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New Testing Procedure for Intestinal Permeability

This was posted to the Celiac Listserv by Don Wiss.

Testing for intestinal permeability is a sensitive and accurate way to screen for celiac disease, with fewer false positive and false negative results than other commonly used screens. Intestinal permeability reflects the ability of the intestinal lining to absorb nutrients while keeping undesirable chemical substances out of the body. In patients with celiac disease who are consuming gluten, even small amounts of damage to the intestine will allow certain large chemical molecules to leak into the bloodstream, from which they may be excreted by the kidneys into the urine. The available permeability test requires that the individual drink a solution which contains two sugars, neither of which is metabolized or changed in the body. One sugar is usually mannitol, which is readily absorbed from the intestine and excreted in the urine. The other sugar is lactulose, which is hardly absorbed

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at all under normal conditions. Any lactulose that is absorbed is excreted unchanged in the urine within 5 to 6 hours. Both sugars are safe to be taken, even by small children. When a person with celiac disease drinks the lactulose/mannitol mixture, an excessive amount of lactulose will appear in the urine, unless the person is on a strict gluten-free diet. If the person has enough celiac disease to create malabsorption, then the mannitol level in urine will be low. The ratio of lactulose to mannitol in urine is the most sensitive index of active celiac disease. An elevated lactulose to mannitol ratio in urine may be due to conditions other than celiac disease, such as intestinal infection, severe food allergy or Crohns disease, but a normal ratio indicates either that the person does not have celiac disease or is in complete remission due to strict adherence to a gluten-free diet. Information about this test can be obtained from the one laboratory that presently offers it, Great Smokies Diagnostic Laboratory in Asheville, NC. Their number is 1-800-522-4762.

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Those labs do not look like celiac tests. The first three MIGHT just be measuring total antibody levels of the three different classes, but on the very right it has IgA Serp (Serp cut off?) and I don't know what the Serp is referring to. The first column is the test name, the second column your value, the third column the units of measure, the fourth column the normal range. The first one is a tiny bit low, all the rest in the normal range.

Since this post is going around again, I thought I would add my recent experience at Rudy's. The staff was very helpful and accommodating. I ordered my family's food first put it on a tray and then ordered mine separately. I ordered only chicken and turkey. The staff changed gloves and used a new cutting board and knife. My server washed his hands, wiped down the scale and put my meat separately into a tray. I washed my hands before I ate. I did not eat any of the side and brought my own fruit to go with it. Since I don't get immediate symptoms, I can't tell you if that was enough. But, their meat (except the pork - maybe ) is gluten free. I think I did everything I can to avoid CC and the staff was extremely helpful . This is the only restaurant I have eaten at in 4 months if that tells you anything. I love Rudy's!!!

I got my script from the doc... it's for total IGA and TTG-IGA. Guess that's a good start? It also says "fasting" on the requisition, do I really need to be?

Something that's always weirded me out since I became somewhat non-responsive on repeat biopsies: I don't get colds anymore. Ever. I used to get maybe 5 a year ? standard stuff. Nothing in the past 3 years. I get a lot of sleep these days, but still. My girlfriend gets sick; I do not. Anyone else find their common transient illnesses take a strange turn after diagnosis? I hypothesize having an abnormal/overactive immune system might take down common bugs hard, but I also assume it's far more complicated than that.

Hello, Has anyone ever heard of a celiac diagnosis through an ultrasound? I have a friend who had an ultrasound for diverticulitis issues and the dr said he also had celiac disease. No blood test, no endoscopy. I don't think he wants to make this life change in his diet without knowing for sure.