Jump to content



Celiac.com Sponsor (A1):



Celiac.com Sponsor (A1-m):


  • You've found your Celiac Tribe! Join our like-minded, private community and share your story, get encouragement and connect with others.

    💬

    • Sign In
    • Sign Up
  • Record is Archived

    This article is now archived and is closed to further replies.

    Destiny Stone
    Destiny Stone

    Testing for Celiac Disease in Patients With Surgical Abdominal Pain

    Reviewed and edited by a celiac disease expert.
    Testing for Celiac Disease in Patients With Surgical Abdominal Pain - Photo: CC/Evil Erin
    Caption: Photo: CC/Evil Erin

    Celiac.com 07/08/2010 - Acute abdominal pain is the most common symptom leading to emergency surgery; accounting for up to 50% of emergency surgical admissions and nonspecific abdominal pain (NSAP) likely accounts for 40% of the cases. While abdominal pain can often be a symptom of celiac disease, up until this point there have been no official studies to determine the  the association of celiac disease and abdominal pain.

    A group of researchers in the UK attempted to uncover the connection between celiac disease and abdominal pain. Using a case-controlled study of 300 consecutive, new, and unselected patients exhibiting acute abdominal pain, and a healthy control group not presenting any abdominal pain, were matched by age and gender and then assessed accordingly.



    Celiac.com Sponsor (A12):






    Celiac.com Sponsor (A12-m):




    Initially, the research team under Dr. David S. Sanders of the Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK,  used immunoglobulins, IgA/IgG anti-gliadin (ADA), and endomysial antibodies (EMA) to evaluate the test subjects for celiac disease. Any of the test subjects that tested with a positive IgA,  AGA, EMA or IgG AGA accompanied by IgA deficiency was provided with the opportunity to receive a small bowel biopsy to confirm a celiac diagnosis; only 1 person declined.

    Among the acute abdominal pain demographic, the median age range was 57 years old and exactly half of the 300 participants were female. All test patients were given an initial biochemical, hematologic, and immunologic profile. Of the patients tested, 33 with abdominal pain had either a positive IgA gliadin antibody, EMA or a combination of both. Of those 33 patients, 9 had histologically proven celiac disease.  Among the healthy control group, 2 people were discovered to have celiac disease.

    Researchers matched case controls and then determined the antibody status of the control group and the abdominal pain group. While there were no corresponding  pairs, the statistical chance of having celiac disease when demonstrating acute abdominal pain has an odds ratio of 4.6. Although when NSAP was solely taken into consideration, the prevalence of celiac disease exhibited profound significance with a rate of 10.5%. 

    Of the test subjects that maintained the gluten-free diet for the recommended time period of 12 -18 months, all of them exhibited an improvement of their symptoms, and their antibody profiles were negative. 

    From this study, researchers concluded that targeting patients with NSAP or those that exhibit  other high risk celiac symptoms, will likely improve  the diagnostic yield of celiac disease, specifically among those exhibiting  typical celiac symptoms. Additionally, the ideal situation would be if more doctors were to recognize NSAP symptoms as  having the potential to be connected with celiac disease and screen for celiac accordingly; as delayed or undiagnosed celiac disease can eventually lead to a myriad of other long-term and permanent health issues including, osteoporosis, infertility, and an increased risk of cancer.

    Source:



    User Feedback

    Recommended Comments

    There are no comments to display.



    Guest
    This is now closed for further comments

  • About Me

    Destiny Stone

    I diagnosed myself for gluten intolerance after a lifetime of bizarre, seemingly unrelated afflictions. If my doctors had their way, I would have already undergone neck surgery, still be on 3 different inhalers for asthma, be vomiting daily and having chronic panic attacks. However, since eliminating gluten from my diet in May 2009, I no longer suffer from any of those things. Even with the proof in the pudding (or gluten) my doctors now want me to ingest gluten to test for celiac-no can do.


  • Celiac.com Sponsor (A17):
    Celiac.com Sponsor (A17):





    Celiac.com Sponsors (A17-m):




  • Related Articles

    Scott Adams
    The following Medline abstract describes a unique study that was done on the quality of life of two groups of people with celiac disease: One that was diagnosed as the result of having symptoms, and the other which had little or no symptoms and whose diagnosis was reached via screen-detection. Both groups were treated for one year with a gluten-free diet, and were then studied to determine their overall response, including their psychological response. Here is the abstract:
    Eff Clin Pract 2002 May-Jun;5(3):105-13
    Mustalahti K, Lohiniemi S, Collin P, Vuolteenaho N, Laippala P, Maki M.
    Department of Pediatrics, Tampere University Hospital, Finland.
    CONTEXT: Since the advent of serologic testing for celiac disease, most persons who receive a diagnosis of celiac disease have few or no symptoms. Although pathologic changes of celiac disease resolve on a gluten-free diet, how a gluten-free diet affects the quality of life for patients with screen-detected celiac disease is unclear.
    OBJECTIVE: To evaluate the effect of a gluten-free diet on the quality of life of patients with screen-detected celiac disease.
    DESIGN: Prospective study of patients before and 1 year after initiating a gluten-free diet.
    PARTICIPANTS: 19 patients with screen-detected celiac disease (found by serologically testing first-degree relatives of celiac patients) and 21 consecutive patients with symptom-detected disease. In all cases, celiac diagnosis was confirmed by finding villous atrophy and crypt hyperplasia on small-bowel biopsy.
    INTERVENTION: Gluten-free diet (explained during a single physician visit). MAIN OUTCOME
    MEASURES: Gastrointestinal Symptoms Rating Scale (GSRS), in which scores range from 0 to 6 (higher scores represent worse symptoms); and quality of life measured with the Psychological General Well-Being Questionnaire (PGWB). Scores range from 22 to 132 (higher scores mean greater well-being).
    RESULTS: At baseline, patients with symptom-detected celiac disease had poorer quality of life and more gastrointestinal symptoms than those with screen-detected celiac disease. Reported compliance with the gluten-free diet was good. All mucosal lesions of the small bowel had resolved at the follow-up biopsy. After 1 year of following the diet, quality of life for patients with screen-detected disease significantly improved (mean PGWB score increased from 108 to 114; P
    CONCLUSIONS: Gluten-free diet was associated with improved quality of life for patients with symptom-detected celiac disease and patients with screen-detected celiac disease. Concerns about the burden of a gluten-free diet, at least over the short term, may be unfounded.
    PMID: 12088289



    Destiny Stone
    Celiac.com 05/21/2010 - Celiac disease is a genetic, permanent auto-immune disease with a variety of symptoms which, when treated with a gluten-free diet, usually subside. While clinical presentation is variable, most patients that are treated for abdominal pain do not have celiac disease. It is therefore important to accurately diagnose celiac disease in patients exhibiting abdominal pain, without unnecessarily testing  patients that do not have celiac disease.
    Researchers at the Arthritis Research UK National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5 BG, UK, evaluated sixteen studies of patients exhibiting abdominal pain. The occurrence of the abdominal symptoms varied vastly including the varied sensitivity of diarrhea. The IgA  and IgG antigliadin antibodies exhibited varying results, particularly for sensitivity.  A recent study used diamidated gliadin peptides and showed good specificity, but the results were limited in that specific target population.
    The conclusive results showed that among adult patients exhibiting abdominal symptoms, “IgA antitissue transglutaminase antibodies and IgA antiendomysial antibodies have high sensitivity and specificity for diagnosing celiac disease”.
    Source:

    JAMA. 2010 May 5;303(17):1738-46. Review.


    Jefferson Adams
    Celiac.com 06/29/2012 - A group of researchers recently set out to study cases of positive tissue transglutaminase antibodies with negative endomysial antibodies to determine whether or not such cases amount to celiac disease.
    The team included Thomas Hornung; Pavel Gordins; Clare Parker; and Nicholas Thompson. They are variously affiliated with the departments of Gastroenterology, and Immunology at the Northern Deanery of Newcastle upon Tyne, and with the department of Gastroenterology at Freeman Hospital in Newcastle upon Tyne in the UK.
    The most sensitive and specific blood tests for diagnosing celiac disease are those that detect immunoglobulin A (IgA) antibodies against human tissue transglutaminase (tTGA) enzyme, and those that measure aspects of connective tissue covering individual smooth muscle fibers, endomysial antibodies (EMA).
    Because of the high sensitivity (up to 98%) and high specificity (around 96%) reported for the tTGA assay, detection of tTGA is currently the primary blood test used in screening for celiac disease.
    The tTGA test also has a high negative predictive value approaching 100%, which makes it an excellent test for excluding celiac disease in both high and low risk groups. In contrast, positive predictive value of the tTGA test is rather poor with values between 28.6% and 60.2% being reported in several studies.
    EMA, on the other hand, has extremely high specificity values close to 100% and positive predictive value values approaching 80%.[5 10] However, compared with tTGA, EMA has lower sensitivity, usually under 90%.
    This being the case, the present standard celiac disease screening strategy is to first use tTGA, and then confirm positive results using EMA. However, doing it this way, doctors often end up with a group of patients who show divergent test results.
    For their study, the researchers wanted to gauge the percentage of patients with positive tTGA and negative EMA, but who were confirmed with celiac disease upon biopsy, and to identify factors in these patients that may help to increase diagnostic accuracy in such patients.
    The research team identified 125 consecutive patients with positive tTGA and negative EMA, who subsequently underwent endoscopy with at least two biopsies from the second part of the duodenum.
    The team charted any tTGA result over 15 U/ml as positive. They excluded any patients with known celiac disease at the time of testing.
    They then reviewed patient notes to assess indications for celiac disease serological screening, including the presence of iron deficiency anaemia, and symptoms such as diarrhea or weight loss, and family history of celiac disease. They defined diarrhea as a bowel frequency of more than three times a day.
    They then assessed histological evidence of celiac disease based on subsequent duodenal biopsies, plus Marsh grading. In cases where patient histology was unclear, they relied on the clinical assessment of a consulting gastroenterologist. Unclear histology included minimal/mild increase in intraepithelial lymphocytes of not more than 30 per 100 enterocytes and without villous atrophy, plus mild villous blunting with no increase in intraepithelial lymphocytes.
    They then categorized patients as either celiac disease negative, or celiac disease positive. Patients with no histological evidence of celiac disease on duodenal biopsies or equivocal histology plus overall clinical impression of celiac disease absence were categorized as celiac disease negative. Patients with histological evidence of celiac disease on duodenal biopsies or equivocal histology plus overall clinical impression of celiac disease presence were categorized as celiac disease positive.
    To measure IgA anti-tTGA antibody the team used a commercially available enzyme linked immunosorbent assay called Aeskulisa, manufactured by Aesku Diagnostics GmbH in Wendelsheim, Germany.
    To detect IgA anti-EMA with the standard immunofluorescent method, they used commercial slides of monkey oesophagus sections (Euroimmun, Euroimmun AG, Lübeck, Germany). They used conjugated sheep antihuman IgA as a secondary antibody, relying on a test manufactured by Instrumentation Laboratory UK Ltd., in Warrington, UK.
    Overall, the team categorized 113 patients (90.4%) as celiac disease negative. Of these, 102 patients had no histological features of celiac disease, while 11 patients had unclear histology plus an overall clinical impression of not having celiac disease.
    They categorized twelve patients (9.6%) as celiac disease positive. Of these, 10 patients had positive histology, and two patients had unclear histology plus an overall clinical impression of having celiac disease.
    Of those with positive histology, 17% were Marsh grade I, 8% were Marsh grade II, 33% were Marsh grade IIIa, 17% were Marsh grade IIIb and 25% were Marsh grade IIIc. Those with celiac disease were more likely to be older and to have a higher tTGA level. The groups showed no difference in any clinical parameter.
    Source:
    Frontline Gastroenterol. 2012;3(2):81-83.


    Jefferson Adams
    Celiac.com 12/03/2012 - Gluten sensitivity has recently been added to the spectrum of gluten-related disorders, but precise diagnostic markers do not yet exist. A research team recently set out to understand the blood test pattern of gluten sensitivity, and to compare it with the blood test pattern seen in celiac disease.
    The researchers included U. Volta, F. Tovoli, R. Cicola, C. Parisi, A. Fabbri, M. Piscaglia, E. Fiorini, G. Caio, of the Department of Clinical Medicine at University of Bologna's St. Orsola-Malpighi Hospital in Bologna, Italy.
    For their study, the researchers looked at blood samples from 78 patients with gluten-sensitivity and 80 patients with celiac disease. They assessed levels of immunoglobulin (Ig)G/IgA antigliadin antibodies (AGA), IgG deamidated gliadin peptide antibodies (DGP-AGA), IgA tissue transglutaminase antibodies (tTGA), and IgA endomysial antibodies (EmA).
    They found positive readings for IgG AGA in 56.4% of patients with gluten-sensitivity, and in 81.2% of patients with celiac disease. Antibody levels for both groups were in the high range.
    They found IgA AGA in 7.7% of patients with gluten-sensitivity, and in 75% of patients with celiac disease, which shows lower enzyme-linked immunosorbent assay activities in gluten-sensitivity patients than in patients with celiac disease.
    Only 1 of the 78 patients with gluten-sensitivity tested positive for IgG DGP-AGA, which was found in nearly 90% of patients with celiac disease.
    All patients with gluten-sensitivity tested negative for IgA tTGA and IgA EmA, while 98.7% of patients with celiac disease tested positive for IgA tTGA, and 95% were positive for IgA EmA.
    Patients with gluten-sensitivity presented a variety of intestinal and extra-intestinal symptoms, including abdominal pain, bloating, diarrhea, constipation, foggy mind, tiredness, eczema/skin rash, headache, joint/muscle pain, numbness of legs/arms, depression, and anemia. Small intestinal mucosa for these patients was either normal or only mildly abnormal.
    The data from these blood tests show that more than half of patients with gluten sensitivity will test positive for IgG AGA, and a small number will test positive for IgA AGA, but none will show positive results for EmA, tTGA, and DGP-AGA, which are the specific markers of celiac disease.
    Source:
    J Clin Gastroenterol. 2012 Sep;46(8):680-5.


  • Popular Now

×
×
  • Create New...