Diagnostic Criteria

[Matisse]

Note that Dr. Alessio Fasano who was basically the father of endoscopy as being the gold standard is now less certain. He gives 5 diagnostic criteria and says you need to meet 4 to be diagnosed with celiac. Thought folks might find this abstract interesting.

Celiac disease diagnosis: simple rules are better than complicated algorithms.

Catassi Carlo; Fasano Alessio (Profiled Author: Alessio Fasano)

Mucosal Biology Research and Center for Celiac Research, University of Maryland, School of Medicine, Baltimore, MD 21201, USA.

The American journal of medicine 2010;123(8):691-3.

PubMedAbstract

Celiac disease is the only treatable autoimmune disease, provided that a correct diagnosis is achieved and a strict, lifelong gluten-free diet is implemented. The current diagnostic algorithm for celiac disease includes initial screening serological tests, followed by a confirmatory small intestinal biopsy showing the autoimmune insult typical of celiac disease. The biopsy, considered the diagnostic gold standard, has been recently questioned as a reliable and conclusive test for every case. Indeed, the wide variability of celiac disease-related findings suggests that it is difficult to conceptualize the diagnostic process into rigid algorithms that do not always cover the clinical complexity of this disease. Instead we find clinically useful the shifting to a quantitative approach that can be defined as the "4 out of 5" rule: the diagnosis of celiac disease is confirmed if at least 4 of the following 5 criteria are satisfied: typical symptoms of celiac disease; positivity of serum celiac disease immunoglobulin, A class autoantibodies at high titer; human leukocyte antigen (HLA)-DQ2 or DQ8 genotypes; celiac enteropathy at the small bowel biopsy; and response to the gluten-free diet.

[cassP]

i love how the Italians are always the pioneers on this topic, as i am 1/2 Italian

and 1/2 Irish... gee thanku double Celiac risk

[ravenwoodglass]

  On 2/26/2011 at 5:12 AM, Matisse said:

Note that Dr. Alessio Fasano who was basically the father of endoscopy as being the gold standard is now less certain. He gives 5 diagnostic criteria and says you need to meet 4 to be diagnosed with celiac. Thought folks might find this abstract interesting.

Celiac disease diagnosis: simple rules are better than complicated algorithms.

Catassi Carlo; Fasano Alessio (Profiled Author: Alessio Fasano)

Mucosal Biology Research and Center for Celiac Research, University of Maryland, School of Medicine, Baltimore, MD 21201, USA.

The American journal of medicine 2010;123(8):691-3.

PubMedAbstract

Celiac disease is the only treatable autoimmune disease, provided that a correct diagnosis is achieved and a strict, lifelong gluten-free diet is implemented. The current diagnostic algorithm for celiac disease includes initial screening serological tests, followed by a confirmatory small intestinal biopsy showing the autoimmune insult typical of celiac disease. The biopsy, considered the diagnostic gold standard, has been recently questioned as a reliable and conclusive test for every case. Indeed, the wide variability of celiac disease-related findings suggests that it is difficult to conceptualize the diagnostic process into rigid algorithms that do not always cover the clinical complexity of this disease. Instead we find clinically useful the shifting to a quantitative approach that can be defined as the "4 out of 5" rule: the diagnosis of celiac disease is confirmed if at least 4 of the following 5 criteria are satisfied: typical symptoms of celiac disease; positivity of serum celiac disease immunoglobulin, A class autoantibodies at high titer; human leukocyte antigen (HLA)-DQ2 or DQ8 genotypes; celiac enteropathy at the small bowel biopsy; and response to the gluten-free diet.

I almost died because his criteria was what was my doctors considered to be needed for diagnosis. I almost was because I am seronegative and no doctor would even endo for celiac with negative blood tests. I also have to disagree with the need to have '(HLA)-DQ2 or DQ8 genotypes' since there are celiacs that don't carry those two genes and new celiac associated genes are being discovered as more is being learned. IMHO the best and most conclusive test is the diet even if the other tests are negative.

[MsCurious]

  On 2/26/2011 at 5:12 AM, Matisse said:

Note that Dr. Alessio Fasano who was basically the father of endoscopy as being the gold standard is now less certain. He gives 5 diagnostic criteria and says you need to meet 4 to be diagnosed with celiac. Thought folks might find this abstract interesting.

Celiac disease diagnosis: simple rules are better than complicated algorithms.

Catassi Carlo; Fasano Alessio (Profiled Author: Alessio Fasano)

Mucosal Biology Research and Center for Celiac Research, University of Maryland, School of Medicine, Baltimore, MD 21201, USA.

The American journal of medicine 2010;123(8):691-3.

PubMedAbstract

Celiac disease is the only treatable autoimmune disease, provided that a correct diagnosis is achieved and a strict, lifelong gluten-free diet is implemented. The current diagnostic algorithm for celiac disease includes initial screening serological tests, followed by a confirmatory small intestinal biopsy showing the autoimmune insult typical of celiac disease. The biopsy, considered the diagnostic gold standard, has been recently questioned as a reliable and conclusive test for every case. Indeed, the wide variability of celiac disease-related findings suggests that it is difficult to conceptualize the diagnostic process into rigid algorithms that do not always cover the clinical complexity of this disease. Instead we find clinically useful the shifting to a quantitative approach that can be defined as the "4 out of 5" rule: the diagnosis of celiac disease is confirmed if at least 4 of the following 5 criteria are satisfied: typical symptoms of celiac disease; positivity of serum celiac disease immunoglobulin, A class autoantibodies at high titer; human leukocyte antigen (HLA)-DQ2 or DQ8 genotypes; celiac enteropathy at the small bowel biopsy; and response to the gluten-free diet.

Thanks for posting this. I have postponed my biopsy until additional serum tests are completed, and then 4 of the five will have been met. I was thinking if they came back positive, I wouldn't do the biopsy. I think reading this just sealed the deal for me. No need for cutting when its evident without. At this point in time, for me its still possible that it is other food allergies or intolerances, so I'm just waiting for results.