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Still No Test to Confirm Celiac Mucosal Status Without Biopsy

Celiac.com 03/16/2009 - Current treatment for celiac disease consists of a lifetime gluten-free diet. However, once the diagnosis is made, most people don’t really receive regular follow-up or monitoring of their treatment unless they have some obvious complaint. That’s beginning to change, and more doctors are beginning to advocate long-term celiac care, which includes regular tests to assess dietary compliance.

To accomplish this goal, doctors are working to determine the best program of follow-up treatment. A team of Austrian researchers recently set out to determine which noninvasive test for celiac disease is best for assessing mucosal status in people with celiac disease.

The research team was made up of doctors Andreas K. W. Vécsei, Ulrike B. Graf, and H. Vogelsang, associated with St. Anna Children's Hospital, Vienna, Austria and the Department of Gastroenterology and Hepatology, Clinic of Internal Medicine III, Medical University of Vienna, Vienna, Austria.

The research team set out to clarify which noninvasive follow-up methods for testing blood serum or intestinal permeability (IPT) – best match the patient’s histology, and whether the accuracy of these tests is affected by the interval between diagnosis and follow-up affects.

The team mined a computer database to compile information from adult patients, diagnosed with celiac disease between December 1989 and July 2006, who underwent follow up via biopsy, IPT, and serological testing via IgG anti-gliadin antibodies (AGA-IgG), AGA-IgA, and endomysial antibodies (EMA).

They measured effectiveness of noninvasive test results based on the presence of villous atrophy upon biopsy. The team divided patients into two groups. The first, group A, comprised patients followed up within 24 months of diagnosis, and group B, comprising patients followed up after 24 months.

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In all, the team was able to evaluate forty-seven patients. The tests showed the following results:

Lactulose/mannitol (L/M) ratio showed a sensitivity of 85% and a specificity of 46.2% for mucosal atrophy, while saccharose excretion showed a sensitivity of 60% and a specificity of 52.6%.

AGA-IgA and AGA-IgG showed 15% and 20%, respectively, and both showed specificity of 100%. AGA was of limited usefulness due to low number of positive results. EMA assay was 50% sensitive and 77.8% specific.

In group A (n = 23) L/M ratio performed best in terms of sensitivity (88.9%), whereas EMA achieved a higher specificity (71.4%). In group B, the sensitivity of the L/M ratio decreased to 85.7%, while the specificity of EMA increased to 91.7%.

The team concluded that these results show that none of the non-invasive tests was an accurate replacement for follow-up biopsy in detecting severe mucosal damage.

Until an accurate test is developed, long-term follow-up monitoring of gluten-free status in people with celiac disease will remain difficult to do reliably without biopsy.

Endoscopy 2009; 41: 123-128

 

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Thank you for posting this I've never been to South America, it's the only continent, bar the poles, I've yet to visit. It's really nice to read that my gluten sensitivity hasn't ruled it out. Maybe I'll get to the land of Luis Suarez yet!

I know this post is a year ago... however it is still on the first page of the travel section! I am from Uruguay, (South America) and I can answer this question for people that may look at it in the future. As a South American - I can say that the cuisine varies greatly. In cities, you shouldn't have any more than the normal amount of difficulty finding food. For example, in Montevideo, the city I am from, you'll have no problem finding dedicated entire Celiac stores. Meat is a large part of restaurant menus, so parilladas (similar in theory to steakhouses, would be very easy to navigate). Uruguayans do eat a lot of pastries, and just like in the states... Most mainstream bakeries are not gluten free, but like I mentioned there are places that specialize. In Uruguay, there is knowledge of Celiac and a large health awareness. Some of the foods can be costly, cost of living in general is not low. In large swaths of South America, the foods you mentioned - Potatoes, rice, meat, etc are abundant, as are fresh fruits and veggies. Avoiding corn does make it tricky. Peru can be a great place for non-gluten eaters. Peru uses very little gluten (they are the original quinoa eaters) but there is a lot of corn in the diet (and since you are corn sensitive, that would be a food you would need to navigate). Latin America spread over two continents! In this area you will find a great variety in cultures, cuisines, and knowledge of celiac. There is no reason why If you want to experience Latin America, that you have to rule out an entire region of the world because of Celiac. Navigating it will be different, but it is doable!

Recently diagnosed last week does the pain ever get better??

George, i am sorry that you are not feeling well! ?? I am not a doctor, but just trying out drugs to stop your symptoms just seems like a band aid approach. It sounds like he suspects IBS which is really, in my opinion, "I be stumped". Has inflammatory bowel disorder (IBD) (more lovely autoimmune disorders) been ruled out? This includes both Crohn's and Colitis. My niece was diagnosed with Crohn's finally with a pill camera after all other tests were given. The damage was not within reach of any scope. I am just throwing out suggestions. Hopefully, you and your doctor will figure it out soon!

Celiac disease is an autoimmune disease that happens to have a known trigger -- gluten. Flare-ups develop (antibodies) causing damage. Not just in the small intestine, but systemically. One gluten exposure can cause antibodies to increase for days or months! Antibodies are being measured during the celiac blood tests. If there is no gluten exposure, there will be no antibodies. These antibodies can come down in some people in as little as two weeks. Recommendations require gluten 2 to 4 weeks daily for the biopsies taken via endoscopy in order to be sure to catch damage, but 8 to 12 weeks for the blood tests. The endoscopy is considered the "gold standard" in helping to diagnose celiac disease, but there are other things that can damage the small intestine. So, the blood test helps solidify the diagnosis. So, if you want a good result on your endoscopy, you need to be eating gluten daily for two week prior at a minimum. I know it is tough and you are feeling sick. Wish there was a better way to catch active celiac disease.