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      Frequently Asked Questions About Celiac Disease   04/24/2018

      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 is Celiac Disease and the Gluten-Free Diet? 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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    MUCOSAL RECOVERY AND MORTALITY IN ADULTS WITH CELIAC DISEASE AFTER TREATMENT WITH A GLUTEN-FREE DIET


    Jefferson Adams

    Celiac.com 04/16/2010 - In most adults with celiac disease, clinical symptoms disappear with a gluten-free diet. However, the exact effects of a gluten-free diet on rates of mucosal recovery in adults with celiac disease is less certain.


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    A group of clinicians recently set out to estimate the rate of mucosal recovery under a gluten-free diet in adult subjects with celiac disease, and to gauge the clinical prospects of ongoing mucosal damage in celiac patients following a gluten-free diet.

    The study group included: Alberto Rubio-Tapia, MD; Mussarat W. Rahim, MBBS; Jacalyn A. See , MS , RD, LD; Brian D. Lahr , MS; Tsung-Teh Wu, MD; and Joseph A. Murray, MD.

    Each patient in the study had biopsy-proven celiac disease, and was assessed at the Mayo Clinic. Also, each patient received duodenal biopsies at diagnosis. After beginning a gluten-free diet, each patient had at least one follow-up intestinal biopsy to assess mucosal recovery.

    The study team focused on mucosal recovery and overall mortality. Of 381 adult patients with biopsy-proven celiac disease, a total of 241 (175 women - 73%) had both a diagnostic and follow-up biopsy available for re-review.

    Using the Kaplan–Meier rate of confirmed mucosal recovery on these 241 patients, the study group found that 34% of patients enjoyed mucosal recovery at 2 years following diagnosis  (95% with a confidence interval (CI): 27–40 % ), and 66% of patients enjoyed mucosal recovery at 5 years (95% CI: 58–74 % ).

    More than 80% of patients showed some clinical response to the gluten-free diet, but clinical response was not a reliable marker of mucosal recovery ( P = 0.7). Serological response was, by far, the best marker for confirmed mucosal recovery ( P = 0.01).

    Patients who complied poorly with a gluten-free diet ( P < 0.01), those with severe celiac disease defined by diarrhea and weight loss ( P < 0.001), and those with total villous atrophy at diagnosis ( P < 0.001) had high rates of persistent mucosal damage.

    With adjustments for gender and age, patients who experienced confirmed mucosal recovery had lower mortality rates overall (hazard ratio = 0.13, 95 % CI: 0.02 – 1.06, P = 0.06).

    One of the most important findings from this study was that a large number of adults with celiac disease see no mucosal recovery, even after treatment with a GFD.

    Compared to those patients who suffered persistent damage, patients who experienced confirmed mucosal recovery had lower rates of mortality independent of age and gender.

    The group notes that systematic follow-up via intestinal biopsies may be advisable in patients diagnosed with celiac disease as adults.


    SOURCE: Am J Gastroenterol. 9 February 2010; doi: 10.1038/ajg.2010.10


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    Guest Carole Boviall

    Posted

    I was diagnosed with celiac disease at age 62 [with biopsy] and have followed a gluten free diet strictly for 6 years but I still have lots of gastric intestinal problems. I have read that after 5 years on the diet, mucosal recovery should be complete. This article confirms what I have suspected, that complete mucosal recovery does not happen for everyone. It also encourages me to seek a knowledgeable specialist for follow-up evaluation. Thanks for the latest clinical information.

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    Guest Suzanne

    Posted

    I was diagnosed with celiac disease at age 62 [with biopsy] and have followed a gluten free diet strictly for 6 years but I still have lots of gastric intestinal problems. I have read that after 5 years on the diet, mucosal recovery should be complete. This article confirms what I have suspected, that complete mucosal recovery does not happen for everyone. It also encourages me to seek a knowledgeable specialist for follow-up evaluation. Thanks for the latest clinical information.

    I would continue to read and investigate other issues as well. I was diagnosed with celiac disease 18 months ago. when I first went gluten free I could not believe how much better I felt, but continued to have issues with digestion. The doctor had advised me that lactose might become an issue, but I really resisted going off milk, it was much harder than going off gluten! I tried lactose free, without much difference. Dr told me then that it was not lactose but casein, a protein in milk that is very similar to gluten. I have made a monumental effort to not do dairy and things are finally starting to feel "normal". most days. ha ha - good luck.

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    Guest Mendel Claxton

    Posted

    I have been experiencing the classic symptoms of celiac disease and that article has encouraged me to get tested.

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    admin
    Wahab PJ, Meijer JW, Mulder CJ.
    Department of Gastroenterology and Hepatology, Rijnstate Hospital Arnhem, The Netherlands.
    Am J Clin Pathol 118(3):459-463, 2002
    Celiac.com 10/28/2002 - The following study strongly supports follow-up care and testing for people with celiac disease. As the study found, over 10% of people with diagnosed celiac disease have still not fully recovered even after five years of treatment.
    To assess histologic recovery in response to gluten withdrawal in celiac disease, 158 patients seen in our hospital during a 15-year period underwent follow-up small intestine biopsies (SIBs) within 2 years after starting a gluten-free diet; further SIBs were done if villous atrophy was present. A modified Marsh classification was used (IIIA, partial villous atrophy; IIIB, subtotal villous atrophy; IIIC, total villous atrophy). Of patients with Marsh IIIA, IIIB, or IIIC lesions, histologic remission was seen in 65.0% within 2 years, 85.3% within 5 years, and 89.9% in long-term follow-up. Eleven patients (7.0%) with persisting (partial) villous atrophy had symptoms and signs of malabsorption and were considered to have refractory celiac disease; 5 of them developed an enteropathy-associated T-cell lymphoma. Children recovered up to 95% within 2 years and 100% in the long-term. Histologic recovery in celiac disease after starting a gluten-free diet takes time and is incomplete or absent in a substantial subgroup of patients (10.1% villous atrophy after 5 years). Systematic follow-up of patients with celiac disease and the malabsorption syndrome and secondary complications is needed.

    admin

    Celiac.com 2/13/2003 - This new study emphasizes the importance of following a strict gluten-free diet, and getting regular follow-up biopsies after your diagnosis. It also speaks to the need to discover whether or not you may have additional food intolerance, such as to cows milk (casein), soy, corn, etc., as some of these can also cause intestinal damage similar to that of celiac disease. -Scott Adams

    Lee SK, Lo W, Memeo L, Rotterdam H, Green PH.
    Gastrointest Endosc 2003 Feb;57(2):187-91
    Current affiliations: Department of Surgical Pathology and Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
    BACKGROUND: The diagnosis of celiac disease requires characteristic histopathological changes in an intestinal biopsy with clinical improvement in response to a gluten-free diet. Endoscopy with procurement of biopsy specimens is often performed to document response to the diet, but there are little data on the appearance of treated celiac disease. This study examined the endoscopic and histopathological appearance of the duodenum of patients with celiac disease whose diet was gluten-free.
    METHODS: A cohort of 39 adult patients (mean age 52 years, range 20-74 years) with biopsy-proven celiac disease was retrospectively reviewed. All had responded clinically to a gluten-free diet that they had maintained for a mean of 8.5 years (range 1-45 years). The endoscopic and histopathological appearances of the duodenal mucosa were reviewed. Blinded review of the diagnostic (initial) and post-treatment biopsy specimens was also performed to assess response of individual patients to the diet.
    RESULTS: The endoscopic appearance was normal in 23%, reduced duodenal folds were present in 46%, scalloping of folds in 33%, mucosal fissures in 44%, and nodularity in 33%. There was more than 1 abnormality present in 46%. Histology was normal in only 21%. The remainder had villous atrophy (69% partial, 10% total). Paired (diagnostic and follow-up) biopsy specimens were reviewed blindly for 12 patients. The mean (SD) intraepithelial lymphocyte count fell from 61 (22) to 38 (17) (normal
    CONCLUSIONS: Despite a good clinical response, abnormal endoscopic and histopathological appearances persist in the majority of patients with celiac disease treated with a gluten-free diet.
    PMID: 12556782

    admin

    J Pediatr Gastroenterol Nutr. 2004 Feb; 38(2): 177-180
    Celiac.com 02/13/2004 - It has been determined that children with celiac disease exhibit an increased level of chromosome aberrations in peripheral blood lymphocytes, which may be a major factor in their higher risk of cancer over time. Now, a study by British and Croatian researchers has found that adherence to a gluten-free diet can actually decrease the number of chromosome aberrations in these children. The researchers compared chromosome aberrations in 17 children with celiac disease--before going gluten-free, then after a minimum 24 month gluten-free diet--and compared these results with that of 15 healthy children. They found that 12 of the 15 celiacs strictly followed the gluten-free diet, and these children had a significantly lower number of chromosome aberrations when compared with both the control group and the other three celiac children who did not follow the diet.
    The researchers conclude: "The frequency of chromosome aberrations in peripheral blood lymphocytes of patients with celiac disease decreased significantly on a gluten-free diet. We conclude that genomic instability is a secondary phenomenon, possibly caused by chronic intestinal inflammation."


    Jefferson Adams
    Celiac.com 11/24/2014 - Following a strict gluten-free diet is the only way to treat celiac disease. However, researchers have been lacking clear agreement on how and when to assess gluten-free dietary adherence in celiac patients or how to determine its effectiveness on villous atrophy.
    To address this reality, a team of researches conducted a prospective study to determine patient adherence to a gluten-free diet, and its effect on histological recovery after 1-year of gluten-free diet.
    The research team included G. Galli, G. Esposito, E. Lahner, E. Pilozzi, V. D. Corleto, E. Di Giulio, M. A. Aloe Spiriti, and B. Annibale. They are variously affiliated with the Department of Digestive and Liver Disease, the Department of Haematology, the Department of Pathology, and the Department of Digestive Endoscopy at Sant'Andrea Hospital Sapienza University Rome in Rome, Italy, and with the Centro Ricerche S. Pietro, Ospedale S. Pietro in Rome, Italy.
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    They defined complete histological recovery as the absence of villous atrophy and ≤30/100 intraepithelial lymphocytes. The team found that 81.5% of patients showed adequate gluten-free diet adherence (ADA), whereas 18.5% had inadequate adherence (IADA).
    Overall, 66% of ADA patients achieved complete histological recovery, but no IADA patients recovered (P < 0.00001).
    Interestingly, ADA patients who achieved complete histological recovery showed about the same antibody seroconversion and symptoms as those who achieved partial histological recovery with P = 0.309 and P = 0.197, respectively.
    Multivariate analysis showed that, for ADA patients with incomplete histological recovery, Marsh 3C was still a risk factor (OR 8.74, 95% CI: 1.87–40.83).
    This study shows that 66% of adult celiac patients who successfully follow a gluten-free diet can make a complete histological recovery after 1-year. However, patients with severe histological damage at diagnosis who successfully follow a gluten-free diet remain at risk for incomplete histological recovery 1 year later.
    Lastly, patients who do not follow a gluten-free diet have no hope of making a full histological recovery.
    For clinicians and doctors, this data should serve as a guideline for determining gluten-free diet adherence in celiac patients, and determining the level of patient recovery. For celiac patients, the data should serve to demonstrate the importance of following a strict gluten-free diet.
    Source:
    Alimentary Pharmacology & Therapeutics 2014; 40(6):639-647.

  • Recent Articles

    Tammy Rhodes
    Celiac.com 04/24/2018 - Did you know in 2017 alone, the United States had OVER TENS OF THOUSANDS of people evacuate their homes due to natural disasters such as fires, floods, hurricanes, tornadoes and tsunamis? Most evacuation sites are not equipped to feed your family the safe gluten free foods that are required to stay healthy.  Are you prepared in case of an emergency? Do you have your Gluten Free Emergency Food Bag ready to grab and go?  
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    Jefferson Adams
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    Source:
    fdfworld.com

    Jefferson Adams
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    Source:
    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764