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Showing results for tags 'detection'.
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Celiac.com 08/21/2023 - Researchers from the University of Kentucky's Martin-Gatton College of Agriculture, Food, and Environment have developed a new and highly effective method for detecting and measuring wheat flour contamination in gluten-free food. Their improved testing methods could significantly improve gluten-free food safety. Gluten-free diets are crucial for individuals with coeliac disease and other conditions that require avoiding gluten. In the UK, approximately 10% of consumers opt for gluten-free products. However, ensuring the absence of gluten in these foods is challenging due to possible cross-contamination in the supply chain. Fourier-transform Infrared Spectroscopy and Machine Learning to Detect Wheat The research team focused on detecting wheat (gluten) flour contamination in gluten-free cornbread using Fourier-transform infrared (FTIR) spectroscopy and machine learning. FTIR employs infrared light absorption to identify a sample's organic and inorganic compounds. Akinbode Adedeji, the principal investigator and an associate professor in biosystems and agricultural engineering, highlighted the prevalence of allergen contamination in the food industry and the need for a rapid method to identify gluten contamination, especially given the sensitivity of individuals with gluten intolerance. To develop the method, the team prepared 13 different cornbread samples with varying levels of wheat flour contamination using corn flour and wheat flour. They analyzed the samples using FTIR with a 'special diamond accessory.' Before using machine learning, they pre-processed the spectra to reduce noise in the raw data and isolate key spectral features, simplifying the machine learning process. A Game-changer for Gluten-Free Food Safety This new testing method could be a game-changer for gluten-free food safety, as it offers manufacturers a reliable and efficient way to ensure their products are truly gluten-free, and safe for individuals with gluten-related conditions. By implementing this technique, the food industry can improve the accuracy of gluten-free labeling and increase consumer confidence in gluten-free products. Read more at foodmanufacturer.co.uk -
Celiac.com 02/26/2018 - People with celiac disease and gluten-sensitivities react adversely to gluten proteins in wheat, barley and rye. The gold standard for assessing gluten levels in foods is a test called the enzyme-linked immunosorbent assay, aka ELISA. Now, ELISA is, by most measures, a good test. However, it does have some drawbacks. ELISA tests do vary by manufacturer, and can provide inconsistent results, including false negatives, which can be harmful for people with celiac disease or gluten-sensitivity. Also, for optimal detection, each type of gluten requires a different ELISA. So, barley, wheat and rye all require separate tests. Researchers Kevin D. Dorfman, Scott P. White and C. Daniel Frisbie claim they have developed a gluten detector that can rapidly detect and quantify different sources of gluten with a single test. Their team says that their gluten assay device is based on floating gate transistor technology, and relies on tiny micro-channels for a sample to move through. Gluten in a sample will bind to one of three capture agents, which can be antibodies or a DNA-based aptamer, that specifically latch onto gluten proteins from certain sources. This binding causes a shift in the voltage read-out of the transistor which acts as a chemical fingerprint that identifies the gluten as being from barley, wheat, or rye. As with ELISA, the device could detect gluten below 20 parts per million, which is the maximum threshold allowed by the U.S. Food and Drug Administration for a "gluten-free" label. Because it has fewer processing steps, and uses automated sampling, the new sensor typically produces results 45 minutes faster due than ELISA tests. The new test is still in development, and not set to replace ELISA anytime soon. But progress in the gluten-free world is rapid these days, so changes to commercial gluten detection systems are likely on the near future. Source: American Chemical Society -
Celiac.com 11/03/2017 - Talk about finding needles in a haystack. Imagine, if you will, sifting through rail cars full of oats and plucking out nearly every stray grain of wheat, barley or rye so that the final product tests at under 20 ppm, instead of the original 200 ppm to 1,000 ppm. Quite a challenge, yes? It's a challenge General Mills take on every day as it produces Gluten Free Cheerios from raw oats into the final product. According to their website, General Mills ships 500,000 cases of Cheerios each week. To do this, General Mills uses a proprietary optical sorting process, for which it has filed a patent with the US Patent Office. That process sifts through those rail cars of oats, with stray gluten ranging from 200 ppm to 1,000 ppm, and "takes it down to less than 20" ppm, said Paul Wehling, principal scientist for General Mills. Mr. Wehling told audience members at the annual meeting of AACC International at Cereals 17 in San Diego on Oct. 9, that the General Mills sorting process achieves a "2- to 3-log reduction of the gluten." To verify their oat sorting results, General Mills uses enzyme-linked immunosorbent assay (ELISA) testing and visual inspection to spot and eliminate gluten-containing grains such as wheat. The company uses hand inspection in place of lateral flow testing, as they find that "hand inspection is much more efficient because we can look at quite a few more seeds," Mr. Wehling said. That process would seem to be validated by Laura K. Allred, regulatory and standards manager for the Gluten Intolerance Group, Auburn, Wash., which recommends companies use a combination of visual testing and ELISA testing. However, the General Mills process is not without critics. One of the more prominent voices in opposition to General Mills has been the Canadian Celiac Association (CCA). The CCA has made numerous statements questioning the process General Mills uses to create their Gluten-Free Cheerios, and other oat products. CCA statements, or statements attributed to the CCA include comments in an article published in October 26, 2017, in which Globalnews.ca writes "[CCA] expressed doubt in the company's mechanical sorting system and claim of 100 per cent removal of cross-contaminants." Candiangrocer.com reported in August 2016 that the CCA was, to paraphrase, "awaiting evidence showing the new line [of Gluten Free Cheerios] is 100% free of gluten." It is unclear what the CCA means by such terms as "100% gluten-free," "100 percent removal," and "100 percent safe for people with celiac disease." Is the CCA hinting that the standard for gluten-free products should be 0 ppm? Besides voicing fear and concerns, and citing alleged complaints by members, the CCA never actually provided any evidence that Cheerios failed to meet the US and Canadian standard of 20 ppm allowable gluten, and were, thus, not gluten-free. The CBC reported on August 31 2016, that the "Canadian Celiac Association is warning against gluten-free Cheerios products over concerns the cereal is not 100 per cent safe for people with celiac disease." Again, the CCA made this recommendation based not on independent product testing, or on any confirmed accounts of gluten-exposure in people with celiac disease who had consumed Cheerios, but on "fear" and "concerns" driven by anecdotal evidence. Moreover, they seemingly disregarded overwhelming anecdotal evidence provided by people with celiac disease who say they eat Cheerios safely. The CCA has yet to provide a satisfactory response for their warnings, or to provide any clarification of their position regarding the safety of products that test under 20 ppm gluten for people with celiac disease. The FDA recently announced that 99.5% of products tested came in under the 20 ppm standard set by the FDA for labeling a product "gluten-free." In fact, only one of 750 samples taken from 250 products tested above 20 ppm. That product was recalled and the manufacturer corrected the problem. There has been no indication the Cheerios tested outside the FDA's gluten-free standard. That means that even an ambitious sorting process like the one developed by General Mills seems to be working as designed. It means that consumers can trust the FDA, and American gluten-free labels, and that consumers of gluten-free foods can buy with confidence. -
Can Aptamers Give Us Better, Faster Gluten Detection?
Jefferson Adams posted an article in Latest Research
Celiac.com 07/04/2016 - The fast rising number of people diagnosed with celiac disease creates challenges to both the food industry and public officials to guarantee safe food. A great deal of effort is going into determining minimal celiac disease-eliciting doses of gluten and to refine and improve gluten-free labeling. A team of researchers recently set out to assess the harnessing of aptamers to overcome challenges in gluten detection. The research team included Rebeca Miranda-Castro, Noemí de-los-Santos-Álvarez, Arturo J. Miranda-Ordieres and María Jesús Lobo-Castañón of the Departamento de Química-Física y Analítica, Universidad de Oviedo in Oviedo, Spain. Their efforts rely largely on the ability to detect gluten protein in food samples at the lowest levels possible. Current analytical devices use antibodies to determine gluten protein levels. These devices have limited sensitivity, and also have some issues with the accuracy and reliability. Aptamers provide an ideal alternative for designing biosensors that can quickly and reliably measure gluten in foods. The team's article highlights the challenges in gluten detection, the current status of the use of aptamers for solving this problem, and what remains to be done to move these systems into commercial applications. They conclude: "The new receptors present high affinity and binding selectivity. In addition, they can be easily labeled with different reporter molecules at a relatively low production cost. These attributes make aptamers ideal reagents for the development of chemical sensors and analytical assays...Although still in its infancy, this sensitive technology will undoubtedly continue to advance." Source: Biosensors 2016, 6(2), 16; doi:10.3390/bios6020016 -
Celiac.com 05/02/2016 - Even with endoscopies, physicians can still miss some cases of celiac disease. A team of researchers recently set out to determine if I-Scan, or virtual chromo-endoscopy, could improve sensitivity of endoscopy to detect markers of villous atrophy in patients with celiac disease. The research team included Hugo A. Penny, Peter D. Mooney, Mitchell Burden, Nisha Patel, Alexander J. Johnston, Simon H. Wong, Julian Teare, and David S. Sanders. They are variously affiliated with Royal Hallamshire Hospital in Sheffield, UK, and with St Mary's Hospital in London, UK. For their study, the team assessed patients from two UK hospitals in 3 groups. For Group 1, they used standard high definition, white light endoscopy (WLE). For Group 2, they used WLE plus I-Scan. For Group 3, they used a non-high definition control group. They recruited an initial group of 758 patients. That group was 62% female, with an average age of 52. They recorded the presence of endoscopic markers, and took at least 4 duodenal biopsies from all patients. They also made concurrent blood tests, and compared observations with patient histology. The patient breakdown was as follows: Group 1: 230; Group 2: 228; Group 3: 300. The team made 135 new diagnoses of celiac disease, with 21 cases in Group 1, 24 in Group 2, and 89 in Group 3. The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 at 85.7% and Group 2 at 75%, compared to non-high definition controls at 41.6%. There was no significant difference between high definition only and I-Scan groups. In non-high definition endoscopy, they found that missed diagnosis was mainly due to lesser degrees of villous atrophy (p = 0.019) and low tTG titre (p = 0.007). From their data, the team concluded that high definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy. Source: Digestive and Liver Disease. -
Celiac.com 08/20/2015 - Celiac disease is frequently mis-diagnosed. Even when patients received endoscopy, celiac disease is often missed or not detected. A team of researchers recently assessed the accuracy of finger prick-based point-of-care tests in the detection of celiac disease, and developed an algorithm for diagnosis. The research team included PD Mooney, SH Wong, AJ Johnston, M Kurien, A Avgerinos, and DS Sanders. They are variously affiliated with the Royal Hallamshire Hospital, Sheffield, United Kingdom and the University of Sheffield, Sheffield, United Kingdom. Their team conducted a prospective study of two groups of celiac disease patients evaluated at the Royal Hallamshire Hospital in Sheffield UK from March 2013 through February 2014. In group one, the team evaluated 55 patients at high risk for celiac disease, and who tested positive for endomysial antibody, using the Biocard test (BHR Pharmaceuticals, Nuneaton, UK) and the Celiac Quick Test (Biohit Healthcare UK, Ellesmere Port, UK), which measure antibodies to tissue transglutaminase (anti-tTG), and the Simtomax test (Tillotts Pharma, Rheinfelden, Switzerland), which measures deamidated gliadin peptide antibodies (DGP). Group 2 included 508 consecutive patients who received an endoscopy for any reason, received the DGP test, and also were evaluated using a diagnostic algorithm that incorporated results from the DGP test and data on symptoms. For both groups, point-of-care tests were administered at the time of endoscopy, and the results compared against results from histologic analyses of duodenal biopsy specimens from all patients. In group 1, the DGP test identified patients with celiac disease with 94.4% sensitivity, the Celiac Quick Test identified patients with 77.8% sensitivity (P = .03 vs the DGP test), while the Biocard test identified patients with 72.2% sensitivity (P = .008 vs the DGP test). In group 2, the DGP test identified patients with celiac disease with 92.7% sensitivity (95% confidence interval, 83.0-97.3), 85.2% specificity (95% confidence interval, 81.5-88.3), a positive predictive value of 49.2% (95% confidence interval, 40.3-58.2), and a negative predictive value of 98.7% (95% confidence interval, 96.8-99.5). Measurement of serum anti-tTG identified patients with celiac disease with 91.2% sensitivity (95% confidence interval, 81.1-96.4), 87.5% specificity (95% confidence interval, 84.0-90.4), a positive predictive value of 53.0% (95% confidence interval, 43.6-62.2), and a negative predictive value of 98.5% (95% confidence interval, 96.5-99.4). The algorithm identified patients with celiac disease with 98.5% sensitivity, and has the potential to reduce duodenal biopsies by 35%. In this prospective study, the test for DGP identified celiac patients with comparable sensitivity and specificity as standard serologic analysis of anti-tTG. Conducting the DGP test before endoscopy might increase the accuracy of the diagnosis of celiac disease. These results look promising, but further study is needed, in lower-prevalence populations, to more accurately determine the potential benefits of the DGP test in celiac screening. Source: Clin Gastroenterol Hepatol. 2015 Jul;13(7):1278-1284.e1. doi: 10.1016/j.cgh.2015.01.010. Epub 2015 Jan 26.
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Celiac.com 04/08/2015 - The goal of growth-monitoring programs in children is the early detection of any disorders that affect growth. Celiac disease is under-diagnosed in kids whose symptoms include faltering linear growth, short stature, or poor weight gain. A team of researchers recently set out to develop new evidence-based parameters for screening for growth disorders and to evaluate the performance of these cutoffs among children with celiac disease measured regularly in a nationwide growth screening program. The research team included Antti Saari, MD; Samuli Harju, BM; Outi Mäkitie, MD, PhD; Marja-Terttu Saha, MD, PhD; Leo Dunkel, MD, PhD; and Ulla Sankilampi, MD, PhD. They are variously affiliated with the Department of Pediatrics, School of Medicine, University of Eastern Finland, Kuopio, the Children’s Hospital at the University of Helsinki and Helsinki University Hospital in Helsinki, Finland, the Folkhälsan Research Centre in Helsinki, Finland, the Department of Molecular Medicine and Surgery at the Karolinska Institute in Stockholm, Sweden, the Department of Pediatrics at Tampere University Hospital in Tampere, Finland, the Centre for Endocrinology at the William Harvey Research Institute of Barts and the London School of Medicine and Dentistry at Queen Mary University of London in London, England and the Department of Pediatrics at Kuopio University Hospital, Kuopio, Finland. Their longitudinal retrospective study included growth data of healthy children from primary health care providers, and children with celiac disease from primary health care, and three university hospital outpatient clinics in Finland, Kuopio University Hospital, Tampere University Hospital, and Helsinki University Hospital, from January 1, 1994, to April 9, 2009. Children of the reference population were under 20 years of age, while children in the celiac disease group were between 1 and 16 years of age. In the reference population of 51,332 healthy children, the team screened according to five age- and sex-specific growth parameters: height standard deviation score and body mass index standard deviation score, distance from the population mean, distance from target height, change in height standard deviation score, and change in body mass index standard deviation score. They evaluated these parameters and their combination in 177 children with celiac disease by analyzing longitudinal growth data from birth until diagnosis of celiac disease. They measured the screening accuracy for detecting abnormal growth in children with celiac disease by using receiver operating characteristics analysis expressed as the area under the curve. When the team screened using the combination of all 5 growth-screening parameters, they detected celiac disease with good accuracy ([95% CI] = 0.88 [0.84–0.93] for girls and 0.84 [0.77–0.91] for boys). When they set the screening specificity at 90%, they saw abnormal growth in 57% of the girls with celiac disease, and in 48% of the boys with celiac disease for two years prior to diagnosis. This study shows that most kids with celiac disease experience faltering growth prior to diagnosis. An effective growth-monitoring program could have detected celiac disease in these kids several years earlier. By using several growth-monitoring parameters in combination, preferably using computerized screening algorithms that are integrated into an electronic health record system, researchers can improve sreening accuracy. Source: JAMA Pediatr. 2015;169(3):e1525. doi:10.1001/jamapediatrics.2015.25.
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Celiac.com 05/31/2006 - Most patients, upon reporting their fear to their doctor that they may have chronic candida infection throughout the intestinal tract, are met with a sneer, a frown, and a chuckle. Most physicians scoff when the large bowel is mentioned as an infected site. However, the Merk Manual, commonly found and held in esteem in any doctors office says that Candida is "Usually transmitted sexually, the infection can also spread from the intestine. The increased incidence is partially due to indiscriminate use of broad-spectrum antibiotics and a large number of women taking contraceptive pills." It also includes corticosteroids (Cortisone) as a possible predisposing factor.(1) Further, a paper printed in "The Journal of the American Medical Association" in 1977 stated: "Vaginal Candidiasis does not occur naturally without infection of C. Albicans within the large bowel and that a cure is not likely as long as the vagina remains the only treatment target."(2) To make matters even more interesting, other inhabitants of the gastrointestinal tract can cause a disruption of the ecology of the large bowel, allowing an overgrowth of C. Albicans. These pathogens also produce gastrointestinal distress and allergic reactions similar to Candida. These microbes or pathogens can lead to an incorrect diagnosis of Candida Albicans, if the doctor is using questionnaires or considering symptoms alone! A partial listing of pathogens would include Aeromas and Plasiomonas, Campylobacter je juni, Citrobacter species, Clostridium difficile, Enterobacter species, Mucoid E. coli and Hemolytic E. Coli, Klebsiella, Pseudomonas and Yersinia Enterocolitica.(3) All can produce similar symptoms to that of a patient with true over-colonization of Candida Albicans. So while the research states Candida can occur both vaginally and in the large bowel, then allowing the broad-spectrum of symptoms we hear about to occur, it also needs to be clarified when another possible microbe is causing the Candida-like symptom. You, the reader, must be careful in allowing yourself and your doctor to begin a Candida regimen before it is documented that you have C. Albicans and not some other pathogen. Any disturbance in your intestinal flora can allow the above mentioned pathogens to begin their dirty work. C. Albicans is not the only opportunist who is waiting for you to use broad spectrum antibiotics. Dont go by symptoms alone! Diagnostic Tools Unfortunately, most tests being used by well-meaning practitioners have drawbacks and require more interpretation than might be currently realized. Stool cultures and rectal mucus swabs have been found of no diagnostic value.(4) That is a rather strong statement bound to offend many people. However, consider these facts. "C. Albicans organisms do not distribute homogeneously throughout the G.I. tract, rather they are found on plaques in the mucosal surfaces and streak scattered throughout the fecal material."(4) In application, this datum means consistent contact with the over-colonization of C. Albicans by fecal matter is not guaranteed due to the nature of growth of C. Albicans. It does not evenly spread itself throughout the bowel. This makes it a matter of chance whether the fecal matter or rectal swab will contact an area which contains C. Albicans. It is true that C. Albicans inhabits the mucosal surface, but in plaques. It is a matter of judgement by the practitioner ! whether the fecal or rectal swab reading is indicative of over-colonization, since everyone does have some Candida Albicans in their bowel. Good practitioners knowing this will want several consecutive negative readings before pronouncing the patient clear of Candida. Also, the amount that qualifies as a true overgrowth in the stool can be a controversy. The true value of a stool culture is in determining the amounts of friendly bacteria relative to unfriendly bacteria, and to discover the presence of harmful bacteria which can weaken the friendly flora, allowing yeast to grow and live. The practitioner who takes into account response to therapy, other biochemical tests which would reveal immune response and mineral absorption in addition to the stool or rectal swab stands a better chance of understanding the patients status. A popular test for detection of antibodies against Candida also has drawbacks. First, a decrease in the antibodies may not mean the patient is doing better, it could mean a decreased immune response. Other biochemical tests are needed to interpret this. An increase in the antibodies may indicate an increase in immune response and not a worsening of the patients health. Many times these antibodies will increase when immune status indicators improve, showing an increase in immune response. So this test also needs to be carefully interpreted. A new test that shows great promise, as it has none of the previously mentioned drawbacks, is the Candisphere Enzyme Immuno Assay. The main difference between this test and other blood studies for C. Albicans is that it is not influenced by the "external" antigens of C. Albicans that are harmless, produced constantly by small "normal" colonies of C. Albicans. Only large numbers of colonies producing a hidden cytoplasmic antigen are reported. This hidden antigen must make its presence known to the bodys immune defenses in order to produce many of the typical symptoms. An overgrowth cannot be missed as with stool or mucus swabs. A blind control treatment study for the FDA revealed a 92% correlation between therapeutic response and test response. The test is now available in the New York City area. I hope this data can be used to clear up some of the confusion both holistic and orthodox practitioners have on this subject. Michael Biamonte holds a Doctorate of Nutripathy, a Degree in Natural Healing, and a Masters in Clinical Nutrition. He is affiliated with the International Academy of Clinical Nutritionists and the International Academy of Nutrition and Preventive Medicine. He is listed in "The Directory of Distinguished Americans" for his research in Nutrition and Physiology. For more info also see: Does Candida Albicans Trigger the Onset of Celiac Disease? References: The Merk Manual, 14th Edition, pages 1625-1626. Miles Mr, Olsen L. Roger A. Recurrent Vaginal Candidiasis, JAMA 238, Pages 1836-1837; 1977. Great Smokies Lab Medical Lab Parasite/Pathogen Primer. Progress in diagnosing. Candida related complex. David Bauman, Ph.D. For an appointment, contact our office at: Michael Biamonte, C.C.N. 139 Fulton St. Suite 507 New York, NY 10038 (212) 587-2330 -
Celiac.com 07/05/2013 - Meanwhile, on the Canadian gluten-free front, a local lawmaker has introduced a bill to have testing for celiac disease covered by the Ontario Health Insurance Plan. Bill Mauro (Lib., Thunder Bay-Atikokan) introduced a private member’s bill Tuesday afternoon in Queen’s Park asking for an amendment to the Health Insurance Act to include serological testing for celiac disease. Mauro cited statistics indicating that about one per cent of Canadians are currently affected by celiac disease, but that 90 per cent of them are undiagnosed. The longer those people remain undiagnosed, the more severe the potential health impact. The long-term impacts of celiac disease can include vitamin deficiencies and higher rates of type 1 diabetes, arthritis, depression, neuropathy, infertility and osteoporosis, among other factors. Celiac disease can be detected with a simple blood test and controlled by diet. With early detection, people with celiac disease can live "a long and healthy life,” Mauro said. Source: tbnewswatch -
Celiac.com 08/27/2012 - Because so many patients are now overweight upon diagnosis for celiac disease, and so fee present as classically underweight, doctors are revising the clinical presentation guidelines for celiac disease diagnosis. That being said, some researchers have voiced concern that some patients might gain further weight while on a gluten-free diet. Recently, a team of researchers conducted a study to assess the impact of a gluten-free diet on body mass index (BMI) in a nationwide group of celiac patients and to isolate any variables that might help to predict favorable or unfavorable BMI changes. The research team included Anniina Ukkola, Markku Mäki, Kalle Kurppa, Pekka Collin, Heini Huhtala, Leila Kekkonen, and Katri Kaukinen. They are affiliated variously with the School of Medicine, University of Tampere, and the Department of Gastroenterology and Alimentary Tract Surgery at Tampere University Hospital, both in Tampere, Finland. To assess weight and disease-related issues, the researchers looked at 698 newly detected adults who were diagnosed with celiac disease by classical or extra-intestinal symptoms or by screening. The researchers measured BMI upon celiac diagnosis and after one year on a gluten-free diet. They then compared the results against data for the general population. Study data showed that 4% of patients were underweight at celiac diagnosis, 57% were normal weight, 28% were overweight and 11% were obese. On a gluten-free diet, 69% of underweight patients gained weight, while 18% of overweight and 42% of obese patients lost weight. BMI remained stable for the other patients. Both symptom- and screen-detected celiac patients showed similar results. The patients with celiac disease showed a more favorable BMI pattern than the general population. The most favorable BMI changes were seen in patients with self-rated gluten-free diet expertise, along with those who were younger upon diagnosis. Dietary counseling did not seem to impact . The initial method of detection does not seem to matter for people with celiac disease who are following a gluten-free diet. Both screen-detected and symptom-detected celiac disease patients who followed a gluten-free diet showed similar improvements in body mass index (BMI). Source: Open Original Shared Link -
American Journal of Clinical Pathology, April 2000 - A New Method of Quantitative Fecal Fat Microscopy and its Correlation with Chemically Measured Fecal Fat Output, by Kenneth Fine, M.D. and Frederick Ogunji Ph.D (Celiac.com 07/09/2000) Patients with gluten sensitivity should be evaluated for nutrient malabsorption because if present, this means there is small intestinal damage and institution of a gluten-free diet is imperative to prevent osteoporosis and other nutrient deficiency syndromes. Furthermore, a test at the time of diagnosis serves as a baseline to be compared to later if needed. For more than 50 years, the primary method used to assess for the presence of small intestinal damage and nutrient malabsorption in patients with celiac disease has been a 72-hour quantitative stool collection. However, because this method requires that patients accurately collect all the stools they pass for 3 days (missed stools lead to falsely low results), the test is logistically difficult for medical centers unaccustomed to the procedure, and the voluminous specimens usually are abhorred by patients and laboratory technicians. It poses obvious problems for children who cannot or will not collect all their stools, as well as for patients with chronic diarrhea, who may have bowel movement frequencies reaching 15 or more per day and/or fecal volumes as high as 2 or 3 liters per day. For these reasons, physicians evaluating patients with suspected or proven gluten sensitivity often avoid tests for intestinal malabsorption altogether. Recently, researchers at the Intestinal Health Institute in Dallas, Texas have developed a new method for quantitating fecal fat excretion that requires collection of only a single stool specimen. Development of this method was based on the fact that as more fat is malabsorbed, the fat globules in stool become more numerous and larger. In a study published in the April 2000 issue of the American Journal of Clinical Pathology entitled A New Method of Quantitative Fecal Fat Microscopy and its Correlation with Chemically Measured Fecal Fat Output, Kenneth Fine, M.D. and Frederick Ogunji Ph.D. tested 180 patients and found a highly statistically significant linear correlation between quantitative fecal fat microscopy (the new method) and chemically measured fecal fat output (the old method). They also showed that their microscopic analysis of just one stool gives comparable results to analysis of an entire 3-day collection. These researchers have, thus, shown that a dedicated quantitative analysis of one stool under a microscope can detect the rise in fecal fat due to intestinal malabsorption (or pancreatic maldigestion) as accurately as 3-day stool collections, making this latter test a thing of the past for most patients. This new stool test for intestinal malabsorption and other celiac-testing is available for order online from a laboratory set up by Drs. Fine and Ogunji to serve the needs of celiac patients. It is called EnteroLab and can be accessed at http://www.enterolab.com/.
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Celiac.com 06/17/2010 - In a recent letter to the editors of Clinical Chemistry, Carolina Arguelles-Grande, Gary L. Norman, Govind Bhagat, and Peter H. R. Green describe how hemolysis interferes with the detection of anti–tissue transglutaminase antibodies in celiac disease. They are variously affiliated with the Departments of Medicine and Pathology at Columbia University's College of Physicians and Surgeons in New York, and with INOVA Diagnostics, Inc., in San Diego, CA. Using human recombinant or erythrocyte tTG-IgA–based ELISA assays to measure anti–tissue transglutaminase (tTG) antibodies is one of the favored methods for diagnosing celiac disease. However, assessments of various tTG kits have shown variations in sensitivity, which has raised some alarms among clinicians. Many clinicians suspect that hemolysis plays a role in these variations. To assess the effect of hemolysis on tTG-IgA titers, the team looked at blood samples from 9 patients with biopsy-confirmed, active celiac disease who chose to participate in the study. They split the samples into 3 groups, with three samples in each group. They divided the samples according to tTG-IgA concentration after thawing. They categorized the samples as high titer (>185 U), intermediate titer (100–140 U), and borderline titer (20–50 U). The team hemolyzed a whole-blood sample taken from 1 tTG/DGP-seronegative patient. They measured hemoglobin in the sample at 149 g/L of hemoglobin. They repeatedly froze and thawed the sample until 90% of cells hemolyzed. They then serially diluted in ratios of 1:2, 1:5, 1:10, 1:50, 1:100, 1:500 in PBS to obtain hemoglobin concentrations of 67.1, 26.8, 13.4, 2.7, 1.3, and 0.27 g/L, respectively. They then added to each sample at a 1:1 ratio. For the tTG sequestration assessment, the team added human recombinant tTG from Diarect AG for final concentrations of 0.04, 0.02, 0.01, and 0.002 g/L. The team used undiluted serum as the baseline titer reference, and serum diluted 1:2 in PBS as a control. To measure antibody titers, they used 2 ELISA test kits: QUANTA LiteTM h-tTG IgA (human erythrocyte tTG-IgA based) and Gliadin II (DGP-IgA based) from INOVA Diagnostics, Inc. The team conducted blinded screens per manufacturer instructions, and compared the results for each group using the Mann–Whitney U-test, with P values <0.05 considered significant. They discovered that adding hemolyzed blood (HB) to sera of patients with active celiac disease lowered levels of anti-tTG, with intermediate- and borderline-titer groups seeing the largest reduction. Anti-DGP antibodies remained unchanged. Total average titer loss of anti-tTG vs anti-DGP antibodies was 36% vs 13% in the high-titer groups (P 0.026), 45% vs 3% (P = 0.026) in the intermediate titer groups, and 51% vs 2% in the borderline-titer groups (P = 0.0022) The team also found that adding ever higher concentrations of hemoglobin lowered the titers of anti-tTG, but not of anti-DGP, causing negative anti-tTG results in samples with low tTG antibody concentrations. The anti-tTG titer decreased 2%–65% in the high-titer groups, 1%–81% in the intermediate-titer groups, and 16%–74% in the borderline-titer group at hemoglobin concentrations of 0.3– 67.1 g/L. This compares with a decrease in anti-DGP titers of 10%–16% for high-titer groups, 4%–8% for intermediate-titer groups, and 7%–3% for the borderline-titer groups at hemoglobin concentrations of 0.3– 67.1 g/L. In all groups, tTG titer reduction was greater at higher concentrations of HB/HGB and gradually recovered as the red tint started to vanish at about 13 g/L of HGB, until complete visual disappearance at about 0.3g/L HGB). In the intermediate- and borderline-titer groups, titer reduction induced false-negative results at 20 U, with the anti-tTG, but not anti-DGP assays for HGB concentrations ≥13 or ≥0.3 g/L, respectively. They also found that raising concentrations of exogenous tTG (recombinant human tTG) to intermediate-titer blood samples triggered a significant reduction in anti-tTG assay titers similar to that seen with hemoglobin (range, 32%–82%; mean, 69%), as compared with that of anti-DGP titers (mean, 18%; range, 1%–38%; P = 0.0159). Hemolysis is clearly indicated by a red tint in serum plasma, and is one of the most common reasons for labs to reject specimens. Visible hemolysis starts at about 0.5 g/L of hemoglobin and is obvious above 1.3 g/L of hemoglobin. The results show that that hemolysis does interfere with the detection of anti-tTG antibodies, and that visibly hemolyzed blood samples generate false-negative anti–tTG-IgA results. These findings may explain false-negative tests for celiac disease that arise when clinicians use tTG-IgA assays. They encourage clinicians and laboratories to take measures to avoid hemolysis. If they notice hemolyzed blood samples, they should alert physicians so new blood samples can be taken. If redrawing samples is not possible, hemolyzed samples should be measured for anti-DGP antibodies. Clinicians who suspect hemolysis should consider using anti-DGP serological tests, which are not influenced by hemolysis. Source: Clinical Chemistry. 2010;56:1034-1036. DOI: 10.1373/clinchem.2010.143263 -
Celiac.com 11/19/2008 - In a development that could benefit people with celiac disease and gluten intolerance, a team of researchers based in Spain and the U.K. has developed a faster, easier way to test food products for the protein that triggers the adverse reactions associated with celiac disease. Such a rapid gluten detection test for food products could help millions of people avoid the indigestion, diarrhea, bloating, and other symptoms that arise when they accidentally consume foods that contain gluten. The research team was made up of Alex Fragoso, Ciara O'Sullivan and other colleagues, and their results will appear in the December 15 issue of the journal Analytical Chemistry. Their development centers on the creation of a new sensor that detects antibodies to the protein gliadin, a component of the gluten found in wheat, rye, and barley. Laboratory tests showed that the new sensor is both highly accurate and far faster than the enzyme-linked immunosorbent assay (ELISA), which is the current standard test for gliadin. The new test can detect gliadin in amounts as small as the parts per billion range, while an ELISA test requires a full 8 hours to do the same thing. Avoiding gluten enables people with celiac disease to avoid symptoms commonly associated with celiac disease and gluten intolerance. However, since gluten can hide in so many seemingly safe foods, such as soy sauce, canned soups, and licorice candy, it can be difficult to know for certain whether foods are in fact free of gluten free. A number of prepared foods clearly list gluten ingredients on their labels, but spotting its presence can be challenging at best, and is often outright hit or miss. A rapid, highly accurate test that can reliably spot gluten in food products promises to make it easier for manufacturers to label their products, and for people with celiac disease and gluten intolerance to avoid gluten and thereby enjoy better health.
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Celiac.com 10/23/2009 - Current estimates put the number of celiac disease sufferers at about 1% of the general population. However, some celiac disease experts, like Dr. Andrew Fassano, predict that up to 10% of the general population may prove to suffer from gluten intolerance. Easier, more reliable testing methods, such as blood antibody screening, have helped promote early detection of celiac disease, thus preventing serious complications of the disorder. Such tests also move researchers closer to knowing if Dr. Fassano’s prediction will hold true. In addition to classic complaints such as indigestion, diarrhea, poor nutritional uptake, among others, people with both celiac disease and gluten intolerance often present with a wide variety of generalized symptoms, and many increasingly show no clinical symptoms at all. A team of researchers recently set out to develop specific and sensitive immunoassays that can reliably detect celiac disease. In this case, they developed immunoassays for the detection of IgG and IgA antibodies to gliadin using synthetic peptides. The research team was made up of Anil K. Bansal, Matthew J. Lindemann, Vince Ramsperger, and Vijay Kumar. The team looked serum results for endomysial (EMA) and tissue transglutaminase (tTG) antibody screens from 200 blood individuals with celiac disease, as well as from celiac disease control subjects, and healthy normal subjects. In order to assess reliability of the Celiac G+ antibody test against EMA, which offers higher sensitivity and higher specificity, the team included samples with both high and low EMA titers. The team compared the Celiac G+ antibody assay against EMA and another commercially available gliadin peptide assays, together with tTG antibody assays. The data show that as the EMA levels increased the sensitivity of detection of antibodies to synthetic peptides on both systems increased, reaching 100% at EMA titers greater than 160. Celiac G+ synthetic gliadin peptide assay provides markedly superior diagnostic performance compared with other gliadin peptide immunoassays. Overall, the diagnostic performance of the Celiac G+ assay for IgA and IgG showed a sensitivity of 80% and 90% respectively in comparison with EMA. Compared to the other available synthetic peptide immunoassays, EMA positivity yielded sensitivities of 59% (IgA) and 75% (IgG). Specificity for celiac G+ antibody assay was 90–95% for IgA and IgG compared to 88–90% specificity for other similar assays. The results show that Celiac G+ ELISA provides better sensitivity and better specificity compared with other available synthetic gliadin peptide immunoassays. Moreover, when used in combination with the IgA tTG antibody test, the IgG Celiac G+ antibody test offers an excellent screening algorithm for suspected cases of celiac disease. As tests for celiac disease and gluten intolerance become better, easier, more reliable, as they become more sensitive and more specific and available to more people, more and more people will come to understand that they suffer from celiac disease and/or gluten intolerance. Every one of those discoveries offers someone a chance to improve their well-being and live a long, healthy life. For now, stay tuned... Annals of the New York Academy of Sciences. 2009 Sep; 1173:36-40.
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High Rates of Celiac Disease and Detection in Finland
Jefferson Adams posted an article in Latest Research
Celiac.com 07/31/2009 - Worldwide, most people with celiac disease remain undiagnosed and untreated, oblivious to their increased risk of mortality, and of developing certain cancers and other celiac-related conditions. Finland has set out to achieve high detection rate by training health personnel, and advocating blood tests for people known to be at risk for developing celiac disease. A team of researchers recently set out to determine whether this approach has been clinically effective in practice. The research team was made up of Lauri J. Virta, Katri Kaukinen & Pekka Collin. Since 2002, Finland's Social Insurance Institution had paid monthly compensation to people with newly diagnosed celiac disease for the additional cost of maintaining a gluten-free diet. To receive this compensation, people must submit proof of diagnosis, including biopsy findings, along with diagnostic criteria, in a statement from a physician. That information is kept in a national database. The researchers used the database to calculate incidence and prevalence rates of celiac disease through 2006. From the database, they selected from a total population aged 16 years or older of 4.31 million, to identify a total of 5020 persons (64% female) who received a new dietary grant in 2004-06. Altogether, 23,553 persons received the dietary grant. Thus, the mean annual incidence of proven celiac disease to be 39 per 100,000 individuals. This puts the national prevalence of adult celiac disease in Finland at 0.55% (0.70% F, 0.38% M). The results varied by region from 33 to 49 per 100,000 in annual incidence, and from 0.41% to 0.72% in the prevalence rates. It seems these figures for proven celiac disease in Finland are the highest yet charted. Nevertheless, many celiac disease cases remain undetected, as the true prevalence in Finnish adults is about 1.5-2.0%. Increased alertness to the condition and active case finding has made this efficient diagnostics possible. Interestingly, people aged 65 to 74 years showed the highest prevalence; in females prevalence peaked at 1.10% (95% Cl: 0.98-1.23) at the age of 68 years and in males, 0.77% (95% CI: 0.67-0.89), also at 68 years. Also, earlier findings have shown that 10-15% of cases will be detected because of atypical symptoms or associated conditions. Scandinavian Journal of Gastroenterology, 2009; 44: 933-938 -
J Pediatr. 2004 May;144(5):632-6 Celiac.com 05/10/2004 - Italian researchers compared the serum samples from 39 celiac disease patients who were diagnosed with celiac disease after their first biopsy with 32 controls who had normal duodenal mucosa and 32 healthy volunteers. Salivary transglutaminase autoantibodies were detected in 97.4% of the patients who had celiac disease, and in 100% of their corresponding serum samples. All of the 32 healthy volunteers tested negative for both serum and saliva transglutaminase autoantibodies. The researchers conclude "This study demonstrates that it is possible to detect salivary transglutaminase autoantibodies in celiac disease with a non-invasive, simple to perform, reproducible and sensitive method."
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Celiac.com 06/25/2003 - Below is an abstract of yet another study that supports the use of human anti-tTG type IgA serological tests to accurately diagnose celiac disease: Alimentary Pharmacology & Therapeutics Volume 17 Issue 11 Page 1415 - June 2003 Antibodies to human recombinant tissue transglutaminase may detect coeliac disease patients undiagnosed by endomysial antibodies N. Tesei*, E. Sugai*, H. Vázquez*, E. Smecuol*, S. Niveloni*, R. Mazure*, M. L. Moreno*, J. C. Gomez, E. Mauriño* & J. C. Bai* Background: The screening and diagnosis of coeliac disease have been simplified by the advent of new serological tools. Aim: To assess the clinical utility of a newly developed kit for antibodies to human recombinant tissue transglutaminase (hu-anti-tTG) in a large population of patients undergoing intestinal biopsy for suspected intestinal disorders. Methods: We evaluated 426 serum samples from consecutive adult patients (250 from untreated coeliac disease patients and 176 from individuals in whom a diagnosis of coeliac disease had been excluded), obtained at the time of intestinal biopsy. Samples were tested for immunoglobulin A (IgA) hu-anti-tTG by enzyme-linked immunoabsorbent assay, IgA endomysial antibodies (EmA) by indirect immunofluorescence and IgA and IgG antigliadin antibodies by enzyme-linked immunoabsorbent assay. A sub-group of samples was also assessed for a guinea-pig-based anti-tissue transglutaminase. Results: According to the cut-off for hu-anti-tTG, the sensitivity, specificity and positive and negative predictive values were 91%, 96%, 97% and 87%, respectively. Simultaneous determination of EmA showed values of 86%, 100%, 100% and 83% for the same parameters. Although 19 coeliac disease patients (7.6%) were negative for EmA and hu-anti-tTG, both tests rendered superior statistical values to antigliadin antibody tests. At diagnosis, IgA deficiency was detected in 11 patients, but both assays were able to detect samples with mild to moderate deficiency. The comparison of hu-anti-tTG with EmA showed excellent concordance between the tests ( statistic, 0.85). Discordance was observed in 20 samples from coeliac disease patients (8%) and in nine samples from controls (5%). Fifteen samples had an EmA-negative but hu-anti-tTG-positive serology, and five showed the converse pattern. Comparison of human recombinant and guinea-pig tests showed concordant results in 96% of cases. Conclusions: The quantitative determination of hu-anti-tTG type IgA using a commercial enzyme-linked immunoabsorbent assay kit was highly sensitive and specific for the detection of coeliac disease. Our results in a large population of patients with a clinical condition suggestive of the disorder demonstrated that the test can be used to detect a substantial number of patients otherwise unrecognized by IgA EmA.
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