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In Vitro Gliadin Challenge Offers Accurate Diagnosis of Difficult Celiac Disease Cases

Celiac.com 10/24/2012 - Doctors can face challenges when attempting to diagnose celiac disease in patients who have already begun a gluten-free diet, and/or when the results of tests are inconsistent.

To better understand this problem, a group of researchers set out to assess the benefits of an in vitro gliadin challenge.

Photo: CC--US Army AfricaThe research team included Raffaella Tortora, MD, Ilaria Russo, PhD, Giovanni D. De Palma, MD, Alessandro Luciani, PhD, Antonio Rispo, MD, Fabiana Zingone, MD, Paola Iovino, MD, Pietro Capone, MD and Carolina Ciacci, MD.

The study cohort included 57 patients without celiac disease, 166 patients with untreated celiac disease, 55 patients with celiac disease on a gluten-free diet, and 59 patients with challenging diagnosis.

The team provided all patients with endoscopy for collection of duodenal samples, which served for the diagnosis of celiac disease and for the in vitro evaluation of the gliadin-induced mucosal expression of seven inflammatory markers: PY99, ICAM-1 (intercellular cell adhesion molecule), HLA-DR, CD3, CD25, CD69, and transglutaminase 2 IgA.

Diagnostic work-up for celiac disease included the search of specific serum antibodies. Researchers asked patients in the challenging diagnosis group to stop gluten-free diet to facilitate the search for these antibodies under untreated conditions.

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They used the area under the receptor-operated curve (ROC) for statistical analyses on accuracy.

For patients with and without celiac disease (not including those on a gluten-free diet) HLA-DR offered the best accuracy for diagnosing celiac disease (area under ROC = 0.99).

Combining the data from the HLA-DR with data of other markers did not increase test accuracy.

The team found similar results in the 39 patients of the difficult diagnosis group undergoing the search celiac disease-specific antibodies under untreated conditions.

In vitro testing of mucosal HLA-DR to gliadin is an accurate tool for the diagnosing celiac disease, and also works in patients who are hard to diagnose.

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4 Responses:

 
Glenn Ribotsky
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said this on
24 Oct 2012 4:18:26 AM PDT
Hmm. Interesting. Wonder if this could be upscaled for use in the average clinical setting, though. (In my experience gastroenterologists are not the most proactive in adopting new tests or treatments--they're fairly conservative, and often stuck to their training textbooks, which is part of why celiac disease has for so long been underdiagnosed.)

 
dappy
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said this on
29 Oct 2012 7:39:35 AM PDT
After being advised to start gluten-free - tests came back inconclusive for me, except for the original antibody blood test. It made going through endoscopy futile. I then had a genetic test, which showed one marker. In my estimation, whether I have celiac disease is still very inconclusive, but I continue the diet and have to take a probiotic as well. Disturbing, not to mention life changing.

 
Norman Nichols
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said this on
03 Feb 2013 3:58:31 AM PDT
Interesting but can't print to show doctor.

 
Sarah
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said this on
01 Aug 2014 8:39:26 AM PDT
Does anyone have any idea which centers offer this test? I asked Dr. Fasano about it at the Gluten & Allergen Free Expo in Atlanta back in May, but it was during his book signing, so there wasn't much chance to talk. According to him, centers are using this test, but I have yet to find one close enough to where I live (Georgia). Perhaps if airline tickets to New York or Massachusetts are not that expensive, I can look into the University of Columbia or Mass General...if they offer this test for certain.




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Call your doctor's office and ask them to relay your request to the doctor to amend the test request, they should be able to sort it without an additional meeting and delay. Worth a try anyway I think the Biocard tests TTG IGA and it may give you an indication. Do post your results here as I'm sure others will be interested in its effectiveness. If it's negative however remember that there are several celiac tests for a reason. Some test on one, some on another etc... However my guess is your doctor will dismiss them and want their own testing. That's the usual experience.

Waiting for the EMA, I bet. Keep advocating! this is interesting. If celiac disease is excluded, she might still have a gluten sensitivity. There just is not specific test for that. http://theglutensummittranscripts.s3.amazonaws.com/Dr_Umberto_Volta.pdf

I think all the flavors are all gluten free. I buy them at my local grocery store which is a Kroger store. Amazon has them too. Jenny at "The Patient Celiac" uses them too (she is a preemie doctor who has celiac disease).

Thanks Frieze, I'm planning on filing a complaint in the next few days.

Cyclinglady, where do you get the nuun tablets? Does it matter the flavor is the brand gluten free for all?