Jump to content
Celiac Disease FAQ | This site uses cookies GDPR notice. Read more... ×
  • Sign Up
  • Join Our Community!

    Do you have questions about celiac disease or the gluten-free diet?

  • Jefferson Adams
    Jefferson Adams
    0

    Serum Tests No Good for Measuring Gluten Compliance in Celiac Disease Patients

      Serum tests are no good for detecting gluten compliance in celiac disease patients.

    Caption: Photo: CC--Max.Pixel

    Celiac.com 06/28/2017 - Tests to measure serum endomysial antibodies (EMA) and antibodies to tissue transglutaminase (tTG) were developed to screen for celiac disease in patients who are actively eating gluten.

    However, doctors often use them to monitor patients on a gluten-free diet. Now, making sure celiac patients are successfully following a gluten-free diet is important, as unconscious gluten ingestion can lead to complications over time. But how accurate are these tests for assessing gluten-free compliance in celiac patients?

    A team of researchers recently set out to assess the sensitivity and specificity of tTG IgA and EMA IgA assays in identifying patients with celiac disease who have persistent villous atrophy despite a gluten-free diet. The research team included Jocelyn A. Silvester, Satya Kurada, Andrea Szwajcer, Ciarán P. Kelly, Daniel A. Leffler, and Donald R. Duerksen. They are variously affiliated with the Farncombe Family Digestive Health Research Institute and Division of Gastroenterology, and the Department of Pathology and Molecular Medicine and Department of Medicine, McMaster University, Hamilton, Ontario.

    To begin their meta-analysis, the team searched PUBMED, EMBASE, BIOSIS, SCOPUS, clinicaltrials.gov, Science Citation Index, and Cochrane Library databases through November 2016. They included studies of subjects with biopsy-confirmed celiac disease, follow-up biopsies and measurement of serum antibodies on a gluten-free diet, biopsy performed on subjects regardless of symptoms or antibody test results.

    Their analysis excluded patients with refractory celiac disease, undergoing gluten challenge, or consuming a prescribed oats-containing gluten-free diet. They determined positive or negative findings based on manufacturer cut-off values. They defined villous atrophy a Marsh 3 lesion or villous height:crypt depth ratio below 3.0.

    They constructed forest plots to determine the sensitivity and specificity of detection for individual studies. For their meta-analysis, they used a bivariate random effects model to determine both sensitivity and specificity.

    Their search of abstracts revealed 5,408 unique citations, which yielded 442 articles for detailed review. Those reviewed articles yielded just 26 studies that met the team’s inclusion criteria (6 of tTG assays, 15 of EMA assays, and 5 of tTG and EMA assays). Inability to cross-tabulate histologic and serologic findings was the most common reason the team excluded a given study from analysis.

    They found that serum assays identified patients with persistent villous atrophy with high levels of specificity: 0.83 for the tTG IgA assay (95% CI, 0.79–0.87) and 0.91 for the EMA IgA assay (95% CI, 0.87–0.94).

    However, the tests showed low sensitivity for detecting villous atrophy: 0.50 for the tTG IgA assay (95% CI, 0.41–0.60) and 0.45 for the EMA IgA assay (95% CI, 0.34-0.57). Results were similar in both pediatric and adult patients.

    A meta-analysis of biopsy-confirmed celiac patients who received follow-up biopsy while on a gluten-free diet, showed that tests for serum tTG IgA and EMA IgA had low sensitivity, detecting persistent villous atrophy less than 50 percent of the time.

    The team supports the search for more accurate, non-invasive, markers of mucosal damage in celiac patients who follow a gluten-free diet.

    Source:


    0


    User Feedback

    Recommended Comments

    There are no comments to display.



    Your content will need to be approved by a moderator

    Guest
    You are commenting as a guest. If you have an account, please sign in.
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Jefferson Adams
    Clinical and Phenotypical Assessment of Seronegative Villous Atrophy
    Celiac.com 11/10/2016 - Seronegative villous atrophy (SNVA) is commonly attributed to celiac disease. However, celiac is not the sole cause of SNVA.
    Recent reports have pointed to a connection with angiotensin-2-receptor-blockers (A2RBs), but data on such cases of SNVA was limited to centers dealing with complex case referrals, and not SNVA in general.
    A team of researchers recently completed a clinical and phenotypical assessment of SNVA over a 15-year period. The research team included I Aziz, MF Peerally, JH Barnes, V Kandasamy, JC Whiteley, D Partridge, P Vergani, SS Cross, PH Green, DS Sanders. They are variously affiliated with the Academic Department of Gastroenterology, the Department of Microbiology, the Department of Histopathology at the Royal Hallamshire Hospital in Sheffield, UK, and with the Department of Medicine, Columbia University College of Physicians and Surgeons, Celiac Disease Center, New York, New York, USA.
    Over a 15-year period (2000-2015) the team assessed 200 adult patients with SNVA. Patients were diagnosed with either seronegative celiac disease (SNCD) or seronegative non-celiac disease (SN-non-celiac disease). The team then made baseline comparisons between the groups, with 343 seropositive celiac disease patients serving as controls.
    Of the 200 SNVA cases, SNCD represented 31% (n=62) and SN-non-celiac disease 69% (n=138). The human leucocyte antigen (HLA)-DQ2 and/or DQ8 genotype was present in 61%, with a 51% positive predictive value for SNCD. The breakdown of identifiable causes in the SN-non-celiac disease group comprised infections (27%), inflammatory/immune-mediated disorders (17.5%) and drugs (6.5%; two cases related to A2RBs).
    However, the researchers found no obvious cause in 18%, while duodenal histology spontaneously normalized in 72% of SNVA patients, while those patients were consuming a gluten-enriched diet.
    Following multivariable logistic regression analysis, the only independent factor associated with SN-non-celiac disease was non-white ethnicity (OR 10.8, 95% CI 2.2 to 52.8); in fact, 66% of non-white patients showed GI infections. On immuno-histochemistry all groups stained positive for CD8-T-cytotoxic intraepithelial lymphocytes. However, additional CD4-T helper intraepithelial lymphocytes were occasionally seen in SN-non-celiac disease mimicking the changes associated with refractory celiac disease.
    Most patients with SNVA, especially non-white patients, do not have celiac disease. Furthermore, a subgroup of patients with no obvious cause for their SNVA will show spontaneous histological resolution while consuming gluten. Based on these findings, the researchers encourage doctors to investigate patient condition before prescribing a gluten-free diet.
    Source:
    Gut. 2016 Sep 7. pii: gutjnl-2016-312271. doi: 10.1136/gutjnl-2016-312271.

    Jefferson Adams
    How Fast do Celiac Kids Recover on a Gluten-free Diet?
    Celiac.com 11/23/2016 - Researchers know that kids with celiac disease have fully responded to a gluten-free diet when symptoms resolve and serology returns to normal.
    A team of researchers recently set out to assess the rate of normalization of the TTG and EMA for children on a gluten-free diet after diagnosis. The researchers included Dominica Gidrewicz, Cynthia L Trevenen, Martha Lyon, and J Decker Butzner.
    After initiated a gluten-free diet in 228 newly diagnosed children with biopsy-proven celiac disease, the team obtained and recorded celiac serologies over a 3.5 year period.
    The team categorized patients based on serology (Group A, TTG >= 10 x upper limit of normal (ULN) and EMA >= 1:80; Group B, TTG >= 10 x ULN and EMA and EMA <= 1:40; and Group C, TTG < 10 x ULN) and by severity of histologic injury at diagnosis.
    They found that in children in Group A showed the highest serology at diagnosis. Of those, 79.7% had abnormal TTG at 12 months after diagnosis (average TTG 12 mo, 68.8 +/- 7.3, normal < 20 kU/L).
    At two years, abnormal TTG persisted in 41.7% of Group A. By contrast, in Group C, which showed the lowest serology at diagnosis, only 35% of children displayed an abnormal TTG at 12 months (average TTG 14.3 +/- 1.9 kU/L). In kids with the most severe mucosal damage, Marsh 3C, 74.2% and 33.2% had an abnormal TTG at 1 and 2 year.
    The data in this study indicate that 3 out of 4 gluten-free diet compliant kids with the highest celiac serology or most severe mucosal injury at diagnosis, took longer than one year in for serology to return to normal.
    Doctors should take serology and histology into consideration at diagnosis in order to properly assess the patient's response to the gluten-free diet. That said, it's encouraging that even the more severe cases of celiac disease will eventually return to normal when the kids follow a gluten-free diet.
    Source:
    Journal of Pediatric Gastroenterology & Nutrition. doi: 10.1097/MPG.0000000000001270

    Jefferson Adams
    What Factors Influence Gluten-free Diet Adherence in Young Adult Men with Celiac Disease?
    Celiac.com 03/03/2017 - Previous studies have shown us that men are generally less troubled living with celiac disease than are women, but most studies of men with celiac disease have been mostly quantitative, and have a bio-medical emphasis.
    A team of researchers recently set out to explore the social experience of young men with screening-detected celiac disease and to highlight daily life situations five years after diagnosis. The research team included Ethel Kautto, Cecilia Olsson, Anneli Ivarsson, Phil Lyon, Agneta Hörnell, and Lena Alex. They are variously affiliated with the Department of Food and Nutrition and Umeå Center for Gender Studies, Umeå University, Sweden, the Department of Food and Nutrition, Umeå University, Sweden, the Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden, the School of Arts, Social Sciences and Management at Queen Margaret University, UK, and the Department of Nursing at Umeå University in Sweden.
    Using a large Swedish school-based celiac screening-study, the team arranged to interview seven young men, all of whom were diagnosed with celiac disease at 13 years-old.
    The semi-structured interviews were analyzed from a gender perspective which resulted in three themes. Those themes were of young adult men being subjected to changes, striving for normality and emphasizing commitment.
    Many of young men reported dissociating themselves from being seen as a person with a life-long chronic disease.
    The analysis also showed that the young men’s daily experiences of living with celiac disease largely depended on their use of characteristics known to be associated with masculinity: such as being self-assured, demanding, and behaving authoritatively.
    In food situations, where the young men had the ability to make use of such characteristics in their informal group, they experienced fewer negative aspects of the disease.
    If the young men did not hold a strong position in their informal group, their situation was insecure and vulnerable and this could lead to avoidance of contacts and social meal situations.
    So, basically, being relaxed and socially confident about eating gluten-free helps to ensure success with the diet.
    Source:
    International Journal of Celiac Disease Vol. 4, No. 4, 2016, pp 138-145. doi: 10.12691/ijcd-4-4-7

    Jefferson Adams
    Does Celiac Disease Follow the Mason Dixon Line?
    Celiac.com 04/11/2017 - A new study shows that people living in the southern United States have less celiac disease than their Northern counterparts, regardless of race or ethnicity, socioeconomic status, or body mass index.
    Rates of celiac disease vary by region, with a sharp variation between Americans living in the northern United States and Americans living in the southern part of the country. A team of researchers recently examined geographic, demographic, and clinical factors associated with prevalence of celiac disease and gluten-free diet in the United States.
    The research team included Aynur Unalp-Arida, M.D., Ph.D, of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Constance E. Ruhl, M.D., Ph.D., of Social & Scientific Systems, Inc., Silver Spring, MD, and Rok Seon Choung, M.D., Ph.D., Tricia L. Brantner, and Joseph A. Murray, M.D., of the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
    For their population-based study, their team analyzed data on gluten-related conditions from the US National Health and Nutrition Examination Survey, from 2009 through 2014, on 22,277 participants 6 years and older. The team found celiac patients using results of serum tests for immunoglobulin A against tissue transglutaminase and endomysium, or of both, a health clinical diagnosis, and adherence to a gluten-free diet.
    The team also accounted for patients who follow a gluten-free diet without a diagnosis of celiac disease. Using the patients' status of gluten-related conditions, the team then compared average serum levels of biochemical and nutritional markers.
    Their results showed that 0.7% of participants had celiac disease, while 1.1% of participants avoid gluten without celiac disease. People who lived at latitudes of 35–39º North or at latitudes of 40º North were more likely to have celiac disease than individuals who lived at latitudes below 35º North, regardless of race or ethnicity, socioeconomic status, or body mass index. People who lived at 40º North or higher were more likely to avoid gluten without a celiac diagnosis, regardless of demographic factors and BMI.
    People with undiagnosed celiac disease, as determined by positive blood tests, had lower average levels of B12 and folate than persons without celiac disease. People with a clinical celiac diagnosis diagnosis had a lower average level of hemoglobin than those without celiac disease.
    Both those with gluten-related conditions and those without showed comparable average levels of albumin, calcium, iron, ferritin, cholesterol, vitamin B6, and vitamin D.
    American living at latitudes of 35º North or greater have higher rates of celiac disease and/or avoid gluten than persons living south of this latitude, independent of race or ethnicity, socioeconomic status, or body mass index.
    Average levels of B12 and folate are lower in individuals with undiagnosed celiac disease, and levels of hemoglobin are lower in participants with a diagnosis of celiac disease, compared to individuals without celiac disease.
    Source:
    Gastroenterology

  • Popular Contributors

  • Forum Discussions

    Rinsing it off under running water real good, this is to get any CC off. Examples, if there is a open air bakery some flour might have settled on your produce at the grocery store. OR if they are giving out samples some person might have been handling a dounut and touched your produce. Rinsing it off under running water works to remove any trace amounts normally.

    Organic. some people in general react to stuff used in growing produce, IE glyphostphate, or like me I have a issue with the wax they coat them with to keep the fresh. Going organic or farmers market fresh helps some with these. I think your nutritionist is covering all the bases.
    Global Gluten Free Beer market report provides complete analysis with current ... Rise in Obesity, Diabetes, Celiac Disease, Other Diagnosed Food ... View the full article
    Thank you GFinDC. Question. When you say, "quick rinse", can you define what is safe for us to use when washing our fruits and veggies? I know that might sound like something I should know but I am seriously taking no chances (at least not on purpose). I've been buying organic produce because I was told I needed to. Do you find that to be true or do I need to find a new nutritionist? 😉
×