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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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    IMPROVING SEROLOGICAL MASS SCREENING IN CHILDHOOD CELIAC DISEASE


    Destiny Stone

    Celiac.com 03/26/2010 - Mass screening studies among the general population for celiac disease show a prevalence of approximately 0.5-1.0% in adults and in children. Yet, despite the growing numbers of newly diagnosed celiac disease patients, most cases still remain undiagnosed and therefore, untreated. In part, the masses of misdiagnosed or undiagnosed  celiac disease  patients are a result of the variety of disguises  celiac disease can have. Celiac disease can manifest into a multitude of symptoms including, but by no means exclusive to, malabsorption syndrome, diarrhea, anemia, infertility and osteoporosis.


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    It has been demonstrated that there is a clear advantage to early testing for celiac disease. Early testing can aide in  avoiding the irreversible damages that come from diagnosis later in life, such as stunted growth and organ damage. It is also faster for children to heal from intestinal lesions caused from undiagnosed celiac disease, when diagnosed early on. New evidence shows that 10 years after being diagnosed with celiac disease, 66% of the children diagnosed exhibited improvement in their health and overall quality of life; indicating that mass screening at an early age is critical.

    This study was based on a previous study performed by  mass screening for celiac disease by a group of scientists in the Netherlands between 1997 and 1998, who studied 6,127 asymptomatic children between the ages of two and four. Using endomysial antibodies (IgA EmA) testing, the children were screened for celiac disease. 57 seropositive children were then given biopsies. The scientists compared different testing methods for celiac disease, evaluated their serological persistence over time, and determined optimum cut-off points for the testing. Using serological samples obtained at biopsy, EmA and tTGA was assessed for each subject studied. Human leukocyte antigen  (HLA)-typing was obtained from 55 children; 26 of those had normal biopsies and were genetically predisposed for celiac disease and 29 of the children had small-bowel alterations known to be  distinctive traits for celiac disease. Of the 26 children with normal biopsies, 4% of them tested positively for HLA-DQ8, and the other 96% tested positive for HLS-DQ2. Of the 29 children diagnosed with celiac disease, all of them tested positive for HLA-DQ2. However, a proportionately  large number of children who tested EmA-positive and were diagnosed with celiac disease, had normal biopsies and were thus regarded as  false positives.

    The results of this test confirmed that celiac disease antibody levels may fluctuate in children who are genetically predisposed for  celiac disease. While the reason for the transient antibodies is still not known, it has been suggested that children who are seropositive but have normal small-intestine biopsies, potentially have celiac disease, and are susceptible to developing gluten sensitive enteropathy as they get older. Future testing is needed to establish results for this hypothesis.

    However, children with histological alterations in their small-intestine biopsy indicative of celiac disease, had considerably higher antibodies for EmA than those without celiac disease.  The tTGA levels were significantly higher and occurred with more frequency in children with celiac disease than in children without celiac disease. EmA persisted in all celiac disease children, but only in 50% of the non-celiac disease children. tTGA was evident in 83% of celiac disease children, and 15% in non-celiac disease children. Additionally, increasing the cut-off points  provided a reduction of false positives, but resulted in lowering test sensitivity. While optimization of standard cut-off points reduced unnecessary biopsies by 50%-96%, it also reduced test sensitivity.

     In conclusion, celiac disease antibodies are proven to be transient in children genetically predisposed to celiac. It is therefore crucial for medical providers to reduce the number of unnecessary biopsies. As this study has demonstrated,  to reduce the number of unnecessary biopsies by 85%, serological mass screening methods may be improved by repeating EmA and/or tTGA in children who test seropositive after 6 months, and before continuing to biopsy.

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    admin

    Great Smokies Diagnostic Laboratory (GSDL), a private, rapid-growth Functional Medicine Clinical laboratory, announced today receipt of 510(K) market clearance from the Food and Drug Administration (FDA) for its Intestinal Permeability test kit, utilizing the lactulose-mannitol challenge drink. Used in the non-invasive assessment of intestinal permeability, the test demonstrated its superior sensitivity as compared to the existing d-xylose test in measuring intestinal permeability, a measurement used in the diagnosis of gastrointestinal malabsorption syndromes, such as celiac disease, colitis, Crohns disease, and Irritable Bowel Syndrome.
    What is intestinal permeability?
    Intestinal permeability refers to impairment of the intestinal mucosal barrier, which is central to healthy absorption of nutrients and protection against bacterial and toxin translocation from the gastrointestinal (GI) tract to the blood stream. Disturbances in mucosal barrier function can lead to malnourishment and increased permeability (leaky gut) which can cause or contribute to disease conditions throughout the body as diverse as asthma, arthritis, and food allergies.
    What are gastrointestinal malabsorption syndromes?
    Although the Centers for Disease Control (celiac disease) has not gathered statistics specifically for malabsorption itself, tens of millions of Americans suffer from related gut mucosal integrity conditions responsible for enormous healthcare expense. Arthritis, for example, strikes over 43 million annually at a cost of more than $65 million (celiac disease), while functional gastrointestinal disorders are responsible for an estimated 2.5 to 3.5 million visits to doctors every year and some $40 million in medication expenditures (University of North Carolina Functional Gastrointestinal Disorders Center). The incidence of these health disorders and other intestinal permeability related- conditions continues to grow at an alarming rate.
    The growing use of non-steroidal anti-inflammatory drugs (NSAIDS), which can irritate the mucosal lining, has contributed significantly to an increase intestinal permeability worldwide. Intestinal Permeability Assessment can be used to monitor treatment of NSAID-related damage to the mucosal barrier and intestinal permeability-related to other irritants in the GI tract. An estimated 20% or more of patients taking NSAIDS develop systematic or endoscopic gastrointestinal toxicity with incidence increasing among the elderly, who account for 40-60% of NSAID users (Canadian Medical Association Journal 1996; 155: 77-88).
    Inflammatory and detoxification disorders, impaired healing following surgery, failure to thrive, and complications from radiation and chemotherapy for cancer have all been linked to intestinal permeability. Recent research has consistently underscored the value of Intestinal Permeability Assessment in GI disorders such as Crohns and Irritable Bowel Syndrome, as well as traumatic care, geriatric interventions, adjunctive AIDS therapy, and pediatric care, especially in the treatment of allergies and immune disorders.
    GSDL is the first commercial laboratory to offer Intestinal permeability testing. Utilizing state-of-the art technology, GSDL has developed a comprehensive range of functional assessments in the areas of gastroenterology, endocrinology, cardiology, nutrition/metabolism, and immunology. The laboratory conducts aggressive, ongoing research and development for innovative functional assessments.

    admin

    J Pediatr 2000;137:356-366.
    Celiac.com 10/10/2000 - Researchers from the University of Colorado School of Medicine, Denver have determined that transglutaminase (TG) antibodies in asymptomatic children are 70% to 83% predictive of biopsy evidence of celiac disease, and may identify children who are likely to develop the disease, as reported in the September issue of the Journal of Pediatrics.
    Dr. Edward J. Hoffenberg and colleagues studied 30 asymptomatic children who had a genetic risk for celiac disease to determine the relationships between TG antibody titer, small bowel histology, growth, and clinical features of celiac disease. Using the Marsh System to grade the small bowel histology Dr. Hoffenberg that out of 30 children with a positive TG antibody test result - 21 (70%) had definite (Marsh score 2 or 3) and 4 (13%) had possible (Marsh score 1) biopsy evidence of celiac disease, further, the TG antibody titer correlated with Marsh score.

    Tina Turbin
    Celiac.com 05/28/2010 - Celiac disease research is linking Irritable Bowel Syndrome with gluten intolerance and doctors are recommending IBS sufferers, especially those with diarrhea-predominant IBS, to get tested for gluten issues or celiac disease. Celiac disease is an autoimmune disease. The source of this being gluten, a protein found in wheat, barley, and rye, often affecting the entire body and manifesting various physical and mental symptoms, and a gluten-free diet is the simple treatment for this disease.
    New research published in the Archives of Internal Medicine has shown that people with IBS are four times more likely to have celiac disease than those without IBS. Doctors, often uneducated about celiac disease or improperly taught that its symptoms are dramatic, don’t associate the common symptoms of IBS, stomachaches, bloating, fatigue, and diarrhea, with celiac disease or gluten intolerance.
    In the January 2009 issue of the American Journal of Gastroenterology, the American College of Gastroenterology began recommending that doctors screen patients who manifest symptoms of IBS for celiac disease as well. The diagnosis is easy to test for. Simple blood tests detect the disease over ninety percent of the time. The diagnosis is then confirmed by an upper endoscopy. A small, flexible tube is slipped into the mouth of the sedated patient, down his esophagus and stomach and into the first part of the small intestine, where biopsies are taken and then examined for changes seen in celiac disease.
    After a correct diagnosis is made, people with IBS who are also celiac can begin the rapid road to recovery with a gluten-free diet. As people become more aware of celiac disease and gluten intolerance, gluten-free foods and gluten-free cooking become more and more available. There are now many delicious gluten-free recipes available for favorite foods and desserts such as gluten-free pizza, gluten-free muffins, and gluten-free cupcakes. Adults and children alike who are gluten intolerant can still enjoy a gluten-free balanced diet with a variety of gluten-free choices.
    In the U.S., a slightly increased rate of celiac diagnosis among adults has already lead to increased support. Gluten-free foods and gluten-free recipes are more readily available than ever. The Gluten-Free Restaurant Awareness Program (GFRAP) assists in the mutually beneficial relationship between people diagnosed with celiac disease or gluten intolerance and restaurants, resulting in an increase in the number of restaurants which can provide service to people following a gluten-free diet while increasing their patronage. Participating restaurants are able to provide gluten-free meals. As more and more people are diagnosed with gluten intolerance, their list of participating restaurants will surely grow.
    However, the U.S. remains behind in celiac awareness. This probably has something to do with the fact that celiac disease is the only autoimmune disease that the government doesn’t support with research grants. Centers such as Dr. Green’s Celiac Disease Research Center are one-hundred percent dependent on charitable donations or university funds. Even though diagnosis is slightly up for celiac adults, this isn’t enough to raise awareness and bring relief for the three million people who suffer from celiac disease, nearly ninety-seven percent of whom don’t even know the cause of their painful symptoms. With increased diagnosis, we will surely see increased support, and soon the celiac community will be able to enjoy the same quality of life and food and cooking options which is enjoyed by, for instance, the lactose-intolerant community.
    If you have been diagnosed with IBS or have similar symptoms, make an appointment with your doctor today to get tested for celiac disease or gluten intolerance. It may just bring you the relief you’ve been looking for all these years.


    Dr. Tom O'Bryan
    Question:  Do I have to re-introduce gluten in order to have an accurate gluten sensitivity test done?
     Answer: Yes and No
     If a person knows they are sensitive to gluten and have gone on a gluten-free diet, and want to know if they can have gluten again, then a  challenge is in order (reintroduce gluten). THIS IS STRONGLY NOT RECOMMENDED. The gluten challenge has many cases of people who were damaged (some permanently) from the reaction to reintroducing gluten Even Small Amounts of Gluten Cause Relapse in Children With Celiac Disease, Journal of Pediatric Gastroenterology and Nutrition 34:26­30,   and it is no longer a requirement for diagnosing celiac disease Am J Clin Nut 1999;69:354-65.
     Among 374 children in whom celiac disease was diagnosed before the age of 2, 5% developed an auto-immune disorder while on a gluten-free diet. Of those who went gluten-free, had years of no symptoms, then went back on a gluten-containing diet, 3.65% prevalence of systemic auto-immune disease with less than 12 months of eating gluten 9.1  % prevalence for 13-36 months of eating gluten again 26.3% prevalence for > 36 months of eating gluten again This means 1 out of 4 people who were sensitive to gluten, went gluten-free and eliminated all of their symptoms developed auto-immune diseases within 3 years of eating gluten again. Gastroenterology 1999;117:297-303.
     If you know you are Gluten Sensitive, and you've gone on a gluten-free diet, and you want to know "am I better", then testing will confirm you are being successful in 'quieting down' the inflammatory cascade that occurs with gluten sensitivity and which sets one up for the development of autoimmune disease.
     And if you want to 'throw the dice', if you want to gamble that you won't be the '1 out of 4' who develops an autoimmune disorder, then you would want to first check and make sure your tests are negative while being on a gluten-free diet, then do your gluten challenge and test again 1-2 months later. Once again, not recommended to do this.
     Many people do not develop celiac disease until later in life. So even if one tests negative now, if they're genetically vulnerable, celiac disease can develop at any time as a result of the body no longer able to handle the stress of life. Something will be the 'straw that broke the camels back' and a person who has had negative tests in the past will begin producing the antibodies and begin the tissue destruction that will eventually manifest as Gluten Sensitivity and/or celiac disease. So in this scenario, these people want to know if they're genetically vulnerable.
     The question is, am I sensitive to wheat?  When a test looking at Gluten Sensitivity comes back positive, it tells us the immune system is reacting to an exposure to gluten. And if you are not eating gluten, it's one of a few things:

     A hidden exposure to gluten  A cross-reactive food  A cross-reactive virus or bacteria  A poorly functioning GI Tract (consider Array #2-Intestinal Antigenic Permeability Screen) An unknown cause (potentially Refractory Sprue).

  • Recent Articles

    Connie Sarros
    Celiac.com 04/21/2018 - Dear Friends and Readers,
    I have been writing articles for Scott Adams since the 2002 Summer Issue of the Scott-Free Press. The Scott-Free Press evolved into the Journal of Gluten Sensitivity. I felt honored when Scott asked me ten years ago to contribute to his quarterly journal and it's been a privilege to write articles for his publication ever since.
    Due to personal health reasons and restrictions, I find that I need to retire. My husband and I can no longer travel the country speaking at conferences and to support groups (which we dearly loved to do) nor can I commit to writing more books, articles, or menus. Consequently, I will no longer be contributing articles to the Journal of Gluten Sensitivity. 
    My following books will still be available at Amazon.com:
    Gluten-free Cooking for Dummies Student's Vegetarian Cookbook for Dummies Wheat-free Gluten-free Dessert Cookbook Wheat-free Gluten-free Reduced Calorie Cookbook Wheat-free Gluten-free Cookbook for Kids and Busy Adults (revised version) My first book was published in 1996. My journey since then has been incredible. I have met so many in the celiac community and I feel blessed to be able to call you friends. Many of you have told me that I helped to change your life – let me assure you that your kind words, your phone calls, your thoughtful notes, and your feedback throughout the years have had a vital impact on my life, too. Thank you for all of your support through these years.

    Jefferson Adams
    Celiac.com 04/20/2018 - A digital media company and a label data company are teaming up to help major manufacturers target, reach and convert their desired shoppers based on dietary needs, such as gluten-free diet. The deal could bring synergy in emerging markets such as the gluten-free and allergen-free markets, which represent major growth sectors in the global food industry. 
    Under the deal, personalized digital media company Catalina will be joining forces with Label Insight. Catalina uses consumer purchases data to target shoppers on a personal base, while Label Insight works with major companies like Kellogg, Betty Crocker, and Pepsi to provide insight on food label data to government, retailers, manufacturers and app developers.
    "Brands with very specific product benefits, gluten-free for example, require precise targeting to efficiently reach and convert their desired shoppers,” says Todd Morris, President of Catalina's Go-to-Market organization, adding that “Catalina offers the only purchase-based targeting solution with this capability.” 
    Label Insight’s clients include food and beverage giants such as Unilever, Ben & Jerry's, Lipton and Hellman’s. Label Insight technology has helped the Food and Drug Administration (FDA) build the sector’s very first scientifically accurate database of food ingredients, health attributes and claims.
    Morris says the joint partnership will allow Catalina to “enhance our dataset and further increase our ability to target shoppers who are currently buying - or have shown intent to buy - in these emerging categories,” including gluten-free, allergen-free, and other free-from foods.
    The deal will likely make for easier, more precise targeting of goods to consumers, and thus provide benefits for manufacturers and retailers looking to better serve their retail food customers, especially in specialty areas like gluten-free and allergen-free foods.
    Source:
    fdfworld.com

    Jefferson Adams
    Celiac.com 04/19/2018 - Previous genome and linkage studies indicate the existence of a new disease triggering mechanism that involves amino acid metabolism and nutrient sensing signaling pathways. In an effort to determine if amino acids might play a role in the development of celiac disease, a team of researchers recently set out to investigate if plasma amino acid levels differed among children with celiac disease compared with a control group.
     
    The research team included Åsa Torinsson Naluai, Ladan Saadat Vafa, Audur H. Gudjonsdottir, Henrik Arnell, Lars Browaldh, and Daniel Agardh. They are variously affiliated with the Institute of Biomedicine, Department of Microbiology & Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; the Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and Division of Pediatrics, CLINTEC, Karolinska Institute, Stockholm, Sweden; the Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden; the Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden; the Diabetes & Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; and with the Nathan S Kline Institute in the U.S.A.
    First, the team used liquid chromatography-tandem mass spectrometry (LC/MS) to analyze amino acid levels in fasting plasma samples from 141 children with celiac disease and 129 non-celiac disease controls. They then crafted a general linear model using age and experimental effects as covariates to compare amino acid levels between children with celiac disease and non-celiac control subjects.
    Compared with the control group, seven out of twenty-three children with celiac disease showed elevated levels of the the following amino acids: tryptophan; taurine; glutamic acid; proline; ornithine; alanine; and methionine.
    The significance of the individual amino acids do not survive multiple correction, however, multivariate analyses of the amino acid profile showed significantly altered amino acid levels in children with celiac disease overall and after correction for age, sex and experimental effects.
    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
    Source:
    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.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
    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.
    So, 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 and emotional support animals.
    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