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Found 43 results

  1. Hello! I am a 19 year old girl who has been dealing with stomach issues for years. However, recently it has seemed to get worse. I have always thought I had a little bit of lactose intolerance, so I stay away from milk usually and take lactaid when i do. I started adderall at the beginning of the summer, but this has been for years. I have always had frequent bowel movements, but in the past two years it has gotten worse. I must go to the bathroom within 10 minutes of eating. I often pass just small stools, usually with mucus or just small fatty stools. I have lost about 30 pounds in a year or so, and have little appetite. I do not know if that is from medicine or something else, as it started before the medicine. I have always had "brain fog" often forgetting what i am saying half way through a sentence, and forgetting things short term VERY often. I have diarrhea alternating with constipation, and can sit on the toilet for a while before even producing a tiny stool. I have always been very fatigued, blaming it on being a college student, but it gets to the point where i dont want to do anything. I am on zoloft for anxiety and depression, and this is not helping. I spend all day on the toilet or waiting to see if I need to use the bathroom. I also urinate VERY often and have issues sleeping or doing anything if I have not immediately before used the bathroom. Please help and let me know if anyone thinks this looks like celiac! I now can eat pretty much anything and not gain weight, but have little appetite usually. My stomach constantly gurgles and rumbles, as well as constantly having small mouth sores for a large part of my life. My menstrual periods are irregular lately, and it is just all over really not fun. Please help me stop this. symtpoms- mucus/liquidy stool or diarrhea alternating with constipation frequent small bowel movements and urination 30 pounds weight loss no reason no appetite depression irregular menstrual periods rumbling of stomach mouth sores lactose intolerance
  2. Celiac.com 12/03/2012 - Gluten sensitivity has recently been added to the spectrum of gluten-related disorders, but precise diagnostic markers do not yet exist. A research team recently set out to understand the blood test pattern of gluten sensitivity, and to compare it with the blood test pattern seen in celiac disease. The researchers included U. Volta, F. Tovoli, R. Cicola, C. Parisi, A. Fabbri, M. Piscaglia, E. Fiorini, G. Caio, of the Department of Clinical Medicine at University of Bologna's St. Orsola-Malpighi Hospital in Bologna, Italy. For their study, the researchers looked at blood samples from 78 patients with gluten-sensitivity and 80 patients with celiac disease. They assessed levels of immunoglobulin (Ig)G/IgA antigliadin antibodies (AGA), IgG deamidated gliadin peptide antibodies (DGP-AGA), IgA tissue transglutaminase antibodies (tTGA), and IgA endomysial antibodies (EmA). They found positive readings for IgG AGA in 56.4% of patients with gluten-sensitivity, and in 81.2% of patients with celiac disease. Antibody levels for both groups were in the high range. They found IgA AGA in 7.7% of patients with gluten-sensitivity, and in 75% of patients with celiac disease, which shows lower enzyme-linked immunosorbent assay activities in gluten-sensitivity patients than in patients with celiac disease. Only 1 of the 78 patients with gluten-sensitivity tested positive for IgG DGP-AGA, which was found in nearly 90% of patients with celiac disease. All patients with gluten-sensitivity tested negative for IgA tTGA and IgA EmA, while 98.7% of patients with celiac disease tested positive for IgA tTGA, and 95% were positive for IgA EmA. Patients with gluten-sensitivity presented a variety of intestinal and extra-intestinal symptoms, including abdominal pain, bloating, diarrhea, constipation, foggy mind, tiredness, eczema/skin rash, headache, joint/muscle pain, numbness of legs/arms, depression, and anemia. Small intestinal mucosa for these patients was either normal or only mildly abnormal. The data from these blood tests show that more than half of patients with gluten sensitivity will test positive for IgG AGA, and a small number will test positive for IgA AGA, but none will show positive results for EmA, tTGA, and DGP-AGA, which are the specific markers of celiac disease. Source: J Clin Gastroenterol. 2012 Sep;46(8):680-5.
  3. Celiac.com 11/26/2012 - I speak to many people from across the country, and internationally, who contact me requesting help. The issues they face are summarized into three categories: individuals with celiac disease who do not have their disease under good control; those with gluten sensitivity who remain less than healthy despite their gluten-free diet; individuals, and this is a big one, who are convinced that they have a gluten problem, due to self experimentation, but who are unable to get any corroboration or support from their doctors. Having been immersed in this field for almost twenty years, it is frustrating not having a laboratory test that will reliably state whether someone has celiac disease or if gluten sensitivity has been ever present. The good news is that this situation has improved. It’s not perfect, but it’s better than it has been, and I wanted to share this data with you and those you care about. These newly available tests can have a big impact on those who need a diagnosis, as well as those who are already gluten-free but want to know why they are not enjoying the good health they desire. I have no affiliation with either of the labs I mention so there is no conflict of interest in my recommendations. The first lab, Cyrex Laboratories, is the newest lab specializing in gluten intolerance in the US. It currently offers four different profiles. There is a fifth one coming, hopefully very soon, that is also very exciting and a description of it follows. I will provide the data that the lab lists in their brochure for each test along with my personal opinion as to its benefit and use. Here at HealthNOW Medical Center we have been utilizing these tests for almost five months—the lab just opened in January after three years of research and passing governmental licensing requirements. Array 1: Gluten Sensitivity “This is a saliva test which is recommended for patients who: Are suspected of having mucosal abnormality Have relatives with celiac disease Have type 1 diabetes Have autoimmune thyroid disorder Have relatives with autoimmune disorders, especially, multiple sclerosis, diabetes and arthritis.” This is an easy screening test for those who wonder if they have gluten sensitivity or celiac disease based on their own symptoms or symptoms in their family. As a saliva test it’s very easy to perform (no blood draw is needed) and it’s the least expensive of all the tests offered. When utilizing saliva, a test is only as accurate as the strength of the salivary immune system. Due to this limitation, the lab also measures this as part of the panel. In the past, labs would not include this measurement, sometimes resulting in false negative results—something we all wish to avoid. Array 2: Intestinal Barrier Integrity Screen “Intestinal barrier integrity plays a vital role in the overall health and well-being of patients. This blood test is recommended for patients who: Have gut dysbiosis, which appears to be resistant to standard therapy Are suspected of having intestinal mucosal damage Complain of food allergy and intolerance Present multiple symptom complaints (including chronic fatigue syndrome) Suffer from abnormal immune cell count and function (including autoimmune diseases) May suffer from depression or neuroautoimmunity [including such conditions as: thyroid disease, arthritis, myocarditis, dermatitis, endocrinopathy, osteoarthritis and pernicious anemia] ” Healing a leaky gut is a very big part of regaining one’s health after a diagnosis of gluten intolerance. Gluten has caused damage to the lining of the small intestine and the presence of this damage is thought to be an initiator of the many “non-digestive” symptoms and diseases that are associated with gluten, including autoimmune disease. Prior to this test two substances have been traditionally used to measure a leaky gut: lactulose and mannitol. The disappointment of the test lay within the sensitivity, or I should say lack of sensitivity, to adequately diagnose subtle leakiness vs. gross leakiness such as that found in advanced celiac disease and complete villous atrophy. Much as an intestinal biopsy can miss the early and more subtle damage to the villi of the small intestine [its lining], so too does the lactulose/mannitol test seem to miss the more subtle changes in a leaky gut. This test will detect increased permeability through the cells that line the small intestine, as well as increased permeability between the cells. Clinically we use this test as a gauge of how we are progressing clinically rather than as a first tier diagnostic tool. There is no sense in measuring a leaky gut when it’s obviously there. But to prove that a clinical program is producing results or to perhaps show a less than compliant patient that their indiscretions are creating problem, this is an excellent test. Array 3: Comprehensive Gluten Sensitivity & Autoimmunity “To broaden the view of celiac disease and gluten sensitivity, our doctors can better diagnose the disorder by assessing antibody production against an array of protein, enzyme and peptide antigens. This blood test is recommended for patients who: Have gut dysbiosis—poor probiotic balance Are suspected of having intestinal mucosal damage—this means damage to the lining of the small intestine Complain of food allergies Complain of chemical hypersensitivity Present multiple symptom complaints (including chronic fatigue syndrome and Fibromyalgia) Suffer from abnormal immune cell count and function May suffer from depression or neuroautoimmunity [see below] Neuroautoimmune patients to consider: thyroid, arthritis, myocarditis, dermatitis, endocrinopathy, polyendocrinopathy, osteoarthritis and pernicious anemia” This panel is the broadly inclusive blood test designed to measure both celiac disease and gluten sensitivity. Because this test measures several aspects of the protein structure (rather than just the single protein fragment heretofore analyzed), we believe it will take many of the false negatives out of the picture—certainly a welcome change. Despite feeling better when removing gluten from their diets, patients like to confirm their own experience with a third party lab test. In the past, lab tests were so riddled with false negatives that we had to encourage patients not to discount their personal experience with a gluten-free diet, despite the absence of correlation with the lab test. This approach was not always successful and at times patients returned to gluten simply because they had no lab test to verify the truth. Inevitably they would return to us many months later, feeling worse than ever and ready to, once again, look at a gluten-free diet. This panel is more sensitive and specific than any we have had in the past, thereby reducing false negatives greatly. A patient does have to be consuming gluten for this profile to be accurate. Array 4: Gluten-Associated Cross-Reactive Foods Complete normalization of gut lesions is very rare in adult patients with celiac disease (8%), despite compliance with the gluten-free diet. This may be due to cross-reactions with an array of foods. This blood test is recommended for patients who: Have gluten sensitivity or celiac disease. Are non-responsive on a gluten-free diet—in other words don’t feel better. Have gut dysbiosis [not enough healthy bacteria and too many unhealthy ones], which appears to be resistant to standard therapy. Have an autoimmune disorder. This panel is very exciting and we are already seeing a dramatic impact on our patients. When one has eliminated gluten (and often dairy) from one’s diet, it obviously takes a big commitment. The last thing such a person might want to hear is that there are other foods they may also need to eliminate. Consider this: What if a temporary dietary change of eliminating foods that are confirmed as problematic on a laboratory test resulted in the difference between continued ill health and good health? Now, perhaps, it sounds like a good idea. That is exactly what we found in patients who were being extremely vigilant about their diet but still felt “glutenated” or just ill and the cause was not being found. Cross-reactive foods are foods with a protein structure similar to gluten’s that, upon ingestion, confuse one’s immune system into thinking that it has ingested gluten. The proteins are confused, one for another, and the reaction is as negative as if one has consumed gluten. This panel looks at twenty five possible foods (mostly in the grain and dairy families) to which one could be experiencing a cross-reactivity reaction. While it definitely takes a further commitment to confront more dietary change, our current patients consider it well worth it based on their health improvement. Finally, Array 5 that is not yet released, will focus on possible autoimmune reactions occurring from gluten. Autoimmune diseases can be “in the works” so to speak for well over a decade before the body experiences its first symptom. As the third leading cause of death in this country and with no known cure, any forewarning of autoimmune activity would be an excellent tool. This test provides another much needed tool for those patients who, although know they are gluten intolerant, cheat on their diet with seeming impunity—meaning they don’t feel any ill effects from having done so. Array 5 will be able to reveal what is occurring on a deeper level of the body such that the patient can see where gluten may be beginning to create autoimmune tendencies in certain organs or systems that he or she cannot feel. The second laboratory I want to mention is Enterolab. Although Enterolab is not new, they are unique. A few things make them different from all other labs I know about: You don’t have to work with a doctor to receive a lab test. Enterolab works directly with the patient on-line. They will send you a test kit after you have paid them and test results are emailed to the customer. Enterolab uses stool testing for their celiac and gluten sensitivity panels. They have a unique technology that allows them to test for these conditions even if the patient has not been eating gluten. They offer genetic testing as well as testing for other food intolerances. Once again, no doctor referral is required. I believe these tests offer benefit not only for those who need a diagnosis but also for those with a diagnosis who are not yet enjoying ideal health. I hope you found this informative. Please do feel free to contact me regarding any further questions that you may have. Our clinic, HealthNOW is a destination clinic and we treat patients from across the country as well as internationally. We are here to help. To your good health!
  4. Hi everyone! I'm new here and about to face a gluten challenge... To recap, I've suffered with bad gastro symptoms for my whole life, but they got worse in my teen years (I'm 26 now). In 2006 I had the TTG blood test for coeliac disease, which came back positive with incredibly high numbers. I then had a biopsy which came back negative, so I was sent away with a diagnosis of IBS. My symptoms continued and I wasn't taken seriously again until 2010 where I had the TTG blood test again. They said sometimes the stomach biopsy can only take from healthy tissue and miss the unhealthy tissue if it's patchy, so if the results were positive they would do a more detailed biopsy. This time the blood results came back completely negative. However, this year I had been on and off gluten free diets and hadn't eaten wheat bread or pasta for years. I hadn't completely eliminated gluten, but certainly wasn't eating a lot. This year I was put under a dietitian and put on the low-FODMAP diet for IBS. I showed some improvement but my symptoms didn't completely clear up. Mainly diarrhea (steatorrhea), cramps, bloating, nausea. The diet is very low in gluten but not gluten free. So now my dietitian and gastroenterologist have looked through my history and think that they may have missed affected patches with the first biopsy and then I had a false negative result in 2010 because I wasn't eating enough gluten... and they want me to do a gluten challenge this month and then have more tests. Which means I have to stuff my face with it for a month or so to get the antibodies back then have blood tests and biopsies again! I just wondered if anybody else has done this and what their experiences were? I ate two pieces of bread on Tuesday evening and was in agony all day Wednesday and yesterday. I haven't had the courage to eat any more as I am so terrified to feel like I used to... I became agoraphobic and didn't want to leave the house because I had diarrhea all the time and didn't even feel like socialising because I felt so rubbish. I do want a proper diagnosis because I think all signs point to coeliac disease, but just wondered if anyone had some advice or information from doing a similar gluten challenge? Thanks!
  5. Celiac.com 09/08/2011 - What started in January as a quiet and limited campaign by Subway to test gluten-free rolls and brownies in the Dallas market, then spread to a few Portland outlets, has rapidly grown into a plan to include more than 500 stores. So far, Subway has been "very pleased" with its tests, and has gotten an "overwhelmingly positive" response from customers. Customers have deluged Subway with requests for a wider roll out, but the company remains committed to getting the process right from R&D to supply to in-store training, all with an eye toward customer satisfaction, says Mark Christiano, Subway's Baking Specialist in the R&D Department. To Subway's credit, they are eager to meet their customers' demands, but cautious to get the entire process right. From product quality to preparation and customer satisfaction, Subway seems committed to getting it right. Subway does plan to expand both the gluten-free tests, and, eventually, incorporate gluten-free options into their menus, but the process will be slow and meticulous, according to Christiano. "We will take our time with this and make sure we deliver these products to the consumer the right way. If it was easy to do, everyone would have gluten-free available. Obviously it's not," he said. Still, rolling out gluten-free bread represents a huge opportunity for Subway. The National Restaurant Association listed gluten-free among the top five culinary themes for 2011. A majority of that market growth will come from the U.S. food service industry, which is expected to grow by more than $500 million by 2014. Even though customers may clamor for more gluten-free offerings, it is important that companies not just chase a dollar, but that they deliver quality gluten-free service that matches their gluten-free product. For their part, Subway is to be commended for putting such a serious amount of R&D into their gluten-free offerings. Their effort to provide both a quality product and to deliver that product consistently and with an eye toward customer satisfaction sets the bar for how to go about it. "(Gluten intolerance) doesn't impact a large mass of people. We're not judging these tests on sales, but instead on what we're able to do for a handful of our customers and their feedback," Kevin Kane, manager of public relations for Subway said. "It's not a money making thing; it's just the right thing to do." As Subway's efforts begin to pan out, look for more gluten-free offerings at your local outlet. Just the small trial of gluten-free rolls and brownies in Dallas offered logistical challenges. Christiano said the company spent about three years in development, followed by extensive training to make sure everyone was on board. The company went as far as working with an undisclosed supplier using a recently purchased gluten-free facility. Beyond the R&D and supply chain efforts to deliver quality raw materials, Subway has taken a great deal of time to design and implement a comprehensive in-store training program that will help them deliver a consistently high-quality and truly gluten-free "Having these items on the menu changes the entire way of doing things. It needs to be taken very seriously. The methods of handling this food have to be followed to a T," Christiano said. This includes extensive instructions, presentations and demonstrations, as well as monthly meetings to reinforce the process. Under Subway's new guidelines, whenever a customer orders a gluten-free roll or brownie, the line staff will wipe down the entire counter of any crumbs. They will then wash their hands and change their gloves. The gluten-free rolls and brownies are pre-packaged on fresh deli paper, and the staff use a single-use, pre-packaged knife for cutting. Each gluten-free sandwich will be made and delivered from order to point-of-sale by the same person, as opposed to being passed down the line in the traditional Subway format. Customers can watch the process from beginning to end. Most importantly, "If they don't like what they see, they can start it over. It's important that our customers feel comfortable and safe," Christiano said. "Nobody is going to die from this, but people get very sick if it's not done right. We want to provide them with a place to eat where they don't have to worry about that." Rather than just jumping on the gluten-free band-wagon, it sounds like Subway has committed to delivering a quality gluten-free experience from start to finish. Stay tuned to learn about their ongoing gluten-free product trials and their efforts to expand those offerings throughout their chain. Source: http://www.qsrweb.com/article/183399/Subway-expands-gluten-free-test
  6. Are you are interested in getting tested for celiac disease but would like to use an affordable and reliable company—perhaps one that even offers the option of confidential celiac disease blood screening? If your answer is yes to any part of this question I would highly recommend ClickMDLab.com. ClickMDLab.com is an online company that offers celiac disease testing via certified LabCorp laboratories, which are conveniently located throughout the USA. ClickMDLab.com offers a confidential screening service that allows you to completely bypass a trip to your doctor’s office—which means that your test results will not end up in your medical records (should you choose this option). My sister recently used their service to be screened for celiac disease via their celiac disease complete panel blood test. Within a few days my sister received her results via e-mail, and she didn't have to deal with a trip to the doctor's office and long wait times associated with the normal screening process. Her results were well-documented and easy to read, and on top of this the staff at CickMDLab.com were available and willing to assist her with any additional questions that she had. My sister had a wonderful first-time experience and we feel it's necessary to spread the word about this great new service. Visit their site for more info: ClickMDLab.com Note: Articles that appearin the "Gluten-Free Product Reviews" section of this site are paid advertisements. For more information about this seeour Advertising Page.
  7. Celiac.com 10/20/2010 - U.S. doctors and patients looking for accurate early diagnosis of celiac disease now have a state of the art celiac disease assay with a high level of sensitivity and specificity. The US Food and Drug Administration (FDA) has given 510(k) clearance for the first two fully automated gliadin tests featuring deamidated peptides for celiac disease. Manufactured by Phadia US, the tests, EliA GliadinDP IgA and EliA GliadinDP IgG, are designed to be used in conjunct with other laboratory and clinical findings in the early diagnosis of celiac disease. According to Gabi Gross, autoimmune franchise leader for Phadia US, "EliA GliadinDP IgA and EliA GliadinDP IgG will offer physicians who suspect a possible case of celiac disease, antibody tests with the lowest number of false positive results." This means less "unnecessary endoscopies and biopsies," she adds. EliA GliadinDP IgA and EliA GliadinDP IgG will offer antibody tests with the lowest number of false positive results for doctors who suspect a patient has celiac disease. The assays are optional on Laboratory Systems Phadia 100Є and Phadia 250 instruments with features like quick turnaround, monthly calibration, onboard instrument dilution, and a discrete single-well, random-access, nonmicrotiter plate format. Phadia also manufactures other approved CLIA moderately complex assays in the EliA autoimmune product line, including anticardiolipin IgG/IgM, anti-B2-glycoprotein 1 IgG/IgM, cyclic citrullinated peptide, tissue transglutaminase IgA/ IgG, gliadin IgA/IgG, dsDNA, antinuclear antibody screen, and ENA antibodies to the following antigens: Sm, U1RNP, RNP70, Ro, La, Scl-70, CENP, and Jo-1. Source: Medscape
  8. Celiac.com 04/20/2010 - A team of researchers recently set out to determine whether new serology assays can detect gluten sensitivity among enteropathy patients seronegative for anti–tissue transglutaminase. Emilia Sugai, Hui Jer Hwang, Horacio Vázquez, Edgardo Smecuol, Sonia Niveloni, Roberto Mazure, Eduardo Mauriño, Pascale Aeschlimann, Walter Binder, Daniel Aeschlimann and Julio C. Bai comprised the research team. They are variously affiliated with the Small Bowel Section of the Department of Medicine at C. Bonorino Udaondo Gastroenterology Hospital in Buenos Aires, Argentina, the Matrix Biology and Tissue Repair Research Unit at the Cardiff University School of Dentistry in Cardiff, UK, and with INOVA Diagnostics, Inc., of San Diego, California. Some patients with celiac disease may not show a normal positive reaction to the test most commonly used for IgA anti–tissue transglutaminase (anti-tTG) antibodies. The research team set out to determine the usefulness of newer assays incorporating synthetic deamidated gliadin-related peptides (DGPs), or other TG isoenzymes as antigen, for detecting gluten sensitivity in IgA anti-tTG–seronegative patients. The team tested blood samples drawn at diagnosis from 12 anti-tTG–seronegative patients with a celiac-like enteropathy, from 26 patients with skin biopsy–proven dermatitis herpetiformis (DH) and, lastly, from 26 patients with IgA anti-tTG–positive celiac disease. All patients showed typical levels of total IgA. On each patient, the team conducted intestinal biopsy and serum testing for detection of IgA and IgG isotypes of both anti-DGP and anti-tTG in a single assay (tTG/DGP Screen; INOVA Diagnostics). They also tested each patient for simultaneous detection of both IgA and IgG anti-DGP antibody isotypes (DGP Dual; INOVA Diagnostics). Lastly, they tested each patient for the detection of antibodies to transglutaminase 3 (TG3) or transglutaminase 6 (TG6). All patients who showed positive anti-tTG results also tested positive in anti-DGP assays. The tTG/DGP Screen caught six of the 19 anti-tTG seronegatives (31.6%), while anti-DGP Dual produced caught five of these cases (26.3%). Whereas both assays detected 2 anti-tTG–negative DH patients with partial villous atrophy, they were positive in only 2 of the 5 cases with no histologically discernible mucosal damage. Testing for antibodies to TG3 and TG6 caught seven of the 19 anti-tTG–negative patients (36.8%), five of whom also tested positive for anti-DGP. From these results, the team concludes that using tTG/DGP Screen, or anti-DGP Dual, to detect anti-DGP improves diagnostic sensitivity of gluten sensitive patients with non–IgA- deficiency, or anti-tTG–seronegativity, and celiac-like enteropathy. The same enhancement is also achieved by detecting antibodies to other TG isoenzymes. Source: Clinical Chemistry 56: 661-665, 2010.
  9. Celiac.com 01/04/2010 - The practice of using antibody testing to diagnose celiac disease has led to an explosion in the number of cases detected among children, coupled with a rise in median age at diagnosis, a new study suggests. European studies have shown that celiac disease is a multi-system disorder, affecting 0.3% to 1.0% of all children. A team of researchers recently set out to examine the impact of serological testing on childhood celiac disease in North America The research team consisted of Kelly E. McGowan, BHSc, Derek A. Castiglione and J. Decker Butzner, MD with the Department of Pediatrics, University of Calgary, Calgary, Canada. Serological testing makes it easier to spot children with atypical or extra-intestinal symptoms or with conditions associated with celiac disease. Serological testing has resulted in a huge increase in celiac disease cases; it has tripled incidence levels, quadrupled diagnosis age, and brought about a greater understanding of the wide variety of presentations of celiac disease in North America. Younger children are more likely to develop classic celiac disease, whereas older children seem more likely to show atypical presentations. The goal of the study was to determine the effects of immunoglobulin A endomysial antibody testing on the incidence and clinical presentation of childhood celiac disease. Researchers compared the incidence and clinical presentation of celiac disease in two groups of patients. Both groups were under a pretesting group of patients under 18 years of age in 1990–1996 and compared with a testing group of patients under 18 years of age in 2000–2006. Average age at diagnosis was 2 years (95% confidence interval: 2–4 years) in the pretest group (N = 36), compared with 9 years (95% confidence interval: 8–10 years) in the test group (N = 199; P < .001); female/male ratios (1.6:1) were similar (P = .982). Incidence of celiac disease increased from 2.0 cases per 100,000 children in the pretest group to 7.3 cases per 100,000 children in the test group (P = .0256). Frequency of classic celiac disease decreased from 67% in the pretest group to 19% (test group; P < .001), but the incidence of classic celiac disease did not change (0.8 vs 1.6 cases per 100000; P = .154). In the test group, researchers uncovered 13 previously unnoticed clinical presentations in 98 children, including 35 with family history, 18 with abdominal pain, and 14 with type 1 diabetes mellitus. The frequency of Marsh IIIc lesions decreased from 64% in the pretest group to 44% in the test group (P = .0403). In the test group, classic celiac disease was most common, making up 67% of cases in young children under 3 years, whereas atypical gastrointestinal and silent presentations were more common in older children. Overall, the contribution of serological testing to the diagnosis of celiac disease has been enormous. Antibody testing for celiac disease has tripled the incidence of celiac disease and quadrupled the average age at diagnosis, thus offering millions of children a higher quality of health. Source: Pediatrics, December 2009.
  10. Celiac.com 07/21/2009 - Accurate blood tests have revolutionized celiac disease diagnosis. Recently, researchers K.E. Evans, A.R. Malloy, and D.A. Gorard set out to review requests for celiac blood testing at a district general hospital laboratory over a decade, to measure the volume of requests, identify their source of referral, and assess positivity rates, along with subsequent rates of duodenal biopsy and histological confirmation. The team used laboratory databases to gather details of patients who requested celiac blood tests from 1997 to 2006. They then categorized the referrals inasto gastroenterology, general practice, and pediatrics and other specialities, while excluding duplicate requests. The team gathered 9976 serological tests in all. From 1997 to 2006, testing requests increased from 302 to 1826. About two-thirds (66%) of requests were made for women. Tests done on children accounted for 14-25% of each year's total. During that same period, test requests made via general practitioner rose from 3.3% to 52%, while the percentage of positive test results fell from 5.7% to 2.6%. The number of duodenal biopsies fell from 85% of seropositive patients in earlier part of the decade to about 75% of seropositive patients in latter part. Most non-biopsied seropositive patients had blood requested by general practitioners. In more than 9 out of 10 seropositive patients (91%), biopsy confirmed celiac disease. The data show that, increasingly, most celiac blood tests are now requested by general practitioners, with twice as many women as men being tested. Rising requests for blood tests but shrinking rates of positivity suggest that people are getting tested earlier, with fewer or less severe symptoms than in the past. Positive blood tests are often not confirmed histologically. Also of note, most patients with celiac disease no longer show classical signs of malabsorption, so diagnosis is often delayed or never made. These days, most adults diagnosed with celiac disease increasingly show few or atypical symptoms. Although duodenal or jejunal biopsy remains the gold standard for diagnosing celiac disease, the availability of easy, accurate blood tests has dramatically improved the diagnosis of celiac disease. More accurate tests for IgA endomysial antibodies and IgA tissue transglutaminase antibodies have replaced less reliable immunoglobulin (Ig) G and IgA gliadin antibody tests, while sensitivity and specificity of Endomysial antibodies and IgA tissue transglutaminase antibody tests now exceeds 95%. Still, doctors recommend biopsy confirmation of positive blood antibody tests, as biopsy of patients with positive blood tests, along with those suspected of having celiac but with negative blood, remains the most comprehensive way of diagnosing celiac disease. Aliment Pharmacol Ther 29, 1137-1142
  11. Celiac.com 09/28/2007 - Figures concerning the diagnostic accuracy of various serologic test and HLA-DQ typing for diagnosing celiac disease have largely come from case–control studies. A team of doctors recently set out to assess the performance of serologic testing and HLA-DQ typing in the diagnosis of celiac disease. Results of their study were published recently in the Annals of Internal Medicine. The team was made up of Muhammed Hadithi, MD; B. Mary E. von Blomberg, PhD; J. Bart A. Crusius, PhD; Elisabeth Bloemena, MD, PhD; Pieter J. Kostense, PhD; Jos W.R. Meijer, MD, PhD; Chris J.J. Mulder, MD, PhD; Coen D.A. Stehouwer, MD, PhD; and Amado S. Peña, MD, PhD Their study looked at patients who had been referred for small bowel biopsy to determine weather they had celiac disease, and evaluated the effectiveness of serologic testing for celiac disease, specifically of antigliadin antibodies (AGA), antitransglutaminase antibodies (TGA), and anti-endomysium antibodies (EMA) and HLA-DQ typing. Data was measured by comparing the performance of serologic testing and HLA-DQ against a reference baseline of abnormal histologic findings and clinical resolution after a gluten-free diet. Of 463 participants, sixteen had celiac disease (prevalence = 3.46% [95% CI, 1.99% to 5.55%]). Testing positive on both TGA and EMA showed a corresponding sensitivity of 81% (CI, 54% to 95.9%), specificity of 99.3% (CI, 98.0% to 99.9%), and negative predictive value of 99.3% (CI, 98.0% to 99.9%). A positive test for either HLA-DQ type increased both sensitivity (100% [CI, 79% to 100%]) and negative predictive value (100% [CI, 98.6% to 100%]), while testing negative for both minimized the negative likelihood ratio (0.00 [CI, 0.00 to 0.40]) and post-test probability (0% [CI, 0% to 1.4%]). Adding HLA-DQ typing to TGA and EMA testing, and adding serologic testing to HLA-DQ typing, saw no corresponding difference in test performance compared with either testing strategy alone. Overall results show TGA and EMA testing were the most sensitive serum antibody tests and a negative HLA-DQ type excluded the celiac disease from the diagnosis. However, the addition of HLA-DQ typing to TGA and EMA testing, and the addition of serologic testing to HLA-DQ typing, provided no change of test performance compared with either form of testing alone. Finally, the findings were somewhat limited, as low number of overall cases of celiac disease rule out meaningful comparisons of testing strategies. Annals of Internal Medicine (volume 147, pages 294-302)
  12. V. Kumar,* M. Jarzabek-Chorzelska, J. Sulej, Krystyna Karnewska,** T. Farrell,* and S. Jablonska *IMMCO Diagnostics, Inc., Buffalo, New York 14228; Departments of Microbiology and Dermatology, State University of New York at Buffalo, Buffalo, New York 14214; and Department of Dermatology, Warsaw School of Medicine, Warsaw, Poland; ** Department of Gastroenterology and Pediatrics, Selesian School of Medicine, Warsaw, Poland Clinical Diagnostic Immunology 9:1295-1300, 2002. Celiac.com 12/31/2002 - Background: Immunoglobulin A (IgA) deficiency is 10-15 times more common in patients with Celiac Disease (celiac disease) than in normal subjects. Serological tests have become the preferred methods of detecting both symptomatic and asymptomatic patients with celiac disease. However, commercially available serological methods are limited in that they detect only the IgA isotype of antibodies (with the exception of IgG gliadin assays); hence, IgA deficient celiac disease patients may yield false negative serology. Methods: Fifteen celiac disease and ten non-celiac disease IgA deficient pediatric cases were examined for IgA and IgG antibodies to endomysium, gliadin and tissue transglutaminase. Results: Twenty five specimens with IgA deficiency were examined. Fifteen were celiac disease cases and ten were non-celiac disease cases. All fifteen IgA deficient celiac disease cases were positive for endomysium antibodies of the IgG isotype and for IgG gliadin antibodies. All but one of the IgA deficient celiac disease cases were also positive for IgG tissue transglutaminase antibodies. None of the non-celiac disease IgA deficient cases were positive for any of the antibody markers. All the specimens examined were also negative for IgA specific antibodies to endomysium, gliadin, and tissue transglutaminase. Conclusions: IgG specific antibody tests for endomysium, gliadin and tissue transglutaminase are useful for the identification of IgA deficient celiac disease patients. IgG antibody tests along with tests routinely being used in clinical laboratories can reliably detect all active celiac disease patients. In addition, the levels of these celiac disease-specific IgG antibodies could be used to monitor patient dietary compliance.
  13. There are two classes of antibodies seen in untreated celiac disease. Antibodies directed against a fragment of gluten called gliadin, and antibodies directed against a particular tissue in the body itself. The two main areas in the body which can be attacked by its own antibodies are the aendomysial (the covering of muscle), and the reticulin ( the framework for kidney and liver), but there are others. To conduct the test, 5ccs of blood is drawn from the patient, and the blood cells are removed. The gliadin test is usually an automated machine-read test, which means there is little room for interpretor error. However, currently in the USA there is no standard methods for conducting the test, or normal ranges for the results. The endomysial tests are more dependent on the experience and ability of a pathologist who looks at a pattern of staining produced by the patients serum on a slice of monkey esophagus. While this test is done in similar way in most labs, there are many differences in how the results are interpreted. How good are these tests? If all of the blood test results are positive a celiac disease diagnosis is 90% accurate. However, there are several circumstances in which the tests can be inaccurate. IGA and IGG are two different varieties of antibodies which are produced by most peoples immune systems. There is a different blood test for each of the antibodies. Of the two tests, the IGA gliadin and IGA endomysial tests are the most accurate. However, this test can become negative relatively quickly after going on a gluten-free diet (3-6 months), which can cause a false negative test result. The IGG is less specific, and can sometimes be positive in non-celiacs. Also, about 4% of celiacs have no IgA at all! For these reasons it is very important that both tests are done for an accurate diagnosis. The biopsy is still considered the "standard candle" to confirm a blood diagnosis, and give a 100% sure diagnosis. For all tests for celiac disease it is necessary that one is on a gluten-containing diet, or false-negative test results could be given. Blood tests may also be useful in following up a known celiac and confirm that the diet is indeed free of large amounts of gluten. Also, because of the lack of standardization, keep in mind that blood test results may not be directly comparable from one lab to the next.
  14. Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: The biopsy may be inconclusive. Serum, if tested for gliadin, endomysial and reticulin antibodies, should provide unequivocal information. Ours and other studies have provided a strong reliability of the serum tests. Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: The biopsy may be inconclusive in a small percentage of patients with so-called patchy lesions in the duodenum. It means that there are histologically normal looking spots with finger like villi and pathologic spots showing flattened mucosa in the upper half of the duodenum. If celiac disease is suspected, the gastroenterologist should obtain several biopsies from different spots of the whole duodenum. Most of the endoscopists routinely examine only the upper half of the duodenum (duodenal bulb and the descending part). The transverse segment of the duodenum is not viewed routinely. Few endoscopic centers have an enteroscope, which is a longer and more flexible endoscope for examining the entire duodenum and jejunum. The enteroscopy allows you to obtain biopsies even from the jejunum. The histological examination of a single biopsy specimen may increases the risk of false negative diagnosis. The experience of the pathologist in the interpretation of small intestinal histology is important. In centers specializing in celiac disease the gastroenterologist routinely reviews the histologic slides together with the pathologist. There is still a possibility of inconclusive results if multiple biopsies are obtained and the histological interpretation is appropriate. All disease has a developmental process. It means that it takes time for the pathological changes to be evident. There are cases when the symptoms suggest celiac disease, however, the histology is not conclusive. This problem occurs in only a few cases. A repeated biopsy may be necessary after a period of higher gluten intake. However, if the antiendomysium antibody test is positive and the histology is not conclusive a gluten-free diet is recommended. The serology test may be inconclusive if: The sample handling and shipping is inappropriate; e.g. the serum was shipped at room temperature for days The patient has IgA deficiency, which occurs in one out of 600 people in the general population and much more frequently in patients with celiac disease. In these cases the antigliadin IgA and the antiendomysium IgA tests give negative results. If the tests are performed in a laboratory specialized in celiac serological tests, the laboratory recommends a test for immunoglobulins. If a patient has IgA deficiency and positive antigliadin IgG test, he/she should undergo further absorptive tests and/or an intestinal biopsy.
  15. The following labs have excellent reputations for such tests: Specialty Labs 2211 Michigan Ave. Santa Monica California 90404 Tel: 310 828-6543 or 800 421-4449 Internet: http://www.specialtylabs.com The University of Maryland at Baltimore Attention: Karoly Horvath, MD, or Athba Hammed, Research Assistant School of Medicine Division of Pediatric Gastroenterology and Nutrition Laboratory UMAB/Bressler Research Building, Room 10-047 655 West Baltimore Street Baltimore, MD, 21201 410 706-1997 or fax at 410 328-1072 University of Iowa Foundation for Celiac Disease Research University of Iowa Hospitals and Clinics 200 Hawkins Drive Iowa City, IA 52242 IMMCO Diagnostics, Inc. Vijay Kumar, Ph.D. IMMCO Diagnostics 60 Pineview Drive W. Amherst, NY 14228 Tel: (716) 691-0091 Toll Free Tel: (800) 537-TEST E-mail: IMMTEST@AOL.COM Immunopathology Laboratory Dept. of Pathology 5233 RCP University of Iowa Hospitals and Clinics 200 Hawkins Drive Iowa City, IA 52242 Tel: (319) 356-2688 Mayo Clinic Dr. Joeseph Murray Internet: http://www.mayohealth.org/mayo/common/htm/index.htm Prometheus, Inc. 5739 Pacific Center Boulevard San Diego, California 92121 Tel: (619) 824-0895 Toll Free (888) 423-5227 Fax: (619) 824-0896
  16. Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: Convincing the doctor initially depends upon the patient. However, the laboratory to which the test is sent should be available to answer questions the doctor may have. Our laboratory always encourages such questions. Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: Lot of physicians in the USA did not get appropriate training to recognize the protean manifestations of celiac disease. However, if the classical symptoms are present--chronic diarrhea, weight loss, protuberant abdomen, foul-smelling stools, etc.--it is absolutely indicated to test the patients serum for antigliadin and antiendomysium antibodies. Professionals participating in this discussion group are educating physicians on an almost daily basis. Generally, it is useful to supply the physician with a review article or a textbook chapter describing the values of serological tests and protean manifestations of celiac disease. If that does not help, you can ask the help of professionals participating in the Cel-Pro list. They have helped several patients by calling physicians and convincing them about the necessity of serological testing.
  17. Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: The three serological tests that are used for diagnosing celiac disease are: Anti-endomysial antibody (EMA) Anti-reticulin antibody (ARA) Anti-gliadin antibody (AGA) Each of these three tests provide a certain degree of reliability for diagnosing celiac disease. Of these, endomysial antibody is the most specific test. The following table is taken from our studies (Lerner, Kumar, Iancu, Immunological diagnosis of childhood coeliac disease: comparison between antigliadin, antireticulin and antiendomysial antibodies). % of Sensitivity % of Specificity Predictive Value % Pos Predictive Value % Neg EMA 97% 98% 97% 98% ARA 65% 100% 100% 72% IgG AGA 88% 92% 88% 92% IgA AGA 52% 94% 87% 74% The following definitions related to sensitivity, specificity, positive and negative predictive values may help: Sensitivity is the probability of a positive test result in a patient with disease. Specificity is the probability of negative test result in a patient without disease. Positive predictive value is the probability of disease in a patient with positive test result. Negative predictive value is the probability of no disease in a patient with negative test result. Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: The summary below shows the results of the main serological tests based on several publications including 388 patients with celiac disease, and 771 healthy subjects. SENSITIVITY- the proportion of subjects with the disease who have a positive test. It indicates how good a test is at identifying the diseased: Percentage of - IgA AGA Percentage of - IgG AGA Percentage of - IgA EMA Average 78% 79% 97% Range 46-100% 57-94% 89-100% SPECIFICITY- the proportion of subjects without the disease who have a negative test. It indicates how good a test is at identifying the non-diseased: Percentage of - IgA AGA Percentage of - IgG AGA Percentage of - IgA EMA Average 92% 84% 98.5% Range 84-100% 52-98% 97-100% POSITIVE PREDICTIVE VALUE- the probability that a person with positive results actually has the disease: Percentage of - IgA AGA Percentage of - IgG AGA Percentage of - IgA EMA Average 72% 57% 92% Range 45-100% 42-76% 91-94% NEGATIVE PREDICTIVE VALUE- the probability that a person with negative results does not have the disease: Percentage of - IgA AGA Percentage of - IgG AGA Percentage of - IgA EMA Average 94% 94% 100% Range 89-100% 83-99% 100% References: McMillan SA, Haughton DJ, Biggart JD, Edgar JD, Porter KG, McNeill TA. Predictive value for coeliac disease of antibodies to gliadin, endomysium, and jejunum in patients attending for jejunal biopsy. Brit Med J 1991;303:1163-1165 Ferreira M, Lloyd Davies S, Butler M, Scott D, Clark M, Kumar P. Endomysial antibody: is it the best screening test for coeliac disease? Gut 1992;33:1633-1637. Khoshoo V, Bhan MK, Puri S, Jain R, Jayashree S, Bhatnagar S, Kumar R, Stintzing G. Serum antigliadin antibody profile in childhood protracted diarrhea due to coeliac disease and other causes in a developing country. Scand J Gastroenterol 1989;24:1212-1216. Chan KN, Phillips AD, Mirakian R, Walker-Smith JA. Endomysial antibody screening in children. J Pediatr Gastroenterol Nutr 1994;18:316-320. Bode S, Weile B, Krasilnikoff PA, Gdmand-Hyer E. The diagnostic value of the gliadin antibody testing celiac disease in children: a prospective study. J Pediatr Gastroenterol Nutr 1993;17:260-264. Calabuig M, Torregosa R, Polo P, Tom s C, Alvarez V, Garcia-Vila A, Brines J, Vilar P, Farr C, Varea V. Serological markers and celiac disease: a new diagnostic approach ? J Pediatr Gastroenterol Nutr 1990;10:435-442.
  18. Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: There is no simple answer to this question as the susceptibility of the patient to developing celiac disease is dependent upon several factors. One factor is the amount of gluten intake. Another is the genetic makeup of the individual. However, we feel that several weeks of gluten intake, especially in doses of 2 gm gluten/day, should result in positive serology in patients with celiac disease. Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: The result of serological tests depends on the diet. Generally, three to six months of a gluten-free diet may result in normal antibody levels in a new patient. A strict gluten-free diet for more than three months may result in inconclusive serological tests in patients, who have started a diet without any diagnostic test. In this case a gluten challenge should be introduced for a proper diagnosis. Each patient has different sensitivity to gluten for reasons that are unclear. The period of gluten challenge and the amount of gluten necessary to provoke serological immune response are individually different. A 0.3 g/kg body weight/day of single gluten challenge causes immunological changes (cellular immunity) in the intestine (J Pediatr Gastroenterol Nutr 1989; 9:176-180) in patients on a gluten-free diet, however, the serological response is much slower. Our recommendation is to ingest at least 0.3 g/kg/day of gluten for two months prior to the serological tests. However, if somebody experiences symptoms during the gluten challenge we recommend to perform serological tests earlier. The protein content of wheat flour is between 7-15% and approximately 90% of the protein content is gluten. That means a slice of bread may have 2-3 g of gluten.
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