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    Is it Time to Revise the Criteria Used to Diagnose Celiac Disease?


    Jefferson Adams

    Celiac.com 06/03/2008 - Among the main things doctors look for when they’re trying to make a classic diagnosis of celiac disease are small intestinal mucosal membrane villous atrophy and inflammation. However, the latest research indicates that these criteria are possibly too narrow, leading to a lack of diagnosis and treatment of people with celiac disease. If this turn out to be the case, then far more people than previously imagined may suffer from celiac disease and not even know it.


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    In an effort to find out if present current diagnostic criteria are in fact too narrow, Finnish researchers led by Markku Maki, MD, professor of pediatrics at the University of Tampere, Celiac Disease Study Group, Tampere, Finland, evaluated 145 patients who were presumed to have celiac disease. Just under half (71) of the patients showed positive endomysial antibodies, and out of these only 48 patients met the textbook definition for celiac disease.

    The research team then split the 23 patients left into two groups. They put the first group on a gluten-free diet for one year, and the second group on a on a standard gluten-inclusive diet for one year. At the end of the year, the doctors conducted follow-up biopsies on all 23 patients. The doctors discovered that the patients who had been on the gluten-free diet did in fact have celiac disease (even though they didn't have any obvious symptoms), and any symptoms that they did have disappeared—they lost their endomysial antibodies and any inflammation that was detected in their intestinal mucosa.

    On the other hand, the patients in the second group whose diets included gluten showed no such positive changes, and their symptoms continued. The still showed positive endomysial antibodies, along with inflammation of intestinal mucous membrane, and gluten-induced lesions in the small intestine.

    The study director said that each of the patients on the gluten-free diet had chosen to remain gluten-free thereafter, and that the patients on the gluten-inclusive diet had chosen to eliminate gluten from their diets and over time also became symptom-free—endomysial antibody-free and showed signs of healing of the mucous membrane.

    Other studies have shown that over time untreated patients who show positive endomysial antibodies may develop the gut injury that is currently required as part of the criteria for diagnosing celiac disease. A greater understanding of the negative effects of untreated or undiagnosed celiac disease, coupled with better testing methods have led to a new strategy that allow doctors to detect celiac disease as early as possible—before any serious damage can occur—this new strategy is likely to be resoundingly welcome among celiac disease sufferers.

     Hopefully the results of this study and others like it will lead to a new awareness among doctors, and will ultimately lead to better methods for diagnosing celiac disease at an earlier stage. This could ultimately mean less suffering and long term physical damage for many people.

    Presented at 2009 Digestive Disease Week in San Diego, CA by Dr. Kurppa, a member of Dr. Maki’s research team, on Tuesday, May 20 at 10:30 a.m. Pacific Time in room 10 (San Diego Convention Center).

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    Guest krista

    Posted

    This was a good article, I just wish the doctors would get their minds out of just the gut. I thought I was going to see that they were finding that celiac is a systemic disorder, which it is, and that they were recognizing the neurological impact. Unfortunately that is not the case but it is wonderful to see that they are recognizing the idiocy of us having to be almost dead before diagnosis. I feel really sorry for the group that had to eat gluten for a year but also know they most likely volunteered for the research. It's also unfortunate for us in the US that this research most likely will be ignored by US doctors for at least 10 years.

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    Guest lcarter

    Posted

    'The doctors discovered that the patients who had been on the gluten-free diet did in fact have celiac disease (even though they didn't have any obvious symptoms), and any symptoms that they did have disappeared—they lost their endomysial antibodies and any inflammation that was detected in their intestinal mucosa.' What criteria did the researchers use then to conclude that this group had Celiac Disease? Why can't that criteria be used to diagnose the disease now?

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    Guest brian

    Posted

    Eat gluten=get symptoms

    Don't eat gluten=don't get symptoms

     

    Is there something else the doctors need? Just because the doctor or I know that I have a particular antibody or intestinal swelling does not change the fact that I am healthier without gluten. Who needs them anyway! You don't need a diagnosis or a medical degree to discover if gluten makes you sick! Don't get me wrong, I work in the medical field, and doctors can do a lot of great things. But they have absolutely missed the ball on this one. How about studying why our bodies are rejecting gluten and fix that. I'll buy the first round of beer to that discovery! But that requires more than just 'watching and waiting' , doesn't it?

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    Guest Ursa Major

    Posted

    I am glad that it was determined that those people had celiac disease after all. But what about those people who did NOT have antibodies? I feel that many (if not most) of them have celiac disease as well. Yet nobody gave them the chance of having a biopsy and trying the diet as well. That is a shame.

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    Seriously! I was indeed half dead before I was diagnosed, and, four years into the gluten-free diet, I still suffer from the neurological problems, which my doctor says may actually never resolve completely.

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    Guest Marlie

    Posted

    Krista, please may I make your words mine? Very good!

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    The other question is, how long will it take for the FDA to get this information? In just a few months we will know if they are going to side with making it easy for manufacturers having so many parts per million of gluten or will they protect us from these crazy manufacturing practices of allowing so many part per million of gluten and rule for zero parts per million gluten.

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    Guest Roxanna

    Posted

    In my family myself and my daughter were taken off of gluten after having seizures not long after being born. We both grew progressively worse over time. By the time I found out that I could not eat gluten I was almost dead. As our daughter, we have a son that was born with the picture perfect symptoms of a gluten problem. After suffering through not being able to talk, seizures, not having feeling all over his body, the list goes on, he is now gluten free. He is 26 yrs old. A little to late. Our daughter was not given meds to help with her seizures until she was 15. Recently my husband was put in a trauma center for a brain injury. He has thrown up for years. Since we dated. He was held over in the hospital because he wouldn't stop throwing up. Finally, (you guessed it) the doctor put him on a gluten free diet. He is beginning to recover. We have a new grand child. He will NOT be introduced to gluten until he is about 2 yrs. A that time it will only be to test him. We hope and pray that he doesn't accidentally get poisoned with it before then. That probably is impossible because people love to kiss babies in the mouth.

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    I submitted a stool sample and a DNA cheek swab (to Enterlab.com) for my 22 month old son who had 'unexplained' chronic diarrhea that would likely 'turn into IBS' as an adult. Within 2 weeks I learned he has food intolerances to gluten, milk, soy, egg, and yeast. I was determined to find the cause of the 'unexplained diarrhea'. I removed the poisons and his stool is totally normal. The doctors continue to buck this type of testing only because it leaves them out of the $$ loop. I thank GOD every day that I stumbled across this very impressive and professional lab in Dallas TX... that works directly with the public!!

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    Guest carolyn

    Posted

    I'm glad at least some are taking seriously that the current standards for diagnosing celiac disease are not working. Repeat: They are definitely not working. It's rather infuriating that so many, many celiacs in the U.S. still will not be diagnosed until they are literally dying from it, already have resulting cancer or other serious, irreversible complications. The blood test is not infallible, and the endoscopy test (as this article proves) only catches the latest stages of the disease. This standard is no way for doctors to fulfill their promise to 'do no harm' to their patients. When a gluten-free diet reverses the often life-disrupting symptoms, that should be a neon-lit red flag that just maybe this person has celiac disease. What other causes of gluten intolerance are there?

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    Alexander R. Shikhman, MD, PhD, FACR
    The Connection between Gluten Intolerance and Sjogren’s Syndrome
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    Hydroxychloroquin (brand name Plaquenil). Leflunomide (brand name Arava). Severe autoimmune conditions associated with Sjogren’s syndrome are treated with the biologic drug rituximab (brand name Rituxan). Integrative therapy for Sjogren’s syndrome. Ear acupuncture (auricular therapy) and body acupuncture to stimulate tear and saliva production. Elimination diet based on individual food-intolerance profiles. Oral probiotics (for example, BLIS K12) and intestinal probiotics. Digestive enzymes. Fish and krill oils. Black currant seed oil. Cordyceps sinensis in combination with wormwood extract to treat the autoimmune component of Sjogren’s syndrome. Zinc and elderberry lozenges. N-acetyl-L-cysteine and glutathione. Our extensive clinical experience demonstrate that early cases of Sjogren’s syndrome can be completely reversed (by both clinical and laboratory criteria) by the strict gluten-free and elimination diet. The advanced cases cannot be reversed; however, even in advanced cases the gluten-free and elimination diet can slow the progression of the disease.
    If you’re concerned that dryness may represent Sjogren’s syndrome, see a rheumatologist for further evaluation and management of your condition.
    References:
    Alvarez-Celorio MD, Angeles-Angeles A, Kraus A. Primary Sjögren’s Syndrome and Celiac Disease: Causal Association or Serendipity? J Clin Rheumatol. 2000 Aug;6(4):194-7. Asrani AC, Lumsden AJ, Kumar R, Laurie GW. Gene cloning of BM180, a lacrimal gland enriched basement membrane protein with a role in stimulated secretion. Adv Exp Med Biol. 1998;438:49-54. Feuerstein J. Reversal of premature ovarian failure in a patient with Sjögren syndrome using an elimination diet protocol. J Altern Complement Med. 2010 Jul;16(7):807-9. Iltanen S, Collin P, Korpela M, Holm K, Partanen J, Polvi A, Mäki M. Celiac disease and markers of celiac disease latency in patients with primary Sjögren’s syndrome. Am J Gastroenterol. 1999 Apr;94(4):1042-6. Lemon S, Imbesi S., Shikhman A.R. Salivary gland imaging in Sjogren’s syndrome. Future Rheumatology, 2007 2(1):83-92. Roblin X, Helluwaert F, Bonaz B. Celiac disease must be evaluated in patients with Sjögren syndrome. Arch Intern Med. 2004 Nov 22;164(21):2387. Teppo AM, Maury CP. Antibodies to gliadin, gluten and reticulin glycoprotein in rheumatic diseases: elevated levels in Sjögren’s syndrome. Clin Exp Immunol. 1984 Jul;57(1):73-8.

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    Read more at Bizjournals.com
     

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    Read more at kark.com
     

    Jefferson Adams
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    Are psychiatric reactions induced by trauma or other life stressors associated with subsequent risk of autoimmune disease? Are stress-related disorders significantly associated with risk of subsequent autoimmune disease?
    A team of researchers recently set out to determine whether there is an association between stress-related disorders and subsequent autoimmune disease. The research team included Huan Song, MD, PhD; Fang Fang, MD, PhD; Gunnar Tomasson, MD, PhD; Filip K. Arnberg, PhD; David Mataix-Cols, PhD; Lorena Fernández de la Cruz, PhD; Catarina Almqvist, MD, PhD; Katja Fall, MD, PhD; Unnur A. Valdimarsdóttir, PhD.
    They are variously affiliated with the Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Rheumatology, University Hospital, Reykjavík, Iceland; the Centre for Rheumatology Research, University Hospital, Reykjavík, Iceland; the National Centre for Disaster Psychiatry, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; the Stress Research Institute, Stockholm University, Stockholm, Sweden; the Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; the Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; the Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden; the Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
    The team conducted a Swedish register-based retrospective cohort study that included 106, 464 patients with stress-related disorders, 1,064 ,640 matched unexposed individuals, and 126 ,652 full siblings to determine whether a clinical diagnosis of stress-related disorders was significantly associated with an increased risk of autoimmune disease.
    The team identified stress-related disorder and autoimmune diseases using the National Patient Register. They used Cox model to estimate hazard ratios (HRs) with 95% CIs of 41 autoimmune diseases beyond 1 year after the diagnosis of stress-related disorders, controlling for multiple risk factors.
    The data showed that being diagnosed with a stress-related disorder, such as post-traumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions, was significantly associated with an increased risk of autoimmune disease, compared with matched unexposed individuals. The team is calling for further studies to better understand the associations and the underlying factors.
    Source:
    JAMA. 2018;319(23):2388-2400. doi:10.1001/jama.2018.7028