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  • Jefferson Adams
    Jefferson Adams

    Is Celiac Disease Substantially Underestimated?

    Celiac.com 09/18/2013 - New tests and new histological criteria for diagnosing celiac disease, along with changing perspectives on the disease's natural history are causing a number of researchers to question past prevalence estimates for celiac disease.

    Photo: CC-- James CridlandA team of researchers recently set out to establish a more accurate estimate of celiac disease rates by using a new serogenetic method.

    The research team included Robert P Anderson, Margaret J Henry, Roberta Taylor, Emma L Duncan, Patrick Danoy, Marylia J Costa, Kathryn Addison, Jason A Tye-Din, Mark A Kotowicz, Ross E Knight, Wendy Pollock, Geoffrey C Nicholson, Ban-Hock Toh, Matthew A Brown and Julie A Pasco.

    They are variously affiliated with the Walter and Eliza Hall Institute of Medical Research, the Department of Medical Biology at the University of Melbourne, the Department of Gastroenterology at The Royal Melbourne Hospital, Melbourne Health in Parkville, Australia, ImmusanT Inc., One Kendall Square, Building 200, LL, Suite 4, Cambridge, MA, USA, the School of Medicine at Deakin University in Geelong, Australia, Healthscope Pathology in Melbourne, Australia, the Human Genetics Group at the University of Queensland Diamantina Institute, Level 5, Translational Research Institute in Woolloongabba, Australia, Endocrinology at Royal Brisbane and Women’s Hospital, Herston, Australia, the NorthWest Academic Centre of the Department of Medicine at The University of Melbourne in St Albans, Australia, Geelong Gastroenterology, Level 1, in Geelong, Australia, the Rural Clinical School at the School of Medicine of The University of Queensland in Toowoomba, Australia, and Roche Diagnostics Australia, in Castle Hill, Australia.

    The researchers assessed human leukocyte antigen (HLA)-DQ genotype in 356 patients with biopsy-confirmed celiac disease.

    They did the same for two age-stratified, randomly selected community groups of 1,390 women and 1,158 men, who served as controls. They tested and screened all patients for celiac-specific serology.

    They found that only five patients with biopsy-confirmed celiac disease lacked the susceptibility alleles HLA-DQ2.5, DQ8, or DQ2.2, and four of these patients had been misdiagnosed. HLA-DQ2.5, DQ8, or DQ2.2 was present in 56% of all women and men in the community cohorts.

    Transglutaminase (TG)-2 IgA levels were abnormal in 4.6% of the community women, and in 6.9% of the community men. Composite TG2/deamidated gliadin peptide (DGP) IgA/IgG were abnormal in 5.6% of the community women and in 6.9% of the community men.

    But in the screen-positive group, only 71% of women and of women and 65% of men possessed HLA-DQ2.5, DQ8, while 75% of women and 63% of men possessed DQ2.2.

    Medical review was possible in 41% of seropositive women and 50% of seropositive men, and led to biopsy-confirmed celiac disease in 10 women (0.7%) and 6 men (0.5%). Based on relative risk for HLA-DQ2.5, DQ8, or DQ2.2, celiac disease affected 1.3% of men and women with positive TG2 IgA screens, and 1.9% of women and 1.2% of men with positive TG2/DGP IgA/IgG screens

    Serogenetic data from these community cohorts indicated that testing screen positives for HLA-DQ, or carrying out HLA-DQ and further serology, could have reduced unnecessary gastroscopies due to false-positive serology by at least 40% and by over 70%, respectively.

    Requiring biopsy confirmation based on TG2 IgA serology leads to substantial underestimations of the community prevalence of celiac disease.

    Testing for HLA-DQ genes and affirmative blood results could reduce the numbers of unnecessary gastroscopies.


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  • 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, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised 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

    Scott Adams
    Celiac.com 03/19/2002 - For the past several years, Gary M. Gray, M.D. and Chaitan Khosla, Ph.D., both at Stanford University, have been studying the underlying causes of Celiac Disease, with an eye toward finding a therapeutic solution that would not require the strict adherence to a gluten-free diet. For the past two years, I have helped organize the Celiac conference at Stanford University; and we have collected blood from Celiac volunteers for their research. Based on a series of studies involving animal tissue, Drs. Gray, Khosla, and coworkers have developed a hypothesis for the cause of the disease. Their findings in animal studies need to be confirmed on human tissue, and any differences in normal and Celiac intestine must be defined. The Stanford researchers are now in need of volunteers who are scheduled for a follow-up biopsy as part of their optimal care to provide intestinal tissue samples. Volunteers must be biopsy-diagnosed Celiacs who, as part of their care, will be undergoing an upper gastrointestinal endoscopy for recovery of small biopsies from the duodenum. For this research, two small (a few milligrams) of additional tissue will be taken during the biopsy, frozen immediately, and transported to Stanford. Please note that volunteers undergoing procedures at locations other than Stanford Hospital could participate. The small amount of additional tissue does not constitute a significant additional risk over and above that you will undergo due to the endoscopy and routine biopsies for the pathologist to examine. The research has been approved by the Human Subjects Committee at Stanford University Medical Center.
    If you would like to participate in this study, please contact Kelly Rohlfs at 650-725-4771 or kellyr@bonair.stanford.edu.If you have questions concerning the risks and benefits of this study, please contact Dr. Gray at 650-725-3366 or gray@stanford.edu. Dr. Gray will coordinate the study with your gastroenterologist at the time of your endoscopy.

    Jefferson Adams
    Celiac.com 08/19/2012 - In an effort to assess rising rates of celiac disease, and an increasing popularity of gluten-free food products, a team of researchers recently conducted a survey. The research team included Alberto Rubio-Tapia, Jonas F. Ludvigsson, Tricia L Brantner, Joseph A. Murray and James E. Everhart.
    Their data indicate that about 1.8 million Americans have celiac disease, while another 1.4 million remain undiagnosed. Surprisingly, their results show that around 1.6 million people have adopted a gluten-free diet despite having no official diagnosis.
    Some of these people likely have celiac disease, while others likely belong to a large group of people who don't actually have celiac disease, but who suffer bloating and other celiac symptoms and seem to be helped by avoiding gluten; people many doctors are now officially describing as 'gluten sensitive.'
    Once a controversial term, the existence of gluten sensitivity has been supported by several studies, among them, a very small but often-cited Australian study.
    In that study, volunteers with gluten reaction symptoms received a gluten-free diet or a regular diet for six weeks, without knowing which one. At the end of the period, those who ate gluten-free had fewer problems with bloating, tiredness and irregular bowel movements.
    Clearly, the current data tell us that "there are patients who are gluten-sensitive," said Dr. Sheila Crowe, a San Diego-based physician on the board of the American Gastroenterological Association.
    The debate is now shifting to the question of how many people suffer from gluten sensitivity, she added. Because gluten sensitivity lacks the clinical markers of celiac disease, that question may not be answered anytime soon.
    Certainly, more and more people without any official diagnosis are turning to gluten-free diets as a way to lose weight, or as part of low carb and/or 'paleo' diets. Those people, together with celiacs and those with gluten intolerance are helping to drive the estimated $7 billion that will be spent on gluten-free.
    There has also been increasing concern among researchers that that many or most people have some kind of gluten sensitivity. Stay tuned for more news on this and other gluten and celiac-related topics.
    Source:
    The American Journal of Gastroenterology

    Gryphon Myers
    Celiac.com 09/04/2012 - North India has what has come to be referred to as a “celiac belt”, where a greater than average number of people exhibit symptoms of celiac disease. This is partially because more wheat is consumed in this region, but also because the population possesses haplotypes necessary for celiac disease to develop. For this reason, it would make sense that emigrants from the area would also be prone to celiac disease. A study centered in Debyshire, UK investigates celiac disease as it manifests in the North Indian, Pakistani and Bangladeshi immigrant populations.
    All celiac disease patients (both Asian and white) who were diagnosed via biopsy in Derbyshire, UK between 1958 and 2008 were identified. Population data from the Office of National Statistics was used to calculate prevalence. Presenting symptoms, adherence to a gluten-free diet and follow up record were also assessed. Asian patients were compared against matched white patients.
    1305 eligible celiac disease patients were identified, 82 of whom were Asian. The prevalence of celiac disease in Asians was considerably higher than in white groups. In the white population, celiac rates were 1:356, whereas in the Asian population they were 1:193. Particularly high celiac rates were seen in Asian women between 16 and 60 years of age: 1:116. No cases of celiac disease were reported in Asian men over 65 years of age.
    A previous study from Leicester has already demonstrated some propensity for Asian populations to develop celiac disease. It is thought that diet plays some role in this tendency.
    One of the most significant findings of the present study is that no Asian man over the age of 65 was diagnosed with celiac disease. It is possible that celiac disease rarely manifests in this group, but is more likely that cultural or other factors lead to a lack of reporting, preventing diagnosis.
    Another finding of the study shows that Asians with celiac disease are more likely to be anemic. This tells us that celiac disease should be considered as a diagnosis for unexplained anemia in Asian patients.
    The study also found that Asians with celiac disease are less likely to adhere to a gluten-free diet. Roughly one third of Asian patients successfully adhered to the diet, whereas nearly two thirds of white patients did. This could be a language issue (an inability to detect gluten-containing foods), or because of family pressure to comply with cultural norms, or because of difficulty adapting cuisine to be gluten-free. In any case, there should be more discussion with Asian immigrant populations to determine the best way to improve gluten-free diet adherence rates.
    Source:
    http://fg.bmj.com/content/early/2012/08/10/flgastro-2012-100200.abstract  

    Jefferson Adams
    Celiac.com 10/29/2013 - In an effort to get a better understanding of the prevalence of celiac disease in Germany, a team of researchers recently conducted a randomly selected population sample.
    The research team included W. Kratzer, M. Kibele, A. Akinli, M. Porzner, B.O. Boehm, W. Koenig, S. Oeztuerk, R.A. Mason, R. Mao, and M.H. Haenle. They are affiliated with the Department of Internal Medicine I at the University Hospital Ulm in Ulm, Germany.
    For their population-based cross-sectional study, the team conducted laboratory testing for tissue transglutaminase and antibodies to immunoglobulin A, endomysium and antigliadin in a total of 2157 subjects (1036 males; 1121 females).
    Next, the team used a questionnaire, that included celiac-specific questions, to survey all subjects who had been examined serologically
    Any individuals with positive antibody titers or with history of celiac disease was sent for biopsy.
    On first follow up, the team again measured antibody titers in these subjects and questioned them regarding symptoms specific to celiac disease and celiac-associated disorders.
    Then, for each celiac-positive subject, the team conducted a second follow-up by telephone.
    They found antibody tests consistent with celiac disease in eight subjects, corresponding to an overall prevalence of 1:270 (8/2157).
    Celiac prevalence among women was 1:224, while it was 1:518 in men. The team found classic celiac symptoms in 62.5% of subjects, atypical celiac disease in 25.0%, and transient celiac disease in 12.5%.
    They found three cases of false-negative test results. This yields a sensitivity and specificity of 62.5% and 50.0%, respectively, for tissue transglutaminase immunoglobulin-A antibody; of 62.5% and 71.4% respectively, for endomysium antibody; and of 62.5% and 71.4%, respectively, for antigliadin antibody.
    This study charts a celiac prevalence rate that falls within the middle third of comparable European studies. These results call into question the use of a single antibody test for celiac screening purposes.
    Source:
    World J Gastroenterol. 2013 May 7;19(17):2612-20. doi: 10.3748/wjg.v19.i17.2612.

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