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Diagnosing Celiac Disease is Still Not a Simple Task

Celiac.com 04/06/2012 - The first step in diagnosing celiac is serological testing, looking for the presence of anti-tTg antibodies. But in adults at least a duodenal biopsy is still the gold standard of diagnosis, partially because of the risk of false positive anti-tTg results. Yet serum anti-tTg levels positively correlate with the severity of small intestinal histopathology. This prompted researchers in Italy to wonder if those patients with the highest ant-tTg levels could be spared an endoscopy, and if so, how high their anti-tTg levels had to be. They conclude, in their words, that "tissue-transglutaminase antibody level 5-folds the upper limit of normal is 100% specific for duodenal atrophy and using this cut-off biopsy could by avoided in 1/3 of patients. Diagnostic criteria of celiac disease in adults need revision."

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Photo: CC - timbrauhnThey retrospectively looked at 945 patients who came to their center because of suspected celiac disease. Three different commercially available methods were used to assess anti-tTg levels, which were then correlated with duodenal histology. By all serological methods used, anti-tTg levels increased in parallel with increasing severity of intestinal damage. As noted above, a cut off of five times the upper limit of normal ant-tTg included all of the patients with significant levels of villous atrophy. Celiac disease was confirmed in these patients by the presence of antiendomysial antibodies (EMS) and by their positive response to a gluten free diet.

The use of serological results alone had previously been suggested as diagnostic guidelines for children, but these authors suggest that many adults could be spared an endoscopy as well. They also note this strategy is already being implemented in primary care, with people adopting a gluten free diet solely on the basis of blood work; this study is valuable in that it validates that approach.

Source:

  • Zanini B, Magni A, Caselani F, Lanzarotto F, Carabellese N, Villanacci V, Ricci C, Lanzini A. High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease. Dig Liver Dis. 2012 Apr; 44(4):280-5. Epub 2011 Nov 25.

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3 Responses:

 
Jen Rad
Rating: ratingfullratingfullratingfullratingemptyratingempty Unrated
said this on
12 Apr 2012 10:58:30 AM PDT
As an adult who clearly has gluten sensitivity, I had a blood test that came back "negative". I chose to go on a GF diet voluntarily anyway and I am much better. However, in Canada, without the diagnosis I cannot claim tax relief for the more expensive diet. I was trying to confirm in this article if the blood test being done routinely could be read more carefully, but it was not clear to me. Is it worth asking my doctor for another blood test?

 
Amy
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said this on
04 May 2012 8:57:17 PM PDT
If you were to go in for another blood test and have been on a GF diet for a while now you will not get a positive result because there would be no reaction going on inside your body to the gluten if you haven't consumed any recently.

 
Donna

said this on
15 Apr 2013 7:05:24 PM PDT
That's what happened in my case, so we checked my HLA celiac genes, and I have both of them which confirmed everything. I'm not sure why more doctors don't do gene testing.




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So as many of you might know at only 6 weeks Gluten Free we were shocked to see how many Neurological Issues were resolved for our daughter. It was shocking and amazing. We quickly began to realize that the difficulty swallowing, the Vertigo, the sensory issues were ALL Gluten related. Now in the last 2 weeks it all slipped away and she is almost entirely back to the way she was before we went Gluten Free. We have a pretty good idea why and are taking the steps to remedy it. BUT...it struck me that (for HER sake and the sake of her long term medical records) I need to get the Gluten Ataxia recognized. I realize now how fragile her health is and how hard she will have to fight to STAY healthy. And worse - potentially EVERY cross contamination will take her out for weeks and make her employment opportunities shaky and vulnerable. My Dr. agrees and is sending us to the McMaster Neurological Department (they are cutting edge, up on all that is new etc) to see if they are willing to work with us. She just put the referral in so I have no idea what will come from it. It my result in nothing? Or she may get a Gluten Ataxia diagnosis? I'm not sure but it is worth fighting for.

In my research, diabetes (type 2) is genetic. You either have the genes to develop diabetes or you do not. Additional weight is most likely due to insulin resistance. I happen to be a thin diabetic. I have never been heavy. I was brought up to consume the Standard American diet (SAD) full of process and sugary foods. The problem most celiacs have is that they just simply convert the SAD diet into a gluten free diet. I disagree. We need to consume foods that naturally contain nutrients that are good for us. Fortified foods were only developed during the last century. In the 20's they added iodine to salt to prevent thyroid disease (goiters). In the 30's they added Vitamin D to prevent rickets (fortified milk was better than that nasty cod liver oil). In the 40's they started fortifying flour. Why? They found that kids entering into the military during WWII were malnourished. Yes. They were malnourished. Remember, the Great Depression preceded the war. Read more: https://www.ncbi.nlm.nih.gov/books/NBK208880/ I consume very few grains because I do have diabetes. I eat fresh veggies (full of fiber), meats, fruit, eggs, and dairy along with plenty of fat (which does not raise blood sugar). I do occasionally fall of the wagon, but never the gluten-free wagon! Granted this diet is not for everyone. We must choose what works best for our individual health issues. But chances are we do not need to consume processed junk food in a daily basis. It is not healthy for a celiac. It is not healthy for anyone! So, everything in moderation and enjoy a varied diet.

I felt great a few weeks after going gluten-free. finally started loosing weight as well. the last few weeks I have not felt good. ok in the morning, then slowly start getting brain fog. shakes. pains. is low blood sugar a side affect of going gluten free????

I had a bone scan it didn't show any fractures, basically I left physical therapy in pain, it then went away. But my knee pain and tingling didn't go away so I tried PT again and I left it pain. Then I realized I had celiac and now all my pain is gone other then the back pain.. I'm basically worried I healed from the celiac and PT caused a whole new problem that never had to happen.

I am trying to find out if going gluten-free can cause low blood sugar. I felt so much better when going gluten-free, but now I feel weak, shaky, tired