Gluten Intolerance

[alexsami]

can gluten intolerance cause fat malabosorption? i had the elevated gliadin antiobdy, however gluten free for a month and then gluten for a week before endoscopy.....biopsy came back negative.....just wondering if gluten intolerance can cause fat malabsorption or do u need villi damage? can i assume i have a problem with gluten or since biopsy is negative should i just disregard it all......thanks

[mushroom]

Eating gluten for a week was not long enough to give an accurate biopsy result, unfortunately, no matter what the doctor said. Of course, the biopsy could have been negative anyway, but....

You are definitely having digesive problems with fat in the stool, whether celiac or not. We know that gluten can negatively impact the pancreas and the output of digestive enzymes, and we know it can also prevent the absorption of nutrients. So your options are to believe the blood work or to go back to eating gluten for 2-3 months to see if you can get a positive biopsy. But now, according to an interview posted on here yesterday, even the God of celiac, Dr. Alesio Fassano, says that the biopsy is not necessary if you meet all the other criteria - symptoms, positive blood work, positive genetic test, and response to the diet. And he was the one who originally called the biopsy "the gold standard" of diagnosis. So do you really want to do that? If you wanted to meet his new diagnostic criteria you could have the genetic testing done instead.

[Roda]

I had a positive biopsy and at that time I did not have fat malabsorption. My villi have healed and now if I get gluten I get it bad. So I don't think necessarily your villi have to be damaged to have steatorrhea.

[T.H.]

can gluten intolerance cause fat malabosorption? i had the elevated gliadin antiobdy, however gluten free for a month and then gluten for a week before endoscopy.....biopsy came back negative.....just wondering if gluten intolerance can cause fat malabsorption or do u need villi damage? can i assume i have a problem with gluten or since biopsy is negative should i just disregard it all......thanks

At this point, doctors don't know much of anything about gluten intolerance. It's only recently been studied enough to say that it likely exists, period. However, when they were looking at whether it exists, I believe that one of the 'proofs' was that the gluten caused problems, but no rise in antibody levels or blunting of villi (I wouldn't swear to that, but I think so).

That said - the idea that the biopsy is the 'gold standard,' which many doctors still adhere to, is actually being contested pretty strongly, even by one of the doctors who pushed hard to get it AS the gold standard originally! (Dr. Fassano).

You may want to look into it: if you google 'biopsy not the gold standard+ celiac disease' or other similar terms, the information will come up.

From what I'm reading, some doctors now consider positive blood work OR positive biopsy, plus a positive reaction to eliminating gluten from the diet, as indicative of celiac disease. Although I believe a number also urge one to be tested for the genes, as well, to try and double check it.

Did you have any positive effect on those weeks that you went gluten free, by any chance? Or was there no noticeable change?

Part of the reason for the change are studies like this one:

From Open Original Shared Link

Children with positive bloodwork, but either pos. or neg. biopsies, were studied. If they were put on a gluten-free diet, their symptoms improved AND their bloodwork improved, whether or not their biopsies were positive, indicating a higher likelihood that they were actually celiac.

Another, different study on pos blood work and neg biopsies also showed that a negative biopsy may not always mean celiac negative, as it were.

"Our results demonstrate that metabolic alterations may precede the development of small intestinal villous atrophy and provide a further rationale for early institution of gluten-free diet in patients with potential celiac disease, as recently suggested by prospective clinical studies,"

from Open Original Shared Link

[alexsami]

At this point, doctors don't know much of anything about gluten intolerance. It's only recently been studied enough to say that it likely exists, period. However, when they were looking at whether it exists, I believe that one of the 'proofs' was that the gluten caused problems, but no rise in antibody levels or blunting of villi (I wouldn't swear to that, but I think so).

That said - the idea that the biopsy is the 'gold standard,' which many doctors still adhere to, is actually being contested pretty strongly, even by one of the doctors who pushed hard to get it AS the gold standard originally! (Dr. Fassano).

You may want to look into it: if you google 'biopsy not the gold standard+ celiac disease' or other similar terms, the information will come up.

From what I'm reading, some doctors now consider positive blood work OR positive biopsy, plus a positive reaction to eliminating gluten from the diet, as indicative of celiac disease. Although I believe a number also urge one to be tested for the genes, as well, to try and double check it.

Did you have any positive effect on those weeks that you went gluten free, by any chance? Or was there no noticeable change?

Part of the reason for the change are studies like this one:

From Open Original Shared Link

Children with positive bloodwork, but either pos. or neg. biopsies, were studied. If they were put on a gluten-free diet, their symptoms improved AND their bloodwork improved, whether or not their biopsies were positive, indicating a higher likelihood that they were actually celiac.

Another, different study on pos blood work and neg biopsies also showed that a negative biopsy may not always mean celiac negative, as it were.

"Our results demonstrate that metabolic alterations may precede the development of small intestinal villous atrophy and provide a further rationale for early institution of gluten-free diet in patients with potential celiac disease, as recently suggested by prospective clinical studies,"

from Open Original Shared Link

wow, thanks for the great responses....appreciate it