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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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    STILL NO TEST TO CONFIRM CELIAC MUCOSAL STATUS WITHOUT BIOPSY


    Jefferson Adams

    Celiac.com 03/16/2009 - Current treatment for celiac disease consists of a lifetime gluten-free diet. However, once the diagnosis is made, most people don’t really receive regular follow-up or monitoring of their treatment unless they have some obvious complaint. That’s beginning to change, and more doctors are beginning to advocate long-term celiac care, which includes regular tests to assess dietary compliance.


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    To accomplish this goal, doctors are working to determine the best program of follow-up treatment. A team of Austrian researchers recently set out to determine which noninvasive test for celiac disease is best for assessing mucosal status in people with celiac disease.

    The research team was made up of doctors Andreas K. W. Vécsei, Ulrike B. Graf, and H. Vogelsang, associated with St. Anna Children's Hospital, Vienna, Austria and the Department of Gastroenterology and Hepatology, Clinic of Internal Medicine III, Medical University of Vienna, Vienna, Austria.

    The research team set out to clarify which noninvasive follow-up methods for testing blood serum or intestinal permeability (IPT) – best match the patient’s histology, and whether the accuracy of these tests is affected by the interval between diagnosis and follow-up affects.

    The team mined a computer database to compile information from adult patients, diagnosed with celiac disease between December 1989 and July 2006, who underwent follow up via biopsy, IPT, and serological testing via IgG anti-gliadin antibodies (AGA-IgG), AGA-IgA, and endomysial antibodies (EMA).

    They measured effectiveness of noninvasive test results based on the presence of villous atrophy upon biopsy. The team divided patients into two groups. The first, group A, comprised patients followed up within 24 months of diagnosis, and group B, comprising patients followed up after 24 months.

    In all, the team was able to evaluate forty-seven patients. The tests showed the following results:

    Lactulose/mannitol (L/M) ratio showed a sensitivity of 85% and a specificity of 46.2% for mucosal atrophy, while saccharose excretion showed a sensitivity of 60% and a specificity of 52.6%.

    AGA-IgA and AGA-IgG showed 15% and 20%, respectively, and both showed specificity of 100%. AGA was of limited usefulness due to low number of positive results. EMA assay was 50% sensitive and 77.8% specific.

    In group A (n = 23) L/M ratio performed best in terms of sensitivity (88.9%), whereas EMA achieved a higher specificity (71.4%). In group B, the sensitivity of the L/M ratio decreased to 85.7%, while the specificity of EMA increased to 91.7%.

    The team concluded that these results show that none of the non-invasive tests was an accurate replacement for follow-up biopsy in detecting severe mucosal damage.

    Until an accurate test is developed, long-term follow-up monitoring of gluten-free status in people with celiac disease will remain difficult to do reliably without biopsy.

    Endoscopy 2009; 41: 123-128

     


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    admin

    Pediatrics 2005;115:1341-1346.
    Celiac.com 05/31/2005 – According to Canadian researchers, the use of Tissue Transglutaminase Antibody (tTG) Screening may soon replace the use of the small bowel biopsy to diagnose celiac disease in children. The researchers reviewed the charts of 103 children who were screened for celiac disease using both small bowel biopsy and tTG. Fifty-eight of the children were found to have positive biopsy results, and out of these, 48 had very high tTG levels (over 100 U), 7 had middle tTG levels (20-100 U), and 3 had low levels (less than 20 U). Out of the 49 children with the highest tTG levels, all but one of them had a positive biopsy result. There were 3 biopsy-positive children who had low tTG levels, two who were found to be IgA negative, and one who had a duodenal ulcer.
    According to the researchers, using tTG values of greater than 100 U and less than 20 U, and knowing the patients IgA status, tTG testing was "98% sensitive and 97% specific in detecting celiac disease." The researchers also point out that the cost of diagnosis could be cut by 30% by utilizing tTG screening. The researchers conclude that children with high tTG titers can proceed straight to a gluten-free diet--if they respond well then their diagnosis is confirmed—if not they can proceed to a biopsy.
    Although the authors dont address this issue specifically, this method would likely lead to an increase in the diagnosis rate of celiac disease, as many people are unwilling to undergo a biopsy--or have their children undergo one.

    admin

    Celiac.com 09/29/2006 - Alvine Pharmaceuticals, Inc., a biopharmaceutical company focused on developing pharmaceutical products for the treatment of celiac sprue, today announced the closing of a $21 million Series A financing. Sofinnova Ventures led the investment round with strong support from Prospect Venture Partners and InterWest Partners. Cargill Ventures and Flagship Ventures also participated in the financing. "This financing brings together a premier group of investors committed to advancing the companys lead product candidate ALV001 into human clinical and safety trials," said Stanford Professor Chaitan Khosla, Ph.D., who co-founded the company. "Celiac sprue is a serious yet common immune disease that is triggered by gluten, a component of cereal grains found in most foods sold in the U.S. While under-diagnosed, as many as one in one hundred individuals suffer from celiac sprue, yet there is no drug therapy available. Alvines mission is to provide innovative drug therapies for this disease and to change the lives of its many patients," he continued.
    "Sofinnova has known Chaitan since the early 90s when we worked together on behalf of Kosan Biosciences. Were thrilled to be working with him again on his current venture," commented Sofinnova Ventures General Partner Nicola Campbell, Ph.D. "Alvines lead products will be beneficial to the celiac market for the treatment of a neglected patient population. ALV001 has proven to be uniquely safe for patients with celiac sprue, an actuality that the management team and investors alike are proud of."
    Joining Khosla in this venture are Alvine co-founders Blair Stewart, President and Kevin Kaster, Vice President of Corporate Development.
    Alvines platform is based on over six years of research, and an extensive intellectual property portfolio licensed from Stanford University and acquired from the Celiac Sprue Research Foundation.
    The Alvine Board of Directors consists of: Nicola Campbell, Ph.D., General Partner, Sofinnova Ventures; Ilan Zipkin, Ph.D., Partner, Prospect Venture Partners; Nina Kjellson, Partner, InterWest Partners; and Chaitan Khosla, Wells H. Rauser and Harold M. Petiprin Professor in the School of Engineering; Professor of Chemical Engineering, Chemistry, and Biochemistry, by courtesy, of Stanford University.
    About Alvine:
    Alvine Pharmaceuticals, Inc., is a Palo Alto-based biopharmaceutical company dedicated to developing and commercializing therapeutics for the treatment of Celiac sprue. Alvines lead molecule, ALV001, is a protease designed to be consumed with food to detoxify the gluten that triggers the autoimmune response in celiac patients. Celiac sprue is believed to affect as many as two million people in the United States alone, many of whom have suffered the symptoms of the disease but have not yet been diagnosed.

    admin

    Celiac.com 01/11/2007 – Researchers in Finland have determined that many patients with untreated celiac disease show the presence of intestinal endomysial autoantibodies (EmA), even in the 10-20% of cases where their serum EmA is negative. The researchers also believe that the negative serum EmA test in these cases is an indication of more advanced and long-standing celiac disease. Normally positive serum EmA is close to 100% accurate, however there is a subset of around 10-20% of patients where the test is negative even though they do have the disease. Dr. Katri Kaukinen and colleagues at the University of Tampere looked at 177 celiac disease patients and found that 22 were serum EmA-negative. A common theme among the 22 serum EmA-negative patients was that they were older and had more abdominal symptoms and other complications that indicated a more advanced stage of celiac disease than their serum EmA-positive counterparts. The research team found that even though the EmA antibodies could not be detected in the blood of these 22 patients, they could be detected in the small bowel mucosa in all of them, and none were detected in 20 control patients. Dr. Kaukinen and colleagues believe that the use of intestinal EmA antibody detection should be used in seronegative individuals who are suspected to have celiac disease.
    This study further supports Dr. Kenneth Fines use of IgA antigliadin antibodies in the stool to detect gluten sensitivity, and one has to wonder if the EmA antibodies, if detectable in the small bowel mucosa, would not also be detectable in the patient’s stool, and if so would that not be a much better and more cost-effective way to perform such a screening?
    Gut 2006;55:1746-1753.

    Destiny Stone
    Celiac.com 03/11/2010 - Many people are confused about which tests provide the most accurate results for a celiac disease diagnosis. In a recent study by a team at the Department of Gastroenternology and Internal Medicine, St. Orsola-Malpigihi Hospital, University of Bologna, Bologna, Italy, researchers evaluated  current testing methods, and made some conclusions about celiac testing that may shed light on the subject for those of us overwhelmed by current conflicting information.
    Duodenal biopsy is considered to be the universal 'gold standard' for celiac diagnosis. However, in recent years the importance of  serological testing has been been emphasized as a reliable marker for antibodies as well. The tTG antibodies of IgA class are currently recognized to be the most effective test for celiac screening, resulting in up to 95% accuracy.  Although, a new serological test, DGP, is now being investigated as a more reliable alternative to tTG.
    A study was devised to compare the effectiveness of DGP antibodies with that of tTG antibodies, and used a meta-analysis of  eleven studies that were published between 1998 and 2008. The study analyzed the results of 937 patients with untreated celiac, and 1,328 control subjects. The analysis of the eleven studies showed that IgA tTG antibodies revealed a higher likelihood ratio (LR) than IgA DGP antibodies, and IgA tTG antibodies exhibited a lower LR than IgA DGP antibodies. The data between the two antibody tests validates that IgA tTG continues to display the most accurate diagnostic tests for a positive celiac diagnosis, as well as for excluding a negative celiac diagnosis.  However  IgG DGP antibody tests were shown to be more effective at identifying 'false negatives' and had more success in determining celiac in patients that had IgA deficiency, and in children under two years old.
    The results of these tests clearly demonstrate that IgA DGP does not offer any advantages to the IgA tTG antibodies, and is actually less accurate and more expensive. However, IgG  DGP antibodies present an invaluable tool  in screening for celiac disease in cases where IgA tTG tests fail. Eventually, a new antibody screening will hopefully be designed which combines IgA tTG and IgG DGP, and reduces the number of tests currently used in celiac screening. However, intestinal biopsy is always required to confirm the presence of celiac disease no matter what serological tests are involved.
    Source:
    http://www.ncbi.nlm.nih.gov/pubmed/20136587


  • Recent Articles

    Jefferson Adams
    Celiac.com 04/26/2018 - Emily Dickson is one of Canada’s top athletes. As a world-class competitor in the biathlon, the event that combines cross-country skiing with shooting marksmanship, Emily Dickson was familiar with a demanding routine of training and competition. After discovering she had celiac disease, Dickson is using her diagnosis and gluten-free diet a fuel to help her get her mojo back.
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    Read the full study in Science.

    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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    You can find my Gluten Free Emergency Food Bags and other useful products at www.allergynavigator.com.  

    Jefferson Adams
    Celiac.com 04/23/2018 - A team of researchers recently set out to learn whether celiac disease patients commonly suffer cognitive impairment at the time they are diagnosed, and to compare their cognitive performance with non-celiac subjects with similar chronic symptoms and to a group of healthy control subjects.
    The research team included G Longarini, P Richly, MP Temprano, AF Costa, H Vázquez, ML Moreno, S Niveloni, P López, E Smecuol, R Mazure, A González, E Mauriño, and JC Bai. They are variously associated with the Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital; Neurocience Cognitive and Traslational Institute (INECO), Favaloro Fundation, CONICET, Buenos Aires; the Brain Health Center (CESAL), Quilmes, Argentina; the Research Council, MSAL, CABA; and with the Research Institute, School of Medicine, Universidad del Salvador.
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    Source:
    J Clin Gastroenterol. 2018 Mar 1. doi: 10.1097/MCG.0000000000001018.

    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:
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