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Jefferson Adams posted an article in Celiac Disease Diagnosis, Testing & TreatmentCeliac.com 01/07/2019 - Researchers have made progress in spotting celiac disease without biopsy in children with certain parameters. Can the same be done for adults? A team of researchers recently set out to evaluate the accuracy of serology-based criteria in adults with variable pre-test probabilities for celiac disease. The research team included V Fuchs, K Kurppa, H Huhtala, K Laurila, M Mäki, P Collin, T Salmi, L Luostarinen, P Saavalainen, and K Kaukinen. New criteria for diagnosing celiac disease in children allow doctors to forgo duodenal biopsies in children who have symptoms, positive blood tests, and celiac disease-associated genes. There’s currently no good data on whether such an approach might work for adults with certain clinical presentations of celiac disease. Three study cohorts included 421 adults with high-risk clinical celiac disease suspicion, 2,357 moderate-risk family members of celiac patients, and 2,722 low-risk individuals from the general population. The team collected blood tests and other physical patient data. Their "triple criteria" for celiac disease included transglutaminase 2 antibodies more than ten times the upper limit of normal, positive endomysium antibodies, and appropriate genetics, but required no symptoms. The diagnosis was made by grading the intestinal biopsies. In all, 274 patients were diagnosed with celiac disease. Of these, 59 high-risk subjects, 17 moderate-risk subjects, and 14 low-risk subjects fulfilled the "triple criteria.” All had histologically proven celiac disease, giving the criteria a positive predictive value of 100%. Altogether, 90 of the 274 newly diagnosed patients could have avoided biopsy. That’s one in three patients who could have avoided biopsy. In all, 37% of high-risk, 20% of moderate-risk, and 48% of low-risk patients could have avoided biopsy. Biopsies of "triple positive" subjects showed no histological findings other than celiac disease. The results of this study are exciting, because it shows that the “triple criteria” can be used by doctors to reliably diagnose celiac disease in adults without using biopsy. Implementing these diagnostic criteria would make diagnosing celiac disease easier in many cases, and will reduce the number of endoscopies by one-third. That’s a winning result all the way around. Source: Aliment Pharmacol Ther. 2018 Dec 27. doi: 10.1111/apt.15109. The researchers in this article are variously affiliated with the Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; the Tampere Center for Child Health Research, University of Tampere, and Department of Paediatrics, Tampere University Hospital, Tampere, Finland; the Tampere Faculty of Social Sciences, University of Tampere, Tampere, Finland; the Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; the Department of Dermatology, Tampere University Hospital, Tampere, Finland; the Department of Neurology, Päijät-Häme Central Hospital, Lahti, Finland; the Research Programs Unit, Immunobiology, and Haartman Institute, Department of Medical Genetics, University of Helsinki, Helsinki, Finland; the Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
Jefferson Adams posted an article in Celiac Disease Diagnosis, Testing & TreatmentCeliac.com 06/03/2008 - Among the main things doctors look for when they’re trying to make a classic diagnosis of celiac disease are small intestinal mucosal membrane villous atrophy and inflammation. However, the latest research indicates that these criteria are possibly too narrow, leading to a lack of diagnosis and treatment of people with celiac disease. If this turn out to be the case, then far more people than previously imagined may suffer from celiac disease and not even know it. In an effort to find out if present current diagnostic criteria are in fact too narrow, Finnish researchers led by Markku Maki, MD, professor of pediatrics at the University of Tampere, Celiac Disease Study Group, Tampere, Finland, evaluated 145 patients who were presumed to have celiac disease. Just under half (71) of the patients showed positive endomysial antibodies, and out of these only 48 patients met the textbook definition for celiac disease. The research team then split the 23 patients left into two groups. They put the first group on a gluten-free diet for one year, and the second group on a on a standard gluten-inclusive diet for one year. At the end of the year, the doctors conducted follow-up biopsies on all 23 patients. The doctors discovered that the patients who had been on the gluten-free diet did in fact have celiac disease (even though they didn't have any obvious symptoms), and any symptoms that they did have disappeared—they lost their endomysial antibodies and any inflammation that was detected in their intestinal mucosa. On the other hand, the patients in the second group whose diets included gluten showed no such positive changes, and their symptoms continued. The still showed positive endomysial antibodies, along with inflammation of intestinal mucous membrane, and gluten-induced lesions in the small intestine. The study director said that each of the patients on the gluten-free diet had chosen to remain gluten-free thereafter, and that the patients on the gluten-inclusive diet had chosen to eliminate gluten from their diets and over time also became symptom-free—endomysial antibody-free and showed signs of healing of the mucous membrane. Other studies have shown that over time untreated patients who show positive endomysial antibodies may develop the gut injury that is currently required as part of the criteria for diagnosing celiac disease. A greater understanding of the negative effects of untreated or undiagnosed celiac disease, coupled with better testing methods have led to a new strategy that allow doctors to detect celiac disease as early as possible—before any serious damage can occur—this new strategy is likely to be resoundingly welcome among celiac disease sufferers. Hopefully the results of this study and others like it will lead to a new awareness among doctors, and will ultimately lead to better methods for diagnosing celiac disease at an earlier stage. This could ultimately mean less suffering and long term physical damage for many people. Presented at 2009 Digestive Disease Week in San Diego, CA by Dr. Kurppa, a member of Dr. Maki’s research team, on Tuesday, May 20 at 10:30 a.m. Pacific Time in room 10 (San Diego Convention Center).