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Celiac Disease Diagnosis, Testing & Treatment

This category contains a comprehensive overview that covers the information on diagnosing and treating celiac disease, including the latest research on the various new tests/screening techniques.
Note: The only medically acceptable treatment for celiac disease is a 100% gluten-free diet for life.


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    Photo: CC--Alisha Vargas

    If people with celiac disease hope to avoid complications, then it's important for their gut mucosa to heal. However, besides biopsy, there is currently no good way for doctors to assess that a patient has healed enough to experience full remission.

    A team of researchers recently set out to assess the role of a point-of-care test (POCT) based on IgA/IgG-deamidated gliadin peptide, in detecting persistent villous atrophy in celiac disease.

    This is what they found.



    Photo: CC--NIAID

    ImmusanT, Inc., the company working to develop a therapeutic vaccine to protect HLADQ2.5+ patients with celiac disease against the effects of gluten, presented data that shows a way to tell the difference between celiac disease (CeD) and non-celiac gluten-sensitive (NCGS) based on cytokine levels.

    Professor Knut Lundin, University of Oslo, presented the data at United European Gastroenterology (UEG) Week 2017.



    Is Celiac Disease Seriously Under-Diagnosed? Photo: CC--US Army

    Are doctors even getting close to diagnosing the actual number of cases of celiac disease? Or are they missing the vast majority?

    Researchers have said for some time that there are far more people with celiac disease than are being diagnosed, and that the vast majority of cases go undiagnosed.

    If a new study by Canadian nutrition researchers is any indication, most cases of celiac disease remain undiagnosed.



    Photo: CC--NAIAD

    For anyone following the efforts by ImmusanT to develop a vaccine for celiac disease, the company's recent presentations at the 2017 International Celiac Disease Symposium (ICDS) in New Delhi, India, were welcome news.

    Nexvax2® is a therapeutic vaccine intended to protect against the effects of gluten exposure while maintaining a gluten-free diet in HLA-DQ2.5+ patients with celiac disease.

    The company announced at ICDS 2017 that it has presented data showing the immunologic basis for the early clinical effects of gluten in celiac disease.



    Can science bring any certainty to diagnosing seronegative celiac disease? Photo: CC--Saturnism

    Patients who have clinical, genetic and histological signs of celiac disease, but no serological markers, present a challenge when it comes to making a diagnosis. If the patient doesn't have elevated antibodies, what signs do doctors look for? What's the best way to evaluate the patient's natural history and response to a gluten-free diet?

    A team of researchers recently set out to outline a specific profile, and to evaluate the natural history and response to a gluten-free diet of patients with seronegative celiac disease.



    Enzyme Latiglutenase seems to improves symptoms in some celiac patients. Photo: CC--DeusXFlorida

    Enzyme Latiglutenase improves symptoms in some celiac patients, but which ones? Enzymes have shown some promise for treating celiac symptoms, but so far none has to improve histology or symptoms in celiac patients.

    There are currently several efforts underway to develop successful commercial enzyme treatments for celiac disease. Efforts include looking at the digestive enzymes in plants, such as the papaya and star fruits, including such predatory plants, such as the pitcher plant.



    Photo: CC--Thirteen of Clubs

    How tightly are doctors following current guidelines for diagnosing celiac disease?

    Current guidelines by the British Society of Gastroenterology recommend that doctors take at least four duodenal biopsy specimens at the time of upper gastrointestinal (UGI) endoscopy when looking for celiac disease. The practice has been shown to increase celiac diagnoses, and to reduced missed diagnoses.

    The Society recently sought to assess compliance with their own guidelines within their institution. Here's what they found.



    Image: CC--Robert Ashley

    Long ignored and dismissed as unscientific and crude, are intestinal worms destined to be the future of autoimmune disease treatments?

    Hookworms. Intestinal parasites. They sound gross. The thought of having one's gut infected with a parasitic worm generally makes people's skin crawl. Indeed, intestinal worms, like hookworm, have a bad reputation among health experts, and have been the subject of fierce public health campaigns seeking their eradication. However, researchers have also documented the gut healing abilities of parasites like hookworm.



    Photo: CC--Matt Brown

    Are we at the beginning of the end for celiac disease? The last few years have seen numerous advances in celiac diagnosis and treatment. People diagnosed recently and in the future face a very different world than that faced by celiacs just five or ten years ago.

    In the old days, the process of properly diagnosing involved blood tests, endoscopies, and biopsies. In the near future, a simple blood test may do the trick.



    Will new tests change the way we diagnose and treat celiac disease and diabetes? Photo: CC--AJC1

    The FDA has granted clearance for Immco Diagnostics' ELISA for celiac disease, and for Roche's Benchtop Analyzer. What does that mean?

    Immco's test is conducted as a solid phase immunoassay and is intended for the qualitative or semiquantitative detection of IgA or IgG antigliadin antibodies in human blood, and thus to aid in diagnosing patients with celiac disease or dermatitis herpetiformis in conjunction with other laboratory and clinical findings.



    Can a blood test change the way we diagnose celiac disease? Photo: CC--Keepingtime_CA

    Doctors attempting to diagnose celiac disease are often confronted by patients who have already given up gluten. For such patients, diagnostic guidelines currently call for a gluten challenge of at least 14 days, followed by duodenal biopsy. There isn't much good data on how many false-positive results are generated by this method. To get a better picture, a team of researchers recently studied responses to 14-day gluten challenge in subjects with treated celiac disease.



    Image: CC--Idaho National Laboratory

    We are very pleased to provide an exciting update on our progress on bringing our therapeutic drug "latiglutenase" and our diagnostic disease management tool "CypCel" to market for patients suffering with celiac disease.

    ImmunogenX is a clinical-stage company founded by dedicated scientists committed to bettering the lives of celiac disease patients. We are focused on celiac disease therapy, disease management and food safety. We acquired the assets of Alvine Pharmaceuticals in 2016 and are marching ahead with great confidence and enthusiasm and plan to start our final Phase 2 trial for latiglutenase later this year.



    Can doctors diagnose celiac disease correctly in the office without biopsy? Photo: CC--Enokson

    Can doctors diagnose celiac disease correctly at least 99 times out of 100 in the office without biopsy?

    A team of researchers recently set out to see if the non-biopsy approach can identify children with celiac disease with a positive predictive value (PPV) above 99% in clinical practice.

    They also wanted to compare the performance of different serological tests and to see if the suggested criteria can be simplified.



    Can blood tests alone accurately diagnose celiac disease? Photo: CC--Garland Cannon

    Until recently, duodenal biopsy was considered the gold standard for diagnosing celiac disease, but that is changing.

    A number of studies have shown that celiac disease can be diagnosed using serological tests alone, but many clinicians have yet to embrace this approach.

    In both retrospective and prospective studies, one research team showed that certain IgA-tissue transglutaminase antibodies levels can predict celiac disease in adults 100% of the time.



    Photo: CC--Pascal

    Designed to reduce or eliminate symptoms of gluten contamination in gluten-sensitive individuals, the product known as AN-PEP, marketed in the U.S. as Tolerase G, is a prolyl endoprotease enzyme, derived from Aspergillus niger, that has shown promise in breaking down gluten proteins.

    The latest news comes in the form of a small study that shows the enzyme to be effective in the stomach itself, where harshly acidic conditions render many enzymes ineffective.



    Photo: CC--Crobj

    Doctors diagnose celiac disease by confirming various clinical, genetic, serologic, and duodenal morphology features. Based on retrospective data, recent pediatric guidelines propose eliminating biopsy for patients with IgA-TTG levels more than 10-times the upper limit of normal (ULN), along with a few other criteria.

    One retrospective study showed that researchers using levels of IgA-TTG and total IgA, or IgA-TTG and IgG against deamidated gliadin (IgG-DGL) could identify patients both with and without celiac disease. A team of researchers recently set out to validate the positive and negative predictive values (PPV and NPV) of these diagnostic procedures.



    Can a vaccine work against celiac disease? Photo: MilitaryHealth

    Currently, a gluten-free diet is the only way to manage celiac disease. Can a celiac vaccine change that? One company thinks so. ImmusanT corporation has developed a therapeutic vaccine, Nexvax2, that is specifically designed to treat celiac disease. The vaccine is an adjuvant-free mix of three peptides that include immunodominant epitopes for gluten-specific CD4-positive T cells. The vaccine is designed to neutralize gluten-specific CD4-positive T cells to further antigenic stimulation.



    Photo: CC--Quinn Dombrowski

    A recent issue of JAMA, the US Preventive Services Task Force (USPSTF) critically examines screening for celiac disease in asymptomatic adults, adolescents, and children.

    Celiac disease exhibits a broad spectrum of symptoms, from subtle or no symptoms to severe malabsorption. Celiac diagnoses have increased significantly over the past few decades, in part because of greater awareness, but possibly because of an actual increase in disease rates. Researchers estimate current rates of celiac disease at 0.71% among US adults, and 0.76% among US children.



    Photo: CC--JFCherry

    From 2009 to 2014, the number of people with celiac disease in the United States held steady, while the number of undiagnosed individuals fell by about half.

    Mayo Clinic researchers, reviewing information from National Health and Nutrition Examination Surveys, say the increase in diagnosis likely stems from better detection, better celiac disease awareness, and/or possibly from the rising popularity of gluten-free diets.



    Photo: CC--Mike

    A number of researchers are looking to provide alternative or adjunct treatments to the gluten-free diet in celiac disease. Meanwhile, a number of companies are currently developing a wide variety of such options, ranging from various kinds of enzyme therapies, to treatments that eliminate celiac disease reactions, even to vaccines to inoculate celiac sufferers against their condition, perhaps allowing for full recovery and a return to non-gluten-free eating habits, as desired. At least, that is one dream.


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