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Improving Serological Mass Screening in Childhood Celiac Disease

Celiac.com 03/26/2010 - Mass screening studies among the general population for celiac disease show a prevalence of approximately 0.5-1.0% in adults and in children. Yet, despite the growing numbers of newly diagnosed celiac disease patients, most cases still remain undiagnosed and therefore, untreated. In part, the masses of misdiagnosed or undiagnosed  celiac disease  patients are a result of the variety of disguises  celiac disease can have. Celiac disease can manifest into a multitude of symptoms including, but by no means exclusive to, malabsorption syndrome, diarrhea, anemia, infertility and osteoporosis.

It has been demonstrated that there is a clear advantage to early testing for celiac disease. Early testing can aide in  avoiding the irreversible damages that come from diagnosis later in life, such as stunted growth and organ damage. It is also faster for children to heal from intestinal lesions caused from undiagnosed celiac disease, when diagnosed early on. New evidence shows that 10 years after being diagnosed with celiac disease, 66% of the children diagnosed exhibited improvement in their health and overall quality of life; indicating that mass screening at an early age is critical.

This study was based on a previous study performed by  mass screening for celiac disease by a group of scientists in the Netherlands between 1997 and 1998, who studied 6,127 asymptomatic children between the ages of two and four. Using endomysial antibodies (IgA EmA) testing, the children were screened for celiac disease. 57 seropositive children were then given biopsies. The scientists compared different testing methods for celiac disease, evaluated their serological persistence over time, and determined optimum cut-off points for the testing. Using serological samples obtained at biopsy, EmA and tTGA was assessed for each subject studied. Human leukocyte antigen  (HLA)-typing was obtained from 55 children; 26 of those had normal biopsies and were genetically predisposed for celiac disease and 29 of the children had small-bowel alterations known to be  distinctive traits for celiac disease. Of the 26 children with normal biopsies, 4% of them tested positively for HLA-DQ8, and the other 96% tested positive for HLS-DQ2. Of the 29 children diagnosed with celiac disease, all of them tested positive for HLA-DQ2. However, a proportionately  large number of children who tested EmA-positive and were diagnosed with celiac disease, had normal biopsies and were thus regarded as  false positives.

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The results of this test confirmed that celiac disease antibody levels may fluctuate in children who are genetically predisposed for  celiac disease. While the reason for the transient antibodies is still not known, it has been suggested that children who are seropositive but have normal small-intestine biopsies, potentially have celiac disease, and are susceptible to developing gluten sensitive enteropathy as they get older. Future testing is needed to establish results for this hypothesis.

However, children with histological alterations in their small-intestine biopsy indicative of celiac disease, had considerably higher antibodies for EmA than those without celiac disease.  The tTGA levels were significantly higher and occurred with more frequency in children with celiac disease than in children without celiac disease. EmA persisted in all celiac disease children, but only in 50% of the non-celiac disease children. tTGA was evident in 83% of celiac disease children, and 15% in non-celiac disease children. Additionally, increasing the cut-off points  provided a reduction of false positives, but resulted in lowering test sensitivity. While optimization of standard cut-off points reduced unnecessary biopsies by 50%-96%, it also reduced test sensitivity.

 In conclusion, celiac disease antibodies are proven to be transient in children genetically predisposed to celiac. It is therefore crucial for medical providers to reduce the number of unnecessary biopsies. As this study has demonstrated,  to reduce the number of unnecessary biopsies by 85%, serological mass screening methods may be improved by repeating EmA and/or tTGA in children who test seropositive after 6 months, and before continuing to biopsy.

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Hello and welcome I don't have an answer, like you I'm eating rice in processed foods as well as a side dish so I'm also wondering if I'm eating too much. If the rice is in a product like flour there's no way to tell how its prepared etc However for this: You can pre soak and rinse the rice in advance and change the way you cook it to reduce your exposure by up to 80% Details: http://www.bbc.co.uk/programmes/articles/2F1MDzyW55pg97Tdpp7gqLN/should-i-be-concerned-about-arsenic-in-my-rice

I use almond, and coconut a lot now my bakery used to use oat and almond blends. We never used rice, or starches as our goal was to keep it low glycemic. Now days we are transitioning to cut out oats. I started having....ok I omitted and gave in after being in denial a similar reaction to oats (10% of celiacs do if I recall) over a year ago. Anyway as for flour blends premade avoiding rice and grains try simple mills at https://www.simplemills.com/collections/all I have composed a huge list of various gluten-free goods here, even recently updated with grain free, and pizza section https://www.celiac.com/gluten-free/topic/117090-gluten-free-food-alternatives-list/

Hello Everyone, New here and have joined because I couldn't find an answer to my question online. I was diagnosed after a long spell with anemia in 2015 and have been on the diet (and improving!) ever since. But I wonder whether how much rice I'm eating is very healthy. I have always liked to bake and it took awhile to find a flour mix I like (Cup 4 Cup - worth its weight in gold...), but a lot of gluten-free food subs in rice (white rice, brown rice, rice flour) plus I eat actual rice as a side dish. Is this too much? Keep in mind, I also eat salads like it's my job and love making vegetable soups too. Any advice on gluten-free foods (specifically flours) that don't fall back on rice as a substitute? I should add that I can't really get excited about quinoa, despite my best efforts. Thanks in advance.

I would say get retested, to be sure, do a gluten challenge with her where she eats gluten for 12 weeks, not much just a half slice of bread a day or a wheat cracker for the blood test and 2 weeks for the biopsy. You mentioned bumps, and dry patches...this might be DH from celiacs and if it is you can go to a dermatologist and they can test it. In some people with DH reactions to gluten, their intestines do not show much damage as most of the antibodies are directed elsewhere. In this case you would have your symptoms. Now Celiac is a autoimmune disease that commonly has other auto immune diseases associated with it. NOW if your daughter has the gene for it she could have another automimmune disease I am not very familiar with and someone else might be able to help you more on suggestions for testing. Now in my personal opinion it sounds like she was still getting into gluten when you said she was off of it. NOTE gluten is a tricky bugger, it is a protein smaller then a germ that can stick in cracks and scratches on all your utensils, food prep area, knifes, etc. As a flour it can hang in the air for hours and even be inhaled effecting some of us. It is present in a lot of things we do not consider, like makeup, playdough, shampoos, seasonings, sauces, even some dry wall spackles. Now if she is in a shared house hold with other kids and not everyone is on this diet she has likely been getting into gluten somewhere, like touching glutened surfaces the other kids touched after eating gluten foods then putting her hand in her mouth or on safe foods. Or just randomly eating gluten foods, note symptoms can last weeks and wane from how it is effecting you. It does not take much to trigger symptoms you might have to be more careful and move her to a whole foods only diet, and have a separate prep area, utensils, cooking zone for her if you wish to keep fixing separate meals for her vs the gluten family. I would suggest just changing the entire family over, anyway perhaps start with a separate fold out table, use freezer paper to line the prep area, a microwave, mini toaster oven, and some microwave cook ware like steamers, steam bags, etc. and using gloves to fix her meals. She will need her own condiment jars (crumbs in hte jars) and area for safe snacks. I would suggest getting her only gluten-free CERTIFIED FOODS for now. You can find some whole food healthy snacks at mygerbs.com, and a few other places. I will provide a link to gluten-free food list. PERHAPS you can change the entire family over....now days it is more like changing brands as everything you used to eat is available in a gluten-free brand. ALSO have a lot of dairy free options there. https://www.celiac.com/gluten-free/topic/117090-gluten-free-food-alternatives-list/

Hi wondering if someone could help. my daughter has mildly raised TTG levels and the gliadine levels, she has one Coeliacs gene, but her biopsy came back negative. We have kept her off gluten (and low dairy) for nearly a year to see if her symptoms improved. They haven't. But I don't know if they are related to gluten specifically. Just wondering if anyone has other suggestions that may be going on with her. Her symptoms are: - Short stature, she's nearly 9 and my 6 year old boy is nearly bigger than her - bumps on back of her arms - urine leaking and occasional soiled pants, which could be from constipation she has at time's - sticking out stomach - dry patchy rashes on her face - joint pain sporadically - vomits every 6 weeks, but hasn't had gluten and seems to be no food connection - reoccurring thrush She had gluten last night at a party and was fine today. I'm a bit lost and not sure where else to turn. Thanks for any help.