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Found 43 results

  1. A month ago I found out my hemoglobin was fairly low and I was diagnosed with iron defiiciency anemia. I put some things together in my head (the seemingly random anemia, Hashimoto's disease, a bunch of GI issues, chronic pain and fatigue dx'ed as fibromyaliga) and asked my doctor about the possibility of Celiac disease. She agreed that it could be the problem and ordered the IgA tTg test, which came out just fine. I don't know if she ordered a total IgA and I'm going to call and ask about that on Monday. I was wondering what people think about more tests. I do have an appointment with a GI doc over a month from now. I can't get an earlier appointment and can't switch to anyone else because I'm on Medicaid and this GI doc is the only one nearby who will take that insurance. I'm seriously considering forgetting about the GI appointment and further tests and dropping gluten ASAP and dairy as much as possible, moving toward dairy-free. I want to get that stuff out of my system and hopefully start feeling better! Is it worth it to keep eating food I know is bothering me so I can get more tests? With the negative IgA tTg test would you pursue other tests? I had pretty much decided to just go gluten free and see how I end up feeling in a few months but wanted to get the opinions of folks who have gone through all of this. Thanks!
  2. Celiac.com 06/27/2013 - Patients with villous atrophy and negative celiac disease serologies pose a diagnostic and therapeutic dilemma. When doctors are unable to determine what is causing villous atrophy in a patient without celiac disease, they usually classify it as a case of "unclassified sprue." However, doctors currently know very little about the best way to treat and manage cases of unclassified sprue. To get a better picture of this dilemma, a team of researchers recently examined the connections between villous atrophy and negative celiac serology. The research team included M. Degaetani, C.A. Tennyson, B. Lebwohl, S.K. Lewis, H. Abu Daya, C. Arguelles-Grande, G. Bhagat G, and P.H. Green. They are variously affiliated with the Celiac Disease Center, and the Department of Medicine at Columbia University College of Physicians and Surgeons at Columbia University Medical Center in New York, USA. For their study, the team looked at adult patients with biopsy-proven villous atrophy and negative celiac serology, evaluated at our tertiary referral center over a 10-year period. They noted test results for HLA DQ2/8 alleles, antienterocyte antibodies, giardia stool antigen, bacterial overgrowth, total serum immunoglobulins, and HIV. They also recorded treatment, response, and repeat-biopsy findings for each patient. They found that most of the 72 cases were classified as seronegative celiac disease, medication-related villous atrophy, and unclassified sprue. The majority of patients diagnosed with unclassified sprue reported symptomatic improvement with immunosuppressive therapy. Some patients diagnosed with unclassified sprue were found to have villous atrophy associated with the use of olmesartan. The team encourages further examination of the role of medications in the development of villous atrophy, along with the optimal dose and length of immunosuppression for patients with unclassified sprue. Source: Am J Gastroenterol. 2013 May;108(5):647-53. doi: 10.1038/ajg.2013.45.
  3. I've been having IBS symptoms for a couple months, and saw a GI recently who had me have blood work done to test for celiac desease. I had not received the results in over a week so I called his secretary and she said he is on vacation. She said the result was 5 units, and that's all she said. I finally got her to fax me the lab report. The doctor's discharge note from my visit listed Labs Transglutam IgA Ab and Total Serum IgA. The lab report that I received from his secretary today shows: IgA 228 MG/DL 70-400 TRANSGLUT IgA 5 UNITS < 20 < 20 Units Negative 20 - 30 Units Weak Positive > 30 Units Moderate to Strong Positive This, I assume, would show that I am negative for the antibodies? But I don't know. I have researched the tests on the net and saw that tissue transglutaminase antibody test is < 4 negative, 4 - 10 weak positive, and 10 - 20 positive. Are these 2 different tests? The secretary called the doctor and he said the only way to know for sure is to perform an EGD and take a biopsy to check the intestine tissue. I told her I had read that the gene test for DQ2 and DQ8 should be done as a process of elimination, and she said it is very expensive and my insurance probably wouldn't pay for it. Can anyone clarify these tests, my results, and what the next steps should be? Thank you!
  4. 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
  5. Hello everyone- I have been reading this forum for the past couple of weeks and wanted to post while I wait for my blood test/Enterolab test/DNA test. It's been very helpful. I'm beginning to suspect I am intolerant or sensitive to gluten, or possibly have celiac. I have not stopped eating gluten. Yet. Here are my symptoms: - Ferritin level of 4. Four. For several years. - Bloating, extreme gas, large stinky stools that float, uncomfortable feeling in abdomen for hours (not after every meal, but many meals). - Vitiligo that has emerged in the past year - Irregular periods - Asthma - Geographic tongue - Dry skin (I live in Florida where it is humid) - Fibroids Does anyone have any thoughts? I would appreciate any feedback. I'm preparing to do a gluten-free trial very soon. Thank you all for your help and have a good evening. Tam
  6. 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
  7. 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.
  8. 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!
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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
  14. 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
  15. 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.
  16. 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)
  17. 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.
  18. 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.
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