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  • 1 1

    Can You Guess the Most Common Misdiagnoses for Celiac Disease?


    Jefferson Adams
    Image Caption: Image: CC--Jared Rodriguez/truthout

    Celiac.com 05/22/2015 - The fact that celiac disease is commonly misdiagnosed will come as little surprise to anyone who's ever gone through what can often be a long, circuitous process of getting diagnosed. Celiac symptoms can be vague, and can mirror symptoms of numerous other conditions.


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    Even though celiac awareness is improving, and blood screens are becoming more common, misdiagnosis remains common for people who are eventually diagnosed with celiac disease.

    Can you guess the most common misdiagnoses that doctors make for patients with celiac disease?

    The most common misdiagnoses include:

    1. Irritable bowel syndrome: People with celiac disease are often told that they have irritable dowel syndrome when they actually have celiac disease. In fact, IBS is the most common misdiagnosis for people with celiac disease.
    2. Inflammatory bowel disease: Coming in a close second to IBS, inflammatory bowel disease is another common misdiagnosis for people who actually have celiac disease.
    3. Gastro-esophageal reflux disease: People with GERD don't have any higher rates of celiac disease than the rest of the population. However, to be fair, a pretty high percentage of newly diagnosed celiac patients have reflux and/or esophageal dysmotility; which might explain the high prevalence of reflux symptoms in celiac disease patients, and the common misdiagnosis of GERD.
    4. Ulcers: Ulcers are often wrongly suspected, well before celiac disease is finally diagnosed.
    5. Viral gastroenteritis: Another very common thing doctors suspect long before they suspect celiac disease, is viral gastroenteritis.
    6. Chronic fatigue syndrome: Fatigue is a common complaint of many people with celiac disease, so maybe it's understandable why many people with celiac disease find themselves with a misdiagnosis of chronic fatigue, rather than an accurate diagnosis of celiac disease.
    7. Allergies: Many people find themselves wrongly diagnosed with environmental allergies long before they are diagnosed with celiac disease.
    8. Parasitic infection: Celiac disease symptoms can mirror symptoms of certain gut parasites, which is one reason that many people with celiac disease find themselves being checked for parasites long before they get checked for celiac disease.
    9. Gallbladder disease: Celiac disease symptoms can mirror symptoms of gallbladder disease, which is why many people who actually have celiac disease find themselves diagnosed with gallbladder problems.
    10. Colitis: Another common culprit for misdiagnosis is colitis, which shares many symptoms with celiac disease.
    11. Cystic fibrosis: Many people don't realize that in a number of cases, the symptoms of celiac disease can lead doctors to suspect cystic fibrosis, rather than celiac disease, thus prolonging diagnosis, treatment and recovery.
    12. Psychological dysfunction: In many cases, celiac disease symptoms can be so hard to pin down that doctors find themselves wondering if the symptoms aren't really in the patient's head. In their quest for diagnosis, many people with celiac disease have been referred to a psychologist, rather than evaluated for celiac disease.
    13. Lactose intolerance: Lactose intolerance is a common misdiagnosis in celiac patients, because the mucosal damage from gluten leaves them unable to digest lactose-containing products.

    In addition to being frustrating and painful, misdiagnosis of celiac disease is a big deal because, left unaddressed, the damage done by the disease continues unabated, and can snowball into further health and wellness problems.

    Have you, or anyone you know, suffered through misdiagnosis before being diagnosed with celiac disease? Share your story in our comments section.

    Source:

    1 1


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    Recommended Comments

    Guest Lisa

    Posted

    I remember having stomach issues as far back as age 6. Through the years I've seen doctors for multiple stomach complaints as well as other issues such as thyroid and infertility. I've been told I had spastic colon, IBS, anorexia and that I was just stressed out. Not until I was 50 did I finally get a diagnosis of celiac disease.

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    Guest Paula

    Posted

    My husband was misdiagnosed with 'anxiety attacks'. Symptoms started in college, and he always got really sick after parties- pizza, beer, barbecues, cake...therefore it must be anxiety.

    It wasn't until our daughter (20 Years later) was failure to thrive & had all the same reactions as daddy - that we finally got diagnoses of celiac. After she tested positive, it was just a matter of begging to talk my husband into getting tested. We honed right in when our son started showing signs too. It is undoubtedly genetic!

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    Guest Liam

    Posted

    I was first screened in 1972, as my elder brother was diagnosed, but the methods of testing then were ineffective. As a result I wasn't diagnosed, and grew up with general bad health which I just accepted, in particular a lot more than my share of colds and ear infections. I also believe it significantly slowed my physical and mental development. In 1994 I went to a doctor with classic symptoms of coeliac disease, but was misdiagnosed again as the doctors weren't looking for coeliac disease. My health continued to decline for another 8 years, and it wasn't till I asked a doctor to test me specifically for coeliac disease that I got the correct diagnosis. It took me more than 6 Years to recover, during which time my weight increased 20 kg, and that is why I believe it was affecting me for all my life before diagnosis.

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    Guest colleen

    Posted

    I think I was diagnosed with most of those on the list before I finally figured out on my own it might be celiac and then found a Dr. that confirmed it. All the time, money and aggravation spent while still eating gluten...and most doctors wouldn't even test me for it because they thought it was something else. Maddening.

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    Guest Vera

    Posted

    I was first diagnosed with night time gerd. After two years I told the doctor that I did not believe I had gerd and asked what else could be causing these symptoms. She said I could have Esophageal cancer of Stomach cancer so we did biophysics but didn't really come up with anything.

     

    I decided to change doctors. I finally found a young doctor who was a licensed M.D. and a licensed NP. It took him about 3 months to suspect Celiac. So I finally got my diagnoses. It has taken me 5 to 6 years but I continue to improve yearly, this even though I am now 77 years old.

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    Guest D. Johnson

    Posted

    It wasn't until I was diagnosed with osteoporosis that I began in earnest to do my own research into why I was not as healthy as I should have been. I had always eaten a very healthy diet with lots of fruits and vegetables and very low in sugar and processed foods plus worked out 3 times a week and still had weak bones. The internet led me to the possibility of celiac disease and I had to beg a new gastroenterologist for the blood test. My GP was stunned when the extremely positive results came back. My old gastro had said IBS 35 years ago and everyone since just believed him!

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    Guest Laura

    Posted

    I was diagnosed with GERD, allergies "to everything", obesity (meaning 'you're lazy and you eat too much'), undetectable kidney stones, and "it's all in your head," in the decades before my celiac diagnosis. By then I had lost motor skills, balance, cognitive functions, hair, and nails. It's hard not to feel bitter about all the years of damage when I was trying so hard to be responsible to go to the doctor.

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    Guest Deborah Hammond

    Posted

    Yes, indeed. I had symptoms for many years. As a child I remember my dad taking me to the ER and being told they found nothing wrong. I had passed out and was in elementary school. I never had much energy and often had bronchitis. As a young adult I began seeking answers from doctors. First I was given muscle relaxants. Then drugs for depression. Then a series of visits to gastroenterologists led to six endoscopies. They never found anything, until the sixth one, because none of the first five docs went through the stomach into the small intestine. They just weren't looking for it. In fact, all six times I was told I likely had a bleeding ulcer or stomach cancer. Even the last time! Because I was bleeding internally. The doc who finally diagnosed me said he had been told in medical school he'd probably never see a case but he found he was diagnosing one a week. Once he saw a case, he kept looking. And in biopsy it looks like nothing else! SO grateful to know and to be gluten free. I was diagnosed at 52.

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    Guest jill

    Posted

    Should be required reading for all med students! I used to sit in the doctor's office and cry because it couldn't be normal to be so tired all the time. Did sleep studies, etc. Even had surgery to fix a deviated septum. No effect. Had a colonoscopy to check for bleeding because massive iron supplements had no effect on my anemia. Finally at age 56 a blood test showed too many platelets and I was sent to a hematology oncologist. Part of his workup was a lung x-ray. The radiologist suspected osteoporosis from looking at my spine. Bingo! My primary finally was able to put together that I was not absorbing calcium and iron and did the blood test for celiac disease. I have been strictly gluten free since them. Within weeks my fatigue was gone. Now I have so much energy I don't know what to do with myself!! With treatment, my bones are getting better and my anemia is almost resolved.

    The awful part of this? When I went back to the GI doctor for an endoscopy to validate the blood test, he told me that my first colonoscopy ten years before had showed that I had celiac disease but the he dismissed it because I had no digestive symptoms.

    Why can't the simple blood screening test be standard for everyone? And doctors should know that while many people do not have standard symptoms internal damage is still being done.

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    Guest WendyKat

    Posted

    I was diagnosed with ulcers, then IBS, then IBD. It wasn't until I met someone with celiac and talked to them and then went to my doctor and demanded to be tested that I got the right diagnosis. Considering the fact that I have TWO other auto-immune diseases that they already knew about, I'm still pretty ticked off that no one thought of it sooner. Auto-immune diseases often come in groups.

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    Guest maggie

    Posted

    I was always "sickly" as a child, but even into my 20's I was constantly diagnosed with "the flu". Every time my stomach ache would get so bad I had to go to the doctor, they would always diagnose it the same way. After a while I did get tested for parasites, but it wasn't until I was in my 40s, had moved, and ironically had a "substitute" doctor because mine was on vacation, did I finally get tested for celiac...

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    Guest Birdieh

    Posted

    My grandson was just diagnosed with celiac disease.  I woke up this morning hoping it was just a dream.  We have a large family, so a lot of occasions with lots of food favorites.  I combed the internet last night for yummy gluten free recipes I can make for him.  He not only had celiac, but also walking pneumonia.  He is going to be 14 in a couple of months.  He took it pretty well.  His mother told him and both of us (his grandparents) at the same time.  I kept pretty upbeat and started naming all the things he could still eat as his mother told him that this would change his life and it was permanent.  I told him I would take him to the store and show him how to shop, read labels etc and next year I will teach him to cook. (I homeschool him and his 3 sisters, which is really a good thing now especially. If anyone has suggestions on good sites other than pinterest to go for this, I would be very appreciative. This will change my cooking habits for them since I really don't want him to watch his sisters eat yummy things that were his favorites, while he eats something else.  

     

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  • Related Articles

    Scott Adams
    The following list was taken from the Fall, 1996 Celiac Disease Foundation Newsletter.
    Anemia IBS Psychological stress, nerves, imagination Diarrhea IBD Diabetes Spastic Colon Ulcers Virus (Viral Gastroenteritis) Chronic Fatigue Syndrome Weight-loss Allergies Amoeba, Parasites, Infection Gallbladder Disease Thyroid Disease Cancer, Lymphoma, Digestive Colitis Cystic Fibrosis Lactose Intolerance Reflux Data from an on-going Celiac Disease Foundation study of 600 Biopsy-proven celiacs.

    Scott Adams
    Like many people with celiac disease, I spent a lot of years and money to go through many tests and misdiagnoses before doctors finally found my problem. Because of the large variety of symptoms associated with celiac disease, diagnosis can be very difficult. Most medical doctors are taught to look for classic symptoms and often make a wrong diagnosis, or no diagnosis at all.
    During my doctor visits my diet was never discussed, even though most of my symptoms were digestive in nature. My symptoms included abdominal pain, especially in the middle-right section while sleeping, bloating, and diarrhea (off and on over a period of several years). A simple (and free!) exclusionary diet would have quickly revealed my problem. An exclusionary diet involves eliminating wheat, rye, oats, barley, dairy products, soy and eggs for several weeks, and recording any reaction as one slowly adds these foods back to their diet.
    It took two years for the doctors to discover that I had celiac disease. During that time I was misdiagnosed with Irritable Bowel Syndrome (IBS), told that I could have cancer or a strange form of Leukemia, treated for a non-existent ulcer with a variety of antibiotics that made me very ill, and was examined for a possible kidney problem. I also underwent many unnecessary and expensive tests including CAT Scans, thyroid tests, tests for bacterial infections and parasites, ultrasound scans, and gall bladder tests. Luckily I ended up reading something about celiac disease in a book on nutrition, which led me to ask my doctor to test me for it. I was finally diagnosed via a biopsy of my small intestine (which is not as bad as it sounds). Although the biopsy is still considered the gold standard of diagnosis, there are also several blood tests for celiac disease.
    I decided to create this Website to help others avoid a similar ordeal. I also want to provide people who know they have the problem with information which will improve their quality of life, and broaden their culinary horizons. To do this, I have compiled information from a large variety of sources including medical journals, books, doctors, scientists and the Celiac Listserv News Group, and posted it all right here. Please remember that I am not a doctor, and none of this information should be considered expert medical advice....enjoy! - Scott Adams

    Amy Leger
    Celiac.com 12/12/2008 - The tales of diagnois for celiac disease are almost alwaysdramatic: Some people go for years dealing with aches and pains and thinkingthat this is just the way their body was built. I remember feeling that way when my one-year-old was so crabby—walkingaround with her big old “Buddha” belly. Recently, I requested the top threesymptoms from adult and child celiacs to put together a survey of the topsymptoms on my blog. I didn’t ask forthe diagnosis stories, but people offered some insight into the trials andtribulations of getting diagnosed with celiac disease—and eventually leadinga new and healthier life!
    It took a major virus, three doctors, x-rays, blood tests toget to Emma’s diagnosis.One doctor toldme “kids throw up” (once every nine days? Really?), a second opinionrecommended Milicon for her “gassy” tummy. Luckily, it all ended the way it should have, with a diagnosis of celiacdisease that only took about 5 months—which is relatively little compared tosome of the stories you’re about to hear.
    One woman wrote me describing her daughter’s symptoms whenshe was diagnosed at age 15, but then she wrote back about the subsequentdiagnoses of her sister and mother.Jeanwas diagnosed at age 70 but she and her family tell me her severe scoliosis atage 12 was a symptom! Can you believebeing misdiagnosed for 58 years?Jean evenhad to be put in a back cast for a time.
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    Kim wrote me and said she was diagnosedat 39 years old when she was hospitalized with stomach pain, vomiting anddiarrhea.But she added at the end ofher note, “ probably shouldhave gotten tested at [age] 11 when I had the same severe cramping that put mein the hospital.” The bright spot inthis story is that her eventual celiac diagnosis, led to the quicker diagnosisof her 5-year-old daughter who was just beginning her symptoms of low weightand anemia.
    Another contributorsaid her 14-year-old son was diagnosed with celiac two years ago, but has alsohad a kidney issue for the last 9 years.But since he has been eating gluten free…his kidneys have also gottenbetter, last report was the best since before he was brought in at age 5!! Now I wonder which really came first?”It does make you wonder.
    But there are somesuccess stories:
    One mom mentionedher son’s quick diagnosis. “[it] started with diarrhea. Thought it was a stomach bug.” Then it moved to constipation and two weekslater things still weren’t right.Thentheir doctor put two and two together, “[An]amazing pediatrician said ‘This sounds like Celiac’ and ran the bloodtests. Andrew was only ‘sick’ about 1 month before diagnosis,” shesaid. However looking back on it all, hehad a big belly and slow to grow.
    Others talked about having celiac disease and not even feeling sick.

    “I onlyfound out about the anemia through a blood test done as part of a completephysical; my general health to that point was excellent, including runningmarathons,” Danny wrote. “The only reason [my 3-year-old daughter]was diagnosed was her yearly blood draw came back positive so we had thebiopsy,” said Monica, a mom of two celiac children. Anna’s dad, Tom, was diagnosed in his 40s aftera family-round of blood testing. He isasymptomatic. The last two pointsshow how important it is to take part in preventative measures, by gettingregular blood testing done for first-degree family members. The National Institute of Diabetes, Digestiveand Kidney Diseases says, “…because celiac disease is hereditary, familymembers of a person with the disease may wish to be tested. Four to 12 percentof an affected person’s first-degree relatives will also have the disease.”
    The stories ofdiagnosing celiac disease may leave many of us angry, frustrated, and possiblygrateful—all at the same time. The missed diagnoses and misdiagnoses of those who have thisdisease presents a roller-coasterride of emotions. I hope this articlehelps you in knowing many others have gone through it and are likely goingthrough it as we speak.We just need tomake sure we’re spreading the word and getting as much awareness out there aspossible to help others in similar situations.

    Jefferson Adams
    Celiac.com 05/11/2015 - Many people with celiac disease know that gluten exposure can cause gut damage and trouble absorbing some vitamins and minerals, which can lead to serious deficiencies. However, even celiac who follow gluten-free diets may experience similar issues, including impaired vitamin and mineral absorption.
    The most common vitamin and mineral deficiencies in celiac patients include the following vitamins and minerals:
    B vitamins, especially B12 Vitamin A Vitamin D Vitamin E Vitamin K Iron Calcium Carotene Copper Folic acid Magnesium Selenium Zinc As a result, patients with celiac disease can develop iron-deficiency anemia, including a type that resists oral iron supplementation, and may also develop osteoporosis and osteopenia due to bone loss resulting from decreased calcium and vitamin D absorption.
    For these reasons, it is important that patients with celiac disease be monitored regularly to ensure that they have proper levels of vitamins and minerals in their bodies.
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    Ingredients:
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    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
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    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    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). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    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. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    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).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics

    Jefferson Adams
    Celiac.com 06/12/2018 - A life-long gluten-free diet is the only proven treatment for celiac disease. However, current methods for assessing gluten-free diet compliance are lack the sensitivity to detect occasional dietary transgressions that may cause gut mucosal damage. So, basically, there’s currently no good way to tell if celiac patients are suffering gut damage from low-level gluten contamination.
    A team of researchers recently set out to develop a method to determine gluten intake and monitor gluten-free dietary compliance in patients with celiac disease, and to determine its correlation with mucosal damage. The research team included ML Moreno, Á Cebolla, A Muñoz-Suano, C Carrillo-Carrion, I Comino, Á Pizarro, F León, A Rodríguez-Herrera, and C Sousa. They are variously affiliated with Facultad de Farmacia, Departamento de Microbiología y Parasitología, Universidad de Sevilla, Sevilla, Spain; Biomedal S.L., Sevilla, Spain; Unidad Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Celimmune, Bethesda, Maryland, USA; and the Unidad de Gastroenterología y Nutrición, Instituto Hispalense de Pediatría, Sevilla, Spain.
    For their study, the team collected urine samples from 76 healthy subjects and 58 patients with celiac disease subjected to different gluten dietary conditions. To quantify gluten immunogenic peptides in solid-phase extracted urines, the team used a lateral flow test (LFT) with the highly sensitive and specific G12 monoclonal antibody for the most dominant GIPs and an LFT reader. 
    They detected GIPs in concentrated urines from healthy individuals previously subjected to gluten-free diet as early as 4-6 h after single gluten intake, and for 1-2 days afterward. The urine test showed gluten ingestion in about 50% of patients. Biopsy analysis showed that nearly 9 out of 10 celiac patients with no villous atrophy had no detectable GIP in urine, while all patients with quantifiable GIP in urine showed signs of gut damage.
    The ability to use GIP in urine to reveal gluten consumption will likely help lead to new and non-invasive methods for monitoring gluten-free diet compliance. The test is sensitive, specific and simple enough for clinical monitoring of celiac patients, as well as for basic and clinical research applications including drug development.
    Source:
    Gut. 2017 Feb;66(2):250-257.  doi: 10.1136/gutjnl-2015-310148.