23296 Can Celiac Disease be Diagnosed without Intestinal Biopsy? - Celiac.com
No popular authors found.
Ads by Google:

Categories

No categories found.


Get Celiac.com's E-Newsletter




Ads by Google:



Follow / Share


  FOLLOW US:
Twitter Facebook Google Plus Pinterest RSS Podcast Email  Get Email Alerts

SHARE:

Popular Articles

No popular articles found.
Celiac.com Sponsors:

Can Celiac Disease be Diagnosed without Intestinal Biopsy?

Celiac.com 05/28/2013 - Is an intestinal biopsy always necessary to diagnose celiac disease, or can diagnosis be made without biopsy? To answer that question, a team of researchers recently set out to compare celiac disease–specific antibody tests to determine if they could replace jejunal biopsy in patients with a high pretest probability of celiac disease.

Image: Public Domain--WikicommonsThe research team included Annemarie Bürgin-Wolff, Buser Mauro, and Hadziselimovic Faruk. They are variously affiliated with the Institute for Celiac Disease in Liestal, Switzerland, and Statistik Dr. M. Buser, Riehen, Switzerland.

Their retrospective study included blood test data from 149 patients with celiac disease, along with 119 controls. All patients underwent intestinal biopsy, and all samples were analyzed for IgA and IgG antibodies against native gliadin (ngli) and deamidated gliadin peptides (dpgli), as well as for IgA antibodies against tissue transglutaminase and endomysium.

They found that tests for dpgli were superior to ngli for IgG antibody determination: 68% vs. 92% specificity and 79% vs. 85% sensitivity for ngli and dpgli, respectively. Predictive values were also higher for dpgli than for ngli; positive (76% vs. 93%) and negative (72% vs. 83%).

Regarding IgA gliadin antibody determination, sensitivity improved from 61% to 78% with dpgli, while specificity and positive predictive value remained at 97% (P less than 0.00001).

Ads by Google:

A combination of four tests (IgA anti-dpgli, IgG anti-dpgli, IgA anti- tissue transglutaminase, and IgA anti-endomysium) yielded positive and negative predictive values of 99% and 100%, respectively and a likelihood ratio positive of 86 with a likelihood ratio negative of 0.00.

Omitting the endomysium antibody determination still yielded positive and negative predictive values of 99% and 98%, respectively and a likelihood ratio positive of 87 with a likelihood ratio negative of 0.01.

Conclusion: Antibody tests for dpgli yielded superior results compared with ngli. A combination of three or four antibody tests including IgA anti-tissue transglutaminase and/or IgA anti- endomysium enabled reliable diagnosis or exclusion of celiac disease without intestinal biopsy in 78 percent of patients.

This two-step method of performing jejunal biopsy only in patients with discordant antibody results (22%) would catch all patients except those with no celiac-specific antibodies; who would then be caught through biopsy.

Source:

Celiac.com welcomes your comments below (registration is NOT required).





Spread The Word







Related Articles



18 Responses:

 
Matt Lewis
Rating: ratingfullratingemptyratingemptyratingemptyratingempty Unrated
said this on
28 May 2013 8:32:36 AM PDT
My wife was diagnosed with celiac disease after stomach biopsy and blood tests were all negative.

She was diagnosed with celiac disease from a capsule endoscopy. Stomach and duodenal biopsies are the tip of the 9 feet of jejunum and often miss celiac disease...

 
Jenny
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated
said this on
03 Jun 2013 2:09:09 PM PDT
Yes I know at least 50 celiacs diagnosed by capsule when standard biopsy and/or blood test was negative.

 
Dylan Cornelius
Rating: ratingfullratingfullratingfullratingfullratingempty Unrated
said this on
23 Oct 2014 3:57:34 PM PDT
Hi Matt,
Where do you find the data that stomach and duodenal biopsies often miss celiac disease? Appreciate your help!

 
tony
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated
said this on
30 May 2013 3:43:22 PM PDT
I had one GI doctor, swear I had it through blood tests and the fact that I have dermatitis herpetiformis since I was 12 years old. The other GI doctor did a biopsy during a colonoscopy. He swears I don't have it. Pasta is the item that gets me sick. But only for the last 5 years, when I was young I ate ziti, ravs and all pasta with no problems.

 
Andrea

said this on
03 Jun 2013 11:28:28 AM PDT
Tony,

Doctors at the New York Presbyterian Celiac Center who are world renowned for their research, studies and treatment of celiac disease say that dermatitis herpetiformis is a condition that confirms the presence of celiac disease in patients who are not otherwise confirmed. If you have the anti-bodies as well, then you have a diagnosis of celiac disease.

 
Rob Carroll
Rating: ratingfullratingfullratingfullratingemptyratingempty Unrated
said this on
03 Jun 2013 9:47:16 AM PDT
I never had a positive blood test, but the endoscopy (which my 3rd GI ordered for an unrelated reason) found it right away. I don't know if these were the same series of blood tests they were using 10 years ago, but I know a lot of people who had false negatives.

 
Rosalyn
Rating: ratingfullratingemptyratingemptyratingemptyratingempty Unrated
said this on
03 Jun 2013 8:59:07 PM PDT
I could not understand one word in this article; therefore I learned nothing that would be helpful. The article was too technical and not written for the average gluten-free person trying to learn more about the disease.

 
Mo
Rating: ratingfullratingemptyratingemptyratingemptyratingempty Unrated
said this on
02 Jul 2013 5:37:19 PM PDT
I so agree with you! I was hoping that I'm not getting a little senile.

 
LKay
Rating: ratingfullratingemptyratingemptyratingemptyratingempty Unrated
said this on
15 Feb 2014 7:13:18 PM PDT
I agree. I think it would be helpful if the article was in English and not medical-alphabet soup.

 
Jules
Rating: ratingfullratingfullratingfullratingemptyratingempty Unrated
said this on
04 Jun 2013 5:47:46 PM PDT
Do patients undergoing the tests have to be eating gluten to test positive?

 
Adamaris
Rating: ratingfullratingfullratingfullratingfullratingempty Unrated
said this on
27 Sep 2013 9:11:38 AM PDT
I also would like to know if I have to eat before taking the blood test, IGA-TTG, I'm so confused because when I eat food containing gluten I get sick.

 
Dylan Cornelius
Rating: ratingfullratingfullratingfullratingemptyratingempty Unrated
said this on
25 Mar 2017 8:44:47 PM PDT
When my gastroenterologist ordered my test, he told me since I hadn't been eating gluten recently, it would likely be a negative result. I ate bread every day for 30 days prior to my test as he directed, though he also said this probably wouldn't be sufficient exposure to yield a positive test result. I grew increasingly more tired and had greater digestive distress as those 30 days passed. My sleep increased from 8 hours nightly to 14 by the end. The test result was negative. Your mileage may vary.

 
laura craigo
Rating: ratingfullratingfullratingfullratingemptyratingempty Unrated
said this on
05 Jun 2013 9:49:02 AM PDT
I have had four positive blood tests months and months apart, but I tested negative on biopsy.

 
Duane Benton
Rating: ratingfullratingfullratingfullratingfullratingempty Unrated
said this on
05 Jun 2013 10:50:06 AM PDT
I had one positive and one negative blood test, but definitely have celiac disease from gluten-free diet results.

 
Jen
Rating: ratingfullratingemptyratingemptyratingemptyratingempty Unrated
said this on
01 Oct 2013 10:08:20 PM PDT
I was diagnosed two weeks ago through a blood test. My doctor explained that I needed a biopsy to have an "official" diagnosis, but he usually didn't order such an invasive procedure unless it was a severe case or unless the patient requested it (I certainly didn't want to deal with that, so I just took his word for it). In two weeks of a GF diet, I'm sleeping better, I don't have abdominal discomfort, my nausea and vomiting is gone, I've lost a significant amount of weight, my thyroid problems have stabilized (for the moment; more bloodwork in a month to confirm) and I just FEEL better. The other day, my mother-in-law made a dessert which she assured me was gluten free. It wasn't (who doesn't know that flour is made from wheat???), and I had horrendous stomach pain for two hours after eating it. I don't need a biopsy to confirm what I already know. I know everyone is different, but in my case, the blood test was more than enough.

 
Julia
Rating: ratingfullratingfullratingfullratingfullratingempty Unrated
said this on
07 Jan 2014 5:02:54 PM PDT
I have heard that there are tax deductions for people DIAGNOSED with celiac. I am sure a biopsy is not worth the while to get them, however, i would make it very clear to your doctor, how you feel after a GF diet and express that it should be noted in your chart. I believe the actual problem lies between diagnosing celiac or gluten intolerance, which is probably the reason for a biopsy.

 
Mlal
Rating: ratingfullratingfullratingemptyratingemptyratingempty Unrated
said this on
04 Feb 2014 3:54:13 PM PDT
Can you expand on what these tax deductions are? How does that work, can you deduct gluten free food as medical expenses or pay them from a health account?

 
Val
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated
said this on
10 Mar 2014 8:25:12 PM PDT
I recently had a negative blood test for celiac and when I had an EGD they took only one biopsy in the small intestine, which came back negative. I am now attempting a gluten free diet and feeling better to a degree. The problems I was having included 20 pound weight loss in 2 months, being extremely shaky, exhausted, dizzy, moody after eating and unable to think clearly. My mom wants me to request a CT scan and not wait on the gluten few diet. I was wondering if anyone had any input on my symptoms from their own experiences?




Rate this article and leave a comment:
Rating: * Poor Excellent
Your Name *: Email (private) *:




In Celiac.com's Forum Now:

All Activity
Celiac.com Celiac Disease & Gluten-Free Diet Forum - All Activity

That makes sense...I cried with relief when I got my diagnosis just because there was finally an answer. Please know that you are not weak or crazy. Keep pushing for testing. It could still be celiac, it could be Crohns. Push your Dr's to figure this out. Best wishes.

Thank you all very much. I actually cried when I got the answer. I wanted an explanation that I could "fix." Now I'm back to thinking I'm just weak and possibly crazy. I know I'm not crazy, but you know.

From what I have read online there is about a 1-3% chance of getting a false positive for celiac disease from a blood test. Was it a blood test that you got done? It may be worth your while to get a biopsy or more testing just to confirm it. I know being gluten free is a pain but it is better than getting cancer or other auto immune disorders.

I prefer edible candy. I have glaucoma and celiac so it helps me on a daily basis for all of my medical problems. I wish I could find a strain that has laxative effects so I didn't need linsess. Leafly.com has a lot of strain information and cannabist is a good resource, too. You can use CBD or THC and not get 'stoned'. I function fine on 20 mg of the candy. I refuse to drive if I smoke though. Good luck, hope it helps.

Is it NCGS or Low stomach acid misdiagnosed Low Stomach Acid and Celiac Disease Dear Gluten Intolerant please consider Low Stomach Acid as a possible Differential Diagnosis as a possible way to achieve remission of your GI symptom's. ?Consider what I say; and the Lord give thee understanding in all things? 2 Timothy 2: 7 Low stomach acid has now been linked to a probable cause of damage to the Small Intestine before and/or occurring with a Non-Celiac Gluten Sensitivity (NCGS) or Celiac diagnosis. See this research as reported on celiac.com that discusses the increased risk of/for someone to develop celiac disease after taking PPI?s. http://www.celiac.com/articles/23432/1/Do-Proton-Pump-Inhibitors-Increase-Risk-of-Celiac-Disease/Page1.html Note how the article starts quoting ?Rates of celiac disease and the use of drugs to inhibit the secretion of stomach acid have both increased in recent decades. A research team recently set out to explore the association between anti-secretory medication exposure and subsequent development of celiac disease.? If these medicine are lowering stomach acid what cause effect relationship does/ could this have on Celaic/NCGS diagnosis is what he is postulating. He goes on to say without being very technical (read the whole article for yourself) that ?The data clearly show that patients who use anti-secretory medications are at much greater risk for developing celiac disease following the use of these medicines. The fact that this connection persisted even after the team excluded prescriptions for anti-secretory medicines in the year preceding the celiac disease diagnosis suggests a causal relationship?. If even after a year OFF these medicines your chances of developing Celiac Disease (celiac disease) not to mention even NCGS which is much more prominent surely the researcher is correct in postulating that there is a cause and effect relationship between low stomach acid and NCGS and/or Celiac disease. Surely there is something we can learn here. I now postulate some homework for the reader of this blog post. Do some research for yourself and see if achlorhydia or hypochlorhydia symptoms don?t at least resemble in some manner all of the GI symptoms you have been having. (I note some of the many symptom?s low stomach acid can present with below as referenced from Dr. Myatt?s online article ?What?s Burning You? for easy reference (It might not be what you think (my words)) It is important to note here that ?some? symptoms does not mean all but many or several. It is called a differential diagnosis. It is an important diagnostic tool in medicine. Think of the tv show ?House? where they spend the whole hour/over a week times going through the ?differential diagnosis? in short any one symptom can/have many different causes. The trick is how to quickly eliminate possible outcomes as symptoms (many) go up. All is usually never meet because that would make the disease in full outbreak and obvious even to the layman a condition described as ?frank? or ?classic? Scurvy or Rickets as an example. Sadly too often after 8 to 10+ years of testing after all the differential diagnosis?s are ruled out you are said by process of elimination to have Celiac Disease if you are lucky or maybe NCGS and not some other acronym GI disease as I like to refer to them as a group. GERD,IBS,UC, Chrons etc because if they turned down that street ? . you are/could be in/at a dead end for they stop looking at the trigger (gluten) as the cause of your gastric upset/digestive disorder(s). So in summary if 3 or 4 or 5 or 6 of these symptoms overlap ?many of? these symptoms could be Low Stomach Acid related. IF that is the cause/case for you then there is hope! For remission! From Dr. Myatts? Online article what?s burning you? From Dr. Myatts? Online article what?s burning you? http://healthbeatnews.com/whats-burning-you/ Diseases Associated with Low Gastric Function Low stomach acid is associated with the following conditions: * Acne rosacea * Addison?s disease * Allergic reactions * Candidiasis (chronic) * Cardiac arrhythmias * Celiac disease * Childhood asthma * Chronic autoimmune hepatitis * Chronic cough * Dermatitis herpeteformis * Diabetes (type I) * Eczema * Gallbladder disease * GERD * Graves disease (hyperthyroid) * Iron deficiency anemia * Laryngitis (chronic) * Lupus erythromatosis * Macular degeneration * Multiple sclerosis * Muscle Cramps * Myasthenia gravis * Mycobacterium avium complex (MAC) * Osteoporosis * Pernicious anemia * Polymyalgia rheumatica * Reynaud?s syndrome * Rheumatoid arthritis * Scleroderma * Sjogren?s syndrome * Stomach cancer * Ulcerative colitis * Vitiligo When low in stomach acid we become low in essential nutrients Quoting from Dr. Myatts ?what?s burning you? online article ?Our bodies need 60 or so essential nutrients. ?Essential? means that the body MUST have this nutrient or death will eventually ensue, and the nutrient must be obtained from diet because the body cannot manufacture it. Many of these essential nutrients require stomach acid for their assimilation. When stomach acid production declines, nutrient deficiencies begin. Calcium, for example, requires vigorous stomach acid in order to be assimilated. Interestingly, the rate of hip replacement surgery is much higher in people who routinely use antacids and acid-blocking drugs. We know that people who have ?acid stomach? were already having trouble assimilating calcium from food and nutritional supplements due to lack of normal stomach acid production. When these symptoms are ?band-aided? with drugs which decrease stomach acid even more, calcium assimilation can come to a near-halt. The result? Weak bones, hip fractures and joint complaints resulting in major surgery. Jonathan Wright, M.D., well-known and respected holistic physician, states that ?Although research in this area is entirely inadequate, its been my linical observation that calcium, magnesium, iron, zinc, copper, chromium, selenium, manganese, vanadium, molybdenum, cobalt, and many other micro-trace elements are not nearly as well-absorbed in those with poor stomach acid as they are in those whose acid levels are normal. When we test plasma amino acid levels for those with poor stomach function, we frequently find lower than usual levels of one or more of the eight essential amino acids: isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. Often there are functional insufficiencies of folic acid and/or vitamin B12.? Remember, these are essential nutrients. Deficiencies of any single one of them can cause serious health problems over time. Weak bones, diminish immune function, failing memory, loss of eyesight and many other ?diseases of aging? are often the result of decreased stomach function.? It is me again reader. So low stomach acid is the triggering agent (often) for low nutrients. Make too much sense! Now don?t take Vitamin?s for this condition where low Vitamins/Minerals are known to be low in patients who have this condition because . . . . (if you do you won?t need to keep coming back to the doctor) I can almost hear the doctor say now. Of course he/she doesn?t say that . . . just that the ?average person? doesn?t need to take Vitamins. Well I hate to break it too you . . . . but if you are having GI problems and reading this blog post on celac.com then you are not the ?average? person. You my friend or a sufferer or a friend of a sufferer still looking for answers. If that is you then consider taking either powdered stomach acid ? Betaine HCL or taking Niacinamide to help you reset your stress clock. A Canadian researcher wrote about this connection 15+ years ago but still most doctors? don?t understand this connection between about how ?Niacin treats digestive Problems? Here is the full link so you can research it more yourself. http://orthomolecular.org/library/jom/2001/articles/2001-v16n04-p225.shtml And you might not after a first reading. I didn?t believe it myself for over a year . . . but every time I thought about it ? it (Low Stomach Acid) made/makes the most sense to me. **** Note: research this yourself. Here is a link about how to take Betaine HCL (powdered stomach) for maximum effectiveness. http://20somethingallergies.com/how-much-hcl-do-i-take-learn-to-test-for-your-correct-dose/ Don?t take my blog post as medical advice. It is only what I did . . . it might not work for you but I think it is worth a try especially if you are not now taking an acid reducer. (see notes below about why this might) be more difficult if you are already taking an acid reducer . . . because the rebound wall (see chris kresser link) keeps us locked in . . . sometimes for years. Since I was not taking acid reducers at the time I took Betaine HCL my stomach problems improved and I am sharing this now in the hopes it might help yours too! Now back to (really) LOW stomach acid being diagnosed as HIGH stomach acid these days. How can we know if it truly high or low? You?ve heard the phrase timing is everything well it is here too! Timeline is important in any diagnosis. IF your stomach acid was HIGH as you often hear (everywhere) you hear take a Proton Pump Inhibitor aka acid reducer?s for heartburn/GERD (medical name for heartburn) then eating food (carbs, greasy things) wouldn?t bother you. The acid would cut it up but if it is already low/weak then even a little acid can burn your esophagus which is not coated like the stomach to protect you from high acid. BUT if it is low to start with then food will WEAKEN our/your acid so that you lose the food fight your in and things (carbs/fats) become to ferment, rancidify and cause heart burn. Leading in time to Non-Celiac disease first and with enough injury (and time) to Marsh lesions qualifying you for diagnosis as a Celiac candidate / patient. See above link between/about PPI?s in the year preceding a Celiac diagnosis. If you (can) be that patient and weight the xx number of years for all this damage to occur, there is a better way it is called digestion! A virtuous cycle can replace the vicious cycle you are now in ? it is caused digestion. Digest your food with healthy stomach acid and your body will thank you for it with the God given burp. A healthy child burps (at 6 months of age normally) and a healthy adult should too and you will again after taken Niacinamide 3/day for 6 months or this is not the right diagnosis. *********Note this is not medical advice only my experience with Niacinamide and my many years researching this topic as a fellow sufferer. Let me make these disclaimer(s). If you are a) experiencing heartburn that causing vomiting (with unintended weight loss) you may have a special case of heartburn that feels like heartburn (on steroids) that is really Bile Reflux and taking Stomach is not something you should do without medical advice and supervision. See this NYtimes article that discusses the many complications often seen with Bile Reflux patients and why it is treated as Heartburn often and why Bile Reflux is especially hard to recover from. http://www.nytimes.com/2009/06/30/health/30brod.html you are already taking an acid reducer then the chance you will get better (off of acid reducers completely) is only 50/50 on your first try but going low CARB can help your transition. Otherwise most people will get better when taking BetaineHCL for gastric support and Niacinamide to help them/you reset your digestive processes. See this online article about how Jo Lynne Shane got off Nexium for good. http://www.jolynneshane.com/how-i-got-off-nexium-for-good.html and her Epilogue http://www.jolynneshane.com/epilogue.html You will see she still struggles some but is much better when she let her natural digestive juices do their job. I call it the ?Natural Order of Things?. See this article about the digestion process being a North South Affair from the bodywisdom website http://bodywisdomnutrition.com/digestion-a-north-to-south-process/ Taking it (Niacinamide) (or any B-Vitamin) should be taken 2 to 3/day (too keep up serum levels) for 3 to 4 months (the time you can store B-Vitamins) in the liver mostly. Once you have a distinctive BURP that displaces the bloating and sense of ?I am going to explode? if I eat another bite (though you haven?t eaten half your meal) then normal digestion is occurring again. If you stool did not sink before this process (of taking Niacinamide begun) and burping became your ?new normal? then it (your stool) will begin to sink too! Burping without bloating is the ?Natural Order? of good digestion. Don?t stop this process of taking B-Vitamins as Niacimaide or Slo-Niacin 2/day for at least 4 months then you should see most of your GI symptom?s go into remission. (I did not say "cure" but remission from your cross contamination's (flares/symptom's etc.) might be possible. Because our defenses are now strong enough to cut up proteins before they reach our small intestine (where most of the damage is done). Think of a castle with a moat around it (stomach acid is designed to protect us) when it is low (the moat doesn?t protect us) and when the moat is dry the castle becomes a ruin!!! So do proteins (lactose (casein), gluten, soy, seafood etc.) to our small intestines (they become ruined) when our stomach acid (moat) is low or worse dry! I repeat again Timeline is important in any diagnosis. All heartburn is not equal. IF your stomach acid is truly high then it WILL occur between meals when there is no food to tamp down the fire (occurring in your stomach) not your esophagus. The excess pressure from fermented carbs push open the trap door allowing the low acid you have to burn the lining of your uncoated esophagus. See also this online article by Chris Kresser to study this more about why/how this could be a case of medical misdiagnosis in more detail https://chriskresser.com/what-everybody-ought-to-know-but-doesnt-about-heartburn-gerd/ This is part of a 3 part series that I think you will find very informative. This (low stomach acid) is a vicious cycle. STRONG stomach acid makes it a virtuous circle/cycle. Now food benefits you because low acid not only causes heartburn it limits your body?s absorptive ability by limiting its ability to cut up your food into digestible peptides and amino acids which are no longer harmful to your Small Intestine but helpful to your overall health because nutrients can now be absorbed because the food particles are now small enough to not cause harm to your villi. I hope this is helpful and it helps you the way it helped me. Maybe it will help you in a similar manner. I write this only as a guidepost on your way. May you find your way back to digestive peace! The ?Natural Order? of things! Praise bee to God! It is not a long way if you know the way . . . . from someone who has found his way back God being his help! There are more things I could say . . . but this post is getting kind of long but you get the gest. I noticed someone else on the celiac.com noticed the same improvement when they treated their low stomach acid and thought it was time a blog post talked about it. It is so much easier to consume all this information in one setting instead of hunting and peeking through several thread posts. Search for the posterboy on celiac.com and you will find it is my focus (how low stomach acid is misdiagnosed) and how Niacinamide helped me to restore its ?Natural Order? in the digestive process because it helped me! Here is the link to the Prousky?s abstract. 15+ years is a long time for people to continue to suffer but if the research it right then Niacinamide might help you too! http://www.yourhealthbase.com/database/niacin-treats-digestive-problems.htm Let?s hope it is not another 15 years before doctor?s and people realize low stomach acid can explain many of the same symptom?s an IBS, NCGS or even a Celiac patient might experience given a long enough time for these conditions to develop from too low a stomach acid to protect our Small Intestine. See link at start of this blog post posted here again for convenience. http://www.celiac.com/articles/23432/1/Do-Proton-Pump-Inhibitors-Increase-Risk-of-Celiac-Disease/Page1.html And it is worth noting about the time Celiac disease started (began to be more prevalent) / to increase in the population Acid reducer?s became more and more popular. *** Some plot the increase in time to Roundup usage but I am not buying it. PPI?s increase seam more plausible to me based on the relatively new research (less than 5 years old) is pretty current by research standards and the near linear response to increased first H2 stomach acid reducer?s then PPI?s in the population at large. *****Note: after I finished writing this blog post new research that in my mind confirms this connection was reported on celiac.com today that notes the link between gastric pH and impaired nutrient absorption. This very topic as I was getting ready to publish my post about low stomach acid possibly being diagnosed as Celiac disease on my posterboy blog mentions how a Celiac patient?s absorption can be impaired by gastric pH. https://www.celiac.com/articles/24738/1/Can-Celiac-Disease-Impair-Drug-Therapy-in-Patients/Page1.html Where they (researchers) say/ask discussing Celiac Disease and whether it (celiac disease) can impair drug therapy in patients. Note the opening paragraph discussing this topic quoting ?Celiac disease is associated with numerous chronic conditions, such as anemia and malabsorption of some critical vitamins. Changes in the gastrointestinal tract, rates of gastric emptying, and gastric pH are responsible for impaired vitamin and mineral absorption." i.e., low gastric pH can effect absorption. It stands to make reasonable sense to me they are related conditions and one is being diagnosed for the other often or at least one is being confused as the other and treating one (raising your stomach pH) might treat the other since many of the symptoms? are the same. *** this/these opinion(s) are my own and do not reflect an endorsement by celiac.com of these ideas, comments, thoughts or opinions. I hope this helps! You the way it did me! Good luck on your continued journey, Remember **** This is not medical advice and should not be considered such. Results may vary. Always consult your doctor before making any changes to your regimen. 2 Timothy 2:7 Consider what I say; and the Lord give thee understanding in all things. Posterboy by the Grace of God,