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Environmental and Other Factors Can Impair Celiac Disease Diagnosis in Symptomatic Children


Blood tests miss in some symptomatic kids.

Celiac.com 06/29/2010 - Properly diagnosing children with celiac disease in conditions where there may be environmental or other causes for classic celiac-associated symptoms, such as malnutrition, diarrhea, and failure to thrive, can present challenges to clinicians.

A clinical team conducted an assessment of celiac disease blood screens in symptomatic 12 to 36 month-old children. The research team included Inês Cristina Modelli; Lenora Gandolfi; Rodrigo Coutinho de Almeida; Gloria Maria A. C. Araújo; Marilúcia de Almeida Picanço; and Riccardo Pratesi.

They are associated with the Graduate Program in Health Sciences at the University of Brasilia School of Health Sciences, the Pediatric Department at the Brasilia University Hospital, and the Pediatric Research Center and Celiac Disease Investigation Center at the University of Brasilia School of Medicine in Brazil.

The clinicians wanted to assess rates of celiac disease in a group of 12 to 36 month-old children using immunoglobulin antibodies against gliadin (IgG and IgA-AGA), against endomysium (IgA-EMA), and anti-human tissue transglutaminase (IgA-tTG) screens.

For the study, the team enrolled 114 boys and 100 girls, aged 12 to 36 months, all following a gluten-containing diet. The team performed IgG and IgA-AGA, IgA-tTG and IgA-EMA blood tests for each patient. The team took biopsies from all children who showed one or more positive blood test, except those for whom IgG-AGA was the only positive result.

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In cases where IgG-AGA was the only positive result, the team used polymerase chain reaction (PCR) HLA genotyping to identify the celiac disease predisposing alleles. HLA genotyping also allowed the team to confirm diagnosis in children flagged as celiac by means of positive serologic testing and compatible biopsy results.

The team found that 131 kids showed normal results. PCR showed the presence of celiac disease predisposing alleles in ten out of 68 children who tested positive on just the IgG-AGA test. Four kids had positive results on all four blood tests, while a fifth child showed positive results IgG and IgA-AGA and IgA-tTG, but showed negative results for IgA-EMA. All five children submitted to jejunal biopsies, which showed classic celiac lesions.

Symptomatic children from 12- to 36-months old that had not been previously diagnosed with celiac disease showed celiac prevalence of 2.3%.

This study shows several things. First, the data reflect the challenges of diagnosing celiac disease in areas where environmental or other causes for classic celiac-associated symptoms might interfere with proper diagnosis. The results also show the advantages of considering biopsies in cases of conflicting or incomplete blood screens in symptomatic children who may be subject to environmental and other mitigating factors.

That such symptomatic children show celiac disease rates that are more than double the general population shows that clinicians attempting diagnosis under such circumstances should be both diligent and exhaustive in their efforts. As it is, symptomatic children with celiac disease are going undiagnosed. To properly diagnose such cases, clinicians should consider any environmental or other causes for classic celiac-associated symptoms that might interfere with proper diagnosis.

There is no reason to assume that these results are exclusive to Brazil. There's no reason to assume these results wouldn't apply anyplace where environmental and other causes might interfere with diagnosis of celiac disease in symptomatic children, including regions of rural and urban poverty.

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If you are worried about your glycemic levels, then you should test with a glucose meter. I have diabetes (insulin resistance/TD2) and rice and potatoes spike me like crazy! I might as well consume ice cream! But if you do not have diabetes, no worries!

Thanks to both of you for your replies. I wasn't so much concerned about the arsenic (although that is an additional consideration) as I was about the glycemic level. I don't bake enough to make blending my own flour blends worthwhile, so I will definitely check out the links you provided, Ennis_TX. So far I'm tolerating oats and my gastro doc says I can keep eating them as long as they're certified GT. I just looked at some crackers I have for hummus and noticed their main ingredient is rice. I should probably just eat the hummus with veggies!

I agree with Ennis. It sounds like she is getting access to gluten way too often to expect healing. I had some pretty severe patches of intestinal damage when I was diagnosed. Anemia was my symptom and I had no gut issues then. So, just because she injests gluten and does not have some major symptoms right away, does not mean she is not building up antibodies. Have those antibodies been re-tested to see if they are in the normal ranges now? Missing patches of damage in the small intestine is possible. Heck, the small intestine is the size of a tennis court (goggle it). So easy to miss. Also, your GI should have taken more than four samples? How many were taken? (Forgive me, if I have forgotten.) Cross contamination in your house is real, especially if you have kids in the house. Member Jebby, a preemie doctor who has celiac disease, was not getting well. Turns out her four small and adorable children were glutening her. She made her house gluten free. Just something to consider. You mentioned she had access to gluten at a party. So, does that mean she caves in and eats it? She needs to become a stakeholder in this diet.

I think that if you soaked in the paddle in vinegar and scrubbed it a few times, you will be fine. But if in doubt, just set the mixer aside for a while until your family's health has improved. In the meantime, use your arm to mix dough! My grandma never had a mixer! I bought a bunch of new stuff because I had been married for 25 years when diagnosed. It was time for new things! Everyone is different in their response to gluten. Science has given us a good estimate, but we know that nothing is "one size fits all". You just have to figure out what is best for you and your family. My anemia resolved within months of being gluten free (ferritin levels). I still have Thalassemia, but it is mild and my body has adapted. It is most likely the one reason that I never made the Olympic team! ? BTW, family and friends are not allowed to bring in gluten into our house with the exception of beer. They can contribute to a potluck by bringing beverages, uncut fruit and veggies, new condiments, tableware, and ice cream ......etc.

Thank you so much. It's so nice to have such friendly and helpful people to talk to while I await my answers. I had an interesting experience yesterday... I ate a bowl of Kraft mac n cheese... then passed out for 4 hours and woke up vomiting. I've had a lot of experiences like that after eating over the past 2 years, but I never put those pieces together because celiac disease was totally off my radar. Just found it very interesting. I've been pushing down lots of gluten-y foods just to make sure my tests will come out right. So tired of waiting! Really, if this isn't the answer to my 40 lb mysterious weight loss, fatigue, and painful gas/bloating... then what's left? Cancer doesn't seem likely in a 33 year old, but I am really scared. Thanks for helping me through this. Anyone who stumbles accross this place is lucky to find such supportive and kind, helpful people! ETA: Another question. I take an antihistamine every day (sometimes twice) for the weird itching I get... will that affect the blood test?