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Testing After Being Gluten Free


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51 replies to this topic

#46 Lisa

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Posted 16 August 2012 - 05:26 PM

Somehow you always seem to miss the point. And when you reply you hardly ever make sense. Write in whole sentences explaining what the heck you are trying to say please.


I'm sorry that you find it a difficulty understanding my posts. But..to address my point....

Celiac Disease is found, often as secondary diagnosis with over 300 symptoms. No one is the same. There are no consistencies. The methods of diagnoses can vary immensely. I am not the exception.

Hopefully, the testing process can be refined in the years to come.
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Lisa

Gluten Free - August 15, 2004

"Not all who wander are lost" - JRR Tolkien

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#47 justlisa

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Posted 16 August 2012 - 05:32 PM

My diagnosis, in my real, everyday world, began with an endoscopy exam. No need to be specific, when nothing is specific. ;)



You say diagnosis instead of testing. So, you didn't have blood work before endo?

Interesting... I've not seen that...
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#48 tom

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Posted 16 August 2012 - 05:53 PM

But Tom, the study said & I pointed that out but you either missed it or chose to ignore it where it says those serological tests DID NOT REACH STATISTICAL SIGNIFICANCE. ...
...

Again?. .. .this was answered the 1st time you said it. This time you left out the most crucial phrase "by day 14".

From page1 of this thread.

I'm not finding that exact line right now, but it's a good thing they continued through to 28 days.

"Antibody titres increased slightly from baseline to day 14 of GC but markedly by day 28."

To use your phraseology (reluctantly) did you "choose to ignore" the fact that none of these studies stops at 14 days?
Or are we "choosing to ignore" that 28 days is far less than 3 months?
Are you still claiming celiacs don't get dx'd in under 3 months despite the very study you keep cherrypicking (re day 14) clearly stating that antibodies increase "markedly by day 28"?

Sheesh
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>>>>>>> tom <<<<<<<

Celiac 1st diagnosed as a toddler, in the 60s. Docs then, between bloodletting & leech-tending, said "he'll grow out of it" & I was back on gluten & mostly fine for 30yrs.

Gluten-free since 12-03
Dairy-free since 10-04
Soy-free since 5-07

#49 Lisa

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Posted 16 August 2012 - 06:00 PM

You say diagnosis instead of testing. So, you didn't have blood work before endo?

Interesting... I've not seen that...


You say diagnosis instead of testing. ????

I did NOT have blood work before my endo. As I stated before, my endo and biopsy offered me a diagnosis. I'm certain I'm not the only one.
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Lisa

Gluten Free - August 15, 2004

"Not all who wander are lost" - JRR Tolkien

#50 justlisa

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Posted 16 August 2012 - 06:16 PM

You say diagnosis instead of testing. ????

I did NOT have blood work before my endo. As I stated before, my endo and biopsy offered me a diagnosis. I'm certain I'm not the only one.


It was a sincere question... I really haven't come across that before...

I was just looking for clarification because "testing" was being discussed, but you said "diagnosis". From what I've been reading, very few get a "diagnosis" with positive blood work, anyway...

As for the rest of the discussion: There are SO MANY sick people who are struggling and unable to get an official diagnosis. It would be very hard, for me, to advocate a position (shorter GC) when I see so many who can't get a diagnosis when they've been consuming gluten all their lives. I would need to see some major advances in testing. Just my thoughts.
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#51 psawyer

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Posted 16 August 2012 - 06:46 PM

A diagnosis is the result of test results in most cases. Arguing that they are different is semantics.

This whole topic has turned into a heated discussion which long ago ceased presenting new ideas, and is just repeating the same ones over and over. It is time for everyone to move on.
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Peter
Diagnosis by biopsy of practically non-existent villi; gluten-free since July 2000.
Type 1 (autoimmune) diabetes diagnosed in March 1986
Markham, Ontario (borders on Toronto)

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#52 Jestgar

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Posted 16 August 2012 - 08:16 PM

But Tom, the study said & I pointed that out but you either missed it or chose to ignore it where it says those serological tests DID NOT REACH STATISTICAL SIGNIFICANCE. That's a pretty strong statement. AND it further said that they observed the TIMING OF INTESTINAL CHANGES DID NOT SIGNIFICANTLY CORRELATE WITH THOSE OF SEROLOGY, SYMPTOMS, OR LAMA.

What do you not understand about that? Or do you refuse to? The serology was NEGATIVE Tom. The serology changed but NOT enough. This is the entire point in this thread.
And I'm sorry if that sounds rude but look what I'm being accused of here. I'm being accused of trying to use completely irrelevant data to prove a point & I AM insulted!

You and Tom are citing reports of the same study. May I suggest you simply read the original paper? Actually the tests DID reach significance for DGP:
Posted Image

This line may have been misleading to the second source of the review:

There was no significant correlation between IgA anti-tTG or IgA/IgG anti-DGP titre and Vh:celiac disease or IEL count at any study visit.

But it's stated under this section compare blood to intestinal damage:

Correlation of non-invasive measures with intestinal histology

We sought to investigate which study end points correlated with the degree of intestinal damage and with change in histology from baseline. Low IEL count at baseline was correlated with greater absolute and per cent change in IEL count from baseline to day 14 (p=0.005 and p=0.003, respectively) but was not correlated with absolute or per cent change in Vh:celiac disease (p=0.711 and p=0.486, respectively). Vh:celiac disease at baseline was not correlated with either absolute or per cent change in Vh:celiac disease (p=0.297 and p=0.068, respectively) or with absolute or per cent change in IEL count from baseline (p=0.103 and p=0.319, respectively). IEL count at baseline was correlated with Vh:celiac disease at baseline (p=0.020) and day 14 (p=0.030) of gluten challenge; however, day 14 IEL count was not correlated with day 14 Vh:celiac disease (p=0.111). Baseline to day 14 change in Vh:celiac disease was not correlated with change in IEL count expressed either as an absolute difference (p=0.345) or as per cent change from baseline (p=0.554).

Change from baseline in IgA anti-tTG was highly correlated with change from baseline in IgA/IgG anti-DGP at both day 14 (p<0.001) and day 28 (p=0.005). There was no significant correlation between IgA anti-tTG or IgA/IgG anti-DGP titre and Vh:celiac disease or IEL count at any study visit. Similarly, there was no significant correlation between absolute change or per cent change from baseline in IgA anti-tTG or IgA/IgG anti-DGP titres and Vh:celiac disease or IEL count at day 14 or in change in Vh:celiac disease or IEL count from baseline.


And this is what the authors recommend:

Based on the data presented, we propose several modifications to the current approach to performing a gluten challenge in clinical practice. Using evidence from this study we propose that a standard gluten challenge be conducted as follows: (1) perform baseline serology testing (IgA anti-tTG and/or IgA/IgG anti-DGP); if results are greater than twice the upper limit of normal for the specific assay in use, proceed directly to duodenal biopsy. Baseline duodenal biopsy in the setting of normal serological testing should be considered in patients known to be positive for HLA DQ2 or DQ8, and in whom gluten challenge is likely to be poorly tolerated necessitating possible abbreviation of challenge; (2) if serology is normal, test for HLA DQ2 or HLA DQ8 and if present, proceed with an initial 2-week gluten challenge at a gluten dose of 3 g per day (equivalent to ∼1 slices of bread); (3) after a 2-week gluten challenge, approximately 90% of patients can be expected to develop findings consistent with coeliac disease; however, if the patient is tolerating gluten challenge well, consider extending the challenge for up to an additional 6 weeks in order to improve diagnostic sensitivity; (4) obtain duodenal biopsies at the termination of the challenge at week 2 (may prolong to 8 weeks if patient tolerating well); (5) perform repeat serology testing at the end of the challenge, that is, at the time of duodenal biopsy; (6) if biopsy histology and serology results are not diagnostic for coeliac disease repeat serology again 2 weeks after the end of the challenge; and (7) if biopsy and serological tests are all negative, coeliac disease is unlikely and the patient can continue on a regular diet with a final follow-up serological test 612 months later. As our findings show, the ability to offer a lower daily gluten load will reduce the acute symptoms of gluten challenge without reducing serological or histological responses. The option of terminating the challenge after just 2 weeks, in the event that symptoms are intolerable, will further enhance patient acceptance


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