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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
Rating: ratingfullratingfullratingfullratingemptyratingempty Unrated
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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Celiac.com Celiac Disease & Gluten-Free Diet Forum - All Activity

Welcome to the forum. Be sure to browse through the DH section for advice and tips. Glad your wife is gluten free. My hubby was gluten free some 12 years before my diagnosis. Sure makes it a bit easier!

As I am sitting here, I am wearing a retainer. Yep, had a tooth extracted a few months ago. To keep the space open for a future transplant, my dentist ordered a retainer. I read that PUB MED study. One kid. Not very scientific at all! Gluten Free Watchdog agrees that the odds of this kid being glutened by her retainer is slim and none. Like my PCV sprinklers lines, retainers probably do not last a lifetime. Ask your dentist how long they should last. No one wants to eat plastic!

I've had them about six or seven times at several different Starbucks locations. My sister has, also. Neither one of us have had any signs of getting glutened. They are served in a parchment paper bag that should be handed to you straight from the oven sealed. I've heard many internet complaints about the bags being dusty, too many ingredients, unhealthy, etc., but honestly, they are pretty darned tasty! And, when you are traveling and hungry, they are even tastier. They sell out quickly at most Starbucks, but I've been able to purchase one as late at 6 p.m.

I wish they didn't use " gluten" as a headline. People abuse and starve children for a variety of " reasons". gluten-free was just one they picked, it could have been paleo or kosher or whatever...

Ugh! This again..... first ...it was one person...not a study... just someone's speculation. if I am remembering correctly - no one actually tested the retainer. The kid was a 12-16 yr old an drew could have gotten caught eating gluten, etc, etc, etc. And then those internet folks who love to spread " bad news" or use that stuff to further their purpose, jumped on it. And then let's talk to a chemist or plastic scientist - if the plastic leaches our actual proteins, like gluten, wouldn't the plastic piece break down after a while? welcome to the world of Celiac internet myths. adding - none of the Celiac Centers, Associations, etc have warned people not to use a retainers.