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Diagnosing Celiac Disease and Lymphocytic Enteropathy by Parallel Serology and Histopathology


Celiac.com 08/12/2011 - Although serological analysis is used in diagnosing celiac disease, histopathology is regarded as most reliable.

A team of researchers set out to assess the clinical, pathological and serological spectrum of celiac disease in a general population via prospective study (Kalixanda study).

The research team included Marjorie M. Walker, Joseph A. Murray, Jukka Ronkainen, Pertti Aro, Tom Storskrubb, Mauro D’Amato, Brian Lahr, Nicholas J. Talley, and Lars Agreus.

For their study, the team evaluated a random sample of 1000 adults from the general population by upper endoscopy, duodenal biopsy, and serological analysis of tissue transglutaminase (tTg) levels. They screened samples that were tTg+ for endomysial antibody (EMA) levels.

The baseline value for celiac diagnosis was villous atrophy with 40 intraepithelial lymphocytes (IELs)/100 enterocytes (ECs).

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The team found 33 subjects with tTg+ and 16 with EMA+. Their histological analysis showed 7/1000 subjects (0.7%) with celiac disease, all of whom showed tTg+ and 6 of 7 of whom showed EMA+.

Another 26 subjects showed tTg+, 7 of 26 showing EMA+. The team then addressed these cases with a second quantitative pathology study, this one a nested case-control design, that used a celiac diagnosis baseline of 25 IELS/100 ECs. Under this criteria, all 13 samples that were tTg+ and EMA+ had more than 25 IELs/100ECs.

A total of 16 subjects (1.6%) showed serological and histological evidence of gluten-sensitive enteropathy. The team quantified IELs in duodenal biopsy samples from 500 seronegative individuals. A total of 19 (3.8%) of those subjects had >25 IELs and lymphocytic duodenosis (LD).

A celiac diagnosis level of ≥25 IELs/100 ECs was strongly associated with serological indicators of celiac disease, while a higher IEL threshold missed half of cases.

Quantification of tTg is a sensitive test for celiac disease, and diagnosis can be confirmed by observation of ≥25 IELs/100ECs in duodenal biopsy. Lymphocytic enteropathy in the form of both celiac disease and Lymphocytic duodenitis, is common, occurring in about 5.4% of the general population.

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3 Responses:

 
JOHN
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said this on
15 Aug 2011 4:43:22 PM PDT
Perhaps the GP's in the UK could avail themselves of this article.

 
mahima
Rating: ratingfullratingfullratingfullratingfullratingempty Unrated
said this on
28 Sep 2011 3:52:14 AM PDT
It.s good.

 
Trickey
Rating: ratingfullratingemptyratingemptyratingemptyratingempty Unrated
said this on
28 May 2013 2:47:58 PM PDT
Some laymen's terms would be helpful...




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In the rare instance that "modified food starch" is made from wheat, it will say so in the ingredients or Contains statement. If you wonder what it is made from, email or call and ask. I think its usually corn or potato Progresso is part of a large company. they would not label something gluten-free unless they know it is. Its a law in the US and Canada.

Progresso soup check the label on their gluten free products, modified food starch is not gluten free.

A recent issue of JAMA, the US Preventive Services Task Force (USPSTF) critically examines screening for celiac disease in asymptomatic adults, adolescents, and children. Celiac disease exhibits a broad spectrum of symptoms, from subtle or no symptoms to severe malabsorption. Celiac diagnoses have increased significantly over the past few decades, in part because of greater awareness, but possibly because of an actual increase in disease rates. Researchers estimate current rates of celiac disease at 0.71% among US adults, and 0.76% among US children. View the full article

I have notice that I am sick much less often.

Thanks everyone. I appreciate the answers. I'm waiting to hear back from her dr and then we will go from there. If the dr doesn't think the results show anything then I will get a second opinion thanks to everything that has been shared on here. I will make sure and not change her diet for now. I am planning on getting tested myself, I have had suspicions since last summer that I could have it. I have a form of autoimmune arthritis, just unclear exactly what it is at this time. I going to ask to be tested for celiac at my next appt though.