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    How is celiac disease diagnosed?


    Scott Adams


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    The traditional approach to diagnosing celiac disease is a three-step process:

    • Perform a biopsy of the lining of the small intestine. This is a surprisingly easy procedure which takes only a few minutes, although small children are usually sedated first, which adds to the cost and complexity of the biopsy. If the villi are damaged (flattened or atrophied mucosa), go to step 2.
    • Place the patient on a gluten-free diet for six months or longer and then perform another biopsy. If the villi are healed, go to step 3.
    • Put gluten back in the diet for six months or longer, and then perform a third biopsy. If the villi are again damaged, then the diagnosis is complete. At this point, the patient goes on a gluten-free diet for life.

    Many doctors now feel that step number three is unnecessary, and some feel that even the second biopsy may be unnecessary. Part of the reason for this change in thinking is the development of three useful antibody blood tests: endomysial, reticulin (IgA), and gliadin (IgG and IgA). If the patient has been eating gluten regularly and all three tests come back positive, there is a very high chance that the patient has celiac disease. If all three tests come back negative, then it is very likely that the patient does not have celiac disease. Mixed results, which often occur, are inconclusive.

    All of the laboratory tests that can be performed are strongly affected by a gluten-free diet. Tests will return negatives if the individual has been on a gluten-free diet for some time, and there is much debate about the length of time a patient must return to a gluten-laden diet before being tested. It probably depends on many factors: the level of damage that was done before starting a gluten-free diet, the length of time the person has been gluten-free, the amount of healing that has occurred, and the sensitivity of the individual to gluten.

    A tentative diagnosis of celiac sprue is usually offered if the patients symptoms clear up after some time on a gluten-free diet. This is often followed by a "challenge" in which one of the offending grains (usually wheat) is eaten to see if the symptoms reoccur. However, this approach is much less desirable than having a firm diagnosis from a combination of antibody tests and one or more biopsies.

    Because a gluten-free diet precludes accurate testing, if you suspect celiac disease, it is advisable to have diagnostic tests performed before starting a gluten-free diet.

    Some physicians will accept positive antibody tests, one biopsy, and improvement on a gluten-free diet as sufficient for diagnosing celiac disease. Many other doctors prefer to perform a second biopsy, feeling that if it shows normal villi after a period of eating gluten-free then the diagnosis is confirmed. There are still some doctors who prefer the three-step approach mentioned above, though most view this as unnecessary.

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    Guest L. Mersky

    Posted

    I received good information about confirming a diagnosis.

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    Guest Willow

    Posted

    I am not supposed to eat gluten but I do anyway, and now I have side pain (left) and I have diarrhea. This has been happening over a year now. Is this bad??

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    Guest Terri W Murray

    Posted

    I am not supposed to eat gluten but I do anyway, and now I have side pain (left) and I have diarrhea. This has been happening over a year now. Is this bad??

    To: Willow, At its worse celiac can be very disabling. Along w/digestive pain and diarrhea, does eating gluten make your stomach swell and extend as if 10 months pregnant? Is the gas so volumous, the passing process is as painful as it is musical? Do you have lesions like small sores on your hips and buttocks? But the number one sign that you are dealing with a severe intolerance is the distinctly different odor associated with your movements. Celiac BMs have a stench that is so foul and so bold it cannot be easily contained nor quickly eradicated no matter what. If after you use the throne, others who come in contact cannot resist making loud, rude comments, then it is time to eat a couple days of wheat heavy meals and on the third day deposit early morning samples in a clean jar and take it to the lab for analysis. Watch out for the warnings given above. Just a few years ago, I saw several GI specialist, one called himself the top celiac physician in the Bay Area, the other was THE number one GI man on the left coast. Yet in spite of my delicately informing them, neither seemed to understand that when one has consumed NO gluten for four years that there was no way I could have any anti bodies! Duh! Shucks my local GI told me I could not have the disease because had part African-American blood. (Yes "Blood") Even I knew the doctor credited for "discovering" celiac was Irish and his introductory study said that people who adhere to the AFRICAN CULTURE where the diet does not consist of gluten causing grains (wheat/barley/sometime oats) but easier digesting grains like millet did not tend to have significant numbers of celiac suffers. So it has nothing to do with one's genes, or bloodline, but how much wheat is consumed and one's ability to digest it. Take lactose intolerance. Yes, certain groups of people tend to have it more than others, but this still goes back to the culture's diet, how much milk and dairy products they tend to consume, and how often, the body's means of metabolizing and what other foods are consumed in combination that can aid or harm said metabolization rate. These are also issues you, Willow must take into account when you speak with your doctor regarding your gluten consumption. Please also remember there lots and lots of hidden gluten in foods you'd never dream would have it. Also find out the list of alternate names the gluten is hidden under like most starches and many additives. That's alot to take it but there one more big ONE... Don't put it off! I let my pain specialists tell me my digestive issues were no big deal. I should not be upset because I had to evacuate my self digitally. I let them tell me it was just a little constipation caused by the opiates, when I knew better. I let them talk circle around me. A year goes by and next , they're removing a totally dysfunctional 85 foot mega colon, and my two day hospital stay turned into 2 code blues, 48 day stay w/ 30 days on-line, needle-only TPN feeding (no food, no liquids), discharged with internal bleeding for 6 mos, requiring 4 transfusions that lead to a 70 lb weight loss in 3 mos, as it turned out was all caused by a post-op complication; a grapefruit size pancreas tumor, benign, the adventure capped off with 5 very painful major fistula surgeries, all failures. So should you get anything from this email, get this:) If you value your health/life , pain and dysfunction are signs something is wrong. Do not wait. Insist on seeing a GOOD specialist NOW and 2) If its celiac, it stinks to high heaven! Good Luck. May it be something small and easily fixed, like eat more fiber. But if it is celiac. Write again and I'll tell you all the best gluten -free stuff that won't cost you and arm and a leg.

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    Guest fred bailey

    Posted

    Too funny. I'm just hours into finally researching gluten free and I'm just laughing my butt off. Ever think that people that commence a gluten free diet do well because they actually quit eating man made crap? After only a few hours of research, I've found out that I mostly eat gluten free foods, salads with turkey, fruit. After a few hours, I'm reminded of a friend of my dad's, some 40 years ago. He quit eating bread in hopes of losing weight, he did.

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    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
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    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.

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    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
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    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
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    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
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    Source:
    Alimentary Pharmacology & Therapeutics