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Jefferson Adams posted an article in Celiac Disease Diagnosis, Testing & TreatmentCeliac.com 10/23/2013 - Celiac disease remains seriously under diagnosed in adults and, in many places, often takes years and even decades to diagnose. A team of researchers recently evaluated the usefulness of an on-site rapid fingertip whole blood point-of-care test (POCT) that would help primary workers to spot patients who might benefit from further diagnostic tests for celiac disease. The research team included Alina Popp, Mariana Jinga, Ciprian Jurcut, Vasile Balaban, Catalina Bardas, Kaija Laurila, Florina Vasilescu, Adina Ene, Ioana Anca and Markku Mäki. They are affiliated with the University of Medicine and Pharmacy “Carol Davila,” the Institute for Mother and Child Care “Alfred Rusescu,” Central University Emergency Military Hospital “Dr. Carol Davila,” Str. Mircea Vulcanescu, in Bucharest, Romania and with theTampere Center for Child Health Research, University of Tampere and Tampere University Hospital, in Tampere, Finland. Because celiac disease often runs in families, the team tested 148 healthy relatives of 70 Romanian index cases with biopsy-proven celiac disease, for a total of 87% of all first-degree family members, with a median age 36 years, for the presence of circulating autoantibodies. In addition to using the POCT to measures blood erythrocyte self-TG2-autoantibody complexes on site, the team took blood samples for later evaluation of serum IgA-class endomysial antibodies (EMA). The then tested all EMA-positive samples for transglutaminase 2 antibodies (TG2-IgA). They conducted blind analysis of all serological parameters in a centralized laboratory with no knowledge of the on site POCT result. The team recommended endoscopic small intestinal biopsies for all POCT- or EMA-test positive subjects. Overall, 12 of 148 (8%) first-degree relatives showed positive results for the POCT, and all twelve tested serum EMA-positive. Only one other test subject showed a positive EMA test result. All remaining 135 healthy first-degree relatives showed negative results for both POCT and EMA. Four subjects who tested positive for both POCT and EMA were negative for TG2-IgA. Ten out of thirteen of the antibody-positive subjects consented to endoscopy. In all, eight out of nine first-degree relatives with celiac-type mucosal lesions of grade Marsh 2 (n = 3) or Marsh 3 (n = 6) showed positive results with the POCT. The three POCT-positive subjects refused endoscopy tested positive for both EMA and TG2-IgA. The fingertip whole blood rapid POCT could be a simple and cheap way to spot biomarkers and promote further testing for faster diagnosis of celiac disease. The team is calling for further studies in adult case-finding in specialized outpatient clinics and in primary care. Source: BMC Gastroenterology 2013, 13:115. doi:10.1186/1471-230X-13-115
Celiac.com 09/28/2007 - Celiac disease is one of the most common lifelong disorders in western countries. However, most cases in North America remain currently undiagnosed, mostly because they present unusual symptoms and because of the low number of doctors who have a sound awareness of celiac disease. In a large European survey, the ratio between diagnosed and undiagnosed cases, found by mass serological screening, was as high as 1 to 7 , an effect termed the ‘celiac iceberg’. In addition to having chronic symptoms that might otherwise respond to a gluten-free diet, undiagnosed patients are exposed to the risk of long-term complications of celiac disease, such as anemia, infertility, osteoporosis, or cancer, particularly an intestinal lymphoma. Celiac Disease is diagnosed by confirming the presence of intestinal damage to the small intestine through a biopsy, along with a clinical response to the gluten-free diet. However, serological markers, e.g., the IgA class anti-tissue transglutaminase (tTG) antibodies, are useful screening tests. The sensitivity and the specificity of the IgA anti-tTG test are 94% and 97%, respectively. To address the large number of undiagnosed cases, a team of researchers recently set out to assess whether an active case-finding strategy in primary care could lead to increased frequency of celiac disease diagnosis, and to assess the most common clinical manifestations of the condition. The team was made up of Carlo Catassi, M.D., M.P.H.; Deborah Kryszak, B.S.; Otto Louis-Jacques, M.D.; Donald R. Duerksen, M.D.; Ivor Hill, M.D.; Sheila E. Crowe, M.D.; Andrew R. Brown, M.D.; Nicholas J. Procaccini, M.D.; Brigid A Wonderly, R.N.; Paul Hartley, M.D.; James Moreci, M.D.; Nathan Bennett, M.D.; Karoly Horvath, M.D., Ph.D.; Margaret Burk, R.N.; Alessio Fasano, M.D. 737 women and 239 men, with a median age of 54.3 years, who attended one of the practices participated in a multi-center, prospective study involving adult subjects during the years 2002-2004. All individuals with celiac-associated symptoms or conditions were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies. Those with elevated anti-tTG were then tested for IgA antiendomysial antibodies (EMA). All who were positive for EMA were advised to undergo an intestinal biopsy and HLA typing. 30 out of 976 study subjects showed a positive anti-tTG test (3.07%, 95% CI 1.98-4.16). 22 patients,18 women, 4 men, were diagnosed with celiac disease. In these 22 cases the most common reasons for screening for celiac disease was: bloating (12/22), thyroid disease (11/22), irritable bowel syndrome (7/22), unexplained chronic diarrhea (6/22), chronic fatigue (5/22), and constipation (4/22). The prevalence of celiac disease in the serologically screened sample was 2.25% (95% CI 1.32-3.18). The diagnostic rate was low at baseline (0.27 cases per thousand visits, 95% CI 0.13-0.41) and rose sharply to 11.6 per thousand visits (95% CI 6.8-16.4, P This study shows that the diagnosis rate for celiac disease can be significantly increased through the implementation of a strategy of active case-finding. Am J Gastroenterol. 2007;102(7):1454-1460.