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Celiac.com 02/10/2024 - Villous atrophy, a condition marked by the blunting or flattening of the microscopic structures called villi in the small intestine, is most commonly associated with celiac disease. However, emerging research and clinical observations have unveiled a spectrum of diverse conditions beyond celiac disease that can lead to villous atrophy. This article explores the lesser-known contributors to villous atrophy, shedding light on various health conditions that may present with similar histological changes in the small intestine. While celiac disease remains a prominent cause, understanding these alternative pathways to villous atrophy is crucial for accurate diagnosis, appropriate management, and a comprehensive approach to gastrointestinal health. From autoimmune disorders to infections and drug-induced reactions, exploring the multifaceted nature of villous atrophy enhances our grasp of gastrointestinal pathology and guides clinicians toward more nuanced and personalized patient care. Other Conditions Associated with Villous Atrophy In the following sections, we delve into a comprehensive exploration of diverse health conditions intricately linked to villous atrophy, shedding light on their unique associations and implications for gastrointestinal health. Eosinophilic Enteritis Eosinophilic enteritis is an inflammatory disorder characterized by an increased presence of eosinophils in the gastrointestinal tract. Eosinophils are a type of white blood cell involved in the immune response. In eosinophilic enteritis, these cells infiltrate the walls of the intestines, causing inflammation and damage. This inflammatory process can lead to various symptoms, including abdominal pain, diarrhea, and malabsorption. In some cases, the inflammation may result in villous atrophy, affecting the absorptive capacity of the small intestine. Diagnosis often involves endoscopic procedures with tissue biopsy to evaluate the extent of inflammation and associated damage. Crohn's Disease Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, from the mouth to the anus. In the small intestine, Crohn's disease can cause inflammation and damage to the intestinal lining, leading to complications such as strictures and fistulas. In some cases, individuals with Crohn's disease may experience villous atrophy, particularly in areas of the small intestine affected by inflammation. The severity of villous atrophy can vary among patients with Crohn's disease, and its presence may contribute to malabsorption issues and nutritional deficiencies. Management often involves anti-inflammatory medications, immunosuppressants, and, in severe cases, surgical intervention to address complications. Giardiasis Giardiasis is an intestinal infection caused by the parasite Giardia lamblia. This parasitic infection can lead to symptoms such as diarrhea, abdominal cramps, and bloating. In addition to the acute phase of the infection, chronic giardiasis has been associated with villous atrophy in some cases. The mechanisms by which Giardia lamblia causes villous atrophy are not fully understood, but it is believed to involve both direct damage to the intestinal lining and an immune response triggered by the presence of the parasite. Diagnosis typically involves stool tests to detect the parasite, and treatment includes antiparasitic medications. Common Variable Immunodeficiency (CVID) Common Variable Immunodeficiency (CVID) is a primary immunodeficiency disorder characterized by impaired antibody production, leading to increased susceptibility to infections. Some individuals with CVID may experience gastrointestinal symptoms, including chronic diarrhea and malabsorption. In severe cases, villous atrophy can occur, impacting the absorption of nutrients in the small intestine. The association between CVID and villous atrophy underscores the complex interplay between the immune system and the intestinal mucosa. Management involves immunoglobulin replacement therapy to address the immune deficiency and supportive measures for gastrointestinal symptoms. Autoimmune Enteropathy Autoimmune enteropathy is a rare autoimmune disorder that primarily affects the small intestine. In this condition, the immune system mistakenly attacks the cells of the intestinal lining, leading to severe inflammation and damage. Villous atrophy is a characteristic feature of autoimmune enteropathy, affecting the absorptive surface area of the small intestine. Individuals with autoimmune enteropathy often present with persistent diarrhea, malabsorption, and failure to thrive. Diagnosis requires extensive evaluation, including endoscopic procedures and tissue biopsy. Treatment involves immunosuppressive medications to modulate the autoimmune response and manage symptoms. Human Immunodeficiency Virus (HIV) Advanced Human Immunodeficiency Virus (HIV) infection can result in various gastrointestinal complications, affecting both the upper and lower parts of the digestive tract. HIV-associated enteropathy may involve villous atrophy, contributing to malabsorption and nutritional deficiencies. The mechanisms leading to villous atrophy in HIV infection are multifactorial, involving both direct viral effects and immune-mediated processes. Additionally, opportunistic infections and other HIV-related complications can further impact the gastrointestinal mucosa. Management includes antiretroviral therapy to control HIV replication and supportive measures to address nutritional deficiencies and associated symptoms. Regular monitoring and a multidisciplinary approach are crucial in the care of individuals with HIV-associated gastrointestinal conditions. Dermatitis Herpetiformis (DH) Dermatitis herpetiformis is a chronic skin condition characterized by intensely itchy, blistering skin lesions. While DH primarily manifests as a skin disorder, its connection to celiac disease is well-established. Both conditions share a common trigger: gluten ingestion. DH is considered the skin manifestation of celiac disease, and individuals with DH often have underlying gluten sensitivity. The immune response triggered by gluten in susceptible individuals leads to the formation of IgA antibodies, which deposit in the skin, causing the characteristic skin lesions. While DH predominantly affects the skin, it is crucial to recognize its association with celiac disease, as individuals with DH may also experience villous atrophy in the small intestine. Therefore, a gluten-free diet is not only essential for managing skin symptoms but also for addressing the underlying celiac disease and preventing intestinal damage. Diagnosis involves skin biopsy for characteristic IgA deposits and, in some cases, intestinal biopsy to assess the extent of villous atrophy. Treatment primarily revolves around strict adherence to a gluten-free diet, often complemented by medications to control skin symptoms. Managing DH effectively requires a multidisciplinary approach, involving dermatologists, gastroenterologists, and dietitians to address both the skin manifestations and the underlying celiac disease. Idiopathic Sprue Idiopathic sprue is a term used for cases of sprue (malabsorption syndrome) where the cause is unknown. It may include cases that do not fit the criteria for celiac disease or other known causes of malabsorption. It shares some features with celiac disease, such as malabsorption and damage to the small intestine, but it lacks specific diagnostic markers for celiac disease. Diagnosis may involve excluding other causes of malabsorption, and it may be considered when typical celiac disease markers are absent. Tropical Sprue Tropical sprue is a malabsorption syndrome that occurs in tropical regions, and its exact cause is not fully understood. It is thought to be associated with infections or environmental factors. It presents with symptoms of malabsorption, such as diarrhea, weight loss, and nutritional deficiencies. It is more commonly observed in tropical regions but can occur in non-tropical areas as well. Collagenous Sprue Collagenous sprue is a rare disorder characterized by collagen deposition in the small intestine. The cause is not well-established. It leads to malabsorption and features similar to celiac disease but is distinguished by the characteristic collagen band in the intestinal lining. Diagnosis involves histological examination of small intestinal biopsies. The management of collagenous sprue may involve a combination of treatments, including a gluten-free diet and immunosuppressive medications. Corticosteroids or other immunosuppressants may be prescribed. Peptic Duodenitis Peptic duodenitis, a condition characterized by inflammation of the duodenal lining due to exposure to stomach acid, shares a commonality with celiac disease in its potential to induce villous atrophy. In peptic duodenitis, the inflammatory response triggered by gastric acid can extend into the duodenum, disrupting the delicate balance of the intestinal mucosa. This sustained inflammation may lead to changes in the architecture of the small intestine, including the villi, finger-like projections crucial for nutrient absorption. The damage incurred can result in villous atrophy, akin to the characteristic intestinal changes observed in celiac disease. Helicobacter Pylori Helicobacter pylori, a bacterium known for its association with gastric ulcers and gastritis, has been implicated in gastrointestinal conditions that extend beyond the stomach, including potential involvement in villous atrophy akin to celiac disease. The presence of H. pylori in the duodenum and small intestine has been linked to chronic inflammation and alterations in mucosal architecture. The bacterium's ability to induce immune responses may contribute to the damage of the intestinal villi, compromising their structure and functionality. This shared consequence of villous atrophy highlights the interconnectedness of various gastrointestinal disorders and underscores the need for comprehensive investigations to discern the specific triggers and mechanisms at play. While celiac disease and H. pylori-related duodenal changes differ in their etiology, understanding the potential overlap in their impact on intestinal health is crucial for accurate diagnosis and tailored therapeutic interventions. Small Intestinal Bacterial Overgrowth (SIBO) Small intestinal bacterial overgrowth (SIBO) is recognized for its capacity to disrupt the normal balance of microorganisms in the small intestine, leading to various gastrointestinal manifestations. In some cases, SIBO has been associated with mucosal damage, mirroring the villous atrophy observed in conditions like celiac disease. The overgrowth of bacteria in the small intestine can interfere with nutrient absorption and trigger an inflammatory response, potentially contributing to the erosion of the intestinal villi. While the mechanisms differ from those in celiac disease, the shared outcome of villous atrophy underscores the intricate relationship between dysbiosis and intestinal health. Lymphoma Lymphoma, a form of cancer that originates in the lymphatic system, can exhibit parallels with celiac disease in terms of inducing villous atrophy. In some cases, individuals with longstanding untreated celiac disease may face an elevated risk of developing enteropathy-associated T-cell lymphoma (EATL), a rare but serious complication. EATL is characterized by the infiltration of malignant T lymphocytes into the intestinal mucosa, leading to structural changes reminiscent of villous atrophy. While lymphoma and celiac disease differ fundamentally, the shared manifestation of villous atrophy underscores the intricate interplay between chronic inflammation and the potential oncogenic transformations within the gastrointestinal milieu. Thiamine (Vitamin B1) Deficiency There is some old research that indicates that prolonged low thiamine (vitamin B1) may cause thinning of the microvillus membrane. While these conditions may share some clinical features with celiac disease, the differences in their etiology, histopathology, and diagnostic criteria make them distinct entities. Accurate diagnosis and differentiation often require a thorough clinical evaluation, including serological tests, histopathological examination, and consideration of geographic or idiopathic factors. Consulting with a gastroenterologist or healthcare professional is essential for proper diagnosis and management. Drug-Associated Enteropathy: Medications Associated with Villous Atrophy Understanding the intricate interplay between medications and intestinal well-being is paramount for individuals managing chronic health conditions. While medications play a pivotal role in alleviating symptoms and improving overall health, certain drugs may harbor the potential to influence the delicate environment of the small intestine. This section delves into the impact of various medications on the intestinal villi, focusing on conditions that may lead to villous atrophy. From common pain relievers to immunosuppressive drugs, the discussion aims to shed light on the nuanced relationship between medications and gastrointestinal health. It underscores the importance of informed healthcare decisions, proactive monitoring, and open communication between patients and healthcare providers to mitigate potential complications and ensure optimal intestinal function during the course of medical treatments. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are commonly used to alleviate pain and inflammation, but prolonged and excessive use has been associated with adverse effects on the gastrointestinal (GI) tract. NSAIDs can cause irritation and inflammation in the small intestine, potentially leading to villous atrophy. The mechanism involves the inhibition of cyclooxygenase enzymes, which play a role in maintaining the integrity of the GI mucosa. Individuals relying on NSAIDs for chronic pain management should be cautious and work closely with healthcare providers to monitor and mitigate potential GI complications. Immunosuppressive Drugs Immunosuppressive drugs, such as methotrexate and mycophenolate mofetil, are crucial in managing autoimmune conditions and preventing organ rejection after transplantation. While these medications target the immune system to curb excessive responses, they may also impact the gastrointestinal lining. Long-term use could lead to intestinal complications, including villous atrophy. Healthcare providers prescribing immunosuppressive drugs carefully assess the risk-benefit profile for each patient and monitor closely for potential adverse effects on the GI tract. Chemotherapy Drugs Chemotherapy, a cornerstone in cancer treatment, aims to eradicate rapidly dividing cells, including cancerous ones. However, the impact isn't limited to tumors, and normal, healthy cells may also be affected. The rapidly renewing cells in the small intestine are particularly susceptible, potentially resulting in damage to the villi and compromising the absorptive capacity of the intestines. Individuals undergoing chemotherapy should discuss potential gastrointestinal side effects with their oncologist to address and manage any complications that may arise. Some Antibiotics Certain antibiotics, such as tetracycline and ampicillin, may disrupt the balance of the gut microbiota, leading to gastrointestinal disturbances. While these antibiotics target harmful bacteria, they can also affect beneficial microbes, influencing the overall health of the intestinal lining. The intricate relationship between antibiotics and the gut underscores the importance of judicious antibiotic use and, when necessary, the simultaneous administration of probiotics to support a healthy gut environment. Proton Pump Inhibitors (PPIs) Proton Pump Inhibitors (PPIs), commonly prescribed for acid reflux and gastroesophageal reflux disease (GERD), reduce stomach acid production. Prolonged use of PPIs has been linked to changes in the small intestine, potentially impacting the structure and function of the villi. Individuals relying on PPIs for an extended period should collaborate with healthcare providers to assess the necessity of continued use and explore alternative approaches to manage acid-related conditions. Opioid Pain Medications Opioid pain medications, including morphine and oxycodone, are known for their analgesic properties but are also associated with side effects such as constipation. Chronic use of opioids may lead to intestinal issues, affecting the normal functioning of the small intestine. It is crucial for healthcare providers to carefully manage opioid prescriptions, considering the potential impact on the gastrointestinal tract, and to explore alternative pain management strategies whenever possible. Patients should communicate openly with their healthcare team about any digestive issues experienced during opioid therapy to ensure timely intervention and support. Conclusion In conclusion, the journey through conditions associated with villous atrophy extends far beyond the realms of celiac disease. This exploration has highlighted the intricate interplay of various factors that can impact the health of the small intestine, leading to structural changes in the form of villous atrophy. Recognizing these diverse contributors is pivotal for healthcare professionals navigating the complexities of gastrointestinal disorders. As we deepen our understanding of the nuanced manifestations of villous atrophy, we pave the way for improved diagnostic accuracy and tailored treatment strategies. The heterogeneity of conditions linked to villous atrophy underscores the need for a holistic and individualized approach to patient care, ensuring that the intricacies of each case are addressed with precision and empathy. Through continued research and clinical vigilance, we strive to unravel the mysteries of these conditions and enhance the well-being of individuals facing the challenges of villous atrophy. Further reading on the topic of other causes of villous atrophy: Not All That Flattens Villi Is Celiac Disease: A Review of Enteropathies

Celiac.com 01/20/2024 - The tissue transglutaminase IgA antibodies (tTG-IgA) test is a crucial diagnostic tool for celiac disease. In individuals with celiac disease, the ingestion of gluten triggers an immune response, leading to the production of antibodies, including tTG-IgA. These antibodies target the tissues of the small intestine, causing damage and inflammation. The tTG-IgA test measures the levels of these specific antibodies in the blood. Elevated tTG-IgA levels are indicative of an active immune response to gluten and suggest the presence of celiac disease. This blood test is an essential component of the diagnostic process, helping healthcare providers identify individuals who may require further evaluation, such as genetic testing and an endoscopic biopsy, to confirm the diagnosis of celiac disease. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) are primarily associated with celiac disease, but they can also be elevated in some other conditions. It's important to note that the presence of elevated antibodies alone doesn't diagnose a specific condition, and further clinical evaluation is needed. Conditions and factors that may lead to elevated tTG-IgA antibodies may include the following: Non-Celiac Gluten Sensitivity (NCGS) Wheat Allergy Inflammatory Bowel Diseases (IBD) Type 1 Diabetes Autoimmune Liver Diseases Rheumatoid Arthritis Thyroid Disorders Genetic Conditions Casein/Cow's Milk Intolerance Non-Celiac Gluten Sensitivity (NCGS) Although it doesn't involve the autoimmune response seen in celiac disease, NCGS can lead to symptoms similar to those of celiac disease and may be associated with elevated tTG-IgA. NCGS is characterized by gluten-related symptoms without the autoimmune response and intestinal damage seen in celiac disease. The exact mechanisms leading to elevated tTG-IgA in NCGS are not fully understood, but it's believed that gluten sensitivity in NCGS may still induce an immune response, even though it differs from the autoimmune process seen in celiac disease. The presence of elevated tTG-IgA in NCGS underscores the complexity of gluten-related disorders and highlights the need for further research to elucidate the underlying immune responses and mechanisms associated with different gluten-related conditions. Wheat Allergy Individuals with a wheat allergy may produce antibodies, including tTG-IgA, as part of the allergic response. Individuals with a wheat allergy may also exhibit increased tTG-IgA levels. Wheat allergy is an immune-mediated response to proteins in wheat, distinct from the autoimmune nature of celiac disease. The presence of elevated tTG-IgA in individuals with a wheat allergy is somewhat perplexing, as tTG is an enzyme involved in the pathology of celiac disease, and its elevation is not commonly associated with allergies. One possible explanation is that the immune response triggered by a wheat allergy might lead to some cross-reactivity or shared epitopes with components involved in celiac disease, causing an increase in tTG-IgA. However, the exact mechanisms behind this phenomenon are not well-elucidated, and more research is needed to understand the connections between wheat allergy and the elevation of tTG-IgA. It emphasizes the intricate interplay between the immune system and various wheat-related disorders, requiring further exploration to unravel the complexities of immune responses in these conditions. Inflammatory Bowel Diseases (IBD) Conditions such as Crohn's disease and ulcerative colitis can cause gastrointestinal inflammation, and elevated tTG-IgA levels have been reported in some individuals with IBD. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) can also be observed in individuals with Inflammatory Bowel Diseases (IBD). IBD, which includes conditions like Crohn's disease and ulcerative colitis, involves chronic inflammation of the gastrointestinal tract. The link between IBD and elevated tTG-IgA is not as straightforward as in celiac disease, and the reasons behind this elevation in some IBD patients remain a subject of research. One hypothesis suggests that the chronic inflammation and alterations in the intestinal mucosa associated with IBD may lead to increased permeability of the gut barrier. This heightened permeability might allow gluten proteins to interact with the immune system in a way that triggers the production of tTG-IgA. The intricate relationship between IBD and tTG-IgA elevation underscores the complex interplay between autoimmune responses and gastrointestinal disorders, requiring further investigation to uncover the underlying mechanisms and clinical implications. Type 1 Diabetes Some individuals with type 1 diabetes may have elevated tTG-IgA antibodies, and there is an increased risk of celiac disease in individuals with diabetes. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) can be found in individuals with Type 1 Diabetes (T1D), establishing a connection between these two autoimmune conditions. Both celiac disease and Type 1 Diabetes involve an autoimmune response, where the body's immune system mistakenly targets its own tissues. In the case of celiac disease, the immune system reacts to gluten, while in Type 1 Diabetes, it attacks the insulin-producing cells in the pancreas. The shared genetic susceptibility to autoimmune disorders could explain the co-occurrence of celiac disease and Type 1 Diabetes. The presence of certain genetic markers might predispose individuals to develop multiple autoimmune conditions. Additionally, environmental factors and common triggers in the immune response pathways could contribute to the simultaneous development of these disorders. Clinicians often monitor individuals with Type 1 Diabetes for celiac disease-related antibodies, including tTG-IgA, to identify and manage celiac disease early, highlighting the importance of understanding these interconnected autoimmune processes for comprehensive patient care. Thyroid Disorders Conditions such as autoimmune thyroiditis (Hashimoto's thyroiditis) and Graves' disease may be associated with elevated tTG-IgA antibodies. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) can be associated with thyroid disorders, particularly autoimmune thyroid conditions such as Hashimoto's thyroiditis. Hashimoto's thyroiditis is an autoimmune disease where the immune system attacks the thyroid gland, leading to inflammation and potential impairment of thyroid function. The link between celiac disease and autoimmune thyroid disorders has been observed, suggesting a shared genetic predisposition for autoimmune conditions. Individuals with celiac disease may have an increased risk of developing autoimmune thyroid disorders, and vice versa. The interconnected nature of autoimmune diseases suggests that the immune system's response to gluten in celiac disease might trigger or exacerbate autoimmune reactions in other organs, including the thyroid. Monitoring thyroid function and related antibodies, such as tTG-IgA, is crucial in individuals with celiac disease to identify and manage potential thyroid complications early. Understanding these complex interactions between autoimmune disorders is essential for comprehensive patient care and effective management of associated health conditions. Autoimmune Liver Diseases Certain autoimmune liver diseases, such as autoimmune hepatitis and primary biliary cirrhosis, may be associated with elevated tTG-IgA antibodies. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) may be detected in individuals with autoimmune liver diseases, particularly autoimmune hepatitis (AIH). Autoimmune hepatitis is a chronic inflammatory condition where the body's immune system erroneously attacks liver cells, leading to liver inflammation and potential damage. The connection between celiac disease and autoimmune liver diseases, although not fully understood, suggests shared autoimmune mechanisms. In some cases, individuals with celiac disease may experience immune system dysregulation that extends beyond the small intestine, leading to autoimmune reactions in other organs such as the liver. The presence of elevated tTG-IgA in individuals with autoimmune liver diseases underscores the complex interplay between various autoimmune conditions. Monitoring liver function and related antibodies is essential for comprehensive healthcare in individuals with celiac disease, as the autoimmune cascade can impact multiple organs. Understanding these connections aids in early detection, proper management, and improved overall outcomes for individuals with autoimmune liver diseases and concurrent celiac disease. Genetic Conditions Some genetic conditions, such as Down syndrome, may be associated with an increased prevalence of celiac disease and elevated tTG-IgA. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) in individuals with genetic conditions such as Down syndrome can be attributed to the increased prevalence of autoimmune disorders in this population. Down syndrome, characterized by the presence of an extra copy of chromosome 21, is associated with a higher susceptibility to autoimmune conditions, including celiac disease. The genetic link between Down syndrome and celiac disease suggests a shared vulnerability to immune dysregulation. Individuals with Down syndrome may exhibit an elevated risk of developing autoimmune disorders due to alterations in immune system function associated with the genetic anomaly. The complex relationship between genetics and autoimmune responses underscores the importance of monitoring individuals with Down syndrome for various health conditions, including celiac disease. Early detection and management of celiac disease in individuals with Down syndrome are crucial for optimizing their overall health and well-being, considering the potential impact of untreated celiac disease on nutrient absorption and long-term health outcomes. Rheumatoid Arthritis Elevated tTG-IgA levels have been reported in some individuals with rheumatoid arthritis. The presence of elevated tissue transglutaminase IgA antibodies (tTG-IgA) in individuals with rheumatoid arthritis (RA) can be linked to the complex interplay between autoimmune disorders. Rheumatoid arthritis is a chronic inflammatory condition primarily affecting the joints, but it is increasingly recognized that individuals with RA may have an elevated risk of coexisting autoimmune diseases, including celiac disease. The shared genetic predisposition and immune dysregulation mechanisms contribute to the observed association between RA and elevated tTG-IgA. In the context of rheumatoid arthritis, the immune system mistakenly attacks the joints, leading to inflammation and joint damage. This dysregulated immune response may extend beyond the joints and manifest as an increased susceptibility to other autoimmune conditions, such as celiac disease. The identification of elevated tTG-IgA in individuals with RA underscores the importance of comprehensive health assessments in autoimmune disorders, as coexisting conditions may impact the overall management and prognosis of these individuals. Regular monitoring and collaboration between healthcare providers specializing in different autoimmune diseases are crucial for a holistic approach to patient care. Casein/Cow's Milk Intolerance Recent studies have shown that elevated tTG-IgA levels have been reported in some individuals with casein/cow's milk intolerance. Conclusion While it's true that elevated tissue transglutaminase IgA antibodies (tTG-IgA) can be associated with various conditions beyond celiac disease, including autoimmune disorders and genetic conditions, the tTG-IgA test remains a valuable tool in the diagnosis of celiac disease. In individuals with celiac disease, there is a specific immune response triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. People with celiac disease often have higher levels of tTG-IgA in their blood due to the immune system's reaction to gluten. When gluten is ingested, individuals with celiac disease produce antibodies, including tTG-IgA, which target and attack the tissues of the small intestine. The elevated tTG-IgA levels are indicative of this immune response and the damage occurring in the intestinal lining. However, it's important to note that the interpretation of tTG-IgA levels should be done in the context of the individual's overall health, medical history, and the possibility of other conditions. A definitive diagnosis of celiac disease typically involves a combination of blood tests, genetic testing (HLA-DQ2 and HLA-DQ8), and, in some cases, an endoscopic biopsy of the small intestine. In summary, while elevated tTG-IgA levels are a common feature in celiac disease, the diagnosis involves a comprehensive assessment, and healthcare providers consider various factors to ensure accurate identification of the condition. It's crucial to interpret antibody test results in the context of the individual's clinical symptoms, medical history, and additional diagnostic tests. If tTG-IgA antibodies are elevated, further evaluation by a healthcare professional, typically including endoscopic procedures and biopsies, is often necessary to confirm or rule out celiac disease.

Celiac.com 12/12/2022 - Atopic dermatitis is associated with immune dysregulation, but epidemiological data on the pattern of autoimmune comorbidity in people with atopic dermatitis are limited. A team of researchers recently set out to determine the risk of autoimmune conditions in people newly diagnosed with atopic dermatitis. The research team included Simon de Lusignan, MD; Helen Alexander, BSc, MBBS; Conor Broderick, MB, BCh, BAO, MSc; Andrew McGovern, MD; Claire Feeney, PhD; Carsten Flohr, PhD. They are variously affiliated with theNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom; the Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom; the Unit for Population-Based Dermatology Research, St John’s Institute of Dermatology, Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom; the Momentum Data, Pendragon House, St Albans, United Kingdom; and with Pfizer Ltd, Tadworth, United Kingdom. A Retrospective Cohort Analysis The team used the the UK-based Oxford–Royal College of General Practitioners Research and Surveillance Centre primary care database to conduct a retrospective cohort analysis that covered the period from January 2009 to December 2018. They compared baseline rates and incidents after diagnosis of autoimmune conditions in nearly 175,000 children and adults with new-onset atopic dermatitis, and nearly 700,000 control subjects, matched for age, sex, and general practitioner practice. Outcomes were a composite of any autoimmune condition, including Crohn disease, ulcerative colitis, celiac disease, pernicious anemia, type 1 diabetes, autoimmune hypothyroidism, Graves disease, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, Sjögren syndrome, vitiligo, alopecia areata, and multiple sclerosis, and each individual autoimmune condition. Their Findings The team found that people diagnosed with atopic dermatitis were more likely to have an existing autoimmune condition, compared to control subjects. Once the team eliminated patients with preexisting autoimmune disease, they found a connection between atopic dermatitis and cases of new-onset autoimmune disease. Patients with more severe atopic dermatitis faced a greater risk than those with moderate or mild atopic dermatitis. People with atopic dermatitis also faced a significantly higher risk for psoriatic arthritis, Sjögren syndrome, Crohn disease, vitiligo, alopecia areata, pernicious anemia, ulcerative colitis, rheumatoid arthritis, and hypothyroidism, but not for other autoimmune conditions. Conclusions From their results, the team concludes that people with atopic dermatitis, especially those with severe atopic dermatitis, face significantly higher risk for developing numerous other autoimmune conditions. Stay tuned for more on this and related stories. Read more in: Allergy and Clinical Immunology

Celiac.com 08/21/2020 - So who, exactly, should be screened for celiac disease? The guidelines and parameters for who and when to test for celiac disease change as new data becomes available. Based on recent study data, and recommendations by the three major celiac disease organizations, many doctors advise celiac screening for patients with any of the following twenty-two conditions or diseases: Anemia Unexplained iron, vitamin B12 or folate deficiency. A 2014 study showed that celiac disease is common in people with unexplained anemia. The study team recommends celiac screening for anyone with unexplained iron-deficient anemia, while the The U.K. National Institute for Health and Care Excellence recommend celiac screening for anyone with unexplained vitamin B-12 or folate deficiency. Aphthous stomatitis People with severe or persistent mouth ulcers (canker sores) should get screened for celiac disease. A 2020 study confirms that doctors should consider celiac disease in patients with severe or recurrent aphthous stomatitis. Autism People with autism have celiac disease at rates almost 20 times higher than in those without autism, reported lead investigator Daniel Karb, MD, a second-year resident at University Hospitals Case Medical Center in Cleveland. As such, many doctors now recommend celiac screening for people with autism. Autoimmune Thyroid Disease The The U.K. National Institute for Health and Care Excellence recommends celiac screening for anyone with thyroid disease. Dental Enamel Defects Certain types of dental enamel defects can be strong indicators of celiac disease. A 2018 study shows that non-specific tooth wear and enamel defects can be strong indications of celiac disease. Dermatitis Herpetiformis (DH) People with dermatitis herpetiformis, aka DH, or Duhring’s disease, suffer from a herpes-like rash. About 10% to 15% of people with celiac disease have DH. Anyone with DH should be checked for celiac disease. Most people with DH see major improvements on a gluten-free diet. Failure to Thrive and Persistent Diarrhea in Children The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and The American College of Gastroenterology recommends celiac screening for children with failure to thrive, especially with persistent diarrhea. Unexplained Fatigue Unexplained fatigue. People with persistent unexplained fatigue should consider screening for celiac disease, according to the U.K. National Institute for Health and Care Excellence. GERD Some studies show no link between Gastroesophageal Reflux Disease (GERD) and celiac disease. A 2015 study showed that celiac disease not a big factor in gastro-esophageal reflux disease. But a 2020 study showed that non-celiac gluten sensitivity is common in patients with refractory functional dyspepsia. Many doctors recommend celiac disease screening for patients with GERD. High Transaminase Levels High transaminase levels can be an indication of liver damage, heart damage, and are common in people with celiac disease. Down syndrome A 2020 study shows that people with Down syndrome have celiac disease at up to twenty times the rate of the general population. Celiac disease screening is important for anyone with Down syndrome. IgA Deficiency The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends testing for celiac disease in asymptomatic children who have conditions associated with celiac disease, including selective IgA deficiency. Irritable Bowel Syndrome in Adults Adults with irritable bowel syndrome should be screened for celiac disease, according to the The U.K. National Institute for Health and Care Excellence. Persistent Unexplained Elevated Liver Enzymes The U.K. National Institute for Health and Care Excellence recommends celiac screening for people with persistently elevated liver enzymes with unknown cause. Recurrent Miscarriages The U.K. National Institute for Health and Care Excellence recommends celiac screening for women who experience recurrent miscarriages. Immediate Relatives of Anyone with Celiac Disease First-degree relatives (mother, father, brother, sister, son, daughter) of anyone with celiac disease should get a celiac screen, according to Mayo Clinic. Short Stature A 2020 study shows that biopsy confirmed celiac disease affects about 1 in 14 patients with all‐cause short stature, and 1 in 9 patients with idiopathic short stature. Based on these results, doctors are recommending screening all patients with short stature should be screened for celiac disease. Thyroiditis Thyroiditis is an auto-immune condition associated with celiac disease. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommends celiac disease screening in children who have thyroiditis. Turner syndrome Turner syndrome is associated with celiac disease. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommends celiac disease screening in children who have Turner syndrome. celiac.comhttps://www.celiac.com/celiac-disease/who-should-get-screened-for-celiac-disease-r5201/ Type 1 diabetes More than 20% of people with Type 1 diabetes have celiac disease. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommends celiac disease screening in children who have Type 1 diabetes. Unexplained Infertility Women with infertility face higher rates of celiac disease. Many doctors do not screen for celiac disease in these women. However, for women experiencing unexplained infertility, especially repeatedly, a celiac disease screen is probably a good idea. Unexplained Neuropathy Patients with unexplained neuropathy, or small fiber neuropathy should be screened for celiac disease and gluten-sensitivity, according to researchers. Unexplained Weight Loss According to the U.K. National Institute for Health and Care Excellence, people who suffer from unexplained weight loss should be screened for celiac disease. Consider Celiac Screening for These Common Physical Complaints People with any of the ten most common complaints of celiac patients, or any of the below conditions that are associated with celiac disease, along with any obvious signs of celiac disease, including persistent diarrhea or stomach upset, should consider celiac screening. These include: Anemia Alternating bowel habit Bloating Constipation Cryptogenic hypertransaminasemia Diarrhea Gastroesophageal reflux disease Osteopenia/Osteoporosis Recurrent miscarriages Unexplained Infertility Other Conditions Associated with Celiac Disease The following conditions are not included in the official celiac screening recommendations by the above organizations. However, anyone with any of the following conditions, along with any obvious signs of celiac disease, including persistent diarrhea or stomach upset, should consider celiac screening. These include: Addisons Disease Alopecia Anxiety and Depression Ataxia Attention Deficit Disorder/ADHD Autism Autoimmune Hepatitis / Chronic Active Hepatitis Bird Fanciers Lung Brain White-Matter Lesions Cerebellar Atrophy Chronic Fatigue Syndrome (myalgic encephalomyelitis or ME, PVS, post viral fatigue syndrome or PVFS) Crohns Disease Congenital Heart Disease Cystic Fibrosis Dental-Enamel Hypoplasia Dyspepsia Epilepsy (with or without cerebral calcification) Farmers Lung Fibromyalgia and Celiac Disease Fibrosing Alveolitis Follicular Keratosis Gall Bladder Disease Gastroparesis Head Aches (Migraine) IBD - Irritable Bowel Disease Impotency Infertility Inflammatory Bowel Disease Lung Cavities Multiple Sclerosis and Celiac Disease Myasthenia Gravis Pancreatic Disorders / Exocrine Pancreatic Insufficiency Peripheral Neuropathy Polymyositis Polyneuropathy Primary Biliary Cirrhosis Pulmonary Hemosiderosis Recurrent Pericarditis Sarcoidosis Schizophrenia / Mental Problems and Celiac Disease Scleroderma Short Stature, Delayed Puberty Small-Intestinal Adenocarcinomas Spontaneous Abortion and Fetal Growth Retardation Systemic Lupus Erythematosus Thrombocytosis (Hyposplenism) Thrombocytopenic Purpura (ITP) Thyrotoxicosis Vasculitis Vitamin K Deficiency Celiac Disease Screening Recommendations by Organization The American College of Gastroenterology The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) The U.K. National Institute for Health and Care Excellence

Celiac.com 04/12/2021 - Celiac disease is an autoimmune disorder of the small bowel, classically associated with diarrhea, abdominal pain, and nutritional deficiencies. Rapid diagnosis of celiac disease is important, since strict adherence to a gluten-free diet can resolve most resolution of clinical and histologic manifestations of the disease. Celiac disease is commonly misdiagnosed, most often as one of these conditions. Numerous diseases and conditions can present with clinical and/or histologic features of celiac disease. In a recent review article, a pair of researchers highlight key clinical and histologic mimickers of celiac disease. Many conditions that mimic celiac disease offer clues to the underlying diagnosis, and many have a targeted therapy. It is important to provide patients with a correct diagnosis, and to avoid an unnecessary gluten-free diet for non-celiac patients. Two researchers recently set out to better understand the conditions that mimic celiac disease. Researchers Amrit K Kamboj, MD and Amy S Oxentenko, MD, are affiliated with the Department of Internal Medicine, Division of Gastroenterology and Hepatology, and the Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, USA. The diagnosis of celiac disease is made when there are compatible clinical features, supportive serologic markers, representative histology from the small bowel, and response to a gluten-free diet. Histologic findings associated with celiac disease include intraepithelial lymphocytosis, crypt hyperplasia, villous atrophy, and a chronic inflammatory cell infiltrate in the lamina propria. The evaluation of a patient with serologically negative enteropathy necessitates a carefully elicited history and detailed review by a pathologist. Medications can mimic celiac disease and should be considered in all patients with a serologically negative enteropathy. Clinical conditions that mimic celiac disease include: Autoimmune and/or inflammatory Conditions Can Mimic Celiac Disease Autoimmune and/or inflammatory conditions such as inflammatory bowel disease (IBD), microscopic colitis, thyroid dysregulation, and adrenal insufficiency may all cause clinical features that mimic celiac disease, or be concurrently present in patient known to have celiac disease. Infectious Diseases Can Mimic Celiac Disease Infectious mimickers include giardiasis and both viral and bacterial gastroenteritis, although most viral and bacterial infections are self-limited and do not cause the chronic symptoms that can be seen with Giardia infection, unless post-infectious IBS ensues. Other chronic parasitic infections may also cause symptoms that mimic celiac disease. Other less common clinical mimickers include tropical sprue, autoimmune enteropathy, drug-induced enteropathy, Whipple’s disease, and others. Irritable bowel syndrome (IBS) Can Mimic Celiac Disease Irritable bowel syndrome (IBS) is the most commonly diagnosed gastrointestinal disorder, and has features that mimic celiac disease.10 Symptoms include abdominal pain along with altered bowel form and/or frequency. IBS is often associated with other disorders including somatic comorbidities. Small Intestinal Bacterial Overgrowth (SIBO) Can Mimic Celiac Disease Small intestinal bacterial overgrowth (SIBO) is known to cause diarrhea, bloating, and weight loss, which may mirror symptoms of classic celiac disease; SIBO may also be a cause of recurrent or refractory symptoms in a patient with known celiac disease. The researchers divide the histological mimickers of celiac disease into early and late. The key difference being that early histologic mimickers are characterized by increased intraepithelial lymphocytes with no villous atrophy, and crypts that are either normal or have minimal hyperplasia. Late histologic mimickers are characterized by increased intraepithelial lymphocytes, partial or total villous atrophy, crypt hyperplasia, and chronic inflammation in the lamina propria. Early histologic mimickers include: Non-steroidal anti-inflammatory drugs Inflammatory bowel disease Small intestine bacterial overgrowth Helicobacter pylori Self-limited gastroenteritis Autoimmune conditions Unexplained Late histologic mimickers include: Medications (olmesartan, ipilimumab, colchicine, mycophenolate mofetil, methotrexate, and azathioprine) Common variable immunodeficiency Giardia Crohn’s disease Autoimmune enteropathy Collagenous sprue Tropical sprue Whipple’s disease Enteropathy-associated T-cell lymphoma CD4+ T-cell lymphoma Unclassified sprue Read the full report in Clin Transl Gastroenterol. 2017 Aug; 8(8): e114.

Celiac.com 04/15/2021 - Cases of celiac disease are on the rise. Celiac disease is associated with both gastrointestinal (GI) and extra-intestinal manifestations, with psychiatric disorders being among the most common extra-intestinal manifestations. The connection between celiac disease and associated psychiatric disorders has not been well documented or studied. A team of researchers recently set out to provide a greater understanding of the existing evidence and theories surrounding psychiatric manifestations of celiac disease. The research team included Emma Clappison, Marios Hadjivassiliou, and Panagiotis Zis. They are variously affiliated with the Medical School, University of Sheffield, Sheffield S10 2YN, UK; and the Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust and University of Sheffield, Sheffield UK For their study, the team conducted an online literature search using PubMed to locate eligible articles containing data on the rates of both celiac disease and psychiatric disorders. They also conducted meta analyses on odds ratios. In all, the team located 37 eligible articles. They detected a significant increased risk for patients with autistic spectrum disorder, attention deficit hyperactivity disorder, depression, anxiety, and eating disorders amongst the celiac disease population compared to healthy controls. They found no significant differences for bipolar disorder or schizophrenia. The data connects celiac disease to an increased risk of depression, anxiety, eating disorders, as well as ASD and ADHD. They point to the need for more research to investigate specific biological explanations as well as the potentially beneficial effects of a gluten-free diet. Data can be helpful in showing connections, and certainly the connection between celiac disease and psychiatric conditions is worthy of study, but further studies are crucial to understanding the connection in any meaningful way. Read more at MDPI.comNutrients 2020, 12(1), 142;

Celiac.com 09/02/2020 - In a recent blog post, the Toronto law firm, Himelfarb Proszanski LLP, noted that people with any of a number of long-term disabilities are routinely denied coverage for their conditions by medical insurance. Chronic mental and psychological disorders, which lack clear visible evidence, are the most commonly denied conditions. These include mental and psychological conditions such as depression, bipolar disorder, paranoid schizophrenia, chronic anxiety and sleep disorders. Generally speaking, the post notes, physical disabilities, like serious back and spinal problems, paralysis, or blindness, are easier to spot and see fewer denials. However, the list of physical conditions that see frequent insurance denials of coverage includes celiac disease, fibromyalgia and chronic arthritis, among others. The post notes that such conditions are often hard to diagnose, and sometimes difficult to prove in court. To qualify for long-term disability insurance benefits, the post says, people with serious depression, bipolar disorder and schizophrenia often need diagnoses from more than two physicians. People denied coverage for these hard-to-diagnose long-term disability conditions face can face an uphill legal battle. “Many insurance and legal experts say the situation is equivalent to discrimination against people who suffer from mental illness or ‘invisible’ disease or ailment,” the firm noted. Even people who have qualified, and are currently receiving benefits are subject to review and sudden denial, said the firm's post. Have you or a loved one faced an uphill insurance battle because of celiac disease or any of the conditions listed above? Be sure to share your story in the comments section below. Read more at the LATimes.com

Celiac.com 07/08/2020 - There are a number of medical, and genetic, conditions related to celiac disease. Those include a number of autoimmune other conditions. Associated Diseases Disorders Common Among Celiacs Having associated autoimmune or other diseases increases the likelihood of developing celiac disease. Associated diseases include: Addison's disease; Autoimmune thyroid disease; Chronic active hepatitis; Dermatitis herpetiformis; Down syndrome or Turner syndrome; Graves disease; Lupus erythematosus; Microscopic colitis (lymphocytic or collagenous colitis); Myasthenia gravis; Rheumatoid arthritis; Scleroderma; Sjogrens syndrome; Systemic lupus erythematosus; and Type 1 diabetes Certain Risk Factors Associated with Celiac Disease These are the ten risk factors most associated with celiac disease include: Age at First Gluten Consumption; Amount of Gluten Consumed; Antibiotics; Being Female; Courses of antibiotics before 2 years old; Ear Infection; Skim Milk consumption; Viral Infection; and Vitamin D Drop Exposure in Infancy. High Rates of Celiac Disease Among Close Relatives of Celiacs Among celiacs and their relatives, there appears to be a higher incidence of other disorders related to the immune system. Celiac Disease Common with These Disorders Other diseases are related in the sense that large numbers of people who have them also have celiac disease. Those include: Type 1 diabetes mellitus, autoimmune thyroiditis, Down syndrome, Turner syndrome, Williams syndrome, selective IgA deficiency, and first-degree relatives with celiac disease Celiac Screening Recommended for These Conditions Additionally, The U.K. National Institute for Health and Care Excellence recommends considering serologic celiac testing for persons with metabolic bone disorder (reduced bone mineral density or osteomalacia), unexplained neurologic symptoms (particularly peripheral neuropathy or ataxia), unexplained sub-fertility or recurrent miscarriage, persistently elevated liver enzymes with unknown cause, dental enamel defects, Down syndrome, or Turner syndrome. Consider Celiac Screening for Top Physical Complaints The ten most common physical complaints of people who have celiac disease are: Osteopenia/Osteoporosis; Anemia; Cryptogenic hypertransaminasemia; Diarrhea; Bloating; Aphthous stomatitis; Alternating bowel habit; Constipation; Gastroesophageal reflux disease and Recurrent miscarriages. People with any one or more of these symptoms might want to consider the possibility of celiac disease, look for any other celiac-related symptoms, and consult a doctor if they suspect celiac disease. Most Common Misdiagnosis for Celiac Disease Celiac disease is commonly misdiagnosed as one of these conditions: Allergies; Chronic fatigue syndrome; Colitis; Cystic fibrosis; Gallbladder disease; Gastro-esophageal reflux disease (GERD); Inflammatory bowel disease; Irritable bowel syndrome; Lactose intolerance; Parasitic infection; Psychological dysfunction; and Ulcers. These Disorders are Commonly Confused with Celiac Disease These twenty-one diseases commonly suspected or diagnosed before celiac disease is discovered. Gluten-Free Diet Can Help In addition, a gluten-free diet appears to have helped some individuals with autism, chronic fatigue syndrome (myalgic encephalomyelitis or ME, PVS, post viral fatigue syndrome or PVFS), attention deficit disorder (ADD), and ADHD. However, a gluten-free diet is is by no means a cure for any of these conditions. For more information on this topic visit the Related Disorders page.

Celiac.com 07/24/2017 - Are many non-celiac gluten-free eaters actually treating undiagnosed medical conditions? Is the gluten-free movement less a fad than we imagine? Currently, about 3 million Americans follow a gluten-free diet, even though they do not have celiac disease. Known colloquially as "PWAGs," people without celiac disease avoiding gluten. These folks are often painted as fad dieters, or hypochondriacs, or both. Call them what you will, their ranks are growing. According to a study in the journal Mayo Clinic Proceedings, the number of PWAGs tripled from 2009 to 2014, while the number of celiac cases stayed flat. A new study from the Mayo Clinic supports these conclusions. The study derived from data gathered in the National Health and Nutrition Examination Survey, as well as serological tests. There is also a growing body of data that support the existence of non-celiac gluten sensitivities, though the evidence is not conclusive. Moreover, researchers really don't have any idea how many non-celiacs on a gluten-free diet may have legitimate reactions to gluten. The phenomenon has emerged in the past five years in medical literature. For a long time, researchers just assumed that only people with celiac disease would eat a gluten-free diet. About a decade ago, when research into celiac disease and gluten-free dieting began in earnest, says Joseph Murray, a celiac researcher at the Mayo Clinic and an author of the new research, researchers "didn't think to ask why people avoid gluten. When we designed this study 10 years ago, no one avoided gluten without a celiac diagnosis." The latest research by Murray and his colleagues showed that the total number of celiac cases leveled off in the last few years, while more non-celiacs began to avoid gluten for different reasons. Researchers still aren't sure what's driving the trend, and whether it will continue. Part of the increase is doubtless to growing awareness of gluten sensitivity. However, Benjamin Lebwohl, the director of clinical research at Columbia University's Celiac Disease Center, estimates that more than half of the 3.1 million PWAGs noted in this latest study have legitimate gluten sensitivity. "An increasing number of people say that gluten makes them sick, and we don't have a good sense why that is yet," Lebwohl said. "There is a large placebo effect — but this is over and above that." Non-celiac patients with gluten sensitivity often complain of symptoms similar to those of celiacs, such as intestinal problems, fatigue, stomachaches and mental fogginess. And while researchers don't know the reason, clinical studies have shown that these symptoms are often relieved by eliminating dietary gluten. One theory that is gaining some credence is that these people may be sensitive to other irritants, such as FODMAPS, a class of carbohydrates shown to cause gastrointestinal symptoms found in wheat, milk, onions and cheese. Look for more studies into this topic, as researchers seek to nail down answers about celiac disease and gluten-sensitivity, and similar symptoms in non-celiacs. Meantime, the number of people who suspect they have non-celiac gluten sensitivity, and who seek improvement in their symptoms by eliminating gluten from their diets, continues to grow. Source: DailyTribune.com

Celiac.com 10/20/2016 - Whether you are an adult or a child, you could have attention deficit hyperactivity disorder (ADHD), autism or even Asperger's Syndrome. If you do not have enough symptom improvements with the traditional treatments, then why not consider an alternative therapy? What about a gluten-free diet? There are so many statistics that show the connection between these mental conditions and celiac disease. Now, in order to help the symptoms, eating a gluten-free and casein-free (Gluten-free Casein-free) diet might actually help. There is evidence of a correlation between ADHD and celiac disease. It is actually fairly strong. Children and adults with undiagnosed celiac disease, seem to have a higher risk than the general population. Once they started a gluten-free diet, the patients or their parents, reported significant improvements in overall behavior and functioning. As for individuals with autism, they might have a food allergy or high sensitivity to foods containing gluten or casein. Eating a Gluten-free Casein-free diet, might help to reduce symptoms and improve speech, social and cognitive behaviors. Children with autism, according to theory, process peptides and proteins in food items that contain casein and gluten differently. The difference within processing, may exacerbate autistic symptoms. Lastly, children with Asperger's Syndrome, can actually have leaky gut syndrome as well. Treating with a gluten free diet could help ease certain symptoms, such as nonsense talk, obsessions, poor coordination, staring off into space and even social difficulties. Then, consider even going one step further and trying an elimination diet. This is an easy method of figuring out what foods your child is truly reacting to. So, as you can see, these three conditions might actually have more improvements with just simple dietary changes. Having less challenges and being able to focus and interact with less difficulty won't be just a dream, but could be a real possibility for your child. References: https://www.verywell.com/depression-behavior-issues-in-celiac-teens-563017 http://www.thesavvyceliac.com/2011/03/12/research-is-food-the-culprit-in-adhd/ http://www.webmd.com/brain/autism/gluten-free-casein-free-diets-for-autism#1 http://www.myaspergerschild.com/2011/11/misbehavior-or-food-allergy.html

Celiac.com 09/12/2016 - Wheat gluten and related proteins can trigger an autoimmune enteropathy, known as celiac disease, in people with genetic susceptibility. However, some people experience a range of gluten reaction symptoms, but without the classic blood or gut markers for celiac disease. The etiology and mechanism of these symptoms are unknown, and so far, researchers have found no biomarkers to explain the issue. A research team recently set out to determine if sensitivity to wheat in the absence of celiac disease is associated with systemic immune activation that may be linked to some type of enteropathy. The research team included Melanie Uhde, Mary Ajamian, Giacomo Caio, Roberto De Giorgio, Alyssa Indart, Peter H Green, Elizabeth C Verna, Umberto Volta, and Armin Alaedini. They are variously affiliated with the Celiac Disease Center and the Department of Medicine at Columbia University Medical Center, New York, New York, USA, Departments of Medical and Surgical Sciences and Digestive System, Centro di Ricerca Biomedica Applicata (C.R.B.A.), University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy, and the Institute of Human Nutrition at Columbia University Medical Center, New York, New York, USA. The study included a group of healthy control subjects, patients with clinical celiac disease, and patients who reported symptoms after wheat consumption, but in whom doctors had ruled out celiac disease and wheat allergy. The team analyzed test samples for markers of intestinal cell damage and systemic immune response to microbial components. Patients with wheat sensitivity showed sharply increased serum levels of soluble CD14 and lipopolysaccharide (LPS)-binding protein, as well as antibody reactivity to bacterial LPS and flagellin. Circulating levels of fatty acid-binding protein 2 (FABP2), a marker of intestinal epithelial cell damage, were much higher in the affected individuals, and correlated with the immune responses to microbial products. Patients with wheat sensitivity who observed a gluten-free diet saw levels of FABP2 and immune activation markers move rapidly toward normal. These findings show a state of systemic immune activation, coupled with a compromised intestinal epithelium, that triggers gastrointestinal symptoms in certain individuals who have wheat sensitivity, but don't have celiac disease. Source: Gut. doi:10.1136/gutjnl-2016-311964