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    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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    Jefferson Adams
    Celiac.com 07/21/2009 - Accurate blood tests have revolutionized celiac disease diagnosis. Recently, researchers K.E. Evans, A.R. Malloy, and D.A. Gorard set out to review requests for celiac blood testing at a district general hospital laboratory over a decade, to measure the volume of requests, identify their source of referral, and assess positivity rates, along with subsequent rates of duodenal biopsy and histological confirmation.
    The team used laboratory databases to gather details of patients who requested celiac blood tests from 1997 to 2006. They then categorized the referrals inasto gastroenterology, general practice, and pediatrics and other specialities, while excluding duplicate requests.
    The team gathered 9976 serological tests in all. From 1997 to 2006, testing requests increased from 302 to 1826. About two-thirds (66%) of requests were made for women. Tests done on children accounted for 14-25% of each year's total. During that same period, test requests made via general practitioner rose from 3.3% to 52%, while the percentage of positive test results fell from 5.7% to 2.6%.
    The number of duodenal biopsies fell from 85% of seropositive patients in earlier part of the decade to about 75% of seropositive patients in latter part. Most non-biopsied seropositive patients had blood requested by general practitioners. In more than 9 out of 10 seropositive patients (91%), biopsy confirmed celiac disease.
    The data show that, increasingly, most celiac blood tests are now requested by general practitioners, with twice as many women as men being tested.
    Rising requests for blood tests but shrinking rates of positivity suggest that people are getting tested earlier, with fewer or less severe symptoms than in the past. Positive blood tests are often not confirmed histologically.
    Also of note, most patients with celiac disease no longer show classical signs of malabsorption, so diagnosis is often delayed or never made. These days, most adults diagnosed with celiac disease increasingly show few or atypical symptoms.
    Although duodenal or jejunal biopsy remains the gold standard for diagnosing celiac disease, the availability of easy, accurate blood tests has dramatically improved the diagnosis of celiac disease.
    More accurate tests for IgA endomysial antibodies and IgA tissue transglutaminase antibodies have replaced less reliable immunoglobulin (Ig) G and IgA gliadin antibody tests, while sensitivity and specificity of Endomysial antibodies and IgA tissue transglutaminase antibody tests now exceeds 95%.
    Still, doctors recommend biopsy confirmation of positive blood antibody tests, as biopsy of patients with positive blood tests, along with those suspected of having celiac but with negative blood, remains the most comprehensive way of diagnosing celiac disease.
    Aliment Pharmacol Ther 29, 1137-1142


    Jefferson Adams
    Celiac.com 10/23/2009 - Current estimates put the number of celiac disease sufferers at about 1% of the general population. However, some celiac disease experts, like Dr. Andrew Fassano, predict that up to 10% of the general population may prove to suffer from gluten intolerance.
    Easier, more reliable testing methods, such as blood antibody screening, have helped promote early detection of celiac disease, thus preventing serious complications of the disorder. Such tests also move researchers closer to knowing if Dr. Fassano’s prediction will hold true.
    In addition to classic complaints such as indigestion, diarrhea, poor nutritional uptake, among others, people with both celiac disease and gluten intolerance often present with a wide variety of generalized symptoms, and many increasingly show no clinical symptoms at all.
    A team of researchers recently set out to develop specific and sensitive immunoassays that can reliably detect celiac disease. In this case, they developed immunoassays for the detection of IgG and IgA antibodies to gliadin using synthetic peptides. The research team was made up of Anil K. Bansal, Matthew J. Lindemann, Vince Ramsperger, and Vijay Kumar.
    The team looked serum results for endomysial (EMA) and tissue transglutaminase (tTG) antibody screens from 200 blood individuals with celiac disease, as well as from celiac disease control subjects, and healthy normal subjects.
    In order to assess reliability of the Celiac G+ antibody test against EMA, which offers higher sensitivity and higher specificity, the team included samples with both high and low EMA titers. The team compared the Celiac G+ antibody assay against EMA and another commercially available gliadin peptide assays, together with tTG antibody assays.
    The data show that as the EMA levels increased the sensitivity of detection of antibodies to synthetic peptides on both systems increased, reaching 100% at EMA titers greater than 160. Celiac G+ synthetic gliadin peptide assay provides markedly superior diagnostic performance compared with other gliadin peptide immunoassays.
    Overall, the diagnostic performance of the Celiac G+ assay for IgA and IgG showed a sensitivity of 80% and 90% respectively in comparison with EMA. Compared to the other available synthetic peptide immunoassays, EMA positivity yielded sensitivities of 59% (IgA) and 75% (IgG). Specificity for celiac G+ antibody assay was 90–95% for IgA and IgG compared to 88–90% specificity for other similar assays.
    The results show that Celiac G+ ELISA provides better sensitivity and better specificity compared with other available synthetic gliadin peptide immunoassays. Moreover, when used in combination with the IgA tTG antibody test, the IgG Celiac G+ antibody test offers an excellent screening algorithm for suspected cases of celiac disease.
    As tests for celiac disease and gluten intolerance become better, easier, more reliable, as they become more sensitive and more specific and available to more people, more and more people will come to understand that they suffer from celiac disease and/or gluten intolerance. Every one of those discoveries offers someone a chance to improve their well-being and live a long, healthy life. For now, stay tuned...
    Annals of the New York Academy of Sciences. 2009 Sep; 1173:36-40.


    Jefferson Adams
    A Systematic Review of Diagnostic Testing for Celiac Disease Among Patients With Abdominal Symptoms
    Celiac.com 06/03/2010 - Clinical presentation of celiac disease can vary considerably from patient to patient. Most patients with celiac disease present atypical symptoms. Moreover, most patients who present abdominal symptoms in primary care do not have celiac disease, and so diagnostic tests for celiac disease are not necessary and should be avoided.
    A team of researchers recently conducted a systematic review of diagnostic testing for celiac disease among patients with abdominal symptoms.
    The team included Daniëlle A. W. M. van der Windt, PhD; Petra Jellema, PhD; Chris J. Mulder, MD, PhD; C. M. Frank Kneepkens, MD, PhD; and Henriëtte E. van der Horst, MD, PhD. Their article appears in the Journal of the American Medical Association.
    The goal of the research was to review and summarize evidence on the performance of diagnostic tests for spotting celiac disease in adults who present abdominal symptoms in primary care or similar settings.
    To obtain initial data, the team search MEDLINE (from January 1966  through December 2009, and EMBASE from January 1947 through December 2009. They also conducted a physical search of references for additional relevant studies.
    The team chose cohort or nested case-control diagnostic studies which included adults presenting non-acute abdominal symptoms, which featured celiac disease prevalence of 15% or less, and in which the tests included gastrointestinal symptoms or serum antibody screens.
    Two independent reviewers conducted studies tool and data extraction. They then calculated sensitivities and specificities for each study and computed pooled estimates using bivariate analysis where there was clinical and statistical homogeneity.
    In all, the team included sixteen studies encompassing 6085 cases in their review.
    Specificity, sensitivity, and confidence intervals for predicting celiac disease varied with abdominal symptoms.  For patients presenting with classic diarrhea, for example, predictive sensitivity ranged from 0.27 to 0.86, while specificity ranged from 0.21 to 0.86.
    Pool estimates for 8 studies on IgA antiendomysial antibodies were 0.90, with a 95% confidence interval [CI] (0.80-0.95) for sensitivity and 0.99, with a 95% CI (0.98-1.00) for specificity, with a positive likelihood ratio [LR] of 171 and negative LR of 0.11.
    Pool estimates for IgA antitissue transglutaminase antibodies (7 studies) were 0.89, with a 95% CI (0.82-0.94) and 0.98 at 95% CI (0.95-0.99), respectively, with a positive LR of 37.7 and negative LR of 0.11.
    IgA and IgG antigliadin antibodies showed variable results, especially for sensitivity, which ranged from 0.46-0.87 for IgA, and from 0.25-0.93 for IgG.
    One recent study using deamidated gliadin peptides showed good specificity (0.94), but the target population offered limited supporting evidence.
    For adults who present abdominal symptoms in primary care or other unscreened settings, IgA antitissue transglutaminase antibodies and IgA antiendomysial antibodies offer high sensitivity and specificity for diagnosing celiac disease.
    SOURCE:  JAMA. 2010;303(17):1738-1746. doi:10.1001/jama.2010.549


    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.
    Between 2009 and 2012, the researchers enrolled 65 consecutive newly-diagnosed adult patients (median age 38 years, 18–70) with biopsy-proven atrophic celiac disease. The researchers assessed patients after one year of gluten-free diet, using duodenal histology, serological assays, symptom reports and a dietary interview based on a validated questionnaire.
    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.

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