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    Those patients for whom there is a high suspicion for celiac disease should have a small bowel biopsy which can be obtained by an experienced endoscopist in the distal duodendum. The best noninvasive tests available for screening for asymptomatic celiac disease are the specific serological tests. These are of several varieties: the anti-gliadin, anti-endomysial, or anti-reticulin antibodies. Our experience and the literature support the use as of endomysial antibody test as the single most specific and probably most sensitive for celiac disease. This test has now become available in specialty laboratories as well as in a small number of academic institutions. All of the tests should be done with the subjects on a normal gluten containing diet. A combination of endomysial and gliadin testing would seem to be the most sensitive as a screening method. A positive test is not, however, considered to be diagnostic and would usually require a small bowel biopsy for confirmation. A trial of dietary exclusion of gluten is *not* recommended as a diagnostic test without a prior abnormal biopsy.
    Because the body will recover when one goes gluten-free, the tests will then come up negative. Without a definitive test one may then stray from the diet, as one will feel well and was never sure that they had it in the first place. As for the two tests: The biopsy will look for flattened villi on the intestinal wall. After one goes gluten-free they will grow back. The blood antibodies are formed as a bodys reaction to the presence of the gluten. If no gluten, then no antibodies are present.

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    J Pharmacol Exp Ther. 2004 May 13
    Piper JL, Gray GM, Khosla C. Stanford University.
    Celiac.com 11/28/2004 - A study by researchers at Stanford University looked at the ability of Prolyl endopeptidase (PEP)--a specific type of enzyme--to break down gliadin peptides in a living organism--rats. In an effort to determine whether a resistance to the break down of proteins by proteases enzymes is the cause of toxicity of the Pro- and Gln-rich peptides, the scientists analyzed the digestive resistance of a panel of alpha and gamma-gliadin peptides that are believed to induce gluten toxicity--all of which happen to be very resistant to gastric and pancreatic protease digestion--but can be broken down by intestinal brush border peptidases. The researchers determined that supplementation of PEP substantially reduced the concentrations of these peptides, and they determined a pharmacologically useful PEP dosage. According to the researchers: "This data verifies and extends our earlier proposal that gliadin peptides, while resistant to proteolysis, can be processed efficiently by PEP supplementation. Indeed, PEP may be able to treat Celiac Sprue by reducing or eliminating such peptides from the intestine."

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    If you would like to learn more about celiac disease genetic testing, or read about my personal experience with Kimball Genetics, be sure to read the following two related articles:
    Your DNA Results Indicate: Super Celiac! By Scott Adams Understanding the Genetics of Gluten Sensitivity by Dr. Scot Lewey Celiac.com 11/29/2006 - Kimball Genetics, Inc. announces its participation this week at the XII International Celiac Disease Symposium in New York City and its support of the Celiac Disease Center at Columbia University. Kimball Genetics has a strong commitment to celiac disease education and genetic testing for this common, chronic, autoimmune disorder. Celiac disease affects approximately 1% of the U.S. population but is highly underdiagnosed, with less than 10% of cases currently detected. In genetically susceptible individuals with the specific markers HLA-DQ2 and HLA-DQ8, ingestion of gluten-containing grains causes inflammation of the small intestine and leads to malabsorption. Symptoms may be gastrointestinal and/or a wide range of other multi-systemic manifestations such as iron-deficiency anemia, chronic fatigue, osteoporosis, dermatitis herpetiformis, and attention-deficit/hyperactivity disorder. Early diagnosis and lifelong treatment with a gluten-free diet is critical to relieve inflammation and symptoms and to reduce the risk for development of secondary autoimmune disorders such as type 1 diabetes. Silent celiac disease, involving inflammation without symptoms, is also important to detect and treat.
    Kimball Genetics offers the Celiac Disease DNA Test, a genetic test with increasingly recognized importance in the diagnostic work-up of celiac disease. The test is valuable because it excludes the diagnosis of celiac disease in patients with a negative result, detects family members at risk for the disorder, and is accurate even when the patient is on a gluten-free diet. Both antibody testing and small bowel biopsy require going off a gluten-free diet to gain reliable results if the patient initiated the diet before diagnosis.
    Kimball Genetics is the only laboratory presently offering celiac disease DNA testing on cheek cell specimens with results available in one day. Dr. Peter Green of the Celiac Disease Center at Columbia University says "Cheek cell testing at Kimball Genetics is convenient and tremendously popular with my patients since it eliminates the need for blood draw. The one-day turnaround time and expert genetic counseling provided with Kimballs service are much appreciated." The Celiac Disease Foundation also recommends Kimball Genetics Celiac Disease DNA test due to these unique features of its service.
    In concurrence with the National Institute of Healths "Celiac Disease Campaign for Health Care Providers and Public," Kimball Genetics, Inc. conducts ongoing educational efforts including presentations to gastroenterologists, family practitioners, nautropaths, chiropractors, and nutritionists, and assists national celiac support groups. Dr. Annette Taylor and genetic counselors from Kimball have written an in depth review about celiac disease, co-authored by Dr. Peter Green, soon to be published in GeneReviews online. In addition, Kimball Genetics is collaborating with Drs. Xavier Castellanos and Dominick Auciello from New York University Child Study Center and Dr. Peter Green from Columbia University on an exciting new research study to determine the incidence of celiac disease in children with attention-deficit/hyperactivity disorder (ADHD) or learning disabilities.
    About Kimball Genetics, Inc.
    Founded in 1994 by Annette K. Taylor, M.S., Ph.D., Kimball Genetics is a national DNA diagnostic laboratory specializing in testing for common genetic disorders that are preventable or can be treated. Known for its unparalleled turnaround time and distinctive focus on genetic counseling and education, the company has a major focus on celiac disease and is at the forefront of education and testing for this disorder. Other major areas of testing currently include inherited hypercoagulability, hemochromatosis, cystic fibrosis, and fragile X syndrome. Soon Kimball will be expanding into pharmocogenomic testing which allows for the personal customization of drug therapy.


    Jefferson Adams
    Celiac.com 05/21/2012 - A trio of researchers recently compared duodenal and jejunal small intestinal biopsies for diagnosis and follow-up of celiac disease. The researchers included J.W. Meijer, P.J. Wahab, and C.J. Mulder from the Department of Pathology, Rijnstate Hospital Arnhem, The Netherlands.
    Current pediatric guidelines advise doctors to take intestinal mucosal specimens from the jejunum using a suction capsule.
    This method can be stressful for patients, time-consuming, expensive and requires the use of imaging technology.
    Taking mucosal biopsies from the distal duodenum using forceps is less stressful for patients, easier, cheaper and can be done using an endoscope.
    For those reasons, the researchers wanted to compare the histological results of biopsies taken from the duodenal mucosa by forceps and from the jejunal mucosa using suction capsule.
    To do so, they evaluated 171 paired biopsies taken from 109 patients from 1 to 75 years of age. Biopsies were made from the distal duodenal mucosa using jumbo forceps and from the jejunal mucosa using Crosby suction capsule.
    For histological interpretation they applied modified Marsh classification, including partial-, subtotal and total villous atrophy as Marsh IIIA, B, and C.
    A total of fourteen (8%) of the suction capsule biopsies were too low quality to be properly scored, while all duodenal biopsies taken with forceps produced adequate material for histological scoring.
    Of the remaining biopsies, a total of 145 of 157 (92%) showed no difference in histological scores.
    The remaining 12 biopsies showed some discrepancy in scoring, four of those showed more severe lesions in the duodenum, while eight showed more severe lesions in the jejunum.
    The differences were clinically significant, and included the presence and absence of villous atrophy in nine of the 157 paired biopsies (6%).
    The results showed that mucosal specimens taken from the distal duodenal and jejunal mucosa are strongly correlated, with clinically significant discrepancies were present in only 6% of paired biopsies.
    Based on these results, the researchers suggest that diagnosis and follow-up of celiac disease can be done using mucosal specimens taken from the duodenum using forceps, rather than the traditional biopsy of the jejeunum using Crosby suction capsule.
    Source:
    Virchows Arch. 2003 Feb;442(2):124-8. Epub 2002 Dec 20.