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    Advantages to Early Intervention for Asymptomatic Celiac Disease


    Jefferson Adams

    Celiac.com 06/13/2011 - Serological screening of asymptomatic people at risk for celiac disease is an effective method for spotting the disease and prompting early treatment, according to the results of a study by researchers from Finland, presented at Digestive Disease Week 2011.


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    The study team showed that diagnosing and treating celiac disease in its earliest stages is beneficial in most screen-detected asymptomatic patients.

    Most of the patients the team studied were willing to continue on a gluten-free diet. On that basis, they assert that it is reasonable to screen at-risk groups.

    Lead author Kalle Kurppa, MD, from the University of Tampere in Finland noted that about 2% of the population has celiac disease, but that 90% of affected persons are never formally diagnosed.

    "Screening for celiac disease is problematic, and treatment is difficult. It is also unclear whether early diagnosis and treatment of screen-detected celiac disease is truly beneficial," Dr. Kurppa said.

    The study team set out to assess the benefit of adopting a gluten-free diet in asymptomatic adults with positive endomysial antibody (EmA) serological screens.

    For the study, the team recruited 3031 relatives of patients with celiac disease.  Of these, 148 showed positive EmA scans. 40 of these patients agreed to be randomly assigned to continue their gluten-containing diets (n = 20) , or to start a gluten-free diet (n = 20).

    In addition to screening for EmA testing, the study team tested for transglutaminase 2 antibodies, and surveyed patients using the Gastrointestinal Symptoms Rating Scale and Psychological General Well-Being instrument.

    The team evaluated laboratory parameters, celiac-specific genetics, bone mineral density, and body composition, along with small bowel mucosal morphology and inflammation.

    The team assessed patients at baseline and again after one year, at which time 18 of 20 control patients chose to begin the gluten-free diet as well.

    The team observed improvements in all patient parameters. The gluten-free diet group showed mucosal healing (changes in the villous height/crypt depth ratio); the control patients did not (P < .001).

    As senior investigator Katri Kaukinen, MD, PhD, explained in a press briefing: "After one year, those on a normal gluten diet had persistence or even a worsening of mucosal lesions, but those who started on a gluten-free diet showed recovery of the mucosa. The difference was really significant at one year."

    The group on the gluten-free diet also showed significantly reduced EmA titers (P < .001) and transglutaminase 2 antibody titers (P < .001) from baseline, along with improvements in symptoms (P < .001) and quality of life (P < .001), compared with the control patients.

    Control patients who switched to a gluten-free diet showed similar changes in all areas, except for quality of life after 1 year.

    Average laboratory readings, body mass index, and bone mineral density all registered within normal ranges at baseline, and showed no significant changes with the intervention. Also, folate and vitamin B12 levels showed substantial improvements on the gluten-free diet.

    Overall, patients had positive attitudes toward screening and the dietary intervention, Dr. Kurppa pointed out. Twenty-seven patients (67%) reported adherence to the gluten-free diet, 10 patients (25%) reported minor lapses, and only 3 patients (8%) reported a lack of adherence.

    Thirty-four patients (85%) were open to maintaining the gluten-free diet going forward.

    Five percent of patients found the gluten-free diet  'easy', Sixty-seven percent found it 'quite easy', while just thirteen percent of patients found if 'difficult.' Somehow, fifteen percent were "uncertain" about that question.

    Over half of the patients found the serological screening to be positive or very positive, and none found it to be a negative experience.

    Dr. Kaukinen noted at the press briefing that although patients first showed few, if any, symptoms, they reported feeling much better on the gluten-free diet.

    "We don't know why celiac patients have these different clinical phenotypes, why some get severe symptoms and others do not," said Kaukinen. It could be that people adapt to minor symptoms, and only realize their symptoms after they are gone. "Some patients told us they felt totally different on the diet," she added.

    Dr. Kaukinen says that the goal of early detection is to prevent worsening of symptoms, vitamin deficiencies, and possibly a loss in bone mineral density. "If we see early signs of disease, why should we wait when we can do something for them now?" she asked.

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    Guest dora macdonald

    Posted

    Just wonderful...I understand more now, thank you so much.

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    Guest Karen

    Posted

    I was just diagnosed with celiac disease two days ago - started the gluten-free diet, which helped. I went to a health food store to get some gluten-free cookies. The chocolate ones were gluten-free and I assumed the vanilla ones were also gluten-free, but they were not - I ate the whole package in two days. I never felt different but I never did feel anything eating gluten. I found out I was celiac at a routine physical. I guess I just start all over with the gluten diet - was wondering if that hurt me more eating the whole package because I don't have symptoms but know it is showing up in my body because of the endoscopy I had. Thank you

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  • About Me

    Jefferson Adams is a freelance writer living in San Francisco. He has covered Health News for Examiner.com, and provided health and medical content for Sharecare.com. His work has appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate, among others.

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  • Related Articles

    Jefferson Adams
    Celiac.com 03/26/2007 - According to a recent Norwegian research report, the adverse immune response to gluten may be tied to a specific set of dendrite cells in the small intestine.
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    Jefferson Adams
    Celiac.com 02/14/2011 - In what may seem for some like an obvious finding, a team of Australian researchers has shown that people can suffer gluten intolerance without having celiac disease. Their study is published in The American Journal of Gastroenterology.
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    Source:

    American Journal of Gastroenterology: 11 January 2011. doi: 10.1038/ajg.2010.487

    Jefferson Adams
    Celiac.com 04/19/2012 - A team of researchers examined the effect of corn, rice and amaranth gluten-free sourdoughs on the release of nitric oxide (NO) and synthesis of pro-inflammatory cytokines by duodenal mucosa biopsies of eight celiac disease patients.
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    They found that lactic acid bacteria acidified and grew well (ca. log 9.0 CFU/g) during fermentation, showing strong proteolysis on all gluten-free samples.
    They also found that duodenal biopsy specimens still released NO and IFN-γ when subjected to treatments with basal medium (control), PT-digest from chemically acidified doughs and PT-digest from doughs fermented with baker’s yeast alone.
    In fact, in every case, biopsy specimens treated with PT-digests from all gluten-free matrices with sourdough fermentation substantially reduced NO release and IFN-γ synthesis.
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    Source:

    EUROPEAN JOURNAL OF NUTRITION. DOI: 10.1007/s00394-012-0303-y

    Jefferson Adams
    Celiac.com 11/14/2013 - Until now, rates of non-celiac gluten sensitivity were largely a matter of clinical speculation, basically, educated guesswork among doctors.
    Some thought that rates of non-celiac gluten-sensitivity might by much higher than rates of celiac disease in the USA. But there was just no actual clinical data supporting these claims.
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    The research team included Daniel V. DiGiacomo, Christina A. Tennyson, Peter H. Green, and Ryan T. Demmer. They are variously affiliated with the Department of Medicine, Celiac Disease Center at Columbia University, and the Department of Epidemiology at the Mailman School of Public Health at Columbia University in New York.
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    Source:
    Rev Esp Enferm Dig. 2013 Apr;105(4):187-193. doi:10.3109/00365521.2013.809598

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/23/2018 - If you’re looking for a great gluten-free Mexican-style favorite that is sure to be a big hit at dinner or at your next potluck, try these green chili enchiladas with roasted cauliflower. The recipe calls for chicken, but they are just as delicious when made vegetarian using just the roasted cauliflower. Either way, these enchiladas will disappear fast. Roasted cauliflower gives these green chili chicken enchiladas a deep, smokey flavor that diners are sure to love.
    Ingredients:
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    Chop cauliflower, or break into small pieces and set aside.
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    Roxanne Bracknell
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    Jefferson Adams
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    Bakery On Main started in the small bakery of a natural foods market on Main Street in Glastonbury, Connecticut. Founder Michael Smulders listened when his customers with Celiac Disease would mention the lack of good tasting, gluten-free options available to them. Upon learning this, he believed that nobody should have to suffer due to any kind of food allergy or dietary need. From then on, his mission became creating delicious and fearlessly unique gluten-free products that were clean and great tasting, while still being safe for his Celiac customers!
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    Jefferson Adams
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    Source:
    FoodProcessing.com.au