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Showing results for tags 'blood test'.
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Hey there, I'm new! I've spent quite some time on this site reading up and thought I'd ask the experts. In end of November I started experiencing symptoms (toilet and gas focus) which in January really started escalating enough to send me to the doctor. I explained my symptoms and got a blood test and results about 10 days ago. My 'Deamidated Gliadin IgA was high at 31 U/mL (normal being <15) while the other results were all normal. Doc told me to go to GI for endoscopy, although stated this isn't a 'huge' increase. Meanwhile my symptoms started escalating to the occasional vomit, massive fatigue and feeling like I would collapse while walking to work. I'm reading a lot about this now (though still don't feel knowledgeable at all), and I'm wondering 1) does this number give any indication of celiac as a stand alone? No family history. 2) Is it possible that if it could be celiac, that it can happen so quickly? It just seems to be so sudden so I'm quite confused. I'm seeing the GI next week for next steps. It's just been a tough couple of weeks and I don't seem to get much help from the GP. Any tips would be appreciated!
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hi guys, i have recently (July) been diagnosed with celiac disease however via blood results my ttg iga was 128 which is ten times over normal and endomysial was a strong positive. I also had high lymphocytes and low vitamin B12. My GP advised due to how high to start a gluten free diet immediately which i did, my bloating, brain fog, bowels etc got how they should be and anxiety also. The Gastro dept have contacted me asking for me to go onto a gluten diet for 8 weeks for a biopsy which i have been glutened and has caused me utter hell in past. My concern is why on celiac foundation website are we told if it is ten times over normal count that pt should not necessarily need an Endoscopy. I have had a MRI due to brain fog, and they had found white matter on my brain that is linked to celiac. PLEASE HELP I HAVE NO IDEA WHAT TO DO, HE JUST TOLD ME TO GO ON GLUTEN DIET NO ADVISORIES NOTHING, EVEN WHEN I AM A STRONG POSITIVE!!!! and i really do not know if it is worth the trauma.
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Celiac.com 04/22/2023 - Celiac disease is an autoimmune disorder that may occur in genetically susceptible individuals. It is initiated by ingestion of gluten present in cereals, primarily wheat and to a much lesser extent other cereal proteins such as prolamines of barley and rye. Celiac disease is characterized by malabsorption resulting from inflammatory injury to the small intestinal mucosa. The classical symptoms of celiac disease include diarrhea, weight loss and malnutrition, however, only a small percentage of patients with celiac disease present with classical symptoms. Such patients represent the tip of the iceberg of gluten sensitivity. Many patients with celiac disease may present with short stature, iron and folate deficiency, anemia, bone loss, aphthous stomatitis, arthralgia, and dental enamel defects. Because of the varying and mild clinical presentations, celiac disease is often diagnosed when the patient has grown to adulthood rather than as a child. Adults may present with iron deficiency, anemia, macrocytic anemia and hypocalcemia. /* DivTable.com */ .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Clinical Presentations of Celiac Disease Classical Features Atypical Chronic Diarrhea Iron-deficiency anemia Failure to thrive Dental enamel defecs Abdominal distension Short stature Osteoporosis/osteopenia Coexistence with other autoimmune disorders Diagnosis based solely on clinical criteria can be misleading and may lead to improper diagnosis and treatment as a result of the variety of clinical presentations often seen in other conditions. Problems with diagnosis has a serious impact on the patient. Delays in diagnosis commonly extend 10-13 years from the first presentation of clinical symptoms, leaving the patient subject to chronic symptoms while searching for proper diagnosis. Failure to diagnose this condition in the short term may predispose an individual to long term complications such as splenic atrophy and intestinal lymphoma. On the other hand, attempts to diagnosis a patient based primarily on clinical criteria may unnecessarily place the individuals on life long gluten-free diet as several transient conditions may mimic celiac disease clinically. /* DivTable.com */ .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Cancer Morbidity on Normal, Reduced-Gluten and Gluten-Free Diet in Celiac Disease Diet Group Number Observed Malignancies Expected Malignancies Observed/ Expected Excess Morbidity Rate Normal 46 7 0.19 36.8 10.7 Reduced Gluten 56 5 0.12 41.7 5.0 Gluten-free 108 3 0.46 6.5 1.2 (Howelle PD, Is Coeliac Disease a Pre-Malignant Condition? Gastrointestinal Immunology and Gluten-Sensitive Disease, 1994. p.185) The true prevalence of celiac disease is difficult to ascertain. However, with the advent of serum antibody methods, incidences as high as one in 300 have been described in the general population, both in Western Europe and in the U.S. celiac disease is prevalent worldwide, but may be rare in individuals of Chinese and Japanese descent. /* DivTable.com */ .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Prevalence of Celiac Disease Country Prevalence based upon Clinical Prevalence based upon Laboratory Finland 1:1000 1:330 Italy 1:1000 1:184 Germany 1:2300 1:500 Netherlands 1:4500 1:250 Denmark 1:10,000 1:330 USA 1:10,000 1:250 Guandalini S & Gupta P Clin appl Immun Rev 2:293-305, 2002 Historically, the diagnosis of celiac disease was based primarily on histological studies of the Jejunal biopsy characterized by villous atrophy, crypt hyperplasia, and lymphocytic and plasma cell infiltrate in the lamina propria. Histological examination of the small intestinal biopsy remains the gold standard for diagnosing celiac disease, but has its limitations. Many patients with celiac disease are small children and histological studies may be viewed by many, especially a child’s parents, to be a great discomfort. There may also be problems with accuracy. Occasionally, a biopsy with abnormally high density of intraepithelial lymphocytes with a normal villous architecture may be reported as normal. It has also been reported that some patients with latent or even active celiac disease show normal histopathology (Gastroenterlogy 104:1263-72, 1993). Celiac disease might also be confused with other disorders when diagnosed histologically. Parasitic infections (giardia lamblia) and malabsorption syndrome, for example, may mimic celiac disease histology. As these limitations have been recognized, serum antibody tests have gained acceptance in screening for celiac disease and in follow-up of patients with celiac disease to determine their compliance to a gluten-free diet. The various serological tests employed in the work-up of patients suspected to have celiac disease include anti-gliadin antibody (AGA), anti-endomysial antibody (EMA), anti-reticulin antibody (ARA) and anti-tissue transglutaminase (tTG) antibody tests. Antibodies to gliadin and tTG are detected by ELISA, whereas endomysium and reticulin antibodies are detected by indirect immunofluorescence. Of the serum antibody tests, EMA and tTG antibody primarily detects antibodies of IgA immunoglobulin isotype, whereas the AGA test detects both IgG and IgA isotypes. No IgM class antibodies to these antigens are detected in patients with celiac disease, hence there is no need to test for IgM class antibodies in the work-up of patients with celiac disease. Of these tests, AGA was the first to be described in the literature and has been evaluated most extensively. AGA of IgG are more sensitive but less specific then IgA-AGA. The major utility of IgGAGA is in celiac disease patients who are IgA deficient. In a study conducted recently in our laboratory, all of the 15 IgA-deficient celiac disease patients were found positive for IgG-AGA and negative for IgA-AGA and other autoantibodies (Celiac Disease and IgA deficiency: How effective are the serological methods of diagnosis? Clinical diagnostic lab Immunology 9:1295-1300, 2002). EMA and ARA are very specific indicators of celiac disease. These assays are immuno-histochemical methods and require experience in reading immunofluorescence reactions. Some investigators suggest that they are less sensitive. However, in all the studies conducted since our laboratory first described EMA back in 1983, we find the EMA assay to be 100% specific and sensitive for celiac disease. Other investigators may find EMA to be less sensitive due to the selection of the substrate, fixation of tissue sections, specificity of conjugate employed or serum screening dilution. Internally, we find that testing for EMA at dilutions of 1:2.5 or 1:5 yield 5% of patients positive for EMA yet negative at 1:10 or 1: 20. It could be that some of the investigators who have reported low sensitivity might be screening the patients at high serum dilutions. Since the identification of tTG as the endomyisal antigen, ELISA methods have been described for detecting antibodies in the sera of patients with celiac disease. The advantage of the anti-tTG antibody assay is that it is an automatable assay that is less subjective than EMA and it is more sensitive and specific than AGA. For these reasons, many laboratories have opted to use the tTG antibody method as the screening method. In these laboratories, it may be the only assay used for detection of celiac disease cases. In the majority of studies of the tTG antibody method, the specificity and sensitivity were found to be between 90-95%. Table 4 on page 15 summarizes the specificity of the AGA, EMA and tTG antibody methods most commonly employed by laboratories performing tests for celiac disease. /* DivTable.com */ .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Diagnostic Specificity of Serological Markers for Celiac Disease Assay Specificity Sensitivity Anti-gliadin Antibody IgG 78% 88% Anti-gliadin Antibody IgA 86% 52% Anti-endomysial Antibody 100% 100% Anti-tissue transglutaminase 98% 90-95% If the prevalence of undiagnosed celiac disease is 4.8 per thousand as reported by Lagerqvist et al (J Intern Med 250:241-48, 2001) then of all the serological methods, EMA is the only method that provides 100% positive and negative predictive value for celiac disease. This raises the question of the optimum method of screening for celiac disease. The answer will vary according to the likelihood of celiac disease in the population studied and upon the experience of the laboratory performing the test. Some investigators may use the AGA or tTG antibody methods for screening and, if positive, confirm using the EMA test. We recommend this approach as it also helps to identify all celiac disease patients, whether IgA-deficient or not. Celiac disease patients are prescribed a gluten free diet for life. Serological tests are useful in monitoring a patient’s response and adherence to the gluten free diet. The levels of the various antibodies (AGA, EMA, ARA and tTG) decrease and eventually disappear in the majority of the patients on a complete gluten free diet. Similarly, these antibodies either appear or rise in level when the patient is on a gluten containing diet. Serological methods, therefore, play a significant role in both diagnosis and follow-up of celiac disease patients. Celiac disease has been associated with many other autoimmune disorders such as type 1 diabetes, thyroid autoimmunity and other autoimmune disorders. Approximately five percent of patients with type 1 diabetes have celiac disease. Similarly, approximately the same percentage of patients with celiac disease have type 1 diabetes. It has been proposed that early detection of celiac disease may be beneficial in such cases as it is believed that adherence to a gluten-free diet may delay the onset of diabetes. If true, this further emphasizes the utility of and need for serum antibody tests in the screening of population genetically susceptible for celiac disease. In conclusion, clinical symptoms of celiac disease are variable and often mild, resulting in significant delays in diagnosis. The use of serological tests has improved the ease of detection, monitoring, and hence— the continuing care of celiac disease patients.
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Celiac.com 01/22/2018 - Celiac disease is marked by HLA-DQ2/8-restricted responses of CD4+ T cells to gluten from wheat, barley or rye. Currently, in order to properly diagnose celiac disease based on serology and duodenal histology doctors need patients to be on gluten-containing diets. This is a problem for many people, who prefer not to begin ingesting wheat again once they have adopted a gluten-free diet. This can present challenges for doctors attempting to diagnose celiac disease. It is known that HLA-DQ–gluten tetramers can be used to detect gluten-specific T cells in the blood of patients with celiac disease, even if they are on a gluten-free diet. The team set out to determine if an HLA-DQ–gluten tetramer-based assay can accurately identify patients with celiac disease. The research team included Vikas K. Sarna, Knut E.A. Lundin, Lars Mørkrid, Shuo-Wang Qiao, Ludvig M. Sollid, and Asbjørn Christophersen. They are variously affiliated with the Department of Immunology, Oslo University Hospital – Rikshospitalet, Norway; the KG Jebsen Coeliac Disease Research Centre, University of Oslo, Norway; the Department of Gastroenterology, Oslo University Hospital – Rikshospitalet, Norway; the Department of Medical Biochemistry, Oslo University Hospital – Rikshospitalet, Norway; and with the Centre for Immune Regulation, Oslo University Hospital – Rikshospitalet and University of Oslo, Norway. For their study, the team produced HLA-DQ–gluten tetramers and added them to peripheral blood mononuclear cells isolated from 143 HLA-DQ2.5+ subjects. There were a total of 62 subjects with celiac disease on a gluten-free diet, 19 subjects without celiac disease on a gluten-free diet due to perceived sensitivity, 10 subjects with celiac disease on a non-gluten-free diet, and 52 seemingly healthy individuals as control subjects. The team used flow cytometry to measure T cells that bound HLA-DQ–gluten tetramers. They then used researchers blinded to sample type, except for samples from subjects with celiac disease on a gluten-containing diet, to conduct laboratory tests and flow cytometry gating analyses. They also conducted analysis on test precision using samples from 10 subjects. They found that an HLA-DQ–gluten tetramer-based test that detects gluten-reactive T cells identifies patients with and without celiac disease with a high level of accuracy, regardless of whether patients are on a gluten-free diet. This test could conceivably allow celiac diagnosis while suspected patients are still on a gluten-free diet. The team notes that their results require a larger study for validation. Could reliable celiac diagnosis be done without making patients consume gluten? Will that become common? Stay tuned for more developments. Source: Gastrojournal.org
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Hi there, my 73 year old mother has been diagnosed as Celiac four years ago. She has been following a strickt diet and has reduced her IGA test from > 100 to around 23 in her last test in February 2022. In August she went for her routine check and her blood work came back > 100. She has not been losing weight or feeling any new symptoms other than changes in blood pressure. She has eaten out on occasion and she always asks servers about food options for her, she has always done this but let's say there might have been some contamination in the past months post-COVID. Could this have increased her results so drastically from 23 to > 100? Her doctor is not really helpful, sent her to her dietician who told her that she must be slacking and the problem is cross-contamination. Since her last test she has stayed home being extra vigilant and will repeat the test in November. Is there anything we should be looking at, should she have a biopsy taken or other take other tests for further investigation? Thank you!
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I have been feeling constantly nauseous for the past 7 years or so with stomach cramping, bloating and a feeling of fullness/nausea/pain after i eat a meal (not over eating i can never finish a standard sized meal) - and a few times over the past few years i have had severe cramping to the point where i faint/lose vision etc - i have had different tests for gynae things in relation to this. But this time the gp has ordered tests for bowel diseases and coeliac disease as my bowel movements have changed over the past few months. I have a bowel movement every few days now instead of daily but on the days i do, its 3 or 4 times in the day and there is little warning and bad cramping. I get my bloods tested in 3 weeks and i havent ate gluten im 24 hours and havent felt any nausea. If i stop eating gluten will that affect my testing? If so, how much gluten should i eat for the next 3 weeks or should i return to my full gluten every meal diet until im tested. I don't have diarrheoa too often so it may not be gluten related but i couldnt believe the difference one day made.
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Celiac.com 04/04/2022 - Consensus is building among researchers and clinicians for skipping biopsy, and diagnosing celiac disease in both children and adults using antibody tests alone. A team of researchers recently set out to assess the diagnostic accuracy of serological tests for celiac disease in adults and children. The research team included Athena L. Sheppard; Martha M. C. Elwenspoek; Lauren J. Scott; Victoria Corfield; Hazel Everitt; Peter M. Gillett; Alastair D. Hay; Hayley E. Jones; Susan Mallett; Jessica Watson; and Penny F. Whiting. They are variously affiliated with the The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK; the Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; the Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK; the Paediatric Gastroenterology Department, Royal Hospital for Children and Young People, Edinburgh, UK; and the Centre for Medical Imaging, University College London, London, UK. The team searched seven electronic databases between January 1990 and August 2020 and looked for diagnostic studies that assessed the accuracy of serological tests for celiac disease against duodenal biopsy. They used QUADAS-2 to determine bias risk, along with bivariate random-effects meta-analyses to estimate serology sensitivity and specificity at the most commonly reported thresholds. They included over one-hundred and ten studies covering nearly thirty thousand patients, all in secondary care populations. Due to variations in diagnostic thresholds, they included a subset of studies in meta-analyses. Overall sensitivity and specificity of immunoglobulin A (IgA) anti-tissue transglutaminase were 90.7% and 87.4%, respectively, in adults, and 97.7% and 70.2% respectively in children. Overall sensitivity and specificity of IgA endomysial antibodies were 88.0% and 99.6% in adults, and 94.5% and 93.8% in children. Anti-tissue transglutaminase sensitivity appears to be sufficient to rule out celiac disease in children. The high specificity of endomysial antibody in adults supports clinical use to rule in celiac disease. This evidence supports the serological diagnosis of celiac disease without biopsy. The research team calls for additional studies in primary care to assess serological testing strategies. This news will come as a relief to anyone who has been made to eat gluten for a few weeks, and suffer a biopsy to get a celiac diagnosis. We truly are on a new threshold of celiac diagnosis, where biopsy will soon be a rare tool, and serological testing will deliver an accurate diagnosis. Stay tuned for more on this and related stories. Read more in pubmed.ncbi.nlm.nih.gov
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So. I've had some digestive symptoms off and on my whole life. And I've always been pale, underweight, etc. Ate a poor diet growing up because we were poor and didn't know better, and then in my teens, felt myself slowly start to feel worse until my system seemed to "break" after going out for a huge Chinese buffet dinner with family. For months afterwards, was struck with nausea, high heart rate/palpitations, constant gurgling in my digestive system, poor sleep, and so on. But I changed my diet and started eating more healthy and whole foods, started taking vitamins and probiotics, and aside from some "off" days every now and then, seemed to do much better. Went into my 30s and got married, had five kids, seemed to have relatively decent health and energy. Then had baby #5 with heavy blood loss afterwards. And then everything seemed to go wrong. In the months that followed, had more fatigue, kept getting sick, had more and more digestive issues (usually loose stools in the morning) about once a week or so. And then about six months postpartum, the kids picked up a stomach bug, I got it, too, and it seemed I never really came back from it. After going to the doctor several times and being told it was just the leftovers from the tummy bug or IBS, I ended up in the ER with heart palpitations and was told my thyroid had gone slightly hyper. Was put on medication for it, slowly started to feel better, though many of the digestive issues never really let me go. So about a year ago (eight months after the ER trip) went to a naturopath who checked for parasites (negative) and checked my nutrients and found I was low in a lot of things, especially iron and B vitamins. So I started taking vitamins, changed my diet even more (cut out gluten, dairy except for an occasional lactose-free yogurt, processed foods) and started to feel better slowly again, but still with some lingering issues. Went to the doctor in June of 2020 (six months after the naturopath) to find that my MCV/MCH were high on my blood tests, and that I had macrocytic anemia, and that I wasn't absorbing B12. So I was put on B12 injections (since pills didn't seem to be doing the trick) and AGAIN started to slowly improve. I started to improve enough that I began branching out with my diet and started sneaking in more gluten again. I went a bit nuts over the holidays this year, having cookies or something every day for several weeks, and then all of a sudden my system crashed right around New Years. I realized it was probably the baked goods, so I went for the blood test for celiac. They did igA and TTIGA and both were normal/negative. So they won't do a biopsy because the blood tests were fine. So now I don't know what to do. I'm planning on making an appointment with a functional medicine doctor to see if they can dig deeper. My symptoms now are off and on nausea, gas (sometimes smelly, but not all the time), feeling worse (nauseated, just overall gross) when I have to pass gas or use the bathroom, upper abdominal pain (but it seems to be centered around the edge of the ribcage, as if it's the bone itself that hurts), poor sleep, weight loss, having to go the bathroom urgently usually first thing in the morning (around 3am-5am), cold hands and chills. All of those symptoms worsened after having more gluten/baked goods over the holidays. Odd things that I can't seem to make heads or tails of are that I wake up around the same time every morning having to use the bathroom and feeling generally ill. Sometimes that feeling returns in the afternoon around 3:30pm. Usually by evening a lot of the symptoms seem to fade out and I start to not feel as bad. I can lie down and go to sleep and not feel terrible, but then start waking up in the middle of the night with gas and then needing to go to the bathroom at that same 3-5am time. And symptoms also always worsen around my cycle. So is it hormonal? Is it a gluten sensitivity? Is the gluten messing with my hormones? Am I losing my mind? I just want to feel better and I feel like ever since I had my last baby 2 1/2 years ago I can't get on top of it.
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Celiac.com 05/04/2021 - Immunoglobulin A tissue transglutaminase gives doctors a noninvasive way to spot celiac disease, but new research suggests that its sensitivity may be lower than estimated, making it a poor screening test, at least in asymptomatic patients. The reason comes down to verification bias, wherein a technique appears to have higher sensitivity and lower specificity than it actually does, because individuals who screen positive are more likely to have their disease confirmed by a follow-up small-bowel biopsy, while those who screen negative are unlikely to have a follow-up biopsy that could reveal missed celiac disease. That matters because the disparity could lead to missed celiac diagnoses, because some of those in the negative group could actually have celiac disease. "What you're missing from when you're calculating sensitivity is, what about the ones that are negative on the index test? Would they have been positive on that reference test? That's not even coming into your calculation because they're not getting that reference test," said Marisa Stahl, MD, a physician and researcher at the Children's Hospital Colorado Center of Celiac Disease in Aurora. Stahl was not involved in the meta-analysis, but commented on it in an interview. To determine whether the studies used by USPSTF may have overestimated sensitivity due to verification bias, Isabel Hujoel, MD, of the Mayo Clinic, Rochester, Minn., and colleagues conducted a meta-analysis, in which they reviewed those same nine studies to see the potential impact of verification bias. They then rated each study as being high, low, or unclear for possible verification bias. In all, they found five studies to be high risk. The only way to fully correct the bias is to run both IgA tissue transglutaminase (tTG) testing and small bowel biopsy on a complete or random sample of patients, and compare the sensitivity and specificity of IgA tTG with the preferred method small-bowel biopsy. But this is almost never done. Instead, when the U.S. Preventive Services Task Force concluded that evidence was insufficient for IgA tTG testing for celiac disease, it relied on a 2016 comparative effectiveness review of nine studies that estimated sensitivity at 92.6% and specificity at 97.6%. USPSTF remained noncommittal because of inadequate evidence surrounding the balance of benefit and harms of screening for celiac disease in asymptomatic individuals. Dr. Stahl was a bit shocked to see that the sensitivity was so much lower than has been traditionally accepted. The data clearly shows that "...the sensitivity is probably lower than what we oftentimes reference, and we should think more about the population of patients that could potentially screen negative and still have celiac disease," she said. Stahl suggests that the problem may be more common in adults, who have a higher incidence of seronegative Celiac disease, though there is no good data on that point, right now. Clearly reduced sensitivity of IgA tissue transglutaminase (tTG) testing is a big deal, and we're likely to hear more on this, so stay tuned. Read the full report in the Journal of Clinical Gastroenterology and the abstract pubmed.ncbi.nlm.nih.gov
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Hi! I recently did blood testing for celiac disease for the first time, and just received my results. What do these results indicate? My follow up appointment with my doctor isn’t for a month but I wanted to understand what my results are. any help in interrupting these would be much appreciated!
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Celiac.com 02/22/2021 - The skin has long been thought to be the body's largest organ. Recently, however, researchers discovered that the largest organ might actually be the interstitium, which lies just beneath the skin's outermost layers. It is that interstitial tissue that is the focus of a new biometric skin patch that may eventually diagnose numerous ailments faster and easier, and more cleanly than traditional blood tests. However, this is no easy task, as the interstitial tissue won't give up its secrets easily. Even though it's close to the skin, and close to blood, getting enough useful fluid from the interstitial tissue to get accurate test data is a bit like squeezing blood from a stone. Getting even a thousandth of a tablespoon, an amount still hundreds of times smaller than a standard blood draw, remains a challenge. A new development might offer a way around that challenge. In a recent paper, researchers at Washington University in St. Louis report using disposable micro-needle patches to capture ISF biomarkers, and to measure them up to about 800 times greater sensitivity than comparable biomarker tests. The thin rectangular patches contain hundreds of plastic micro-needles, each less than a millimeter long. To use them, simply press the patch against your finger, then dip the patch into a liquid solution of nanoparticles, which will sense and reveal presence of the certain known proteins. Because blood based testing can present logistical and financial challenges for poor and/or rural populations, such a test represents a logistical, scientific and financial breakthrough. "Currently, the new skin patches work on just a few biomarkers, but by significantly improving the sensitivity of immunoassays,” says Srikanth Singamaneni, a materials scientist who led the study, researchers may be able to help to meet the "need for bio-diagnostics in low- and middle-income countries—and even in rural parts of the United States.” The test can detect cytokine IL-6, and research has shown that detecting cytokines may be the best way to diagnose gluten sensitivity. A cheap, portable, reliable test that could spot celiac disease, gluten sensitivity and other health conditions, could be a major benefit to large numbers of people who remain undiagnosed, and for whom traditional blood tests are often out of reach. The team's data appears in Nature Biomedical Engineering. Read more on this in an excellent article by Wired.com
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Celiac.com 09/24/2020 - Celiac disease is an autoimmune condition in which eating wheat, rye, or barley triggers an adverse immune reaction in the gut. Celiac disease affects about one percent of the population. Diagnosis can be a long and arduous process. In the United States, the average person with celiac disease can wait up to ten years from the time of first symptoms to diagnosis. Left undiagnosed, autoimmune disease can cause organ damage and bowel cancer. Anyone who has ever had to suffer through a long, convoluted process to get their celiac disease diagnosis can now rejoice for any new celiacs going forward. That's because researchers have developed a single blood test that can diagnose celiac disease without biopsy. Until now, the "gold standard" for celiac diagnosis was the duodenal biopsy, which is normally performed by a gastroenterologist in the days or weeks after a positive blood test, during which time the patient needs to keep consuming gluten. However, nearly half of patients did not need to undergo a more risky biopsy procedure at all. This data, coupled with the need to catch up with a backlog of endoscopies created during the Covid-19 pandemic, has provoked a change in guidance from the British Society of Gastroenterology and The National Institute for Health and Care Excellence (NICE). An upcoming report by British researchers for the leading gastroenterology journal Gut, shows that the standard tTG blood test alone is 95 percent accurate for diagnosing celiac disease. Trials show the tTG blood test to be 95 percent sensitive (meaning it detects celiac disease 95 times out of 100), and 95 percent specific (meaning it gives a false positive result just 5 times out of 100). The test measures blood levels of anti-transglutaminase antibodies, or tTG2, which are higher in people with celiac disease. TTG2 proteins are among the proteins trigger the immune reaction the causes inflammation when celiac eat wheat, rye, or barley. Celiacs have hundreds times more tTG proteins than non-celiacs. Being able to diagnose celiac disease quickly and accurately, via blood test alone, is a huge game-changer for celiac patients. Tens of thousands of people with suspected celiac disease can now get a diagnosis with a simple blood test, sparing them from the more risky biopsy procedure. Not only will many be spared the prolonged side-effects, and invasive, drawn-out diagnosis, they will also be spared the long-term damage that come with undiagnosed celiac disease. Read more at DailyMail, news-medical.net, and bmj.com.
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I was feeling unwell after eating certain foods the last 6months, I went to the doctor an he did a blood test for Coeliac. It came back positive. Gliadin igG- 16.0 u/ml TTg IGa- 31.0 u/ml as I got these results a week before Xmas everyone is closed an I have to wait now until they reopen. I’m continuing to eat gluten to help have my biopsy be accurate. Are my numbers high? I’m feeling very overwhelmed, I’m also on medication for high cholesterol which was 8.8 August 2020, so I changed my diet to help that, now this.
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Celiac.com 12/14/2020 - The science behind celiac disease diagnosis has been moving rapidly away from biopsy. First, biopsy screening was eliminated for celiac diagnosis in most children. Then, the European Society for the Study of Paediatric Gastroenterology, Hepatology and Nutrition guidelines suggested that celiac disease can be diagnosed without taking duodenal biopsies. The latest diagnostic guidelines suggest that a 10-fold increase in IgA antitissue transglutaminase (tTG) antibody levels, in combination with EMA positivity, supports a diagnosis of celiac disease, without the need for a duodenal biopsy. However, this approach has not yet been widely adopted into clinical practice for diagnosing adults, mainly due to a limited international multi-center data, and testing in groups with low celiac disease rates. New research confirms that most adults do not require a biopsy for a reliable celiac disease diagnosis. A recent study by a team of researchers showed that a 10-fold increase in serum IgA antitissue transglutaminase (tTG) antibody levels has high predictive capacity and diagnostic reliability for detecting small intestinal injury diagnostic of celiac disease in adults. The research team included Hugo A Penny, Suneil A Raju, Michelle S Lau, Lauren JS Marks, Elisabeth MR Baggus, Julio C Bai, Gabrio Bassotti, Hetty J Bontkes, Antonio Carroccio, Mihai Danciu, Mohammad H Derakhshan, Arzu Ensari, Azita Ganji, Peter H R Green, Matt W Johnson, Sauid Ishaq, Benjamin Lebwohl, Adam Levene, Roxana Maxim, Hamid Mohaghegh Shalmani, Mohammad Rostami-Nejad, David Rowlands, Irene A Spiridon, Amitabh Srivastava, Umberto Volta, Vincenzo Villanacci, Graeme Wild, Simon S Cross1, Kamran Rostami, and David S Sanders. Their study looked at three different groups of people: Group 1 featured 740 patients assessed in the specialist celiac disease clinic at a UK center; Group 2 featured 532 patients with low suspicion for celiac disease referred for upper GI endoscopy at a UK centre; while Group 3 included 145 patients with raised tTG levels from multiple international sites. The team used Marsh 3 histology as a reference standard to determine the performance features of an IgA tTG titre of ≥10×ULN for a diagnosing celiac disease in adults. Across all three groups of adult patients, the data shows that nearly every person with IgA tTG levels of ≥10×ULN has small intestinal mucosal changes (Marsh 3 lesions) that are hallmarks of clinical celiac disease as diagnosed via the former "gold standard" of duodenal biopsy. The team's data reveal that IgA tTG levels of 10×ULN have 100% specificity at detecting Marsh 3 lesions in Group 2's 532 adults with low suspicion of celiac disease, for a disease rate of 3.2%. The team also found that an IgA tTG cut-off of 10×ULN was effective at spotting patients with Marsh 3 lesions using different tests at various international locations. However, the team feels that establishing test-specific thresholds and/or standardized tTG tests used with this pathway could help to refine this method for widespread clinical use. The results of this study show that IgA tTG levels of ≥10×ULN strongly reflect intestinal changes consistent with adult celiac disease diagnosis. As such, the results support the elimination of biopsy in the diagnosis of most cases of adult celiac disease, in favor of the no-biopsy approach. Read more, including detailed data, at Gut.bmj.com The researchers are variously affiliated with the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK; the Medicine, Gastroenterology Hospital Dr C Bonorino Udaondo, Buenos Aires, Argentina; the Gastroenterology & Hepatology Section, Department of Medicine, University of Perugia Medical School, Perugia, Italy; the Department Clinical Chemistry, Amsterdam Gastroenterology and Metabolism and Infection and Immunity Institutes, Amsterdam UMC, Amsterdam, The Netherlands; the Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy; the Pathology Department, Grigore T. Popa University of Medicine and Pharmacy Iasi, Iasi, Romania; the Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; the Department of Pathology, Ankara University Medical School, Ankara, Turkey; the Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; the Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA; Gastroenterology, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK; the Department of Gastroenterology, Dudley Group NHS Foundation Trust, Birmingham City University, Birmingham, UK; the Gastroenterology Department, Grigore T. Popa University of Medicine and Pharmacy Iasi, Iasi, Romania; the Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran; the Department of Gastroenterology, Queen Elizabeth II Hospital, Hertfordshire, UK; the Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; the Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; the Department of Pathology, Spedali Civili, Brescia, Italy; and with the Department of Gastroenterology, MidCentral District Health Board, Palmerston North, New Zealand.
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Celiac.com 10/31/2020 - Since this article was originally published in 2008, the tTG test has become the standard for celiac disease screening, while a newer test called "Deamidated Gliadin Peptide (DGP)" is now considered the best for CD, and the company 2G Pharma is unfortunately no longer in business. Do you know someone who might benefit from a celiac blood test? Maybe they are too shy to assert themselves. Or maybe they’ve been turned down flat by a physician who is not current with the medical literature on celiac disease. As many of us know, asking for celiac testing is sometimes like hitting a brick wall. Stories abound of incorrect diagnoses, cavalier indifference, dismissal, denial, frustration, illness, often leading to a pervasive sense of futility. Each of these stories is punctuated by pain, illness, heartache, and sometimes, death. For the lucky ones, a health care professional who is well versed in celiac disease sometimes furnished the answer. Others found their own way to a gluten free diet. Until now, most have not been so lucky. However, the brick wall is starting to crumble. A powerful force is poised to bring new hope to that unlucky, unhappy, unhealthy majority of untreated, undiagnosed group with celiac disease. 2G Pharma Inc. is now offering an at-home test for IgA tissue transglutaminase antibodies (tTG) called the Biocard celiac test. Although currently only available in Canada, it can be ordered over the Internet for only $50. Although not yet approved by Health Canada, the newer version also tests for IgA deficiency, and will thus be more accurate than the celiac testing offered by many conventional laboratories (because they often fail to consider IgA deficiency). Few physicians would deny the extreme likelihood of celiac disease in the context of positive tTG test results. If the test shows IgA deficiency (when approved) although it is not as reliable an indicator of celiac disease, it would also be well accepted as indicating the need for further investigation for celiac disease. So this new test is offering something very special, and for a very small price. Those of us who are familiar with celiac disease know that if it goes untreated it can pose a wide range of challenges. Untreated celiacs can appear healthy. Or they can manifest just a single sign or symptom such as isolated iron deficiency or osteoporosis, or rheumatoid arthritis or cancer or thyroid disease or a brain disorder or a fertility problem. On the other hand, untreated celiacs can also show a confusing array of signs, symptoms, and associated autoimmune disease. Still others will report concerns and symptoms that seem more like psychological complaints than physical manifestations of a diet-driven autoimmune disease. For instance, we now know that there are more overweight and obese individuals with untreated celiac disease than there are underweight celiacs. That is what they mean when researchers talk about the protean manifestations of celiac disease. Whatever the symptom, sign, or ailment, it can stand alone as the sole indicator, or it can be one of a constellation of problems that are due to, or associated with, an underlying case of undiagnosed celiac disease. Yet few physicians will make the connection. Until now, most cases of celiac disease will never be diagnosed because medical professionals are taught to look for a consistent complex of signs and symptoms. Most believe that untreated celiac patients are gaunt, wasted, sickly, and have protruding bellies. While this may have been true in the past we now know that celiac disease is difficult, often impossible, to identify on the basis of symptoms. Objective testing is often the only way that celiac disease can be diagnosed. Thus, this new test will identify the vast majority of untreated celiac patients. And the test is easily defended against those who might look askance at home testing. Korponay-Szabo et. al. report in Alimentary Pharmacology and Therapeutics that this test is 97% specific and 97% sensitive (1). Test sensitivity is determined by how many celiacs are identified by a positive test. Only 3% of those with celiac disease failed to be identified by this test. However, the one celiac patient that was missed in this research project suffered from IgA deficiency, which is much more common in the context of celiac disease than in the general population. Further, because the newer form of this test would have identified this deficiency, it is very likely that the patient would be further investigated for celiac disease. Thus, the test could be argued to have been 100% sensitive in their study. The same group reported that the test is 97% specific. That means that the test will show positive in cases of celiac disease as well as in 3% of patients who do not have celiac diseae. Several other groups of researchers report that many of those who test positive for tTG often go on to develop celiac disease within a few months or years. Crovella et. al., report in Digestive and Liver Disease, similar results but with one important exception. When this test was used among a group of impoverished individuals who were infected with filariasis its specificity weakened substantially. People who were infected with this parasite showed positive tTG test results despite the absence of celiac disease. Thus, despite 100% specificity among Brazilian urbanites, the test was only 76% specific when used to screen impoverished suburban Brazilians. Thus, although this test is less than ideal in some third world settings among those with filariasis infections, it is clearly a powerful tool for identifying celiac disease in the industrialized world. Closer to home, 2G Pharma Inc. is rolling out this new test in Canada, as I write this column. I suggested to Janet Monk that there might be a little cross-border shopping. Her company has chosen to take the high road and avoid the risk of contravening U.S. import/export laws. Sadly, many crooks and charlatans feel perfectly happy to send drugs and other dangerous substances into the US. Yet this young company, offering a simple (but powerful) blood test that could save the US medical system billions of dollars annually, is forced to await appropriate approvals before sending their product into the US. Bear in mind that it is not a drug. It is an at-home test for a dangerous disease that goes undiagnosed in 97% of cases in the U.S. (3) and because of all the associated ailments, takes an enormous toll on at least three million Americans (4). I would love to see this product available in the U.S., if only to stem the enormous risk of illness and lurking cancers that have been shown to reduce on a gluten free diet among those with celiac disease. If you live in Canada, you can order or encourage others to order the test. If you live elsewhere, perhaps there is something you can do to make this test available in the U.S. If nothing else, you can order and make use of the test when you visit Canada. In the meantime, this grand new test is poised and ready help diagnose the millions of Americans who will otherwise go untested and undiagnosed. I am confident that some alternative can be implemented to harness this test and get it working for Americans and Canadians alike. Sources: Korponay-Szabó IR, Raivio T, Laurila K, Opre J, Király R, Kovács JB, Kaukinen K, Fésüs L, Mäki M.Coeliac disease case finding and diet monitoring by point-of-care testing. Aliment Pharmacol Ther. 2005 Oct 15;22(8):729-37. Crovella S, Brandao L, Guimaraes R, Filho JL, Arraes LC, Ventura A, Not T.Speeding up coeliac disease diagnosis in the developing countries. Dig Liver Dis. 2007 Oct;39(10):900-2. Epub 2007 Aug 13. Green PH.Where are all those patients with Celiac disease? Am J Gastroenterol. 2007 Jul;102(7):1461-3. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.
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Hi everyone, This is my first post so bear with me. I have been lurking and reading many helpful posts but was hoping to share my current situation and ask for advice. Around 2 months ago I got what I thought was the flu. I had a fever, aches, diarrhoea and an odd fast heart rate with a bounding pulse. I also developed high blood pressure for the first time in my life and it was usually around 150/100 when high. Most of the symptoms cleared up in a couple days but the diarrhoea and heart complications remained. I have seen a cardiologist and they ran me through tests like ECG and 24 hrs halter. The diagnosis was that my heart was structurally normal and he thought my heart was reacting to the virus as I recovered. In the first month I lost about 10-15lbs and became pretty weak. My stomach would normally feel fine through the day but would cause a lot of bloating pain overnight. I eventually saw a GI doc and he ran a series of blood tests for me. My thyroid, liver and full blood counts were good but the celiac screen showed a positive value. Below were my results. anti-gliadin peptides iga 13, normal range 0-25 anti-gliadin peptides igg under 2, normal range 0-25 TTG IGA 3, normal range 0-20 TTG IGG 31, normal range 0-10 So it would appear my TTG IGG was the only positive which seems a bit unusual. The GI doc would like to do the biopsy but I have concerns about getting put to sleep when my heart is abnormal. I am hoping I can consider the elevated TTG IGG as a diagnosis and forego the biopsy if possible. I have 2 young kids and am 32 right now so I am hoping to look at Long term recovery. In terms of background I had GBS when I was 18 so I have a history with autoimmune. My Sister has autoimmune arthritis and my Mother has autoimmune psoriasis. My grandpas sister and my cousin have celiac disease. I started taking some vitamin supplements and feel better but the worst symptoms remaining are the heart complications, achey joints and poorly digested food. Thanks for your time.
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Celiac.com 02/13/2019 - Microsoft and Adaptive Biotechnologies have announced a major milestone in their efforts to develop a blood test capable of diagnosing numerous diseases with a single blood sample. The companies are attempting to use data to map the immune system’s response to perceived threats. By cataloging the body’s immune responses to certain threats, and how those responses are reflected in the blood, they hope to create a single test to diagnose numerous diseases, including type 1 diabetes, celiac disease, ovarian cancer, pancreatic cancer and Lyme disease. To do this, they need huge amounts of data, and massive computing power for data sorting. The team’s artificial intelligence programs are central to their data crunching efforts. The team announced recently that the AI systems central to their task are now operational. Using that AI power, Adaptive and Microsoft are hoping to sequence immune data from 25,000 people with the five diseases by recruiting voluntary collaborators worldwide. Through the collaboration, they hope to collect information on how the T cells and white blood cells, central to the human immune response, bind to antigens. Once they’ve done that, the team hopes to develop methods for accurately diagnosing people with a given disease, or who have higher genetic risk for that disease. “Our AI systems are now ready. So please join us in decoding what ‘story’ the immune system is telling us,” wrote Peter Lee, Microsoft Corporate VP of AI and Research, on Twitter. Adaptive is working with the University of Florida, the Fred Hutchinson Cancer Research Center, and the University of Colorado and Virginia Mason, to profile thousands of people with type 1 diabetes, celiac disease, ovarian cancer, pancreatic cancer and Lyme disease, or with higher genetic risk factors for those diseases. Learn more about joining this scientific breakthrough at Adaptivebiotech.com
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How long did it take you to get your blood test results? How were you notified of the results (letter, phone call etc.)?
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