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Celiac.com 06/03/2010 - Clinical presentation of celiac disease can vary considerably from patient to patient. Most patients with celiac disease present atypical symptoms. Moreover, most patients who present abdominal symptoms in primary care do not have celiac disease, and so diagnostic tests for celiac disease are not necessary and should be avoided. A team of researchers recently conducted a systematic review of diagnostic testing for celiac disease among patients with abdominal symptoms. The team included Daniëlle A. W. M. van der Windt, PhD; Petra Jellema, PhD; Chris J. Mulder, MD, PhD; C. M. Frank Kneepkens, MD, PhD; and Henriëtte E. van der Horst, MD, PhD. Their article appears in the Journal of the American Medical Association. The goal of the research was to review and summarize evidence on the performance of diagnostic tests for spotting celiac disease in adults who present abdominal symptoms in primary care or similar settings. To obtain initial data, the team search MEDLINE (from January 1966 through December 2009, and EMBASE from January 1947 through December 2009. They also conducted a physical search of references for additional relevant studies. The team chose cohort or nested case-control diagnostic studies which included adults presenting non-acute abdominal symptoms, which featured celiac disease prevalence of 15% or less, and in which the tests included gastrointestinal symptoms or serum antibody screens. Two independent reviewers conducted studies tool and data extraction. They then calculated sensitivities and specificities for each study and computed pooled estimates using bivariate analysis where there was clinical and statistical homogeneity. In all, the team included sixteen studies encompassing 6085 cases in their review. Specificity, sensitivity, and confidence intervals for predicting celiac disease varied with abdominal symptoms. For patients presenting with classic diarrhea, for example, predictive sensitivity ranged from 0.27 to 0.86, while specificity ranged from 0.21 to 0.86. Pool estimates for 8 studies on IgA antiendomysial antibodies were 0.90, with a 95% confidence interval [CI] (0.80-0.95) for sensitivity and 0.99, with a 95% CI (0.98-1.00) for specificity, with a positive likelihood ratio [LR] of 171 and negative LR of 0.11. Pool estimates for IgA antitissue transglutaminase antibodies (7 studies) were 0.89, with a 95% CI (0.82-0.94) and 0.98 at 95% CI (0.95-0.99), respectively, with a positive LR of 37.7 and negative LR of 0.11. IgA and IgG antigliadin antibodies showed variable results, especially for sensitivity, which ranged from 0.46-0.87 for IgA, and from 0.25-0.93 for IgG. One recent study using deamidated gliadin peptides showed good specificity (0.94), but the target population offered limited supporting evidence. For adults who present abdominal symptoms in primary care or other unscreened settings, IgA antitissue transglutaminase antibodies and IgA antiendomysial antibodies offer high sensitivity and specificity for diagnosing celiac disease. SOURCE: JAMA. 2010;303(17):1738-1746. doi:10.1001/jama.2010.549
Celiac.com 07/08/2010 - Acute abdominal pain is the most common symptom leading to emergency surgery; accounting for up to 50% of emergency surgical admissions and nonspecific abdominal pain (NSAP) likely accounts for 40% of the cases. While abdominal pain can often be a symptom of celiac disease, up until this point there have been no official studies to determine the the association of celiac disease and abdominal pain. A group of researchers in the UK attempted to uncover the connection between celiac disease and abdominal pain. Using a case-controlled study of 300 consecutive, new, and unselected patients exhibiting acute abdominal pain, and a healthy control group not presenting any abdominal pain, were matched by age and gender and then assessed accordingly. Initially, the research team under Dr. David S. Sanders of the Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK, used immunoglobulins, IgA/IgG anti-gliadin (ADA), and endomysial antibodies (EMA) to evaluate the test subjects for celiac disease. Any of the test subjects that tested with a positive IgA, AGA, EMA or IgG AGA accompanied by IgA deficiency was provided with the opportunity to receive a small bowel biopsy to confirm a celiac diagnosis; only 1 person declined. Among the acute abdominal pain demographic, the median age range was 57 years old and exactly half of the 300 participants were female. All test patients were given an initial biochemical, hematologic, and immunologic profile. Of the patients tested, 33 with abdominal pain had either a positive IgA gliadin antibody, EMA or a combination of both. Of those 33 patients, 9 had histologically proven celiac disease. Among the healthy control group, 2 people were discovered to have celiac disease. Researchers matched case controls and then determined the antibody status of the control group and the abdominal pain group. While there were no corresponding pairs, the statistical chance of having celiac disease when demonstrating acute abdominal pain has an odds ratio of 4.6. Although when NSAP was solely taken into consideration, the prevalence of celiac disease exhibited profound significance with a rate of 10.5%. Of the test subjects that maintained the gluten-free diet for the recommended time period of 12 -18 months, all of them exhibited an improvement of their symptoms, and their antibody profiles were negative. From this study, researchers concluded that targeting patients with NSAP or those that exhibit other high risk celiac symptoms, will likely improve the diagnostic yield of celiac disease, specifically among those exhibiting typical celiac symptoms. Additionally, the ideal situation would be if more doctors were to recognize NSAP symptoms as having the potential to be connected with celiac disease and screen for celiac accordingly; as delayed or undiagnosed celiac disease can eventually lead to a myriad of other long-term and permanent health issues including, osteoporosis, infertility, and an increased risk of cancer. Source: Ann Surg. 2005 Aug;242(2):201-7.
Celiac.com 05/21/2010 - Celiac disease is a genetic, permanent auto-immune disease with a variety of symptoms which, when treated with a gluten-free diet, usually subside. While clinical presentation is variable, most patients that are treated for abdominal pain do not have celiac disease. It is therefore important to accurately diagnose celiac disease in patients exhibiting abdominal pain, without unnecessarily testing patients that do not have celiac disease. Researchers at the Arthritis Research UK National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5 BG, UK, evaluated sixteen studies of patients exhibiting abdominal pain. The occurrence of the abdominal symptoms varied vastly including the varied sensitivity of diarrhea. The IgA and IgG antigliadin antibodies exhibited varying results, particularly for sensitivity. A recent study used diamidated gliadin peptides and showed good specificity, but the results were limited in that specific target population. The conclusive results showed that among adult patients exhibiting abdominal symptoms, “IgA antitissue transglutaminase antibodies and IgA antiendomysial antibodies have high sensitivity and specificity for diagnosing celiac disease”. Source: JAMA. 2010 May 5;303(17):1738-46. Review.