New! Biopsy For The Folks On gluten-free Diet

[lcarter]

WOW! This is great news! Hopefully it will be available real soon to those of us who are asked to do a gluten challenge so that biopsies can be done:

Patients who do not get a confirmed celiac diagnosis from standard tests could obtain one from an in vitro gliadin challenge, in which biopsied duodenal mucosa are tested using the toxic part of wheat gluten called gliadin, according to a study in the American Journal of Gastroenterology. University of Salerno researchers said the challenge method is helpful for patients who are on a gluten-free diet prior to the biopsy because they do not have to revert to eating gluten foods to achieve the diagnosis.

In Vitro Gliadin Challenge: Diagnostic Accuracy and Utility for the Difficult Diagnosis of Celiac Disease

The American Journal of Gastroenterology , (27 September 2011) | doi:10.1038/ajg.2011.311

Raffaella Tortora, Ilaria Russo, Giovanni D De Palma, Alessandro Luciani, Antonio Rispo, Fabiana Zingone, Paola Iovino, Pietro Capone and Carolina Ciacci

Abstract

OBJECTIVES: Diagnosis of celiac disease is difficult when treatment with gluten-free diet (GFD) is started before diagnosis and/or when the results of tests are inconsistent. The objective of this study was to evaluate the in vitro gliadin challenge.

METHODS: The study cohort included patients without celiac disease (negative controls, n=57), patients with celiac disease (positive controls, n=166 untreated and n=55 on GFD), and patients with difficult diagnosis (n=59). All patients underwent endoscopy for collection of duodenal samples, which served for the diagnosis of celiac disease and for the in vitro evaluation of the gliadin-induced mucosal expression of seven inflammatory markers: PY99, ICAM-1 (intercellular cell adhesion molecule), HLA-DR, CD3, CD25, CD69, and transglutaminase 2 IgA. Diagnostic work-up for celiac disease included the search of specific serum antibodies. Patients of the difficult diagnosis group were asked to stop GFD for repeated search of these antibodies under untreated conditions. The area under the receptor-operated curve (ROC) was used for statistical analyses on accuracy.

RESULTS: HLA-DR had the highest accuracy for celiac disease diagnosis in analyses on negative controls and positive controls also excluding patients on GFD (area under ROC=0.99). Accuracy of test did not increase combining data of HLA-DR with data of other markers. Findings were similar in the 39 patients of the difficult diagnosis group undergoing the search celiac disease-specific antibodies under untreated conditions.

CONCLUSIONS: The in vitro response of mucosal HLA-DR to gliadin is an accurate tool for the diagnosis of celiac disease also in patients with difficult diagnosis.

[GlutenFreeManna]

METHODS: The study cohort included patients without celiac disease (negative controls, n=57), patients with celiac disease (positive controls, n=166 untreated and n=55 on GFD), and patients with difficult diagnosis (n=59). All patients underwent endoscopy for collection of duodenal samples, which served for the diagnosis of celiac disease and for the in vitro evaluation of the gliadin-induced mucosal expression of seven inflammatory markers: PY99, ICAM-1 (intercellular cell adhesion molecule), HLA-DR, CD3, CD25, CD69, and transglutaminase 2 IgA. Diagnostic work-up for celiac disease included the search of specific serum antibodies. Patients of the difficult diagnosis group were asked to stop GFD for repeated search of these antibodies under untreated conditions. The area under the receptor-operated curve (ROC) was used for statistical analyses on accuracy.

RESULTS: HLA-DR had the highest accuracy for celiac disease diagnosis in analyses on negative controls and positive controls also excluding patients on GFD (area under ROC=0.99). Accuracy of test did not increase combining data of HLA-DR with data of other markers. Findings were similar in the 39 patients of the difficult diagnosis group undergoing the search celiac disease-specific antibodies under untreated conditions.

CONCLUSIONS: The in vitro response of mucosal HLA-DR to gliadin is an accurate tool for the diagnosis of celiac disease also in patients with difficult diagnosis.

That sounds promising but I'm confused about the part I bolded above. Why did they ask those patients to go back to eating gluten for the test?

[Takala]

No, sounds like they said STOP the Gluten Free Diet, then they collected tissue samples and put 'em in a petri dish sort of environment and hit 'em with the gliadin protein- bombs to watch what happens.

Interesting.

We could prolly put a webcam on my belly and get the same results after eating a bad brand of chips. "Look, it's expanding!"

[RiceGuy]

No, sounds like they said STOP the Gluten Free Diet, then they collected tissue samples and put 'em in a petri dish sort of environment and hit 'em with the gliadin protein- bombs to watch what happens.

Wouldn't that be the same as eating gluten?

We could prolly put a webcam on my belly and get the same results after eating a bad brand of chips. "Look, it's expanding!"

Heh, a "bellycam"?

Seriously though, this does sound promising, and I'd like to think it'd be developed to the point that it'd be extremely reliable, and become the standard. That is unless/until something better comes along.

[lcarter]

WOW! This is great news! Hopefully it will be available real soon to those of us who are asked to do a gluten challenge so that biopsies can be done:

Patients who do not get a confirmed celiac diagnosis from standard tests could obtain one from an in vitro gliadin challenge, in which biopsied duodenal mucosa are tested using the toxic part of wheat gluten called gliadin, according to a study in the American Journal of Gastroenterology. University of Salerno researchers said the challenge method is helpful for patients who are on a gluten-free diet prior to the biopsy because they do not have to revert to eating gluten foods to achieve the diagnosis.

In Vitro Gliadin Challenge: Diagnostic Accuracy and Utility for the Difficult Diagnosis of Celiac Disease

The American Journal of Gastroenterology , (27 September 2011) | doi:10.1038/ajg.2011.311

Raffaella Tortora, Ilaria Russo, Giovanni D De Palma, Alessandro Luciani, Antonio Rispo, Fabiana Zingone, Paola Iovino, Pietro Capone and Carolina Ciacci

Abstract

OBJECTIVES: Diagnosis of celiac disease is difficult when treatment with gluten-free diet (GFD) is started before diagnosis and/or when the results of tests are inconsistent. The objective of this study was to evaluate the in vitro gliadin challenge.

METHODS: The study cohort included patients without celiac disease (negative controls, n=57), patients with celiac disease (positive controls, n=166 untreated and n=55 on GFD), and patients with difficult diagnosis (n=59). All patients underwent endoscopy for collection of duodenal samples, which served for the diagnosis of celiac disease and for the in vitro evaluation of the gliadin-induced mucosal expression of seven inflammatory markers: PY99, ICAM-1 (intercellular cell adhesion molecule), HLA-DR, CD3, CD25, CD69, and transglutaminase 2 IgA. Diagnostic work-up for celiac disease included the search of specific serum antibodies. Patients of the difficult diagnosis group were asked to stop GFD for repeated search of these antibodies under untreated conditions. The area under the receptor-operated curve (ROC) was used for statistical analyses on accuracy.

RESULTS: HLA-DR had the highest accuracy for celiac disease diagnosis in analyses on negative controls and positive controls also excluding patients on GFD (area under ROC=0.99). Accuracy of test did not increase combining data of HLA-DR with data of other markers. Findings were similar in the 39 patients of the difficult diagnosis group undergoing the search celiac disease-specific antibodies under untreated conditions.

CONCLUSIONS: The in vitro response of mucosal HLA-DR to gliadin is an accurate tool for the diagnosis of celiac disease also in patients with difficult diagnosis.

My understanding of this is that: first, they did biopsies on each of the three groups. Then, they had the "hard to diagnose" group drop the gluten free diet [after the biopsies]. It was done this way so that the blood antibody tests could be done while on a GFD, in order to cross check that these patients are positive on both tests. It was a scientific way to verify the validity of the in vito testing. Furthermore, the abstract of the article and the preceding paragraph [starting with "Patients who do not get confirmed..."] came from from Digestive Health Smart Briefs, by Craig H. Lubin, MD and the American College of Gastroenterology. So, their conclusion on the success of in vitro testing as a diagnostic tool for possible celiac disease in patients who are already on a GFD, is the conclusion stated by the scientists and doctors, not my conclusions. That is why this is so fantastic! Hope this helps. [see:[url=Open Original Shared Link

[lcarter]

here's another reference to this new type of test: Open Original Shared Link

[salexander421]

My understanding of this is that: first, they did biopsies on each of the three groups. Then, they had the "hard to diagnose" group drop the gluten free diet [after the biopsies]. It was done this way so that the blood antibody tests could be done while on a GFD, in order to cross check that these patients are positive on both tests. It was a scientific way to verify the validity of the in vito testing. Furthermore, the abstract of the article and the preceding paragraph [starting with "Patients who do not get confirmed..."] came from from Digestive Health Smart Briefs, by Craig H. Lubin, MD and the American College of Gastroenterology. So, their conclusion on the success of in vitro testing as a diagnostic tool for possible celiac disease in patients who are already on a GFD, is the conclusion stated by the scientists and doctors, not my conclusions. That is why this is so fantastic! Hope this helps. [see:[url=Open Original Shared Link

This was my take as well.

[GretaJane]

That is so awesome. My 4 yo son has been on a GFD since about 1 month old due to chronic diarrhea. Has has failed every gluten challenge. He fit the genetic profile for highest risk for celiac. He has never eaten enough gluten for antibody testing or biopsy. My husband told me he thinks I am making it all up and doesn't believe our son is Celiac. So a proper diagnosis is key for him to takethis seriously. My husband is fine with not feeding him anything that looks like gluten, but laughs at restricting anything that may have small amounts of it. Good thing I am the one responsible for feeding him 99% of the time. I do not want to put our son back on gluten for testing purposes because he gets diarrhea so bad I could not send him to school. Can't wait for this test to become available.

[ravenwoodglass]

This appears to be an invitro form of the mucosal challenge used in some countries. In that one they insert a gluten suppository or use a gluten swab in the cheek and then biopsy the tissue a few hours later. Both methods to me seem much more humane and specific than the barbaric practice of putting us through a food challenge that makes us sick for months and can have dire consequences.

[Bubba's Mom]

It's wonderful that they're developing better tests. Still, in most cases the Dr.s don't seem to catch up with the current tests/treatments? Most will just order the standard old blood tests.

They need some Pharmacutical company to have their hand in this test in some way. They'll get out there and promote it!

[domesticactivist]

Is there any way to get the mucosal challenge here in the states?

[Leper Messiah]

Nice post, always good to see progress

I'm in the undiagnosed bracket so be interesting if this becomes widely available, although it won't affect me that much, I'll still be avoiding gluten, it'd be nice to have some certainty.

[lcarter]

I sure hope that this in vitro test works and becomes standard practice. It will make it it sooooo much easier to diagnose! I am one of those "old folks" who slipped through the net before Celiac was even on the radar and diagnosed with an elimination diet and challenge. Since I get so ill when exposed even slightly, it's not recommended to do another challenge in order to do biopsies at this late date. So, when my daughter was recently diagnosed with similar problems, I decided to have the genetic test to help clarify her situation. But, surprise-surprise, according to Prometheus labs, I don't have DQ2 or DQ8, so they say very little chance it's Celiac. I'm not convinced they have all the answers yet, so will stay gluten-free + DF ..... and healthy in the meantime.