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    Diagnosing Celiac Disease is Still Not a Simple Task


    Diana Gitig Ph.D.
    Image Caption: Photo: CC - timbrauhn

    Celiac.com 04/06/2012 - The first step in diagnosing celiac is serological testing, looking for the presence of anti-tTg antibodies. But in adults at least a duodenal biopsy is still the gold standard of diagnosis, partially because of the risk of false positive anti-tTg results. Yet serum anti-tTg levels positively correlate with the severity of small intestinal histopathology. This prompted researchers in Italy to wonder if those patients with the highest ant-tTg levels could be spared an endoscopy, and if so, how high their anti-tTg levels had to be. They conclude, in their words, that "tissue-transglutaminase antibody level 5-folds the upper limit of normal is 100% specific for duodenal atrophy and using this cut-off biopsy could by avoided in 1/3 of patients. Diagnostic criteria of celiac disease in adults need revision."


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    Photo: CC - timbrauhnThey retrospectively looked at 945 patients who came to their center because of suspected celiac disease. Three different commercially available methods were used to assess anti-tTg levels, which were then correlated with duodenal histology. By all serological methods used, anti-tTg levels increased in parallel with increasing severity of intestinal damage. As noted above, a cut off of five times the upper limit of normal ant-tTg included all of the patients with significant levels of villous atrophy. Celiac disease was confirmed in these patients by the presence of antiendomysial antibodies (EMS) and by their positive response to a gluten free diet.

    The use of serological results alone had previously been suggested as diagnostic guidelines for children, but these authors suggest that many adults could be spared an endoscopy as well. They also note this strategy is already being implemented in primary care, with people adopting a gluten free diet solely on the basis of blood work; this study is valuable in that it validates that approach.

    Source:

    • Zanini B, Magni A, Caselani F, Lanzarotto F, Carabellese N, Villanacci V, Ricci C, Lanzini A. High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease. Dig Liver Dis. 2012 Apr; 44(4):280-5. Epub 2011 Nov 25.
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    Guest Jen Rad

    Posted

    As an adult who clearly has gluten sensitivity, I had a blood test that came back "negative". I chose to go on a gluten-free diet voluntarily anyway and I am much better. However, in Canada, without the diagnosis I cannot claim tax relief for the more expensive diet. I was trying to confirm in this article if the blood test being done routinely could be read more carefully, but it was not clear to me. Is it worth asking my doctor for another blood test?

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    Guest Amy

    Posted

    As an adult who clearly has gluten sensitivity, I had a blood test that came back "negative". I chose to go on a gluten-free diet voluntarily anyway and I am much better. However, in Canada, without the diagnosis I cannot claim tax relief for the more expensive diet. I was trying to confirm in this article if the blood test being done routinely could be read more carefully, but it was not clear to me. Is it worth asking my doctor for another blood test?

    If you were to go in for another blood test and have been on a gluten-free diet for a while now you will not get a positive result because there would be no reaction going on inside your body to the gluten if you haven't consumed any recently.

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    Guest Donna

    Posted

    If you were to go in for another blood test and have been on a gluten-free diet for a while now you will not get a positive result because there would be no reaction going on inside your body to the gluten if you haven't consumed any recently.

    That's what happened in my case, so we checked my HLA celiac genes, and I have both of them which confirmed everything. I'm not sure why more doctors don't do gene testing.

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  • About Me

    Diana received her B.A. in Biochemistry from the University of Pennsylvania, and then a Ph.D. in Cell Biology and Genetics from Cornell. Now she is a freelance science writer and editor in White Plains, New York.  Her son was diagnosed with celiac disease in 2006, at the age of five, and she has been keeping her family healthy by feeding them gluten free treats ever since.

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    Clin Chem Lab Med 2010;48:685–91. DOI: 10.1515/CCLM.2010.136

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