years. My gastro doc ran the basic tests (colonoscopy, endoscopy with all the biopsies, etc.) and my GP ran all the other stuff (CT scan, Echo of gallbladder, bloodwork). ALL normal except slight gastritis in stomach and a few diverticuli along my colon. Gastro doc said I have classic IBS. I have seriously tried every single diet change on the planet to heal up, and some have been quite extreme. The ONE thing I found for sure is that if I go strict without gluten and dairy for, say, 3 weeks, and then eat gluten again I get sicker than a dog. Now, during all my tests, my gastro doc biopsied me for celiac but at the time I didn't KNOW he was going to test me for it and HE didn't know I wasn't eating gluten. When he told me the celiac came back negative I said that was good because I hadn't been eating gluten for awhile anyway. The gasto doc was shocked and said the NEGATIVE results could totally be wrong. He told me to "Go eat all the bread that God made and come see me so we can redo the test". I took some gluten afterwards and immediately got sick. I didn't go back to my gastro doc because I wasn't about to continue to eat the gluten for 2 weeks. My GP doc says he wants to diagnose me with celiac just based on my symptoms alone. Now, the burning pain in my left upper side is so awful. Like a 6 or 7 on my pain scale.. and I've birthed 6 children with no meds. It used to come and go and now it's mostly here. I try hard to stay away from gluten but since the pandemic have been eating out "gluten free" and I think I get exposed. Yet, I'm still not sure if I am even celiac! I read somewhere that if a person is highly sensitive to gluten that an exposure can make them sick for up to a year? Now my GP doc wants to run more tests to see if I have other issues. My main question is whether gluten exposure can cause this type of burning pain? Has anyone else experienced this? Thanks, Missi
  21. Celiac.com 10/19/2021 - There is some data to indicate a connection between celiac disease and IgA nephropathy (IgAN). In celiac disease IgA-class tissue transglutaminase (tTG) autoantibodies are seen in the small bowel mucosa and extraintestinal organs, in addition to circulating in serum. A team of researchers recently studied whether celiac disease-type IgA-tTG deposits occur in kidney biopsies in a case series of IgAN patients with or without celiac disease. The research team included Rakel Nurmi, Ilma Korponay-Szabó, Kaija Laurila, Heini Huhtala, Onni Niemelä, Jukka Mustonen, Satu Mäkelä, Katri Kaukinen, and Katri Lindfors. They are variously affiliated with the Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University in Tampere, Finland; the Celiac Disease Center, Heim Pál National Pediatric Institute in Budapest, Hungary; the Department of Pediatrics, Faculty of Medicine and Clinical Center, University of Debrecen in Debrecen, Hungary; the Faculty of Social Sciences, Tampere University in Tampere, Finland; the Medical Research Unit, Seinäjoki Central Hospital in Seinäjoki, Finland; and the Department of Internal Medicine, Tampere University Hospital in Tampere, Finland The team looked at nine IgAN patients, four of whom had celiac disease. The team measured serum tTG autoantibodies at the time of the diagnostic kidney biopsy, and looked at colocalization of IgA and tTG in the frozen kidney biopsies. The results showed IgA-tTG deposits in the kidneys of three IgAN patients with celiac disease though two patients had been diagnosed with celiac disease years later. They fund no deposits in a known celiac disease patient who was following a gluten-free diet. Of the five non-celiac IgAN patients, three showed IgA-tTG deposits in their kidneys. From their small study, the team concludes that tTG-targeted IgA deposits can be found in the kidney biopsies of gluten-consuming IgAN patients, but they likely won't be much help in spotting celiac disease, due to limited specificity. Read more in Nutrients
  22. Hello All, my 4 year old recently tested positive on the celiac blood test. His numbers were off the charts.. below are his test results. Transglutaminase Iga: 405 emdomysial Iga: positive 1:8 Gliadian Igg: 89 Iga serum 142 from what I have read, with test results this high you can diagnose celiac without doing the biopsy. But the GI doctor is trying to push us to do it to see the extent of the inflammation even though the treatment (stop eating gluten) would be no different if it were an early or advanced stage. I don’t want to put him through unnecessary trauma and have to feed him gluten again. has anyone had numbers this high and had a negative biopsy for celiac? The dr said it would be highly unlikely he doesn’t have celiac so not sure why she is pushing so hard. He only has minor physical symptoms like constipation and trouble sleeping. The reason we got him tested is due to his extreme behavior issues, anxiety and sensory processing disorder. I’m torn on what to do..
  23. Celiac.com 04/16/2021 - When undergoing an evaluation for possible Celiac disease or gluten sensitive enteropathy doctors usually recommend an upper endoscopy with small intestinal biopsy. What that is and why it is recommended may not be clear to many people who are facing the decision of whether to undergo the procedure themselves or whether to subject their child to this exam. What is an endoscopy and how is it done? During upper endoscopy a thin flexible tube, about the diameter of a fat pencil, is passed in the mouth down the upper gastrointestinal tract. This tube has a video chip on its tip. From the mouth it is advanced down the esophagus, or inside a feeding tube, into the stomach. It is then advanced into the first part of the small intestine known as the duodenum. Thus, upper endoscopy is also known as esophagogastroduodenoscopy or EGD for short. The scope has internal channels for flushing water, suctioning secretions and passing instruments that can obtain pinch biopsy samples of tissue for microscopic examination. The scope dials control internal cables that allow the tube to be turned up/down and right/left at the tip. Do you feel and endoscopy or remember it? Typically, people undergoing the exam in the U.S. are sedated with medication. These medications are similar to Valium. They have a good amnesia and relaxing effect and are called midazolam or versed and are usually combined with a narcotic pain medication like meperidine (Demerol) or Fentanyl. The result is a sort of drowsy twilight amnesia. Lately, a very short-acting intravenous sedative, called propofol (diprovan) is increasingly being used for deeper sedation or general anesthesia. Occasionally, usually in very young children or people with severe lung problems, general anesthesia is required. The exam is usually not felt or remembered because of the medications. What is examined and how well is the lining is seen? Celiac disease affects the upper portion of the small intestine, in the two sections known as the duodenum and jejunum. The examination of the small intestine is usually limited to the first section, termed the duodenum, though occasionally the second section known as the jejunum may be reached especially when a longer endoscope is used. The video images are very high resolution with the latest endoscopes and may have a magnification and color contrast mode to detect very subtle signs of damage of the small intestine. What are the typical endoscopy findings? The characteristic appearance of the surface of the small intestine in celiac disease includes superficial ulcerations that are commonly linear, flattening of the folds, notching or scalloping of the folds and a mosaic-like pattern. However, the surface may appear normal and only under microscopic examination of samples will the lining show signs of gluten-induced injury. What are intestinal biopsies? What are their limitations? What can be missed? Samples of small intestine are obtained with biopsy forceps that consist of tiny jaws with cups that permit pinching off samples of the intestinal lining. This is painless and very safe. The samples are placed in a preservative solution and sent to a pathology lab. The tissue is then processed, embedded in paraffin wax, cut into thin slices and mounted on a microscope slide. The slides are stained before being examined under the microscope by a pathologist. Small intestine injury from gluten may be patchy. Therefore, several samples are recommended. A minimum of 4 pieces and preferably 8 to 12 samples should be obtained to avoid missing microscopic signs of Celiac disease. What does the pathologist look for on the slides to determine if there is Celiac disease or gluten injury? The pathologist examines the slide for evidence of damage or injury characteristic of gluten sensitivity. Occasionally special stains are required to see signs of irritation known as inflammation. Inflammation in the gut is characterized by an increased number of a type of white blood cells. For Celiac disease the characteristic white blood cell involved in gluten-induced intestinal injury are called lymphocytes. In early celiac and gluten sensitivity without celiac disease, the biopsy may be normal and the diagnosis may not be established by intestinal biopsy without special stains or, in the research setting, by electron microscopy. Summary The procedure of endoscopy is safe, painless, and very helpful for confirming the diagnosis of celiac disease while excluding other upper intestinal disorders. However, the main drawback of endoscopy is that nearly everyone must have sedation to tolerate the exam and it can be expensive if not fully covered by the patient’s insurance. Furthermore the biopsies may not confirm the diagnosis. If the biopsy is normal, misread as normal, or is borderline, the diagnosis of celiac disease is neither confirmed nor excluded. Sometimes, celiac disease is diagnosed by endoscopic biopsy in people who either have normal blood tests or as an incidental finding in those undergoing endoscopy for other reasons. When the biopsy is abnormally classic for Celiac disease and the blood tests are negative but the patient responds to a gluten-free diet, the term seronegative (blood test negative) celiac disease is often used. Fear or confusion about endoscopy should not prevent anyone who is suspected of having celiac or gluten sensitivity from undergoing endoscopy.
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