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Celiac.com 01/21/2015 - Congratulations, shoppers with celiac disease and non-celiac gluten sensitivy, you are among the world's best informed and most loyal consumers, according to Paul Valder, President and CEO of the Allergen Control Group. The Allergen Control Group, with the endorsement of the Canadian Celiac Association (CCA), operates the Gluten Free Certification Program (GFCP). Speaking of these consumers, Valder says that they are not only the best ingredient label readers in the world, but "[o]nce they've identified a brand as safe, they'll stick with it, even if that means visiting multiple stores on a weekly basis." The Gluten-Free Certification Program has certified over 100 facilities in 12 countries, and over 2,500 products. Currently, over 130 GFCP-approved and trained auditors provide global coverage to accommodate today's multi-national supply chains. Brand loyalty among gluten-free consumers can be encouraged with a certified gluten-free product label. Such a label, says Mr. Valder, "…creates a distinction from other products that are advertised as gluten-free." Does this sound like you? Do you read every ingredient on every label? Will you travel to multiple stores to find your trusted gluten-free brand? Share your comments below. Read more at Global Food Safety Resource. -
Celiac.com 11/15/2008 - Managing celiac disease can be challenging in the best of circumstances, so imagine the frustration of experiencing on-going gastro-intestinal symptoms even while following a gluten free diet. Such frustration is increasingly common among people with celiac disease. With increasing frequency, doctors worldwide are finding persistent villous atrophy in celiac patients who are following a gluten-free diet. Results of a study published recently in the Scandinavian Journal of Gastroenterology indicate that persistent intestinal villous atrophy in celiac disease patients on a gluten-free diet is associated with gastrointestinal symptoms considered 'atypical' for celiac disease and which are different from those present at the original celiac disease diagnosis. A team of doctors based in Italy recently set out to assess a possible connection between persistent damage of the villi and 'atypical' gastrointestinal symptoms in celiac disease patients on a gluten-free diet. The team assembled a study group of 69 patients with celiac disease, all of whom were following a gluten-free diet. They then isolated 42 patients with gastrointestinal symptoms that warranted esophagogastroduodenoscopies (group I), while the remaining 27 control patients were asymptomatic at the time of the study, and served as a control group. Group I showed higher numbers of persistent endoscopic lesions compared with the control group. In fact, 35 patients (85%) from group I showed villous atrophy compared to just 9 (33%) of the control group. The team noted that the gastrointestinal symptoms experienced by group I differed from those present at the time of their celiac disease diagnosis. 6 patients from group I experienced anemia/diarrhea/weight loss, while 12 experienced symptoms similar to gastroesophageal reflux disease, and 24 patients experienced abdominal pain and/or constipation. Among the patients from group I, there was no difference in gender distribution, age and duration of gluten-free diet between those with normal villi and those with persistent partial villous atrophy, though the patients with persistent symptoms showed higher intraepithelial eosinophil counts than the asymptomatic patients. These findings speak to the importance of developing protocols to monitor the progress of celiac patients over the long term. Until such protocols are developed, it is important that people with celiac disease pay close attention to any symptoms that may be celiac-related, and report those symptoms to their health care professionals at the earliest signs of trouble. Scandinavian Journal of Gastroenterology; 2008: 43(11): 1315-21
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Celiac.com 07/27/2011 - Based on associations made between microscopic colitis and celiac disease in scientific literature, but limited population-based data, a team of researchers set out to assess rates of microscopic colitis in celiac disease. The research team included M. Stewart, C. N. Andrews, S. Urbanski, P. L. Beck, and M. Storr. They were looking to better understand how these two diseases might be connected, and to identify any factors that might cause them to occur together. This led them to conduct a population-based review of all people diagnosed with celiac disease and microscopic colitis in a large Canadian medical center over a 5-year period. To do that, they searched endoscopy and pathology databases to find all diagnosis made for celiac disease and microscopic colitis within the Calgary Health Region between 2004 and 2008. To get accurate results, they made sure to standardize age and gender data from their study with 2006 Canadian Census data. They then used standardized incidence ratios (SIR) to figure out how often the two disease occur together. In the study population, they found, over a five-year period, 763 patients diagnosed with celiac disease, and 1106 diagnosed with microscopic colitis. In the general population, the standard rates of celiac disease ran from 10.4 to 15.7 per 100,000 people, while the standard rates of microscopic colitis ran from 16.9 to 26.2 per 100,000 people. The study team found 40 patients with both celiac disease and microscopic colitis, 21 of whom were females aged 40–60 years. In the celiac disease group, microscopic colitis occurred at an annual rate of 11.4 per 1000 cases of celiac disease with an overall SIR of 52.7. These findings showed a strong association between microscopic colitis and celiac disease. In fact, the diseases occurred together in the study population at rates of about 50-times those expected in the general population. One prominent finding was that middle-aged women suffered especially high rates of celiac disease together with microscopic colitis. Therefore, the team recommends that middle-aged women with celiac disease and persistent diarrhea undergo lower endoscopy with biopsies to check for microscopic colitis. Source: Alimentary Pharmacology & Therapeutics. 2011;33(12):1340-1349.
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Celiac.com 03/10/2015 - Up to now, celiac disease has been described only in sporadic cases of obesity. A research team recently set out to evaluate retrospectively celiac disease rates in a large group of overweight/obese children and adolescents. The research team included Raffaella Nenna, Antonella Mosca, Maurizio Mennini, Raffaele E. Papa, Laura Petrarca, Roberta Mercurio, Monica Montuori, Alessandra Piedimonte, Maria Bavastrelli, Ilaria C. De Lucia, Margherita Bonamico, and Andrea Vania. For their study, the team consecutively evaluated 1,527 overweight/obese children and adolescents, 10 girls and 7 boys had positive celiac serology and showed villous atrophy. All celiac patients immediately began a well-balanced gluten-free diet, and rapid weight loss followed. The study shows that celiac rates in overweight/obese children are similar to rates in the general Italian pediatric population, and that those children benefit from proper diagnosis and a healthy gluten-free diet. Source: Journal of Pediatric Gastroenterology & Nutrition: March 2015 - Volume 60 - Issue 3 - p 405–407. doi: 10.1097/MPG.0000000000000656 -
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. -
Celiac.com 01/18/2012 - A number of small studies have shown a connection between celiac disease and various gastrointestinal (GI) cancers, but the results haven't been corroborated by larger studies, or by blood and biopsy analysis of large populations. That means that researchers just haven't been able to say with certainty what the results of those smaller studies might mean about cancer risks for the larger population. Recently, a clinical team set out to assess GI cancer risks for a larger population. The study team included Peter Elfström, Fredrik Granath, Weimin Ye, and Jonas F. Ludvigsson. They assessed risk GI cancers by using data from large groups of patients with either celiac disease, inflammation, or latent celiac disease. They assessed data from 28,882 patients with celiac disease, all with villous atrophy, and Marsh scores of 3. They also assessed data for 12,680 patients with inflammation, all with Marsh scores of 1–2. They evaluated biopsy samples at 28 different pathology centers. They assessed a third group of 3705 patients with latent celiac disease, that is, with normal mucosa, but positive blood tests. The team then compared the results against data from an age- and sex-matched population. They found that 372 of the patients with celiac disease developed incident GI cancers, while 347 patients with inflammation, and 38 with latent celiac disease developed GI cancers. That means that the first year after diagnosis and initial biopsy, celiac disease carried a 5.95-times greater risk of incident GI cancer, with a 95% confidence interval [CI], 4.64–7.64). The hazard ratio for inflammation was 9.13 (95% CI, 7.19–11.6) and for latent celiac disease was 8.10 (95% CI, 4.69–14.0). After the first year, patients showed no significant increase in GI cancer risk. The HR for celiac disease was 1.07 (95% CI, 0.93–1.23), for inflammation it was 1.16 (95% CI, 0.98–1.37). HR for latent celiac disease it was 0.96 (95% CI, 0.56–1.66). The absolute risk for any GI cancer in people with celiac disease was 101/100,000 person-years, with an excess risk of 2/100,000 person-years. The results carried some relatively good news. That is, even though celiac disease, inflammation, and latent disease all increase a person's risk for GI cancers in the first year after diagnosis, there is no increase in risk beyond the first year. Source: Clinical Gastroenterology and Hepatology. Volume 10, Issue 1 , Pages 30-36, January 2012
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Celiac.com 01/02/2012 - To properly diagnose celiac disease doctors must observe classic histological changes to small bowel mucosa. Success rates can vary among clinics and practitioners. A clinical team recently compared biopsy interpretation between different pathology practice types. A research team recently assessed variability in small bowel histopathology reporting between different pathology practice settings, and its impact celiac disease diagnosis. The researchers included Carolina Arguelles-Grande, Christina A. Tennyson, Suzanne K. Lewis, Peter H. R. Green, and Govind Bhagat. The team used a pathologist to blindly assessed biopsies from community hospitals (n=46), university hospitals (n=18) and commercial laboratories (n=38) for differences in histopathology reporting and agreement in diagnosis of celiac disease and degree of villous atrophy (VA) by k analysis. Data showed very good agreement for primary diagnosis between the authors and university hospitals (k=0.888), but only moderate agreement compared with community hospitals (k=0.465) or commercial labs (k=0.419). The review showed that diagnosis varied in 26 (25%) cases, leading to a 20% increase in celiac disease diagnosis after review. The 49 patients diagnosed with celiac disease by both institutions showed fair agreement in degree of VA (k=0.292), with moderate agreement between the authors and commercial laboratories (k=0.500) and fair agreement with university hospitals (k=0.290) or community hospitals (k=0.211). In 27% of cases, the degree of VA was upgraded, while VA was downgraded in just 2% of cases. Data also showed poor agreement for Marsh score categories 1 and 2 (k<0.0316), with both missed at other centers, and just fair or moderate agreement for Marsh scores 3a and 3b. They found that data on the degree of VA and intraepithelial lymphocytosis were lacking in 26% and 86% of reports, while non-quantifiable descriptors, such as ‘blunting’ or ‘marked atrophy’ were common. The data show that community-based hospitals and commercial pathology labs are under-diagnosing celiac disease-related histological changes. To combat variations in biopsy interpretation and reduce under-diagnosis of celiac disease, the team calls for greater celiac disease awareness and uniformity in small bowel biopsy reporting among pathologists. Source: Journal of Clinical Pathology (2011). doi:10.1136/jclinpath-2011-200372
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Celiac.com 12/23/2011 - A research team recently sought to figure out the basic level of awareness of celiac disease and gluten sensitivity among the general public and trained and untrained chefs, and to compare dining habits of people with celiac disease and gluten-sensitivity to those of the general public. In face-to-face interviews, and via internet survey, researchers asked people about their knowledge of celiac disease and gluten sensitivity. They also asked people with celiac disease and gluten sensitivity about their dining habits, in addition to asking chefs about their levels of training and education. In all, the researchers surveyed 861 persons from the general public. They found that 47% had heard of celiac disease, 67% had heard of gluten sensitivity, and 88% had heard about peanut allergy. They surveyed 790 people with either celiac disease (82%, n=646), or gluten sensitivity (18% n=144). The vast majority of respondents to the study were female, making up 83% of those with celiac disease, and 90% of those with gluten sensitivity. Those with celiac disease and gluten sensitivity were older than the general public respondents, 57% of the patients were over 45 years of age compared with just 32% of the general public respondents (p< 0.0001). The 200 chefs who were surveyed showed a much higher awareness of celiac disease, with 77% of chefs having heard about celiac disease compared to less than half of the general population. Interestingly, many more people in both groups had heard of gluten sensitivity, with 89% for chefs, and 67% for the general population, respectively. Still, the chefs, like the general public, had a tendency to underestimate celiac disease was underestimated by both chefs (56%) and the general public (69%) while peanut allergy was overestimated by 55% of the general public and 60% of chefs. People with celiac disease may not be surprised to learn that a large majority, 63% of the 790 following a gluten-free diet reported avoiding restaurants more, and eating take-out food much less often than the general public. One important finding was that the level of training had a great deal of impact on a chef's knowledge of celiac disease. Overall, trained chefs were much more likely to be familiar with celiac disease compared with untrained chefs (83% vs. 52%) Also, there was a direct connection between the average price of a meal and the likelihood that the chef was familiar with gluten-free concerns. The more expensive the restaurant, the more likely the chef was familiar with celiac disease and gluten-free concerns. Restaurants with an average check below $25 had a 64% rate of awareness, while the rate for restaurants with a check over $65 had a 94% awareness of gluten-free concerns (p<0.0001). In general, the survey team was impressed by what they saw as a fairly high degree of awareness of gluten-related concerns. Interestingly, both trained and untrained chefs were more likely to have heard of gluten sensitivity than of celiac disease. Most people with celiac disease avoid restaurants, and eat out the home far less often than the general public. Still, many do eat out, and they do so by making sure they get their needs met. The simple take away is that chefs are generally pretty aware of gluten-intolerance and celiac disease, and that chefs with better training and higher-end restaurants are more likely to deliver a gluten-free dining experience. As always, communication goes a long way toward ensuring a pleasant and successful restaurant experience for anyone with celiac disease. Knowing your needs, sharing your concerns, and asking your server and/or chef about their gluten-free options and preparation methods can go a long way toward a smooth gluten-free dining experience. Source: http://www.journals.elsevierhealth.com/periodicals/yeclnm/article/PIIS1751499111000527/fulltext
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Celiac.com 01/29/2008 - If the results of a recent study are any indication, the Greeks might be among those least affected by celiac disease. The study on the prevalence of celiac disease in Greece shows that the people of Thessaly have a prevalence of celiac disease that is among the lowest of all the European populations. Recent discoveries point to a greater prevalence of celiac disease than previously expected in a number of European populations, and the availability of new, accurate serological tests has made screening in the general population possible. These facts, coupled with the reality that no data exist regarding the prevalence of celiac disease in Greece, recently sparked a team of researchers to use a novel diagnostic algorithm to examine the general population of Thessaly, in central Greece, in an effort to determine rates of prevalence for celiac disease. Led by doctors Roka V, Potamianos SP, Kapsoritakis AN, Yiannaki EE, Koukoulis GN, Stefanidis I, Koukoulis GK, Germenis AE, the researcher team selected 2230 participants (1226 women, 1004 men, median age 46 years, range 18-80 years) by a random sampling from the adult general population of Thessaly. The researchers took blood samples and checked them for total immunoglobulin A (IgA)-serum levels, to eliminate IgA deficiency. The research team then examined samples that showed total IgA within the normal range for IgA antibodies compared to native human-tissue transglutaminase (anti-tTG); the researchers then tested samples that were anti-tTG positive for IgA antiendomysial antibodies (EmA). The researchers then examined samples from participants with selective IgA deficiency for IgG antigliadin antibodies. They referred for biopsy and human leucocyte antigen (HLA) typing those participants that showed EmA-positive or antigliadin antibody-positive. No participant with selective IgA deficiency was detected. Four individuals tested positive for EmA, all of whom were biopsy-proven coeliacs. Therefore, the prevalence of celiac disease within this general population sample is 1: 558 or 1.8 per 1000 (SE 0.13). The two men, two women that did show abnormal histology were between the ages of 18 and 35. Two of them were considered to be asymptomatic and two presented with a sub-clinical course. All four showed the heterodimer HLA-DQ2. The evidence indicates that the people of the central Greek area of Thessaly have a prevalence of celiac disease that is among the lowest of all the European populations. Eur. J. Gastroenterol Hepatol. 2007 Nov;19(11):982-7.
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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 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. -
Celiac.com 03/22/2010 - The main cause for gluten intolerance continues to puzzle scientists, but pathogenesis theories include both genetic susceptibility and environmental triggers, like a virus or infection. For the first time, scientists working with the Academy of Finland’s Research Program on Nutrition, Food, and Health have found genes in the body that are associated both with the immune system and with the body's ability to properly digest gluten in the intestinal tract. Gluten intolerance arises from an autoimmune reaction in the small intestine to the gluten protein found in wheat, barley and rye. Academy Research Fellow Paivi Saavalainen, a veteran researcher in hereditary risk factors for gluten intolerance, says that "some of the genes we have identified are linked with human immune defense against viruses. This may indicate that virus infections may be connected in some way with the onset of gluten intolerance.” Data shows that rates of celiac disease in America have increased more than 400% since World War II. Meanwhile, a Finnish scientist internationally known for his gluten research says that the number of people in Finland who suffer from gluten intolerance has doubled over the last two decades. Since the early 1980s, the percentage of Finns with gluten intolerance has risen from about 1 percent of adults to about 2 percent, according to Professor Markku Mäki, head of a research project in the Academy of Finland's Research Program on Nutrition, Food and Health. "We've already seen a similar trend emerge earlier on where allergies and certain autoimmune disorders are concerned. Screening has shown that gluten intolerance occurs in 1.5 per cent of Finnish children and 2.7 per cent of the elderly. The higher figure for older people is explained by the fact that the condition becomes more frequent with age," says Mäki. For the immune study, when researchers scanned the genetic maps of more than 9400 celiac patients, they found areas of immune system disturbance. Their evidence also indicated that genes connected with the inability to digest gluten were also connected with other autoimmune diseases such as type 1 diabetes and rheumatoid arthritis. Saavalainen and his team have succeeded in localizing risk genes in both individual patients and entire families, which adds weight to the notion that gluten intolerance is inherited. The researchers are hoping to use the genetic information to craft better screening tests for gluten intolerance, as up to 75% of people with gluten intolerance remain undiagnosed due to mild or atypical symptoms, and many with condition may unwittingly suffer damage to their intestinal villi. Professor Maki points out that many present first with iron deficient, or folic acid deficient, anemia. Source: Academy of Finland
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Celiac.com 05/18/2009 - People with clinical irritable bowel syndrome (IBS) suffer from biopsy-proven celiac disease at rates that are more than four times higher than in non-IBS control subjects, according to the results of a recent systematic review and meta-analysis conducted by Alexander C. Ford, MBChB, MD, MRCP, from Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada, and colleagues. Prior studies have indicated that people with IBS had higher rates of celiac disease, but evidence has not been clear, and medical guidelines do not always call for celiac screening in these individuals. To determine rates of celiac disease in random adults meeting clinical criteria for IBS, the research team reviewed MEDLINE from 1950 to May 31, 2008, and EMBASE from 1980 to May 31, 2008. They isolated case series and case-control studies that contained data for celiac disease blood screens. They found 14 such studies. From each study, they isolated and aggregated positive serologic test results for celiac disease and biopsy-proved celiac disease. They then compared the data to that for patients with IBS and control individuals, using an odds ratio (OR) and 95% confidence interval (CI). The team isolated 4204 suitable cases from the identified studies. Of those, 2278 met clinical criteria for IBS (54%). The overall rate of positive immunoglobulin A (IgA)–class antigliadin antibodies (AGA) was 4.0% (95% CI, 1.7% – 7.2%), the rate of positive endomysial antibodies (EMA) was 1.63% (95% CI, 0.7% – 3.0%), and the rate of tissue transglutaminase (tTGA) was 4.1% (95% CI, 1.9% – 7.0%). For biopsy-proven celiac disease, the overall rate was 4.1% (95% CI, 1.9% – 7.0%). In patients who met the clinical criteria for IBS compared with non-IBS control subjects, aggregate OR for positive IgA-class antigliadin antibodies was 3.40 (95% CI, 1.62 – 7.13), aggregate OR for either positive EMA or tTGA was 2.94 (95% CI, 1.36 – 6.35), and aggregate OR for biopsy-proved celiac disease was 4.34 (95% CI, 1.78 – 10.6). The study did have some weaknesses, including issues with the methodology governing study selection, possible spectrum bias in case-control studies, possible selection bias in studies based in secondary care, and, in some cases, results too limited to allow meaningful aggregation of data. Still the research team concludes that rates of biopsy-proven celiac disease are more than four times higher for IBS patients than for non-IBS controls. The team recommends that, if screening is undertaken, EMA or tTGA testing be used in lieu of IgA-AGA testing due to their higher positive predictive value, though they admitted that results will depend on celiac rates in the population being screened. The study was supported by the American College of Gastroenterology. Arch Intern Med. 2009;169:651–658.
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Rates of Celiac Disease 2.5 Times Greater Among Elderly
Jefferson Adams posted an article in Latest Research
Celiac.com 10/10/2008 - A team of Finnish researchers announced that they have found high rates of undetected celiac disease in elderly populations. They have also noted that a significant number of those older people diagnosed with celiac disease showed only minor symptoms. The study team was made up of doctors A. Vilppula, P. Collin, M. M¨aki, R. Valve, M. Luostarinen, I. Krekel¨a, H. Patrikainen, K. Kaukinen, and L. Luostarinen. Even with a wealth of new information on celiac disease from numerous recent studies, along with better testing methods, we still don’t know very much about rates of celiac disease in older people. Motivated by that fact, the team recently set out to study the prevalence of celiac disease in elderly populations. In theory, celiac disease should occur in the elderly at rates similar to, or lower than, those of the general population. Since current research indicates that about 1 person in a hundred has celiac disease, it seems logical to figure that rates of celiac disease among the elderly would be the same or even lower than rates for the general population. The researchers figured that clinically silent or undiagnosed celiac disease would be rare in elderly populations, as they would be likely to develop obvious symptoms. But the team was surprised to find that rates of celiac disease among the elderly are more than double those of the general population. They looked at 2,815 individuals between the ages of 52–74. They took blood samples from everyone and isolated people who showed signs of clinical celiac disease. They then screened the samples for IgA tissue transglutaminase antibodies. Subjects with positive antibody tests were given a small bowel biopsy. The doctors found celiac disease in 60 individuals, 25 (0.89%) through positive blood tests, and 35 (1.24%) through biopsy, for a total prevalence of in elderly subjects of 2.13% with 95% confidence intervals (1.60–2.67%). Of the screen-detected cases, only 15 had symptoms, and those were mostly mild. Driving home the dangers of late diagnosis, two out of the 60 had small bowel T-cell lymphoma and two had gastric cancer. Altogether, celiac disease was diagnosed through biopsy, and by blood test without a post-gluten-free diet follow-up test at a rate of 2.45% (1.88–3.02%). This study shows that celiac disease is far more prevalent in elderly people than in the general population. To better detect and treat celiac disease in elderly populations, the doctors are encouraging the use of active case finding using blood tests, since undetected celiac disease can lead to serious complications and even early death. 2008 Editrice Gastroenterologica Italiana S.r.l. -
Scand J Gastroenterol. 2003 Jul;38(7):727-31. Effectiveness of the sorbitol H2 breath test in detecting histological damage among relatives of coeliacs. Tursi A, Brandimarte G, Giorgetti GM, Inchingolo celiac disease. Dept. of Emergency, L. Bonomo Hospital, Andria (BA), Italy. Celiac.com 08/07/2003 - An Italian study conducted by Dr. L. Bonomo and colleagues and published in the July 2003 edition of Scandinavian Journal of Gastroenterology concludes that A significant proportion of coeliacs may be missed if relatives are screened by serology only, while the efficacy of sorbitol H2-BT in screening relatives is confirmed. This study confirms that neither a breath test nor serology can replace intestinal biopsy, which remains the gold standard for the diagnosis of celiac disease, thus confirming the continued importance of performing biopsies for diagnosing celiac disease. The studys goal was to determine the diagnostic capabilities of serological tests (antigliadin (AGA), antiendomysium (EMA) and anti-tissue transglutaminase (anti-tTG)) and sorbitol H2 breath test (H2-BT) in the detection of celiac disease in first-degree relatives. The study screened 111 first-degree relatives of 37 celiac families using both test methods to determine candidates for small bowel biopsy. First-degree relatives with abnormal test results underwent a small bowel biopsy, as did those with negative serological and H2 breath test results who had clinical complaints or suspected that they may have celiac disease. The biopsy results were expressed using the Marsh classification system, and celiac disease was diagnosed in 49 of the 111 screened relatives of celiacs, or in 44.14%. A breakdown of the results is as follows: 5 showed Marsh IIIc, 8 Marsh IIIb, 16 Marsh IIIa, 13 Marsh II and 7 Marsh I lesions. 19 relatives showed the classical form of celiac disease, 20 showed the sub-clinical form, and 10 showed the silent form. The serological test results indicated an overall positivity of only 36.73%, with strong positive results only in those with severe intestinal damage and Marsh IIIb-c lesions. The sorbitol H2-BT breath test results showed an overall positivity of 83.67%, and showed strong positivity in patients with slight histological damage (Marsh I-IIIa).
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