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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    GENDER AND MENTAL HEALTH ARE FACTORS IN IRRITABLE BOWEL DISEASE-RELATED SYMPTOMS IN CELIAC DISEASE


    Jefferson Adams

    Celiac.com 05/06/2008 - In the majority of people with celiac disease,strict adherence to a gluten-free diet can result in a quality of lifethat is on par with non-celiacs. Still a small percentage of celiacsseem to suffer from persistent gastrological discomfort in the form ofirritable bowel or irritable-bowel-like symptoms. Very few studies havebeen done on persistent gastrological problems in adults with celiacdisease. Those that have been done rely upon univariate statisticalanalysis in clinical samples at the secondary or tertiary care leveland fail to assess the potential influence of non-celiac diseasespecific factors, which are considered to be a risk factor of irritablebowel syndrome (IBS), such as mental disorders, or gender.


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    Ateam of researchers made up of doctors Winfried Hauser, Frauke Musial,Wolfgang Caspary, Jurgen Stein, and Andreas Stallmach set out todetermine rates of irritable bowel syndrome, irritable bowelsyndrome-related symptoms, and consecutive health care-seeking behaviorand their influence upon health-related quality of life (HRQL) and anyconceivable bio-psychosocial factors influencing adult patients withceliac disease. The research team made a medical and socio-demographicsurvey of 1000 adult celiac patients from the German Celiac Society bypost. The medical portion of the survey included bowel history. Theteam also had patients fill out a Short Form Health Survey (SFHS),along with the Hospital Anxiety and Depression Scale.

    516 ofthe questionnaires came back completed. Respondents were similar ingender ratio and median age from the whole membership directory of theGerman Celiac Society, a group of more than 18,000 people who reportedsuffering from celiac disease at the age of 18. Of these, 213 (41.3%)had a diagnosis of celiac disease that was made by a duodenal biopsy,37 (7.2%) by serological tests (celiac disease-specific antibodies), 34(6.6%) using stool tests for trans-glutaminase antibodies, and 232(45.0%) using intestinal biopsy and serological tests.

    A totalof 446 patients indicated that they had biopsy-proven celiac disease. Of these 446patients, 18 were excluded because they indicated adherence to agluten-free diet for less than 1 year. Sixteen patients were tossed outbecause they reported a major non-adherence to the gluten-free diet. Thus,the study group was confined to 412 patients with self-reportedbiopsy-proven celiac disease who were on a strict gluten-free diet for at least one year. The survey showed that out of these 412 patients that met the criteria, 96 patients, or just over 23% metmodified Rome I criteria for Irritable Bowel Syndrome. Of those 96patients, 76 patients, or nearly 80%, made an effort to get help, bothmedical and non-medical, as a result of the bowel symptoms (we’ll callthe patients who sought help "irritable bowel syndrome patients").

    Irritable bowel syndrome-like symptoms were shown to drive SFHS scores sharply downward. Mentalhealth disorders, being female, falling off the gluten-free dietall contributed to a greater likelihood of irritable bowel syndrome symptoms.

    Theresults of the study seem strengthen the bio-psychosocial model of irritable bowel syndrome, in which biological and psychological factorsare understood to affect the clinical manifestation of celiac disease.Under this model, irritable bowel syndrome-like symptoms in adults withceliac disease are understood through a combination of clinical andsocio-psychological mechanisms. This model leads doctors to anunderstanding of celiac disease and other gastro-intestinal ailmentsthat goes beyond simple biological or psychological factors alone, andlooks at factors like adverse life events, stress, and hypochondriasisamong others.

    Limited studies indicate that gender differencesin visceral perception, cardio-autonomic responses, gastrointestinalmotility, and brain activation patterns to visceral stimuli are afactor in irritable bowel syndrome. Gender differences in psychosocialfactors have not been fully studied.

    The results of this studyalso support the need for further investigation to determine exactly whatfactors contribute to the bio-psychosocial model of what is called’celiac irritable bowel syndrome.’

    Future psycho-physiologicalstudies in patients with celiac disease and irritable bowel syndromeshould look to determine if psychological discomfort can prolongmucosal inflammation, reduce visceral pain thresholds, or disturb gutmotility.

    In the event that the right psychotherapeutictreatment for irritable bowel syndrome-like symptoms and/or mentaldisorder serve to improve reduced HRQOL in adult patients with celiacdisease and irritable bowel syndrome-like symptoms, it might benecessary to take a second look at interventional practices.

    So,in a nutshell, this all means that things like mental health, gender,and other non-clinical factors might play a role in irritable bowelsyndrome-like symptoms in people with celiac disease, and that furtherstudy is needed to sort out all of the possibilities and determine ifthere might be better ways to treat celiac disease that will reduce oreliminate irritable bowel syndrome-like symptoms.

    Psychosomatic Medicine 69:370 –376 (2007)


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    Guest krista

    Posted

    Many of us have found that other foods are producing IBS. There is no mention of whether the study looked at whether the folks who continued to have IBS symptoms were assessed to find out if perhaps casien or soy might be a factor in the continued discomfort. There is also the assumption among most medical professionals that things that are put onto the skin, such as shampoos and lotions etc. are safe no matter what is in them. How many of the study group were still using gluten containing personal care products?

    Also many of us suffer needlessly because our medications are a gluten source. Many trust pharms and their doctors to know if something is safe and as a result have long standing contamination from items such as supplements, over the counter meds, prescrition meds, wheat germ oils, alcohol and vinager and other items that are thought to be safe that in the reality are not.

    For folks that have neuro impact in the celiac spectrum of disease adherence to a gluten free diet is often not enough to stop the autoimmune process that is inflaming the brain and blood. They need to avoid the items that many of us are taught are 'safe by processing'. Many who continue to have issues will achieve resolution by ferreting out the other items we are forming antibodies to and becoming zero tolerance strict with the gluten-free diet. Something doctors don't seem to think many of us can do.

    IBS is not a diagnosis, it is a symptom. Unfortunately in our pharmadriven society there is too much of a rush to label and not enough time spent looking for the cause of the symptom.

    It is unfortunate that many doctors and researchers seem to ignore that the impact of your body fighting a substance that it considers poison can result in neuro impact. The depression and anxiety are too often a symptom and not a cause. The rush to medicate folks for depression rather than find the physical trigger for it keeps many of us suffering for years.

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    Guest Donnie

    Posted

    People with Celiac may have other food intolerance, and food allergies. They can cause GI problems, if ingested. Doctors usually ignore this fact, and push mind altering drugs on people who don't need them. I have been allergic to corn all of my life, as well as other foods and sulfites. If I accidentally eat any of them, because they are not properly labeled in food products, I get sick. Mind control drugs would not help. Avoidance of the problem food is the only thing that does help. This is not rocket science, but is ignored by doctors.

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    Guest April

    Posted

    Interesting, but no one has proven that the link mentioned in the article is a causative one. It seems almost useless to include 'anxiety' and 'depression' as mental health disorders when they are also common characteristics of people who are sick and have not been diagnosed or helped yet. Has anyone conducted a study yet to find out how often 'anxiety' and 'depression' are present in people with undiagnosed illnesses? Would be hard to construct - but a good contribution to science.

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    Guest Debra

    Posted

    Gluten and/ or lactose intolerance in infants would cause extreme pain and untreated would lead to helpless or dissociative reactions which would lead to parents responding less lovingly and more fearfully. Allergies treated with dulling antihistamines would also lead to maladaptive cognitive functioning and, without sharpness and persistence, it is VERY DIFFICULT to get a doctor to look into intestinal symptoms, fogginess, etc. I shudder to think how many 'mental problems' started out as reactions to abuse and gluten abuses us without visible bruises. Think of the 'shame' of gaseousness and how a child might feel in school. Combine IBS symptoms with periods and having to sit still for 8 hours. I could go on and on. Pain starts the cycle.

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    Guest Margaret

    Posted

    After my daughter went on a gluten-free diet she improved immensely; however within six months she was having stomach problems again. Her pediatrician said it was IBS. We followed the recommendations for this condition, but it was soon apparent this was not helping. Thank God for a Naturopath Doctor who identified other food allergies that were upsetting her intestines (soy, milk, eggs). When these were eliminated, she was a happy gal again.

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    Guest helen

    Posted

    There is legitimacy to the issues raised in this article. I propose inhaled dermatitis or irritable bowel triggered by handling gluten items - I own a restaurant and exposure to large amounts of gluten has sent me home with a stomach ache and skin rash.

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    Guest g harrison

    Posted

    I was almost convinced that I was a hypochondriac until I discovered it was gluten that was causing the multitude of symptoms that had afflicted me for over 25 years. When doctors don't have an answer, they make you feel as though you are inventing the problem. May be they don't listen to females or take them seriously and attribute their continued symptoms of IBS as female traits or manifestations of mental illness instead of recognizing their own biases have led to the demographics of the statistics in the first place. What drug company funded this study?

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    Women always lose out. That's why I try not to listen to my male doctors. I'm sick but I'll continue to search for the real answer. I wish men realized we are not inventing these symptoms. Women simply suffer more than men. Thanks for the encouraging article.

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    admin

    Lancet Nov 2001 Volume 358, Number 9292 1504-08 03
    Celiac.com 11/14/2001 - A recent study published in The Lancet by Dr. David S Sanders et al. of the Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK, explored the number of people who were diagnosed with irritable bowel syndrome but actually had celiac disease.
    The case-control study was done at a university hospital in which 300 consecutive new irritable bowel syndrome patients who met the Rome II criteria for their diagnosis were compared against 300 healthy age and sex-matched controls. Both groups were investigated for celiac disease by analysis of their serum IgA antigliadin, IgG antigliadin, and endomysial antibodies (EMA). Patients and controls with positive antibody results were offered duodenal biopsy to confirm the possibility of celiac disease.
    An amazing 66 patients with irritable bowel syndrome tested positive for the antibodies, and 14 of them or 4.6% had active celiac disease as compared with 2 or 0.66% of the non-IBS matched controls. In other words there is a sevenfold increase over the normal population in the number of people with IBS who have celiac disease. All of the patients with celiac disease in the IBS group were therefore misdiagnosed. The study did not indicate how many of the other 52 patients who had positive antibody results would eventually develop celiac disease, but this would be an interesting follow-up study. Celiac.com believes that the 4.6% with celiac disease will grow higher over time.
    Conclusion: All patients with irritable bowel syndrome should be screened celiac disease.

    admin
    Celiac.com 09/30/2002 - The Canadian Medical Association Journal (Hoey, 2002;166:479-80) published the following, Irritable Bowel Syndrome: Could it be Celiac Disease?, as excerpted below. This was an analysis of a Lancet article (Sander et al, 2001;358:1504-8) called, Association of Adult Coeliac Disease with Irritable Bowel Syndrome: A Case-Control Study in Patients Fulfilling Rome II Criteria Referred to Secondary Care.
    Here are the CMAJ excerpts:
    Irritable Bowel Syndrome is found in 10% to 20% of people with the use of standard diagnostic tools such as the Rome II criteria. Rome II criteria is specified below: At least 12 weeks, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has 2 out of 3 features:
    Relieved with defecation Onset associated with a change in frequency of stool Onset associated with a change in form (appearance) of stool Symptoms that cumulatively support the diagnosis of irritable bowel syndrome:
    Abnormal stool frequency (more than 3 bowel movements per day or fewer than 3 bowel movements per week) Abnormal stool form (lumpy/hard or loose/watery stool) Abnormal stool passage (straining, urgency or feeling of incomplete evacuation) Passage of mucus Bloating or feeling of abdominal distention Question: What proportion of patients who meet the Rome II criteria for irritable bowel syndrome have celiac disease?
    Case subjects: The article cites that 300 people (214 women, 86 men ranging in age from 18 to 87, (mean 56 years)) met the Rome II criteria out of 686 new patients who were referred by a family physician to a university hospital gastroenterology clinic. Control subjects were healthy people without irritable bowel syndrome. Also, most control subjects were companions of the patients who were matched to case subjects by age (within 1 year) and sex, as well as questioned in the same manner as case subjects.
    All case and control subjects underwent a wide range of baseline investigations, including full blood count, measurement of erythrocyte sedimentations rate, blood urea nitrogen and serum electrolyte levels, and thyroid function tests. In addition, they were investigated for celiac disease by analysis of serum levels of IgG antigliadin, IgA antigliadin and endomysial antibodies. Most of the case subjects, particularly those older than 45, underwent colonoscopy or sigmoidoscopy and barium enema. Case and control subjects with positive antibody test results were offered duodenal biopsy to confirm the possibility of celiac disease.
    Of the 66 case subjects who had positive antibody test results,
    49 had elevated levels of only IgG antigliadin
    4 of only IgA antigliadin and
    6 of only endomysial antibodies
    Fourteen of the 66 were subsequently found to have histologic evidence of celiac disease; 11 of the 14 were positive for endomysial antibodies. Nine of the of 66 case subjects were lost to follow-up or refused duodenal biopsy; 1 of them was positive for endomysial antibodies.
    Of the 44 control subjects who had positive antibody test results,
    41 had elevated levels of only IgG antigliadin
    1 of only IgA antigliadin and
    2 of IgG antigliadin and endomysial antibodies
    Only the last 2 subjects elected to undergo duodenal biopsy, and both were found to have histologic evidence of celiac disease.
    Commentary: The authors found that a high proportion of patients (about 5%) who were referred to a university hospital gastroenterology clinic and who met the Rome II criteria did have celiac disease. In addition, the clinic specialists uncovered other organic abnormalities in almost 20% of the referred patients.
    The study had several weaknesses. For instance, although most of the case subjects underwent extensive investigations of the lower gastrointestinal tract, the control subjects did not. Thus, some of the case subjects who were lost to follow-up or refused investigation and many of the age-matched control subjects might have been found to have irritable bowel disease, celiac disease or other gastrointestinal abnormalities.
    The authors conclude from their findings that patients who meet the Rome II criteria for irritable bowel syndrome and who are referred to a secondary care centre should be investigated routinely for celiac disease.
    In an editorial accompanying the Lancet article, a gastroenterologist cautioned that more studies are needed. He noted an earlier study in which 121 consecutive patients were referred for investigation of irritable bowel syndrome. Using Rome I criteria and similarly extensive investigation, the researchers detected no cases of celiac disease.
    Because of the findings from the Lancet study, the editorialist has decided to further lower his threshold for screening for celiac disease among patients referred for investigation of irritable bowel syndrome. Perhaps other gastroenterologists would be wise to do the same.
    I verified the five percent as cited in the CMAJ as 14 out of the 300 patients who met the Rome II criteria also had celiac disease. The CMAJ also cites the following, Studies in Europe have shown that up to 1% of the adult population may have celiac disease. We can make our own conclusions from this study in Lancet and we might agree that 1% may be understated but further studies have to be performed to corroborate a higher percentage of undiagnosed celiacs; I hope this definitely encourages closer scrutiny of IBS patients like myself who was diagnosed with IBS in 1997 with only a symptom of left side tenderness below my rib cage and a sigmoidoscopy which revealed no abnormalities except a hemorrhoid. Then, in the summer of 2001, I was diagnosed with lactose intolerance and IBS once more before discovering from medical research and my food dairy taken since May 2001, along with corroboration by an allergist in October 2001, that it may be celiac disease, as my malabsorption symptoms grew worse.
     

    admin
    Aliment Pharmacol Ther 19(11):1199-1210, 2004.
    Celiac.com 06/08/2004 - Researchers at the University of California, San Francisco have determined that everyone with Irritable Bowel Syndrome (IBS) should also be screened for celiac disease. The researchers used decision analysis to estimate the number of celiac disease cases detected, quality-adjusted life-years gained, and costs resulting from screening suspected IBS patients for tissue transglutaminase antibody and antibody panel. Positive tests were followed up with an endoscopic biopsy. A gluten-free diet was initiated to improve the quality of life in those with celiac disease.
    The results of this study indicate that 3% of the 1,000 patients with suspected IBS have celiac disease. Based on these results the researchers analyzed the costs of several celiac disease screening methods used a decision analysis formula to determine whether or not the screening is cost effective. The researchers conclude that celiac disease screening in patients with suspected irritable bowel syndrome is likely to be cost-effective even at a relatively low celiac disease prevalence.
    Perhaps the researchers should have taken their analysis one step further and concluded that it would make good economic sense to screen the entire population of the USA (as well as that of other countries) for celiac disease, rather than just those with IBS, given the fact that it affects approximately 1% of the population--which is the only conclusion that I could reach after my review of their good work. -Scott Adams

    Jefferson Adams
    Celiac.com 02/25/2013 - Patients with celiac disease often report symptoms compatible with irritable bowel syndrome (IBS). However, there haven't been any systematic studies regarding how adherence to a gluten-free diet might affect rates of irritable bowel syndrome-type symptoms in patients with celiac disease.
    To better answer that question, a research team conducted a meta-analysis of celiac disease patients to determine rates of irritable bowel syndrome-type symptoms, and how those symptoms relate to a gluten-free diet.
    The research team included A. Sainsbury, D.S. Sanders, and A.C. Ford, of the Leeds Gastroenterology Institute at St James's University Hospital in Leeds, United Kingdom.
    For their analysis, the team searched MEDLINE, EMBASE, and EMBASE Classic to identify cross-sectional surveys or case-control studies reporting prevalence of IBS-type symptoms in adult patients (≥16 years old) with established celiac disease.
    The team used case or control status and adherence to a gluten-free diet to determine the number of individuals with IBS symptoms.
    The team analyzed data from 7 studies with 3383 participants.
    They then calculated pooled prevalence and odds ratios (ORs), with 95% confidence intervals (CIs).
    They found that pooled prevalence of IBS-type symptoms in all patients with celiac disease was 38.0% (95% CI, 27.0%-50.0%).
    People with celiac disease had higher pooled odds ratios for IBS-type symptoms than did control subjects (5.60; 95% CI, 3.23-9.70).
    In patients who did not follow a strict gluten-free diet, the pooled odds ratios for IBS-type symptoms, compared with those who were strictly adherent, was 2.69 (95% CI, 0.75-9.56).
    Patients who did not adhere to the gluten-free diet had higher odds ratios for IBS-type symptoms compared with controls (12.42; 95% CI, 6.84-11.75).
    Such patients also had higher odds ratios compared with that observed for celiac disease patients who followed a strict gluten-free diet or controls (4.28; 95% CI, 1.56-11.75).
    The results show that patients with celiac disease suffer IBS-type symptoms more frequently than control subjects, and that following a strict gluten-free diet might help to reduce those symptoms.
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    Clin Gastroenterol Hepatol. 2012 Dec 13. pii: S1542-3565(12)01491-7. doi: 10.1016/j.cgh.2012.11.033.

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    Connie Sarros
    Celiac.com 04/21/2018 - Dear Friends and Readers,
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    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
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    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
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    Source:
    cnbc.com

    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center