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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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  • 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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  • HONG KONG GLUTEN, WHEAT FREE PRODUCTS
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  • SMAS: www.celiac.com
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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
  • carlyng4's Blog
  • 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
  • collgwg's Blog
  • blueangel68's Blog
  • 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
  • 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
  • Having a Bad Day at the Doctor's Office
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Found 15 results

  1. Celiac.com 06/04/2020 - Currently, in order to properly diagnose celiac disease based on serology and duodenal histology, doctors need patients to be on gluten-containing diets, even if they are causing symptoms, and this is called a "gluten challenge." This is a problem for many people, especially those who have already given up gluten, and see benefits from the gluten-free diet. For those people, going back on gluten for several weeks can be demoralizing. For many, it's a deal breaker. This can present challenges for doctors attempting to diagnose celiac disease. According to the University of Chicago Celiac Disease Center, a gluten challenge should be done as follows: Eat gluten prior to celiac disease blood tests: The amount and length of time can vary, but is somewhere between 2 slices of wheat bread daily for 6-8 weeks and 1/2 slice of wheat bread or 1 wheat cracker for 12 weeks 12 weeks; Eat gluten prior to the endoscopic biopsy procedure: 2 slices of wheat bread daily for at least 2 weeks; A Three Month Gluten Challenge May be Necessary, and the Length Can Differ Between Kids and Adults In a 2013 study by Maaike J. Bruins, of the DSM Biotechnology Center, The Netherlands, found that: Future Tests May Spot Celiac Disease Without Prolonged Gluten Consumption Research on systemic cytokine release that occurs after gluten sensitive individuals ingest gluten may lead to new tests that can spot celiac disease without gluten consumption, however, until further research is done, and such tests are developed and made available, a gluten challenge will be necessary to make a formal celiac disease diagnosis.
  2. Celiac.com 12/10/2022 - Increased awareness and celiac disease-specific diagnostic tests have aided the diagnosis of celiac disease. For instance, blood antibody testing has become a useful tool for screening suspected cases of celiac disease. These blood tests can be very sensitive in the detection of patients with severe intestinal damage, but invariably are negative in patients with mild lesions(1). Furthermore, some pathologists are not experienced in recognizing and detecting cases in which mild intestinal damage or even partial villous atrophy is present in biopsy samples. Yet, for these tests to be accurate a patient must be on a gluten-containing diet and doctors often put patients on an oral gluten challenge only after the patient has been on a gluten-free diet and/or their blood antibody tests prove negative. The oral gluten challenge requires a patient to ingest gluten at the direction of a specialist such as a gastroenterologist for testing purposes such as preparation for an endoscopic exam with biopsies of the small intestine, still considered the gold standard of diagnosis. The demands of the oral gluten challenge are time-consuming, can exacerbate or provoke symptoms, and intentionally put celiac patients at risk for further intestinal damage. As a patient, I was gluten-challenged because I had already instituted a gluten-free diet (despite negative blood antibody tests), three weeks before my appointment with the gastroenterologist. I suffered intense and severe symptoms that were provoked by the gluten challenges—not to mention the psychological impact posed by the challenges. At the direction of my gastroenterologist, I was instructed to "make complete damage" in a span of several days upon the first of three, short gluten challenges. At one point, I was ingesting gluten up to seven times in one day. After the close of the third gluten challenge, I felt chronically cold; it was difficult to walk without extreme fatigue and weakness; and I found it difficult to eat or drink due to intense, unrelenting stomach spasms. I had already lost ten percent of my weight before the gluten challenges but lost an additional seven percent after the gluten challenges. Furthermore, I began experiencing heart symptoms and suffered constant and severe joint pain in my extremities. The gluten challenges devastated my already compromised health and made my recovery more difficult and fraught with further complications. It has become clear that there is a need for methods of testing which do not expose patients to the health risks of an oral gluten challenge. Also, tests that offer more sensitive diagnostic value are needed for prompt and early diagnosis. Several research studies have evaluated the diagnostic potential of various methods without the requirement of an oral gluten challenge. Some of these studies examine the possibility of challenging intestinal biopsies with gluten outside the body in culture media (in vitro). Other studies have tested the immune response elicited by sites outside the small intestine. In vitro gluten challenge Today, anti-endomysial antibodies (EmAs) and anti-tissue transglutaminase antibodies (tTGs) are being used in the detection of celiac disease because of their sensitivity (detection of true CD-positive patients) and specificity (omission of non-celiac patients)(2). However, the blood antibody screening tests have not proven sensitive enough in the presence of mild intestinal damage or whereby only an increased intestinal lymphocyte (a type of white blood cell) count is present as a sign of the immune activation(1,3). Therefore, the production of EmA in cultured intestinal biopsies challenged with gliadin has been evaluated for its usefulness in celiac disease diagnosis. Carroccio et al found that EmA positivity of cultured biopsies challenged with gliadin for 48 hours correlated with the degree of intestinal damage, the shorter the treatment with a gluten-free diet (i.e., newly diagnosed celiac patients), and higher counts of inflammatory cells (i.e., white blood cells including lymphocytes) in the intestinal biopsies(2). A higher proportion of celiac patients with more severe intestinal lesions (95%) were EmA positive in their gliadin-challenged cultured biopsies as compared to celiac patients with mild intestinal damage (75%) who were EmA positive. However, this test still had higher sensitivity to detect 58% more celiac patients with mild intestinal damage than the blood EmA tests which were positive in only 17% of them. Furthermore, in newly diagnosed celiac patients, 90% of patients were EmA positive in their cultured biopsies before the addition of gliadin and 96% with the addition of gliadin. Finally, those patients who were EmA positive with the biopsy culture challenge with gliadin had significant higher numbers of inflammatory cells than those who were negative. Sixty-two percent of celiac patients on a gluten-free diet (GFD-treated) for 12 months, were EmA positive in biopsies challenged in culture with gliadin for 24 hours(4). EmA was not observed in any of their pre-challenge biopsies. However, EmA was detected in all of the cultured intestinal biopsy samples, challenged with gliadin after 72 hours. In addition, none of the control (non-celiac) patients had EmA detectable in their biopsies challenged in culture with or without gliadin. Local Challenge of Nasal Tissue and Oral Lining Other exciting prospects in the diagnosis of celiac disease are on the horizon which offer easy access to testing. For instance, other sites outside the intestine such as the nasal tissue and the oral lining are being studied for whether they can elicit a gliadin-specific immune response. In a study of GFD-treated celiac patients, gluten provoked a significant but only mild gliadin-specific inflammatory response in the nasal tissue scrapings (not biopsies) of the celiac patients via activation of lymphocyte cells but not in control patients(5). Another study involved the injection of gliadin into the oral lining of ten GFD-treated celiac patients who were negative for EmA(6). After a 24-hour gliadin challenge, oral biopsies were taken and the number of lymphocytes was significantly increased in celiac patients but not in the controls. Further evaluation of these methods, including studies of untreated patients, is needed to confirm their usefulness in the diagnosis of celiac disease. Rectal Gluten Challenge The rectum is an easily accessible site for which a gluten challenge can be performed and rectal biopsies taken7. The test does not require any patient preparation or the more invasive procedure of an endoscopic exam with biopsies. Also, no pre-challenge biopsies are required for comparison. The diagnostic power of the rectal gluten challenge is demonstrated by its ability to recognize gluten sensitive patients whose blood antibody tests are negative at presentation or whose biopsies are inconclusive(7). The four-hour rectal gluten challenge provided both 100 percent specificity and sensitivity in the diagnosis of gluten-sensitive patients in comparison with blood EmA which had only a 70% sensitivity and 98% specificity. In a group of 45 untreated patients, the rectal gluten challenge showed a significant increase in the numbers of lymphocytes responding to gluten whereas the non-celiac group of patients demonstrated a negative response in their lymphocyte populations. Furthermore, celiac patients on a GFD for two or more years still had more rectal lymphocytes than non-celiacs(8). Post rectal gluten challenge results of biopsy samples disclosed a significantly increased inflammatory infiltration of lymphocyte cells in celiacs but not in control patients. Inherently, the traditional oral gluten challenge is designed to cause intestinal damage to a celiac patient and may exacerbate or provoke symptoms, which may not be acceptable to the patient. The true cost of a diagnosis of celiac disease is the overt and acute as well as silent and chronic damage to the celiac patient caused by the undertaking of an oral gluten challenge. However, the future use of alternative diagnostic tests in practice offers the patient choices outside the risks and complications of oral gluten challenges. Since rectal gluten challenges, as well as the oral or nasal gluten challenges, must be taken internally, more studies must be done to evaluate the safety of using these potential methods of diagnosis. Some of these studies sought to find a more sensitive way to detect early events in the staging of celiac disease. Others also sought to find if the immune system could identify gliadin outside the gastrointestinal tract to make testing more accessible and easier on the patient. Both the sensitivity and specificity of methods such as EmA detection in cultured biopsies challenged with gliadin may one day change the way celiac disease is currently diagnosed, in the presence of more severe intestinal damage or villous atrophy. Instead, these alternative methods to oral gluten challenge have the potential to facilitate early diagnosis of celiac patients with inconclusive biopsies, those with only mild intestinal damage and negative blood antibody tests as well as high-risk patients such as relatives of celiac patients, and patients with associated autoimmune diseases. References: Tursi A, et al. 2003. The symptomatic and histologic response to a gluten-free diet in patients with borderline enteropathy. J Clin Gastroenterol 36: 13-17. Carroccio A, et al, 2002. Production of anti-endomysial antibodies in cultured duodenal mucosa: Usefulness in coeliac disease diagnosis, Scand J Gastroenterol 37: 32-38. Tursi A, et al. 2003. Prevalence of antitissue tranglutaminase antibodies in different degrees of intestinal damage in celiac disease. J Clin Gastroenterol 36: 219-21. Picarelli A, et al, 2001. Forty-eight hours of biopsy culture improve the sensitivity of the in vitro gliadin challenge in the diagnosis of celiac disease, Clin Chem 47: 1841- 1843. Torre P, et al, 2002. Immune response of the coeliac nasal mucosa to locally-instilled gliadin, Clin Exp Immunol 127: 513-518. Lahteenoja H, et al, 2000b. Local challenge on oral mucosa with an alpha-gliadin related synthetic peptide in patients with celiac disease, Amer Jour Gastroenterol 95: 2880-87. Ensari A, et al, 2001. Diagnosing coeliac disease by rectal gluten challenge: a prospective study based on immunopathology, computerized image analysis and logistic regression analysis, Clin Sci 101: 199-207. Troncone R, et al, 1996. In siblings of celiac children, rectal gluten challenge reveals gluten sensitization

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  4. Celiac.com 09/05/2022 - According to studies, most people with celiac disease are exposed to gluten on a regular basis, even those who are trying to be diligent about avoiding gluten. For these people, eating gluten can trigger gastrointestinal symptoms and intestinal damage. Anyone whose ever had that happen can testify to the unpleasant results, including the stomach pain, bloating, diarrhea, and other symptoms. Currently, there aren't too many options for celiacs who are exposed to small amounts of gluten, especially for those exposed on a regular basis. A team of researchers recently set out to assess changes in the ratio of villus height to crypt depth in celiac patients exposed to 2g of gluten per day for 6 weeks, as part of a study on IMGX003 (Latiglutinase). On behalf of theCeliacShield Study Group, the research team included Joseph A. Murray; Jack A. Syage; Tsung-Teh Wu; Chaitan Khosla; and Jennifer A. Sealey-Voyksner. They are variously affiliated with the Mayo Clinic, Gastroenterology and Hepatology in Rochester, MN; the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; ImmunogenX, Inc., Newport Beach, CA; the Boston Biostatistics Research Foundation, Framingham, MA; Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland; and Stanford University, Stanford, CA. The team administered the double-blind, placebo-controlled gluten-challenge as part of a Phase 2 trial to assess the safety and efficacy of a 1,200 mg dose of IMGX003 in celiac patients exposed to 2 g of gluten per day for 6 weeks. The team used ANCOVA to assess progress toward their main endpoint, which was a change in the ratio of villus height to crypt depth (Vh:celiac disease), along with secondary endpoints, which included densities of intraepithelial lymphocytes (IEL) and symptom severity. Tertiary endpoints included serology and gluten-immunogenic peptides (GIP) in urine. Forty-three out of fifty randomized patients completed the challenge. Twenty one patients received IMGX003, while twenty-two received a placebo. The results showed that IMGX003 reduced gluten-induced intestinal mucosal damage and symptom severity in celiac patients on a six week gluten challenge of 2 grams per day. Drugs like IMGX003 could potentially play a role in receding symptoms and gut damage in people with celiac disease who are exposed to low amounts of gluten, especially through accidental exposure. Still, we've seen promising drugs come and go, each falling by the wayside when they failed to deliver in clinical trials. Stay tuned for more on this and related stories. Read more at gastrojournal.org
  5. Celiac.com 01/11/2006 - There is an abundance of stories about people who begin a gluten-free diet, find that they feel better then decide they want a firm diagnosis of celiac disease. They are facing several problems. First, they may be gluten sensitive without the intestinal lesion of celiac disease. This is very likely since about twelve percent of the population is gluten sensitive, but only a little more than one percent of the general population has celiac disease. Another problem faced by gluten-free individuals who want a diagnosis is that it can take more than five years after returning to a regular gluten-containing diet before the characteristic damage of celiac disease can be seen on a biopsy1. Simply put, after beginning a gluten-free diet, only a positive biopsy is meaningful. A negative biopsy does not rule out celiac disease. A variety of opinions have been offered regarding how much gluten, for how long, should result in a definitive biopsy. The reality is that no such recommendation is consistent with the medical literature1-4. Some people with celiac disease will experience a return of intestinal damage within a few weeks of consuming relatively small amounts of gluten. Such brief challenges are valuable for these individuals. However, many people with celiac disease or dermatitis herpetiformis will require much larger doses of gluten, over much longer periods, to induce characteristic lesions on the intestinal wall. Unfortunately for these latter individuals, a negative biopsy after a brief gluten challenge can, and often is, misinterpreted as having ruled out celiac disease. Blood tests can compound this problem. If, as seems likely, celiac patients who are slow to relapse are also the ones who develop milder intestinal lesions, they are the very celiac patients for whom blood tests are very unreliable5. Claims to have ruled out celiac disease based on brief challenges with small quantities of gluten is a mistake that could lead to serious, even deadly, consequences. We may forget that gluten consumption by a person with celiac disease can lead to deadly cancers and a variety of debilitating autoimmune diseases. Any recommendation of a gluten challenge should be accompanied by a clear warning that the process may overlook many cases of celiac disease. The absence of such warnings is inexcusable. And what about non-celiac gluten sensitivity? The absence of an intestinal lesion does not rule out gluten induced damage to other tissues, organs, and systems. Evidence and research-based information in this area is sadly lacking but we do know that undigested or partly digested gliadin can damage a wide range of human cells6. Thus, one need only be consuming gluten and experience increased intestinal permeability for gluten-induced damage to be a factor in an almost infinite number of ailments. There are several partial answers to this problem. One, which Ive raised before, is to employ Dr. Michael N. Marshs rectal challenge for the diagnosis of celiac disease, particularly when the individual has already begun a gluten-free diet. This test permits a definitive diagnosis of celiac disease for up to six months after beginning a gluten-free diet. That would catch a great number of celiac patients who have found relief through a gluten-free diet and now want a diagnosis. Another piece of this puzzle is to test for IgG anti-gliadin antibodies. Although these antibodies are considered "non-specific," they inarguably identify an immune response to one of the most common foods in a regular North American diet. Although these individuals may experience improved wellness on a gluten-free diet, we just dont know enough about non-celiac gluten sensitivity to do more than recommend that they continue on this diet since it makes them feel better. Ron Hoggan is an author, teacher and diagnosed celiac who lives in Canada. His book "Dangerous Grains" can be ordered at Celiac.com. Rons Web page is: www.DangerousGrains.com. References: Kuitunen P, Savilahti E, Verkasalo M. Late mucosalrelapse in a boy with coeliac disease and cows milk allergy.Acta Paediatr Scand.1986 Mar;75(2):340-2. Bardella MT, Fredella C, Trovato C, Ermacora E, Cavalli R, Saladino V, Prampolini L. Long-term remission in patients with dermatitis herpetiformis on a normal diet. Br. J. Dermatol. 2003 Nov;149(5):968-71. Shmerling DH, Franckx J. Childhood celiac disease: a long-term analysis of relapses in 91 patients.J Pediatr Gastroenterol Nutr. 1986 Jul-Aug;5(4):565-9. Chartrand LJ, Seidman EG. Celiac disease is a lifelong disorder. Clin Invest Med. 1996 Oct;19(5):357-61. Rostami K, Kerckhaert J, von Blomberg BM, Meijer JW, Wahab P, Mulder CJ. SAT and serology in adult coeliacs, seronegative coeliac disease seems a reality.Neth J Med. 1998 Jul;53(1):15-9. Hudson DA, Cornell HJ, Purdham DR, Rolles CJ. Non-specific cytotoxicity of wheat gliadin components towards cultured human cells.Lancet. 1976 Feb 14;1(7955):339-41.
  6. Celiac.com 03/30/2016 - The woman's voice, polite but firm came over the line: "We cannot accommodate your mother." "You can't accommodate her?" I wondered if I'd heard wrong. "No. We just had a team meeting and it was decided we cannot accommodate your mother because of her diet." "Oh." The line hummed as I took in both the news and the woman's frosty tone. The previous week the woman, the admissions coordinator of the nursing home, had been all warm and inviting, even eager to have my mother. Finally I came out with, "Well…thank you for letting me know," and the line clicked dead as the woman hung up. I had not seen this coming. I hadn't realized that a nursing home would, or could, turn down a patient based on the need for a therapeutic diet. I thought the reason for a nursing home was to care for ill people. When I toured the nursing home, the woman proudly proclaimed the facility as being on Newsweek's top recommended list, and gave the appearance of understanding my mother's gluten-free diet, saying, "My niece has told me of it. She's convinced me to eat more gluten-free." The woman went so far as to take notes on my mother's preferences, her love of sleeping in and drinking coffee, and then plopped in my arms a thick packet of Medicare forms. In all ways she had been exceedingly pleasant. Indeed everyone I met at the facility had been pleasant. Purring cats roamed the facility's hallways, birds sang from cages, and they even had a pot-bellied pig in the shade of a tree that could be seen through a window, all for the comfort of the patients. It struck me that they could do these many things for their patients, but feeding one small woman with celiac disease a gluten-free diet was beyond them. My mother is eighty-eight years old, a pixie with a contagious smile and genteel Southern manner. She was diagnosed with celiac disease at the age of seventy-five. At that time she was on daily use of a nebulizer, sleeping half days and could not leave home and the bathroom unless she took Imodium. The diagnosis and strict adherence to the gluten-free diet returned her to an active life. She took up painting and driving her aging neighbors out to enjoy shopping. A year ago, in rapid succession, a mass was found in one of her lungs, glaucoma took her sight and a stroke impaired her right hand and memory. For months, she required caregivers around the clock. Today she is mobile with the aid of a walker and can manage nights on her own. She can do one thing for herself, and that is get herself to and from the bathroom. Everything else must be done for her—bathing and dressing and maintaining clothes, medications, food preparation, working the television and her bedside radio. On occasion she will get confused and afraid, so I try not to leave her alone for more than an hour. With the aid of private caregivers and hospice assistance, I have been able to keep her in my home, where she has lived for the past six years. However, her funds are depleting for private care, and there is no one to help me care for her. After the disappointing phone call from the nursing home admissions coordinator, I sat thinking over all the above facts and allowing myself a sizable hissy fit. Then I gathered myself together and took another look at the nursing home facilities in my area. For the next two weeks, I sought more information and made lists. My plan was to be better prepared in knowledge and approach. Running on the theory that it is lack of knowledge that causes the fear of a situation, I put together information on my mother: a list of her conditions, needs and food preferences. Because of no longer having teeth, nor wearing dentures, and her advanced age, she needs soft foods, her favorites being eggs and Vienna sausage, puddings, bananas. At the time she would eat mashed chicken and some vegetables, all simple things. I wanted to reassure the admissions director and staff of the nursing facilities that my mother was easily cared for, and that I was willing to help with her food. I also had two brochures from Gluten Intolerance Group: a single sheet on celiac disease itself, and a color glossy brochure, put together in cooperation with the National Foundation for Celiac Awareness, entitled Celiac Disease in the Older Adult. I hoped to engage the interest of people whose primary aim and business is providing healthcare to the elderly. What I discovered is a general lack of any interest in the welfare of the elderly. The young woman admissions coordinator of my second choice of facilities, a modern, airy facility, answered my question about their kitchen and possible meeting with the dietary manager, with, more or less, "I've shown you around the building. I don't know what else you want to know." Then she added, "And right now we don't have any female beds available." At another facility, the admissions coordinator brushed aside any idea of speaking with the dietician. She did not know what celiac disease was, but assured me they could, "probably handle it." The best facility that I found had a waiting list of at least forty names. They stayed so full that they did not provide temporary respite care. Even so, the admissions coordinator showed me around the building, which was very old, and the sight of an elderly blind woman slumped uncomfortably in a wheelchair in the hallway haunted me. Yet their menu posted on the bulletin board seemed promising. "We do home-cooking," the coordinator said proudly. Then she glossed over my request to see their kitchen and meet the dietician. She admitted to never having heard of celiac disease, but said, "We've had many people with uncommon conditions," and put my mother's name on the waiting list. My eye followed her fingers working the pen far down the yellow legal pad. When I offered to leave the brochures about celiac disease with her, she did not even glance at them, but dismissed them with a sweeping wave, saying, "Oh, there's no need." Weeks passed. My mother's hospice social worker joined in on the search. She found a facility willing to give the respite stay a chance. "They've had a previous celiac patient," she said. By now I was quite skeptical, but also curious with this news. The facility she suggested was the closest near my home, and I could easily visit each day. I agreed to meet with the admissions coordinator. The woman said that, yes, the facility had had a previous patient with celiac disease. It was the experience with this patient, who had been uncooperative and would steal food off other patients' trays, that caused the hesitation on their part. "But we're told your mother wouldn't do that," she said. Upon studying the fact that my mother was quite incapable of snatching food anywhere, the admissions coordinator said they were willing to offer respite care. I was impressed (surprised is the better word) when the coordinator called the dietary manager to meet me. He read the diet listing I had made up for my mother and said they would have no trouble in providing for her. I volunteered to bring her favorites of chocolate pudding and canned peaches and Vienna sausage for times they might have things she could not eat, and of course any homemade gluten-free cakes. We packed my mother up, and she went for her week respite at the facility. Her long-time caregivers went as well to provide support in the strange environment, help her learn her way to the bathroom, and to circumvent the inevitable glitches. The first day for lunch in the dining room, my mother was brought Vienna sausages (which I had provided), nothing else. My mother's caregiver went to the kitchen and inquired of the cooks, surveyed the kitchen and the menu of baked chicken and broccoli and how it was cooked and said, "She can have that." We began to wonder how the previous patient had been fed. I also began to wonder if anyone even glanced at the diet I had printed for my mother. However, the glitches that week were small. My mother ate well, enjoying their broccoli and branching out to embrace canned spinach. We learned the main reason the facility could and did for that week, succeed in feeding my mother quite well was that they had a full working kitchen and did not rely on food service, where all the meals come prepackaged. The respite week also worked because of my mother's private caregivers. They monitored the food and educated the kitchen staff. The dietary manager went so far as to voice his gratitude to one of the caregivers for helping them learn what my mother and could not eat. While it appeared no one read any of the dietary information, over all the stay went well enough that a month later, I decided to try it for long term care. The plan was to have her private caregivers ease my mother through the transition for approximately a month, and then gradually reduce their hours, as the nursing home staff learned my mother's needs. We believed it possible to educate the staff. The first week went fairly smooth, with a few expected glitches. After that, things went downhill. A semi-soft diet had been requested; this never materialized. My mother's food would be placed on her tray in her room, and left, covered. Either my mother's private caregivers or I had to come in and help my mother eat. Mom's private caregivers continued to mash any meat and large chunks of vegetables, such as sweet potato served still in the skin. They continued to intercept sandwiches on bread and dishes of cake and snack cookies left on her tray. Throughout all of this, my mother's caregivers or I consulted with the dietary manager and the kitchen staff. We thanked them for the good food when it came. We explained again what she could and could not have. We formed the habit of checking each day's menu and writing out foods from that menu that my mother could eat. The kitchen staff accepted these menus and taped them near the stoves. When there was nothing on the menu that my mother could or would eat, we suggested easy canned substitutions. Sometimes she got these substitutions, sometimes not. Then came the day when I was told that for the evening meal my mother had been served a hotdog and fries of some sort, both too hard for her, or anyone, to eat. (Keep in mind we are paying for this food.) My mother's caregiver took her back to the room and served my mother her snack cakes and pudding I had provided. Her roommate shared in the cakes, because she had come in too late from her dialysis treatment to get dinner. Why her tray had not been saved for her, I have no idea. I had never seen this woman provided any sort of special diet, and she was both diabetic and had kidney disease. The following morning I also I learned one of the kitchen staff responsible for following the therapeutic diet said to my mother's caregiver: "Oh, she doesn't need that diet. That's all made up." I faced the fact that providing for my mother was too much trouble for the staff, and they were simply unwilling. My mother was never going to get the food nor the care in eating that she would require at this facility. As of this writing, my mother is back home. Private caregiver hours have been drastically reduced. I am able to do this, for now. Here are some chilling facts: Studies indicate that today in our country not only are the incidents of celiac on the rise in all age groups, but the median age for celiac diagnosis is just under 50 years of age, with one-third of newly diagnosed patients being over the age of 65.* (Celiac Disease in the Elderly, Shadi Rashtak, MD and Joseph A. Murray, MD) This is the age group who are the primary caregivers for themselves and their parents. This is the age group who more often must undergo surgeries and stays in rehabilitation nursing facilities. Couple the above figures with the fact that we are an aging population. At the current rate, the number of people age 65 and older is projected to double between now and 2050. The baby boomers, responsible for the great population growth, now average over the age of 65.* (An Aging Nation: The Older Population in the United States, by Jennifer M. Ortman, Victoria A. Velkoff, and Howard Hogan, U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau.) These simple facts paint a picture of a growing challenge. We must be able to provide short and long term nursing home care for the many celiac patients around us today—my mother, myself, the number of over-60 celiacs I've talked to—as well as the tidal wave looming on the horizon. In addition, we have other food intolerances on the rise, and we have the needs of those with diabetes and kidney disease and other conditions requiring dietary restrictions. At present, all of these people, not only those with celiac, are being overlooked and discounted. I have no solid answers to this immense problem. I do have suggestions on things that can be started. The celiac community must recognize and begin to talk seriously about the problem of dietary care in nursing homes. Printing up a glossy brochure with the advice to have the doctor write an order for a therapeutic diet is a start. We have to step out more aggressively with ways to educate and implement therapeutic diets in a real way. We have programs in place educating restaurants and the food industry. Let's get aggressive with the health industry. Of course, my experience is that these facilities do not want to be educated. This is where legislation is required. We need to lobby for legislation that requires compliance in the nursing facility industry, in the same way that food labeling compliance was attained. Further, we need to support the push for legislation for a required number of CNAs per patient in nursing home facilities. At present, there are laws only governing the minimum number of RNs required per patient in nursing facilities. * (Minimum Nurse Staffing Ratios for Nursing Homes, Ning Jackie Zhang; Lynn Unruh; Rong Liu; Thomas T.H. Wan, Nurs Econ. 2006;24(2):78-85, 93.) There are no mandatory minimums for the number of CNAs, the people who actually do the bulk of the patient care—those who would monitor a person's diet and help that person to eat. At present the nursing home facility is allowed to choose for themselves the number of CNAs they need. I remarked to a friend that there were a number of camps for children with celiac disease, places the child could get away and enjoy and eat safely. "Well, what about for the elderly?" my friend said. "It seems if they can do it for kids, they could do it for the elderly." What about the elderly? This is our new challenge—to make certain those elderly people with food sensitivity needs are well cared for.

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  8. Celiac.com 12/04/2019 - There still is no easy and accurate way to monitor and diagnose celiac disease in patients who've been on a gluten-free diet for a while. Celiac disease patients on a gluten-free diet experience reactions to gluten, but researchers really don't understanding those reactions in any meaningful way. Systemic cytokine release was recently linked to reactivation of gluten immunity in celiac disease. A team of researchers recently set out to define the nature and time-course of symptoms and interleukin-2 changes specific for celiac disease patients. Their study shows that interleukin-2 assessment could help doctors monitor and diagnose celiac disease in patients already following a gluten-free diet. The research team included Jason A. Tye-Din, A. James M. Daveson, Hooi C. E, Gautam Goel, James MacDougall, Sarah Acaster, Kaela E. Goldstein, John L. Dzuris, Kristin M. Neff, Kenneth E. Truitt and Robert P. Anderson. They are variously affiliated with the Immunology Division, Department of Medical Biology, The Walter and Eliza Hall Institute, University of Melbourne, Parkville, Vic., Australia; Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia; University of Queensland, Brisbane, Qld, Australia; Sir Charles Gairdner Hospital, Perth, WA, Australia; ImmusanT, Inc., Cambridge, MA, USA; Prometrika, LLC, Cambridge, MA, USA; and Acaster Lloyd Consulting Ltd., London, UK. The team presented a gluten challenge to 25 celiac disease patients following a gluten-free diet, and to 25 healthy control subjects. Each group consumed a standardized 6 gram gluten challenge. The team compiled a Celiac Disease Patient-Reported Outcome survey and global digestive symptom assessment each hour for up to 6 hours after gluten challenge. They also recorded adverse events over a 48 hour period, and assessed serum interleukin-2 levels at baseline, and at 2, 4 and 6 hours. Healthy control subjects showed no detectable levels of serum interleukin-2, while 92% of celiac patients showed no detectable levels at baseline, but levels >0.5 pg/ml at 4 hours. Patient-reported outcome severity scores remained steady for all control subjects, while scores for celiac patients rose sharply after gluten in celiac disease patients. Symptoms of gluten exposure started at the 1 hour mark, and topped out after three hours. Patients with serious reactions typically suffered from nausea and vomiting, while those with milder reactions experienced headache and fatigue. The highest interleukin-2 levels were associated with more severe symptoms, especially nausea and vomiting. The timing and severity of gluten ingestion symptoms in people with celiac disease are strongly connected to elevated levels of serum interleukin-2. A gluten food challenge combined with interleukin-2 assessment could be valuable clinical tool for monitoring and diagnosing celiac disease in patients established on a gluten-free diet. Alimentary Pharmacology & Therapeutics
  9. Celiac.com 06/13/2012 - In general, doctors and researchers know a good deal about how celiac disease works, and they are finding out more all the time. However, they know very little about non-celiac gluten sensitivity (NCGS). In an effort to learn more about non-celiac gluten sensitivity, a team of researchers recently carried out a study to measure the presence of somatization, personality traits, anxiety, depression, and health-related quality of life in NCGS individuals, and to compare the results with celiac disease patients and healthy control subjects. They also compared the response to gluten challenge between patients with non-celiac gluten sensitivity and those with celiac disease. The research team included M. Brottveit, P.O. Vandvik, S. Wojniusz, A. Løvik, K.E. Lundin, and B. Boye, of the Department of Gastroenterology at Oslo University Hospital, Ullevål in Oslo, Norway. In all, the team looked at 22 patients with celiac disease and 31 HLA-DQ2+ NCGS patients without celiac disease. All patients were following a gluten-free diet. Over a three day period, the team challenged 17 of the celiac disease patients with orally ingested gluten. They then recorded the symptoms reported by those patients. They did the same with a group of 40 healthy control subjects. The team then had both patients and healthy control subjects complete questionnaires regarding anxiety, depression, neuroticism and lie, hostility and aggression, alexithymia and health locus of control, physical complaints, and health-related quality of life. Interestingly, patients with non-celiac gluten sensitivity reported more abdominal (p = 0.01) and non-abdominal (p < 0.01) symptoms after the gluten challenge than patients with celiac disease. The increase in symptoms in non-celiac gluten sensitivity patients was not related to personality. However, the two groups both reported similar responses regarding personality traits, level of somatization, quality of life, anxiety, and depressive symptoms. Responses for both groups were about the same as for healthy controls. The results showed that patients with non-celiac gluten sensitivity did not show any tendencies toward general somatization, as both celiac disease patients and those with non-celiac gluten sensitivity showed low somatization levels. Source: Scand J Gastroenterol. 2012 Apr 23.
  10. Celiac.com 10/24/2012 - Doctors can face challenges when attempting to diagnose celiac disease in patients who have already begun a gluten-free diet, and/or when the results of tests are inconsistent. To better understand this problem, a group of researchers set out to assess the benefits of an in vitro gliadin challenge. The research team included Raffaella Tortora, MD, Ilaria Russo, PhD, Giovanni D. De Palma, MD, Alessandro Luciani, PhD, Antonio Rispo, MD, Fabiana Zingone, MD, Paola Iovino, MD, Pietro Capone, MD and Carolina Ciacci, MD. The study cohort included 57 patients without celiac disease, 166 patients with untreated celiac disease, 55 patients with celiac disease on a gluten-free diet, and 59 patients with challenging diagnosis. The team provided all patients with endoscopy for collection of duodenal samples, which served for the diagnosis of celiac disease and for the in vitro evaluation of the gliadin-induced mucosal expression of seven inflammatory markers: PY99, ICAM-1 (intercellular cell adhesion molecule), HLA-DR, CD3, CD25, CD69, and transglutaminase 2 IgA. Diagnostic work-up for celiac disease included the search of specific serum antibodies. Researchers asked patients in the challenging diagnosis group to stop gluten-free diet to facilitate the search for these antibodies under untreated conditions. They used the area under the receptor-operated curve (ROC) for statistical analyses on accuracy. For patients with and without celiac disease (not including those on a gluten-free diet) HLA-DR offered the best accuracy for diagnosing celiac disease (area under ROC = 0.99). Combining the data from the HLA-DR with data of other markers did not increase test accuracy. The team found similar results in the 39 patients of the difficult diagnosis group undergoing the search celiac disease-speciï¬c antibodies under untreated conditions. In vitro testing of mucosal HLA-DR to gliadin is an accurate tool for the diagnosing celiac disease, and also works in patients who are hard to diagnose. Source: Am J Gastroenterol 2012; 107:111–117; doi:10.1038/ajg.2011.311; published online 27 September 2011
  11. Celiac.com 02/04/2013 - Ever wonder what happens to all those celiac disease patients who volunteer to do a gluten-challenge in the name of science? Well, the short answer is that they likely suffer, and may incur gut damage, at least in the short term. A team of researchers looking for ways to reduce or eliminate that problem recently conducted a study using larazotide acetate, a first-in-class oral peptide that prevents tight junction opening, and may reduce gluten uptake and associated problems. The research team included C. P. Kelly, P. H. R. Green, J. A. Murray, A. DiMarino, A. Colatrella, D. A. Leffler, T. Alexander, R. Arsenescu, F. Leon, J. G. Jiang, L. A. Arterburner, B. M. Paterson, R. N. and Fedorak. They are affiliated with the Celiac Center of Beth Israel Deaconess Medical Center at Harvard Medical School in Boston, the Celiac Disease Center at Columbia University in New York, NY, the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, MN, Thomas Jefferson University Hospital in Philadelphia, PA, the Pittsburgh Gastroenterology Associates in Pittsburgh, PA, with Gastrointestinal Specialists of Troy, MI, the Department of Internal Medicine at the University of Kentucky, in Lexington, KY, with Alba Therapeutics Corporation in Baltimore, MD, and with the Division of Gastroenterology at the University of Alberta in Edmonton, AB. The team wanted to find out how well larazotide acetate worked and how well it was tolerated by celiac disease patients undergoing a gluten challenge. To do this, the team conducted an exploratory, double-blind, randomized, placebo-controlled study that included 184 patients who maintained a gluten-free diet before and during the study. After a gluten-free diet run-in, the team randomly divided patients into groups and gave them either larazotide acetate in doses of 1, 4, or 8 mg three times daily, or a placebo. Both groups also received 2.7 grams of gluten daily for six weeks. The team then assessed ratios of lactulose-to-mannitol (LAMA), an experimental biomarker of intestinal permeability, and measured clinical symptoms by Gastrointestinal Symptom Rating Scale (GSRS) and anti-transglutaminase antibody levels. They found no significant differences in LAMA ratios between larazotide acetate and placebo groups. Larazotide acetate 1-mg limited gluten-induced symptoms measured by GSRS (P = 0.002 vs. placebo). They did find that the average ratio of anti-tissue transglutaminase IgA levels was 19.0 over baseline in the placebo group compared with 5.78 (P = 0.010) in the 1mg larazotide acetate group, 3.88 (P = 0.005) in the 4mg larazotide acetate group, and 7.72 (P = 0.025) in the 8mg larazotide acetate group. Both the larazotide acetate and placebo groups showed similar rates of "adverse events." Overall, the team found that larazotide acetate reduced gluten-induced immune reactivity and symptoms in celiac disease patients undergoing gluten challenge and was generally well tolerated. However, the team found no significant difference in LAMA ratios between the larazotide acetate and placebo groups. Even though they did not find anything revolutionary, the results and design of their study will likely be helpful in shaping future gluten-challenge studies in patients with celiac disease. Source: Aliment Pharmacol Ther. 2013;37(2):252-262.
  12. Celiac.com 08/10/2012 - A diagnosis of Celiac disease is measured mainly by an adverse response to gluten, yet there is very little in the way of data regarding gluten challenge in adults on a gluten-free diet. A research team recently studied the kinetics of histological, serological, and symptomatic responses to gluten challenge in adults with celiac disease. The research team included D. Leffler, D. Schuppan, K. Pallav, R. Najarian, J.D. Goldsmith, J. Hansen, T. Kabbani T, M. Dennis, and C.P. Kelly. They are affiliated with Beth Israel Deaconess Medical Center in Boston, Massachusetts. For their study, the team wanted to address a lack of data regarding the kinetics of responses to gluten, which causes assessment issues in clinical practice and research when gluten-challenge is performed. For their study, the researchers recruited twenty adults with biopsy-proven coeliac disease. For each participant, the team conducted two run-in visits followed by a 14-day gluten-challenge at a randomly assigned dose of 3 or 7.5 g of gluten/day. Patients visited study team doctors at 3, 7, 14 and 28 days after the start of their gluten challenge. The researchers performed duodenal biopsy during the run-in and at days 3 and 14 of gluten challenge. The team used two pathologists to measure villous height to crypt depth ratio (Vh:celiac disease) and intraepithelial lymphocyte (IEL) count/100 enterocytes. Upon each visit, the team also assessed antibodies to tissue transglutaminase and deamidated gliadin peptides, lactulose to mannitol ratio (LAMA) and any physical symptoms. Compared to the initial data, results after 14 days showed substantially lower Vh:celiac disease (2.2-1.1, p Interestingly, gastrointestinal symptoms increased significantly after three days, but had returned to baseline by day 28. There were no differences between the higher and lower gluten doses. The team concludes by noting that a 14-day gluten challenge at or above 3 g of gluten/day triggers cellular, tissue, and blood changes in most adults with celiac disease. These findings will help researchers create more accurate clinical trials, and show that many individuals will meet celiac diagnostic criteria after a basic 2-week gluten challenge. Source: Gut. 2012 May 22.
  13. Celiac.com 08/13/2012 - Research has indicated that giving small amounts of wheat-rich food to people with celiac disease, who are on a gluten-free diet, will trigger interferon (IFN)-γ-secreting T cells in the bloodstream. These T cells react to gluten, and can be easily detected. However, very little is known about how this procedure might be reproduced in the same patient groups that underwent two, or more, gluten challenges. A team of researchers recently set out to assess the reproducability of this short wheat challenge method for detecting immune an response to gluten. The research team included A. Camarca, G. Radano, R. Di Mase, G. Terrone, F. Maurano, S. Auricchio, R. Troncone, L. Greco, C. Gianfrani. They are affiliated with the Institute of Food Sciences-CNR, Avellino Department of Paediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University of Naples, Naples, Italy. They evaluated fourteen celiac patients in remission who consumed wheat bread for 3 days, along with thirteen patients who underwent a second gluten challenge after 3-10 months on a strict gluten-free diet. The team then analyzed the immune reactivity to gluten in peripheral blood by detecting IFN-γ both before and 6 days after patients began a a gluten-inclusive diet. They found that gliadin-specific IFN-γ-secreting CD4(+) T cells increased significantly by day 6 of the first challenge. These cells arose as prevalently human leucocyte antigen (HLA)-DQ restricted and with a phenotype of gut homing, as suggested by the expression of β7-integrin. They also saw a reaction to gliadin after the second wheat consumption, although the responses varied by individual at each challenge. The study showed that a short wheat challenge offers a non-invasive approach to investigate the gluten-related immune response in peripheral blood of people who are sensitive to gluten. Moreover, the study showed that the procedure can be reproduced in the same subjects after a gluten wash-out of at least 3 months. The results of this study mean that we can likely expect this procedure to find its way into clinical practice in the future. Source: Clinical and Experimental Immunology. 2012 Aug;169(2):129-36. doi: 10.1111/j.1365-2249.2012.04597.x.
  14. Troncone R, Greco L, Mayer M, Mazzarella G, et. al. Gastroenterology, 1996; 111: 318-324 The final paragraph says: In conclusion, our data show that approximately half of the siblings of patients with celiac disease show signs of sensitization to gluten as they mount an inflammatory local response to rectal gluten challenge. The genetic background and the clinical meaning of such gluten sensitivity need to be established. Further studies, particularly at the jejunal level, are necessary before deciding if any action is to be taken in this subset of first-degree relatives.
  15. The following post if from Karoly Horvath, M.D., khorvath@POL.NET, who is one of the two directors of the celiac center at University of Maryland in Baltimore. Q: Does that mean I could be getting damage without knowing it because I have no obvious reaction? A: Based on our studies a typical (biopsy proven flat mucosa, proved immune reactions to gluten) gluten intolerant patient does not react immediately with clinical symptoms for a gluten challenge (J Pediatr Gastroenterol Nutr 1989, 9:176-180). However, ingestion of GRAMS OF GLUTEN causes several changes in the intestine. There is an accumulation of inflammatory cells One cell type -so called mast cells- releases factors which factors in long-term damage the villi and they also release a factor which; Increases the permeability -leakiness- of the intestine, which is a temporarily change after a single ingestion but may be permanent after repeat dietary mistakes. Karoly Horvath, M.D., Ph.D., Baltimore
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