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Celiac.com 05/05/2025 - Celiac disease is a common autoimmune disorder affecting about 1% of the global population. Diagnosing it typically requires examining small intestine (duodenal) biopsies under a microscope to detect damage to the intestinal lining. However, even expert pathologists don’t always agree on diagnoses—studies show their assessments match only about 80% of the time. This inconsistency can lead to delayed or incorrect diagnoses, leaving patients without proper treatment. To improve accuracy and speed, researchers have developed a machine learning model that can diagnose celiac disease from biopsy images as reliably as a human pathologist—and possibly even better. This breakthrough could help reduce diagnostic errors and speed up treatment for those with celiac disease. How the Study Was Conducted The research team trained an artificial intelligence (AI) model using a large dataset of 3,383 biopsy images from four different hospitals. These images came from various scanning machines to ensure the AI could work with different types of medical equipment. The model was designed to analyze whole-slide images of duodenal biopsies stained with hematoxylin and eosin (a standard method for viewing tissue samples). To test the model’s accuracy, the researchers used an entirely new set of 644 biopsy scans from a different hospital that the AI had never seen before. They also compared the AI’s diagnoses with those of four specialist pathologists to see how well it performed against human experts. Key Findings 1. The AI Model Matched or Outperformed Pathologists The model correctly diagnosed celiac disease with over 95% accuracy, 95% sensitivity (ability to detect true cases), and 95% specificity (ability to rule out non-cases). Its performance was so precise that its area under the receiver operating characteristic curve (AUC-ROC, a measure of diagnostic accuracy) exceeded 99%, indicating near-perfect ability to distinguish between celiac and non-celiac cases. When compared to four expert pathologists, the AI’s diagnoses were statistically indistinguishable from theirs, meaning it performed at least as well as a trained specialist. 2. The Model Works Across Different Hospitals and Scanners Since the AI was tested on biopsy images from a completely new hospital—using different scanning technology than it was trained on—the results prove it can generalize well to real-world clinical settings. This is crucial because medical imaging equipment varies between hospitals, and a useful diagnostic tool must work reliably across different systems. 3. Potential to Speed Up and Standardize Diagnoses Currently, diagnosing celiac disease requires a pathologist to manually review biopsy slides, which can be time-consuming and subjective. This AI model could: Reduce human error by providing a consistent, objective assessment. Speed up diagnosis by automating part of the review process. Assist pathologists in difficult or borderline cases where celiac damage is subtle. Why This Matters for People with Celiac Disease 1. Faster, More Accurate Diagnoses Many people with celiac disease face long delays in diagnosis due to inconsistent biopsy interpretations. An AI tool that matches expert pathologists could help patients get answers sooner, allowing them to start a gluten-free diet and prevent further complications. 2. Reducing Misdiagnosis and Uncertainty Since pathologists don’t always agree on biopsy results, some patients may be misdiagnosed or left in limbo. A highly accurate AI system could provide a second opinion, reducing uncertainty and ensuring correct treatment. 3. Improving Access to Specialized Care Not all hospitals have pathologists who specialize in celiac disease. An AI model like this could help standardize diagnoses across different medical centers, ensuring patients in smaller or rural clinics receive the same quality of assessment as those in major hospitals. 4. Future Applications in Celiac Disease Research Beyond diagnosis, this technology could be used to: Track disease progression in clinical trials. Study how gluten exposure affects intestinal damage over time. Develop even more precise tools for detecting early or mild cases. Conclusion This study demonstrates that artificial intelligence can diagnose celiac disease as accurately as expert pathologists—and possibly even more consistently. By reducing human error and speeding up the diagnostic process, this technology could help countless individuals get timely and correct diagnoses, leading to better management of their condition. For people with celiac disease, faster and more reliable biopsy analysis means less waiting, fewer misdiagnoses, and quicker access to treatment. While human experts will still play a critical role, AI-assisted diagnosis could become a valuable tool in ensuring everyone with celiac disease gets the care they need. As this technology develops, it may soon become a standard part of celiac disease testing, improving outcomes for patients worldwide. Read more at: ai.nejm.org Watch the video version of this article:

Celiac.com 05/02/2025 - For those who experience unpleasant reactions after consuming gluten, understanding whether they have celiac disease or non-celiac gluten sensitivity (NCGS) is crucial for managing their health. Although both conditions involve adverse responses to gluten, they differ in terms of causes, symptoms, diagnostic methods, and long-term health implications. This article will break down the key differences between celiac disease and NCGS, explore the proper testing methods, and highlight what this means for individuals living with either condition. Understanding Celiac Disease Celiac disease is an autoimmune disorder in which the immune system mistakenly attacks the lining of the small intestine when gluten is consumed. This immune response damages the villi—small, finger-like projections in the intestine responsible for nutrient absorption—leading to malnutrition and a range of serious health complications. Celiac disease affects approximately 1% of the global population and has a strong genetic component, meaning it often runs in families. Symptoms of Celiac Disease Symptoms of celiac disease can vary significantly from person to person, making diagnosis challenging. Some of the most common symptoms include: Chronic diarrhea or constipation Unexplained weight loss Fatigue and weakness Abdominal pain and bloating Anemia due to iron deficiency Joint and muscle pain Skin rash known as dermatitis herpetiformis Neurological symptoms such as headaches, brain fog, and numbness in hands and feet Delayed growth and developmental issues in children Left untreated, celiac disease can lead to severe complications such as osteoporosis, infertility, neurological disorders, and an increased risk of certain cancers, particularly intestinal lymphoma. Understanding Non-Celiac Gluten Sensitivity (NCGS) Non-celiac gluten sensitivity, often referred to as gluten intolerance, is a condition in which individuals experience symptoms similar to celiac disease after consuming gluten but do not test positive for celiac disease or wheat allergy. The exact cause of NCGS is not well understood, but it does not involve the autoimmune response or intestinal damage seen in celiac disease. Symptoms of NCGS Symptoms of NCGS can overlap with those of celiac disease but tend to be less severe and primarily involve digestive and neurological discomfort. Common symptoms include: Bloating and gas Stomach pain Fatigue Brain fog Headaches Joint pain Diarrhea or constipation Unlike celiac disease, NCGS does not lead to long-term damage to the intestines or cause serious complications. However, it can significantly impact an individual’s quality of life and daily functioning. Proper Testing and Diagnosis Because the symptoms of celiac disease and NCGS overlap, proper testing is necessary to distinguish between the two conditions. The diagnostic process typically involves the following steps: Testing for Celiac Disease Blood Tests – The first step in diagnosing celiac disease is a blood test that checks for specific antibodies, such as tissue transglutaminase (tTG-IgA) and endomysial antibodies (EMA-IgA). Children should also have DGP-IgA and DGP-IgG blood tests as well. A positive result suggests the need for further testing. Genetic Testing – While not diagnostic on its own, genetic testing can determine if an individual carries the HLA-DQ2 or HLA-DQ8 genes, which are necessary for celiac disease to develop. A negative result makes celiac disease extremely unlikely. Intestinal Biopsy – If blood tests indicate celiac disease, an endoscopic biopsy of the small intestine is often performed to confirm the diagnosis. Damage to the villi is a definitive sign of celiac disease. Testing for NCGS Since there is no specific test for NCGS, diagnosis is based on exclusion. This process involves: Ruling Out Celiac Disease – If celiac blood tests and biopsies are negative, celiac disease is unlikely. Ruling Out Wheat Allergy – A wheat allergy test (IgE-mediated allergy testing) ensures that the symptoms are not due to an allergic reaction. Gluten Elimination Diet – If celiac disease and wheat allergy are ruled out, a doctor may recommend a gluten elimination diet. If symptoms improve on a gluten-free diet and return when gluten is reintroduced, NCGS is the likely diagnosis. What This Means for People with Celiac Disease or Gluten Sensitivity Celiac Disease: The Need for Strict Gluten Avoidance For individuals diagnosed with celiac disease, adhering to a strict, lifelong gluten-free diet is essential. Even small amounts of gluten can trigger an immune response and cause intestinal damage, so cross-contamination must be carefully avoided. This means: Reading ingredient labels carefully Avoiding shared cooking surfaces and utensils that may have come into contact with gluten Being cautious when dining out and verifying gluten-free preparation methods Ensuring proper nutrition, as deficiencies in vitamins and minerals are common in celiac patients NCGS: A More Flexible Approach People with NCGS may not need to be as strict with gluten avoidance as those with celiac disease. While eliminating gluten can alleviate symptoms, some individuals find they can tolerate small amounts of gluten without serious consequences. However, maintaining a primarily gluten-free diet is recommended to prevent discomfort. The Importance of a Proper Diagnosis Misdiagnosing oneself with celiac disease or NCGS without medical testing can lead to unnecessary dietary restrictions or continued exposure to harmful gluten in the case of undiagnosed celiac disease. It is crucial to work with a healthcare professional to ensure an accurate diagnosis and a tailored management plan. Conclusion While both celiac disease and non-celiac gluten sensitivity involve adverse reactions to gluten, they are fundamentally different conditions with distinct causes, symptoms, and long-term implications. Celiac disease is an autoimmune disorder requiring strict gluten avoidance to prevent severe health consequences, while NCGS is a sensitivity that does not cause intestinal damage but can still significantly impact well-being. Understanding these differences and obtaining the correct diagnosis is essential for managing symptoms effectively and maintaining overall health. Whether you have celiac disease or NCGS, working closely with a healthcare provider can help you navigate your dietary needs and live a healthier life.

Celiac.com 07/25/1996 (Updated: 12/29/2020) - Like many people with celiac disease (it's an autoimmune disease and not a wheat allergy or the same as gluten sensitivity, gluten intolerance, or sensitivity to gluten), I spent a lot of years and money and endured many tests and misdiagnoses before doctors finally discovered that I needed to avoid gluten (including all gluten containing ingredients). Gluten is a protein found in gluten containing grains that include wheat, rye, and barley, and is often hidden in processed foods. To treat my celiac disease I had to go on a gluten-free diet for life, which meant that I had to learn to read food labels, and I ate mostly naturally gluten-free foods like meats, fruits, nuts, vegetables, gluten-free breads, and foods that were labeled gluten-free or made using gluten-free grains. My symptoms, which included weight loss, abdominal pain (especially in my middle-right section while sleeping), bloating, and long-term diarrhea, slowly disappeared. Because of the large variety of symptoms associated with celiac disease, and the fact that many celiacs have few or no symptoms, diagnosis can be very difficult, which is why is still takes an average of 6-10 years to get diagnosed. Most medical doctors are taught to look for classic symptoms and often make a wrong diagnosis, or no diagnosis at all. During my doctor visits my diet was never discussed, even though most of my symptoms were very typical, and greatly related to food digestion. A simple (and free!) exclusionary diet would have quickly revealed my problem. An exclusionary diet involves eliminating wheat, rye, oats, barley, dairy products, soy and eggs for several weeks, and recording any reaction as you slowly add these foods back into your diet. Unfortunately it took my doctors over two years to make a diagnosis, and during that time I was misdiagnosed with Irritable Bowel Syndrome (IBS), told that I could have cancer or a strange form of Leukemia, treated for a non-existent ulcer with a variety of antibiotics that made me very ill, and was examined for a possible kidney problem. I also underwent many unnecessary and expensive tests including CAT Scans, thyroid tests, an MRI, tests for bacterial infections and parasites, ultrasound scans, and gall bladder tests. Ultimately the only reason I every got my diagnosis was because I ended up reading something about it in a book on nutrition, which led me to ask my doctor to be screened for it. I was finally diagnosed via a blood test for celiac disease, followed by a biopsy of my small intestine (which is not as bad as it sounds). A full recovery took me 2-3 years, and during that time I also had temporary food intolerance issues to things like dairy (casein), corn, tomatoes, and chicken eggs. During the 1-2 year time period after going 100% gluten-free I was thankfully able to add those things back to my diet. I created Celiac.com to help others avoid a similar ordeal. I also want to provide people who know they have the problem with information which will improve their quality of life, and broaden their culinary horizons. To do this, I have compiled information from a large variety of sources including medical journals, books, doctors, scientists, and news sources, and posted it all right here. Many of our articles are written by medical professionals such as nurses, doctors, and other celiac disease experts.

Celiac.com 02/17/2025 - Celiac disease, a chronic autoimmune disorder triggered by gluten, has traditionally been diagnosed through intestinal biopsies. However, new approaches aim to simplify this process, especially for children, by relying more on blood tests to confirm the diagnosis. This study examines whether a repeated blood test for a specific antibody can replace a second, more complex confirmatory test, making the diagnostic process easier and less invasive for children. The Current Diagnostic Process Under the no-biopsy approach introduced by European guidelines in 2012, children with a suspected diagnosis of celiac disease can forgo an intestinal biopsy if they meet certain criteria. These include having very high levels of immunoglobulin A anti-tissue transglutaminase-2 antibodies in their blood, confirmed by a second test for anti-endomysial antibodies. While this method reduces the need for biopsies, it still requires two separate tests, which can be time-consuming and stressful for families. Purpose of the Study The researchers wanted to determine if the second test, which detects anti-endomysial antibodies, is truly necessary. They investigated whether repeating the initial test for anti-tissue transglutaminase antibodies could be just as effective in confirming the diagnosis. By eliminating the need for the second test, the diagnostic process could become simpler and more accessible. Methodology The study analyzed data from 933 children who were suspected of having celiac disease based on their initial blood test results. Each child’s first test showed antibody levels more than 10 times the upper limit of normal, which is considered a strong indicator of celiac disease. A second confirmatory test for anti-endomysial antibodies was performed within two months of the first test. The researchers compared the results of the two tests to assess their alignment and reliability. Key Findings High Agreement Between Tests: All children in the study who had high levels of anti-tissue transglutaminase antibodies also tested positive for anti-endomysial antibodies in the confirmatory test. Consistency Across Samples: Almost all confirmatory tests showed very high levels of anti-endomysial antibodies, further supporting the initial test results. Potential for Simplification: Given the high level of agreement, the study suggests that repeating the initial anti-tissue transglutaminase test could replace the anti-endomysial antibody test as the confirmatory step. Implications for Diagnosis The study’s findings have significant implications for the diagnosis of celiac disease in children. By relying on repeated testing of anti-tissue transglutaminase antibodies, healthcare providers can streamline the diagnostic process, reduce costs, and eliminate the need for more complex tests. This approach is especially beneficial for families seeking a faster and less invasive confirmation of the diagnosis. Meaning for Families and Children with Celiac Disease For families navigating the challenges of a celiac disease diagnosis, this study provides a pathway to quicker and more straightforward answers. Reducing the need for biopsies and multiple tests not only minimizes the physical burden on children but also alleviates emotional stress for parents. Early and accurate diagnosis enables children to start a gluten-free diet sooner, preventing further complications and improving their quality of life. Conclusion This research highlights the potential to simplify the diagnostic process for celiac disease by replacing the second confirmatory test with a repeat of the initial antibody test. By doing so, healthcare providers can maintain diagnostic accuracy while making the process more accessible and less invasive for children and their families. For those living with celiac disease, this advancement represents a meaningful step toward easier, faster diagnoses and improved management of the condition. Read more at: pubmed.ncbi.nlm.nih.gov Watch the video version of this article:

Celiac.com 10/14/2024 - Celiac disease has long been associated with symptoms like malnutrition and weight loss due to malabsorption issues caused by damage to the small intestine. However, recent studies suggest that the presentation of celiac disease may be changing. This systematic review and meta-analysis aimed to investigate the prevalence of obesity, overweight, and underweight in patients newly diagnosed with celiac disease. The study reviewed data from several research sources to provide a comprehensive overview of body mass index trends among those diagnosed with celiac disease before they started a gluten-free diet. Methodology and Data Sources The research team conducted an extensive search across multiple databases, including PubMed, Embase, Scopus, and Web of Science, to identify studies that focused on the body mass index of newly diagnosed celiac disease patients. These studies measured the prevalence of underweight, overweight, and obesity at the time of diagnosis. Only studies that utilized accepted body mass index categories, which classify a body mass index above 30 as obesity, above 25 as overweight, and below 18.5 as underweight, were included in the analysis. In total, 23 studies involving more than 15,000 celiac patients were analyzed alongside a comparison group of over 800,000 healthy individuals. Key Findings The meta-analysis revealed surprising findings that challenge the conventional view of celiac disease as a condition primarily associated with being underweight. Only 11% of newly diagnosed celiac patients were found to be underweight. On the other hand, approximately 37% of the patients were overweight or obese at the time of diagnosis. This marked an increase in the prevalence of obesity and overweight in celiac patients over the years. Between 2003 and 2009, around 22% of patients were either overweight or obese, but this figure rose to 32% in studies conducted from 2016 to 2021. The analysis also found that patients with a higher body mass index tended to be older and, to a lesser degree, female. These patients were less likely to present with typical gastrointestinal symptoms of celiac disease, which could contribute to delays in diagnosis. Moreover, the prevalence of underweight among celiac patients decreased, aligning more closely with the rates of underweight seen in the general population. Trends Over Time and Geographical Differences The study revealed significant changes in the body mass index trends of celiac disease patients over time. In the early 2000s, it was more common to see celiac patients who were underweight, but by the mid-2010s, the proportion of overweight and obese patients had increased significantly. This shift could be attributed to various factors, including greater awareness of celiac disease, more widespread screening efforts, and better access to gluten-free foods that are often high in calories and fat. Geographically, the prevalence of obesity and overweight among celiac patients varied. In North American and European studies, overweight and obesity rates were significantly higher than in studies conducted in countries like India, where a larger proportion of celiac patients were still underweight at the time of diagnosis. These differences may reflect varying levels of access to healthcare and differences in diet and lifestyle between countries. Implications for Celiac Disease Diagnosis The findings of this study highlight the importance of not relying solely on weight status when diagnosing celiac disease. The traditional view that celiac patients are typically underweight has been challenged by the significant proportion of newly diagnosed patients who are overweight or obese. This shift suggests that many overweight or obese individuals with celiac disease may go undiagnosed for longer periods because their weight does not fit the stereotypical presentation of the disease. As a result, they may suffer from the long-term effects of untreated celiac disease, including nutrient malabsorption, autoimmune disorders, and increased risk of certain cancers. Physicians and healthcare providers should be aware that weight alone is not a reliable indicator of celiac disease. Overweight or obese individuals who present with other symptoms, such as fatigue, bloating, or unexplained nutrient deficiencies, should still be evaluated for celiac disease, even if they do not fit the traditional clinical profile. The Role of a Gluten-Free Diet One of the most interesting findings of this study is the role that a gluten-free diet can play in the weight status of celiac patients. Many studies have shown that after starting a gluten-free diet, patients often gain weight. This is due to the restoration of intestinal function and the ability to absorb nutrients more effectively. However, there is also evidence that patients on a gluten-free diet tend to consume more processed, calorie-dense gluten-free products, which may contribute to weight gain over time. A Growing Number of Newly Diagnosed Celiac Patients are Overweight or Obese This systematic review and meta-analysis provide important insights into the changing presentation of celiac disease. While the disease was once primarily associated with being underweight, a growing number of newly diagnosed patients are now overweight or obese. This has significant implications for the way celiac disease is diagnosed and managed. It is crucial for both doctors and patients to recognize that celiac disease can occur at any weight and that relying on weight status alone may lead to delays in diagnosis and treatment. For individuals with celiac disease, this study reinforces the need for careful dietary management and long-term monitoring. Following a gluten-free diet can lead to significant health improvements, but it is also important to make healthy food choices to avoid unintended weight gain or other complications. This research underscores the importance of a holistic approach to managing celiac disease, one that considers the full spectrum of symptoms and health outcomes beyond just weight. Read more at: bmcgastroenterol.biomedcentral.com

Celiac.com 10/23/2023 - A recent study conducted by a team of US investigators is shedding light on the use of European thresholds for diagnosing celiac disease in North America. This study seeks to determine how often biopsies are performed on children who are considered at high risk for celiac disease based on common diagnostic tests, yet meet the criteria for non-biopsy diagnoses according to European standards. Dr. Denis Chang, the study's lead author, discussed the trial's design and its implications for celiac disease diagnostics in North America during an interview with HCPLive at the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) 2023 Annual Meeting in San Diego. Celiac disease is an autoimmune disorder that affects the small intestine and is triggered by the consumption of gluten, a protein found in wheat, rye, and barley. The gold standard for diagnosing celiac disease is through an endoscopy, which involves taking biopsies to confirm the damage caused by gluten. However, serology, or blood testing, has become a game-changer in the diagnostic process. It helps identify individuals who require an endoscopy based on a positive blood test, typically the tissue transglutaminase (tTG-IgA) test. While tTG-IgA is a reliable biomarker, it is not infallible and can yield false positives or negatives. In 2012, European colleagues established guidelines that allow for a celiac disease diagnosis in some cases where a highly positive tTG-IgA result is combined with another positive blood marker, EMA IgA. These guidelines initially included genetic risk and symptoms but no longer do. In contrast, North American guidelines have not incorporated these standards, partially due to the wide array of diagnostic assays used to identify celiac disease, each with its own methodology. Dr. Chang also emphasizes the concern of potentially overlooking other diagnoses by not conducting an endoscopy, such as eosinophilic esophagitis, which is commonly seen in celiac patients. In an ideal world, a standardized and widely accepted diagnostic assay strategy would simplify the diagnostic process and potentially pave the way for developing new clinical therapies for celiac disease. Currently, there are no FDA-approved drugs for treating celiac disease, and the most promising agents in development are primarily intended for adult patients. Dr. Chang explained that an alternative diagnosis method could help expand the pool of individuals, both providers and patients, who can collaborate to advance celiac disease research and treatment options. Additionally, it could offer clarity for patients who have received a presumed celiac disease diagnosis based solely on high blood markers, without undergoing a biopsy. This investigation into the use of European diagnostic thresholds in North America is a significant step toward streamlining the diagnosis of celiac disease. See more at the Conference|North American Society For Pediatric Gastroenterology, Hepatology & Nutrition

Celiac.com 09/04/2024 - Researchers conducted a retrospective, observational cohort study with the aim of determining whether iron deficiency at the time of celiac disease diagnosis affects the tissue transglutaminase antibody (TTG) normalization rate among pediatric patients on a gluten-free diet. Celiac disease is an immune-mediated disorder triggered by gluten consumption in genetically predisposed individuals, often diagnosed using specific serological tests. A gluten-free diet is the only effective treatment, and the study investigates whether iron deficiency affects the rate of antibody normalization in pediatric patients adhering to this diet. Methods The researchers conducted a retrospective, observational cohort study involving children aged 2-18 years diagnosed with celiac disease between January 2016 and December 2020. Data on demographics, hemoglobin, ferritin, and antibody levels were collected at diagnosis and one year after starting a gluten-free diet. Iron deficiency was defined by specific hemoglobin and ferritin levels. The primary focus was to compare tissue transglutaminase antibody normalization rates between children with and without iron deficiency at diagnosis. Results The study included 118 pediatric patients. At diagnosis, 51.7% had iron deficiency, with a higher prevalence among females in the non-iron deficient group. The median age at diagnosis was slightly lower for those with iron deficiency. After one year on a gluten-free diet, 65.5% of children with iron deficiency achieved antibody normalization, compared to 53.8% of those without iron deficiency, though this difference was not statistically significant. Notably, male children had a significantly higher rate of antibody normalization than females. Discussion The study's findings indicate that iron deficiency at the time of celiac disease diagnosis does not significantly impact the rate of antibody normalization after one year on a gluten-free diet. However, male children showed a higher likelihood of achieving normalization compared to females. This gender disparity suggests that other factors might influence antibody normalization rates, warranting further research. The study's results align with previous research showing no significant difference in serological response between children with and without anemia at diagnosis. Conclusion The study concludes that iron deficiency at diagnosis does not hinder tissue transglutaminase antibody normalization in pediatric celiac disease patients adhering to a gluten-free diet. The observed higher normalization rates among males suggest that gender-specific factors may influence the immune response to a gluten-free diet. Future research should focus on understanding these factors and their implications for managing celiac disease in children. Significance for Celiac Disease Patients For individuals with celiac disease, this study provides valuable insights into the role of iron deficiency in disease management. It reassures parents and healthcare providers that iron deficiency at diagnosis does not delay antibody normalization, highlighting the importance of maintaining a gluten-free diet. Additionally, the gender-specific findings may guide personalized treatment approaches, improving outcomes for children with celiac disease. This study underscores the need for ongoing research to optimize care for pediatric celiac disease patients. Read more at: cureus.com

Celiac.com 06/08/2023 - For people who suspect they have celiac disease, an accurate diagnosis is crucial for managing health and making informed dietary choices. Traditionally, the gold standard for celiac diagnosis has involved a gluten challenge, where individuals are required to consume gluten-containing foods to induce disease activity. However, this approach can be burdensome and time-consuming. Now, a new study conducted at two US centers has shed light on new biomarkers that could help to rapidly improve the way celiac disease is diagnosed and researched. The Research Team The research team included Maureen M. Leonard, Jocelyn A. Silvester, Daniel Leffler, Alessio Fasano, Ciarán P. Kelly, Suzanne K. Lewis, Jeffrey D. Goldsmith, Elliot Greenblatt, William W. Kwok, William J. McAuliffe, Kevin Galinsky, Jenifer Siegelman, I-Ting Chow, John A. Wagner, Anna Sapone, and Glennda Smithson. They are variously affiliated with the Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, Massachusetts; the Celiac Disease Research Program, Harvard Medical School, Boston, Massachusetts; the Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts; the Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Takeda Pharmaceuticals Inc. Co., Cambridge, Massachusetts; the Department of Medicine, Columbia University Medical Center, New York, New York; the Department of Pathology, Boston Children’s Hospital, Boston, Massachusetts; Invicro, A Konica Minolta Company, Boston, Massachusetts; and the Benaroya Research Institute at Virginia Mason, Seattle, Washington. A Randomized Double-blind Trial In a randomized, double-blind trial, the team enrolled 14 adults with biopsy-proven celiac disease. The participants were divided into two groups and assigned to consume either 3 grams or 10 grams of gluten per day for a period of 14 days. The primary objective was to assess the changes in villous height: crypt depth (Vh:celiac disease), a key histological marker of celiac disease activity. However, the study also aimed to explore other biomarkers that could potentially supplement or even replace histology as a diagnostic tool. The results of the study were largely encouraging. All of the biomarkers assessed showed changes in response to gluten challenge, demonstrating their potential for evaluating disease activity. However, the time to reach maximal change, the magnitude of change, and the gluten dose-response relationship varied across different biomarkers. Notably, Vh:celiac disease, a measure of the structural integrity of the small intestine, VCE enteropathy score as assessed by video capsule endoscopy, enzyme-linked immune absorbent spot (ELISpot), gut-homing CD8 T cells, intraepithelial leukocytes, and gluten-specific CD4 T cells, all demonstrated significant changes only at the higher gluten dose of 10 grams. However, symptoms reported by the participants, and plasma interleukin-2 (IL-2) levels, increased significantly or near significantly at both gluten doses. Interestingly, IL-2 appeared to be the earliest and most sensitive marker of acute gluten exposure. Conclusions These findings can help to improve celiac disease diagnostics, by identifying modern biomarkers that are sensitive and responsive to gluten exposure, this study offers the possibility of less invasive and shorter-duration gluten challenges. This would not only ease the burden on individuals undergoing diagnostic testing but also streamline celiac disease research, enabling more efficient and precise investigations. The potential benefits of these novel biomarkers extend beyond diagnostics. They could also play a crucial role in monitoring disease activity, assessing treatment responses, and even exploring the effects of gluten on individuals who are at risk of developing celiac disease. While this study represents a significant step forward, further research is needed to validate and refine the biomarkers. Future studies may investigate their utility in larger populations and explore their correlation with long-term clinical outcomes. This study shows the potential for modern biomarkers to improve celiac disease diagnostics. By providing a preliminary framework for the rational design of gluten challenge protocols, this work brings us one step closer to more efficient and patient-friendly diagnostic approaches for celiac disease. Stay tuned for more on this and related stories. Read more in Gastroenterology

Celiac.com 07/04/2024 - Celiac disease is an autoimmune condition where the ingestion of gluten causes an immune reaction that damages the small intestine in genetically predisposed individuals. This disease can lead to various systemic and localized health issues, including those affecting the oral cavity. One significant oral manifestation linked to celiac disease is dental enamel defects. A new study explores the connection between celiac disease and dental enamel defects, the potential mechanisms behind these defects, and the role of dentists in early diagnosis and management. The Relationship Between Celiac Disease and Dental Enamel Defects Dental enamel defects are abnormalities in the structure of the tooth enamel, often presenting as discoloration, pitting, or grooving of the teeth. These defects can occur due to several reasons, including genetic factors, nutritional deficiencies, and systemic diseases like celiac disease. Research has shown a high prevalence of dental enamel defects among individuals with celiac disease, ranging from 50% to 94.1%. These defects are often symmetrical and occur in a chronological pattern, which can be categorized using Aine’s classification system. Pathophysiological Mechanisms The development of dental enamel defects in individuals with celiac disease is thought to be due to multiple factors. One primary factor is the malabsorption of essential nutrients caused by the damage to the intestinal villi in the small intestine. This damage impairs the body's ability to absorb nutrients critical for proper enamel formation, such as calcium and vitamin D. Additionally, the autoimmune response triggered by gluten ingestion may directly affect the cells responsible for enamel formation. Clinical Implications for Oral Health The presence of dental enamel defects can significantly impact oral health. These defects can increase the susceptibility to dental caries, lead to aesthetic concerns, and cause sensitivity. Research indicates that individuals with celiac disease often have higher decayed, missing, and filled teeth (DMFT) scores, indicating more severe dental decay. They are also more likely to experience recurrent aphthous stomatitis and symptoms of dry mouth, which can further exacerbate oral health issues. The Role of Dentists in Early Diagnosis Dentists play a crucial role in the early diagnosis of celiac disease. Since dental enamel defects can be an early indicator of celiac disease, dentists can identify potential cases through routine dental examinations. By recognizing the patterns of enamel defects and considering patient history, dentists can refer patients for further investigation, including serological testing and intestinal biopsy. Aine’s classification of enamel defects provides a structured approach for dentists to categorize and suspect celiac disease. Interdisciplinary Collaboration Effective management of celiac disease and its oral manifestations requires a collaborative approach between dentists and gastroenterologists. This interdisciplinary collaboration ensures comprehensive care, addressing both the systemic and oral health aspects of the disease. Regular dental check-ups are essential for monitoring and managing dental enamel defects in celiac patients, helping to prevent further complications and improve overall health outcomes. Conclusion This study underscores the significant association between celiac disease and dental enamel defects. Early recognition of these oral manifestations by dentists can lead to timely diagnosis and management of celiac disease, even in the absence of gastrointestinal symptoms. Understanding this relationship emphasizes the importance of integrated care involving both dental and medical professionals. This holistic approach can enhance the quality of life for individuals with celiac disease, ensuring better health outcomes and effective management of both their oral and systemic health. Implications for Celiac Disease Patients For individuals with celiac disease, this study highlights the importance of regular dental visits and the need for heightened awareness of potential oral health issues. Early detection of dental enamel defects can prompt further investigation into underlying celiac disease, facilitating timely intervention and adherence to a gluten-free diet. This proactive approach can help prevent further health complications and improve overall well-being for those with celiac disease. By recognizing the critical role of dentists in the early diagnosis and management of celiac disease-related oral manifestations, this research paves the way for improved interdisciplinary collaboration and comprehensive patient care. Further large-scale studies are recommended to deepen our understanding of the link between celiac disease and dental enamel defects, ultimately contributing to better health outcomes for affected individuals. Read more at: mdpi.com

Celiac.com 06/24/2024 - Celiac disease is a common chronic autoimmune disorder that affects approximately 1 in 70 people worldwide. This condition results in damage to the small intestine when gluten is ingested. Traditionally, European countries use a case-finding approach, where general practitioners look for celiac symptoms, including family history and a history of autoimmune diseases to diagnose celiac disease. Despite this, many cases remain undiagnosed, prompting discussions about the potential benefits of population-wide screening. Italy's Screening Initiative In September, the Italian Parliament approved a national screening program for celiac disease in children aged 1-17 years. This decision followed a trial led by Professor Carlo Catassi of Marche Polytechnic University, which screened children aged 5-11 years in six Italian cities. The study found a prevalence of 1.65%, meaning nearly 1 in every 60 children had celiac disease, a rate higher than expected. Importantly, only 40% of these children were diagnosed before the trial, indicating that 60% of cases remain undiagnosed without mass screening. The Debate on Screening for Celiac Disease The idea of screening for celiac disease has been debated for nearly 30 years. In 1996, Catassi carried out the first large-scale celiac screening study in Italy, finding that for each diagnosed case, there were about seven undiagnosed cases. David Sanders, a professor of gastroenterology, noted similar situations in the UK during the 1990s. Increased awareness among doctors has improved diagnostic rates, but at least two-thirds of celiac cases remain undiagnosed, posing risks for complications like infertility, anemia, and osteoporosis. Some argue that individuals with minimal symptoms may not need to be aware of their condition, but Catassi believes early diagnosis is crucial to prevent serious health issues over time. Arguments for and Against Population-Wide Screening One major argument opposing population-wide screening is the potential for false positives. However, a 2021 study by Catassi showed that anti-tissue transglutaminase immunoglobulin A tests are highly reliable, with a sensitivity in children of 93% and specificity of 98% at diagnosing celiac disease. In this study, there were no false positives, although 2%-3% of people with celiac disease could have false negatives due to IgA deficiency. Genetic markers can help identify individuals at risk who may initially test negative. Another concern is that healthy individuals diagnosed through screening might undergo unnecessary dietary restrictions. However, evidence suggests that untreated celiac disease can lead to long-term health issues, and population-based screening in Norway showed that most undiagnosed individuals improved their quality of life on a gluten-free diet. Building the Evidence In 2017, the US Preventive Services Task Force looked at the evidence and found it insufficient to assess the benefits and harms of screening for celiac disease. Wanda Nicholson, the current chair of the task force, emphasized the need for more studies comparing outcomes of screened versus unscreened individuals and the impact of gluten-free diets among those who test positive. The Italian screening program will hopefully provide valuable insights into such questions. Catassi has argued that the overall benefits of early diagnosis will outweigh any drawbacks of screening, though he acknowledged the need to evaluate the program's results over time. Despite concerns about participation and cost-effectiveness, Sanders welcomed Italy's initiative as it could inform future policies globally. Conclusion Italy's decision to implement nationwide screening for celiac disease in children is a significant step towards understanding and managing this autoimmune disorder. The findings from this program could highlight the true prevalence of celiac disease and the benefits of early diagnosis. For those with celiac disease, especially undiagnosed cases, this screening could prevent serious health complications and improve quality of life. While further research is needed to validate the effectiveness and practicality of such screenings, Italy's program could pave the way for similar initiatives worldwide, offering hope to many affected by this chronic condition. Read more: medscape.com

Celiac.com 06/22/2024 - Celiac disease is an autoimmune disorder where gluten ingestion damages the small intestine. Traditionally, diagnosis involves blood tests for specific antibodies and a confirmatory biopsy, an invasive procedure with associated risks. Research is exploring less invasive methods, including the use of tissue transglutaminase immunoglobulin A (TTG-IgA) antibodies as a potential predictor. Study Overview A recent study presented at Digestive Disease Week 2024 investigated the accuracy of TTG-IgA antibodies in diagnosing celiac disease without biopsy. The study looked at patients located at six U.S. sites who had undergone esophagogastroduodenoscopy (EGD) and TTG-IgA testing. Exclusions were made for prior celiac diagnosis, IgA deficiency, or adherence to a gluten-free diet to maintain result accuracy. Key Findings - Patient Demographics and Biopsy Results Among 4,312 patients, 27.5% showed villous atrophy, indicating celiac disease. These patients were typically younger (average age 41) and predominantly non-Hispanic white (89.5%). They had significantly higher TTG-IgA levels, averaging five times the upper limit of normal (ULN). Diagnostic Accuracy of TTG-IgA The study revealed that over a quarter of patients had elevated TTG-IgA levels. For any level above the ULN, sensitivity was 81.8%, and specificity was 95.7%. The positive predictive value (87.7%) and negative predictive value (93.3%) supported the test's overall accuracy, which was 91%. The area that was under the receiver operating characteristic curve (AUC) was 0.92, indicating high accuracy. High TTG-IgA Levels In patients with TTG-IgA levels of more than 10 times the ULN, only two out of 132 did not have villous atrophy, resulting in a false-positive rate of 0.1%. This suggests that very high TTG-IgA levels are a strong indicator of celiac disease and could potentially reduce the need for biopsy. Implications for Noninvasive Diagnosis Lead investigator Dr. Claire Jansson-Knodell noted the potential for TTG-IgA to serve as a noninvasive diagnostic tool, particularly for patients with very high antibody levels. However, caution is advised for cases with mildly elevated TTG-IgA, where diagnostic accuracy may not be sufficient to eliminate the need for a biopsy. Future Research The research team plans to conduct a prospective study to gather more data, aiming to confirm the practicality and reliability of using TTG-IgA as a noninvasive diagnostic tool in clinical practice. Conclusion This study suggests that TTG-IgA antibodies hold significant potential as a noninvasive diagnostic indicator for celiac disease, particularly in patients with very high antibody levels. While promising, further research is needed to validate these findings and ensure the accuracy and safety of using TTG-IgA as a standalone diagnostic tool. This could lead to a future where a simple blood test replaces the need for invasive biopsy in diagnosing celiac disease. Read more: gastroendonews.com

Celiac.com 05/27/2024 - Celiac disease diagnosis typically involves a two-step process, including antibody detection and endoscopy with duodenal biopsy. However, recent evidence suggests that elevated IgA anti-tissue transglutaminase (tTG) levels may accurately predict celiac disease, potentially eliminating the need for biopsy. This study aimed to assess the accuracy of the no-biopsy approach in diagnosing celiac disease in adults. Methods - A Systematic Review and Meta-analysis A systematic review and meta-analysis were conducted, including studies reporting on IgA-tTG levels ≥10 times the upper limit of normal (ULN) against duodenal biopsies in adults with suspected celiac disease. Sensitivity, specificity, and likelihood ratios were calculated, with positive predictive values determined across different disease prevalence rates. Results - IgA-tTG levels ≥10×ULN had 100% Specificity and a Positive Predictive Value of 98% The meta-analysis of 18 studies with over 12,000 participants indicated that IgA-tTG levels ≥10×ULN had 100% specificity and a positive predictive value of 98% for celiac disease in adult patients referred to secondary care. The predictive value varied based on disease prevalence, with a 99% positive predictive value at a 40% disease prevalence rate. Conclusion & Discussion The findings support the no-biopsy approach for selected adult patients with high IgA-tTG levels and moderate to high celiac disease pretest probability, potentially avoiding invasive endoscopy and biopsy. Collaboration between primary and secondary care is crucial for successful implementation, considering patient preferences and risk factors. Further research is needed to evaluate this approach in primary care and low-pretest probability cases, as well as its cost-effectiveness and regulatory implications. The study provides robust evidence for the no-biopsy approach in diagnosing celiac disease in adults, aligning with pediatric guidelines. However, concerns regarding false-positive diagnoses and missed concurrent pathology warrant careful patient assessment and diagnostic pathway standardization. Collaboration and shared decision-making are key to successful implementation, emphasizing the need for clear clinical guidelines and educational initiatives. Future Directions Future research should focus on evaluating the no-biopsy approach in primary care and low-pretest probability cases, assessing lower IgA-tTG thresholds, and considering the role of confirmatory testing. Additionally, studies on patient preferences, cost-effectiveness, and regulatory aspects are necessary to determine the approach's feasibility and impact in clinical practice. Read more at: gastrojournal.org

Celiac.com 05/04/2024 - Congratulations on taking the proactive step to undergo a celiac disease blood panel and/or endoscopy! While receiving positive celiac results can initially be overwhelming, it's essential to recognize that you've now embarked on a journey towards better health and well-being. Understanding your diagnosis is the first crucial step in managing celiac disease effectively, and with the right knowledge and support, you can navigate this path with confidence and optimism. Understanding Your Celiac Disease Diagnosis Being diagnosed with celiac disease can be a significant moment, often filled with a range of emotions including surprise, confusion, and sometimes even panic. It's important to understand that celiac disease is a manageable condition, and with the right approach, everything can indeed get better soon. Embracing the Gluten-Free Lifestyle One of the most significant steps you can take after a celiac disease diagnosis is to embrace a gluten-free lifestyle. While it may seem daunting at first, there are now countless resources, support groups, gluten-free products and recipes available to make this transition smoother. Remember, most people with celiac disease report feeling significantly better once they adopt a strict gluten-free diet, and many of the health risks associated with the disease will disappear after going on the diet. Seeking Support and Resources Finally, don't hesitate to seek support and utilize available resources. Joining celiac disease support groups, both online and offline, can provide valuable insights, tips, and emotional support from others who have walked a similar path. Additionally, working closely with healthcare professionals, such as registered dietitians specializing in celiac disease, can help you navigate dietary challenges and ensure optimal management of your condition. Embracing Hope and Optimism Embarking on a gluten-free lifestyle after a celiac disease diagnosis is a pivotal step towards reclaiming your health and well-being. While the journey may have its challenges, staying committed to a strict gluten-free diet can lead to significant improvements in your symptoms over time. It's important to note that the time frame for symptom improvement can vary widely from person to person. Some individuals may experience relief from certain symptoms, such as digestive issues, within a few weeks of starting a gluten-free diet. Others may take several months to notice substantial improvements, especially for symptoms like fatigue, skin rashes, or neurological issues. Consistency and diligence in adhering to a gluten-free diet are key factors in how quickly you may experience symptom relief. Avoiding even small traces of gluten is crucial, as exposure can trigger immune responses and prolong symptom persistence. Many people celiac disease have nutrient deficiencies that require supplementation, so be sure to talk to your doctor about getting screened for any, and make sure any supplements you take are gluten-free. Correcting any nutrient deficiencies can help speed up your recovery. In addition to dietary changes, incorporating healthy lifestyle habits such as regular exercise, stress management, and adequate sleep can also contribute to overall well-being and symptom alleviation. Remember, every individual's journey with celiac disease is unique, and it's essential to work closely with healthcare professionals, such as dietitians and gastroenterologists, to monitor your progress, address any concerns, and make necessary adjustments to optimize your health outcomes. With patience, perseverance, and the right support system, many individuals with celiac disease find that their symptoms improve significantly. While a celiac disease diagnosis may initially feel overwhelming, it's crucial to approach it with hope and optimism. With the right knowledge, support, and lifestyle adjustments, you can manage celiac disease effectively and look forward to a healthier, happier future. Don't panic – everything will indeed get better soon!

Celiac.com 05/03/2024 - In February 2019, a young woman named Chelsea received a life-changing diagnosis: celiac disease. Reflecting on her past, she realized that the signs of this condition had been present even during her high school years. Initially, she dismissed feelings of bloating and discomfort after consuming foods like pizza and pasta as the result of indulging in too much junk food. However, as she entered adulthood and began her career, her health began to deteriorate rapidly. The bloating became frequent and painful, accompanied by persistent exhaustion that made it challenging to focus on work. Reluctant to seek medical attention, she eventually consulted a doctor after developing a persistent rash on her arm, a classic sign of celiac disease. The doctor suspected irritable bowel syndrome (IBS) but decided to conduct comprehensive blood tests, including one for celiac disease. Upon receiving a positive test result for the tTG IgA antibody, indicating her immune system's reaction to gluten ingestion, the young woman experienced a mix of relief and dread. While relieved to have an explanation for her symptoms, she struggled with the idea of giving up her favorite foods. A Strict Gluten-Free Diet for Life Her treatment journey involved consultations with a gastroenterologist and adhering to a strict gluten-free diet for life. This dietary overhaul meant not only eliminating obvious sources of gluten but also being vigilant about hidden sources in sauces and seasonings. Supported by a dietitian, she gradually adapted to her new lifestyle, learning to read labels, explore gluten-free recipes, and advocate for her dietary needs in social settings. Despite occasional challenges, she found empowerment in managing her condition and cherishing the support of her partner, who joined her in adopting a gluten-free diet. Today, she embraces her life with celiac disease, prioritizing her well-being and enjoying newfound vitality. Read more about Chelsea's story at msn.com

Celiac.com 03/11/2024 - Celiac disease, a condition triggered by gluten sensitivity in genetically susceptible individuals, affects approximately 1% of the global population. Traditionally, diagnosing celiac disease involves a stepwise process, beginning with blood tests to detect antibodies against tissue transglutaminase (tTG), followed by an invasive duodenal biopsy to confirm the diagnosis. However, this biopsy procedure poses risks and discomfort to patients. Recent research has explored the feasibility of diagnosing celiac disease without the need for a biopsy, relying solely on serological markers. A team of scientists conducted a retrospective analysis of medical records from biopsy-diagnosed celiac disease patients. They specifically examined the correlation between the severity of intestinal damage, as assessed by Marsh grading, and levels of anti-tTGA antibodies in the blood. The research team included Parul Punia, Kiran Bala, Mansi Verma, Ankita Nandi, Parveen Mahlotra, Sunita Singh, Seema Garg, Aparna Parmar, and Devender Kumar. They are variously affiliated with the departments of Microbiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND; Microbiology, PGIMS, Rohtak, IND; Gastroenterology, PGIMS, Rohtak, IND; and Microbiology, bps khanpur gmch, Sonepat, IND. Severity of Marsh Lesions Corresponds to Anti-tTGA Antibody Levels Their study included 94 symptomatic celiac disease patients with available anti-tTGA antibody reports. Among these patients, those with more severe intestinal damage, categorized as Marsh grade 3 lesions, consistently exhibited higher levels of anti-tTGA antibodies. Remarkably, serum antibody levels exceeding ten times the upper limit of normal (ULN) were strongly associated with Marsh grade 3 lesions. These findings suggest that in symptomatic adults with celiac disease, the severity of intestinal damage may be accurately predicted using blood tests alone, without the need for invasive biopsies. Specifically, anti-tTGA antibody levels exceeding ten times the ULN could serve as a reliable indicator of Marsh grade 3 lesions. Adopting a non-biopsy approach to diagnose celiac disease could offer several benefits, including reduced patient discomfort, avoidance of procedural risks, and potentially faster diagnosis and initiation of treatment. However, further research and validation studies are warranted to confirm the reliability and effectiveness of this approach across diverse patient populations. In conclusion, the non-biopsy approach for diagnosing celiac disease represents a promising avenue for improving patient care, and diagnostic efficiency, in people with celiac disease. Read more at Cureus.com

Celiac.com 12/15/2023 - Celiac disease is a chronic condition triggered by gluten consumption, which often reveals itself through symptoms like chronic diarrhea and malabsorption. However, a significant number of patients exhibit atypical manifestations such as iron deficiency anemia, idiopathic short stature, hypertransaminasemia, or infertility. Unfortunately, due to a lack of awareness among healthcare professionals about these diverse presentations, many patients with atypical symptoms are not screened for celiac disease. A recent review aims to shed light on the considerations for diagnosing this condition, delving into screening criteria, atypical manifestations, and diagnostic tools. Patients with atypical manifestations often first approach primary care physicians or specialists outside of gastroenterology. Recognizing this, the research team conducted an extensive review of literature to understand the prevalence of celiac disease in various gastrointestinal conditions like chronic diarrhea and non-gastrointestinal conditions such as short stature, cryptogenic hypertransaminasemia, cryptogenic cirrhosis, and idiopathic ataxia. The research team included Prashant Singh, Achintya Dinesh Singh, Vineet Ahuja, and Govind K Makharia. They are variously associated with the Department of Gastroenterology, University of Michigan, Ann Arbor, MI, United States; the Department of Medicine, Cleveland Clinic, Cleveland, OH, United States; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. Their review emphasizes the importance of awareness among healthcare professionals regarding atypical presentations of celiac disease, to facilitate timely screening and diagnosis. Additionally, it highlights special scenarios where screening is crucial, even in the absence of symptoms. Individuals with type 1 diabetes, Down’s syndrome, and first-degree relatives of celiac disease patients fall into this category, requiring careful consideration for screening. Definite Indications for Celiac Disease Screening: Patients with chronic diarrhea - Found in 43%-85% of patients. Patients with iron deficiency anemia - Affects approximately 1 in 31 celiac disease patients. Patients with short stature - Affects around 11.2% of patients with celiac disease Patients with type 1 diabetes - Around 6% of type 1 diabetics also have celiac disease. First-degree relatives of patients with celiac disease - The approximate risk of developing celiac disease is 1 in 13 in sons, 1 in 16 in brothers, 1 in 32 in mothers and 1 in 33 in fathers. Patients with dermatitis herpetiformis - Around two-third of patients with dermatitis herpetiformis have villous abnormalities and one third of them have no enteropathy, and 17% of those with celiac disease have dermatitis herpetiformis. Patients with Down’s syndrome - 5.8% of those with Down's syndrome also have celiac disease. Probable Indications for Celiac Disease Screening: Patients with liver diseases Cryptogenic hypertransaminesemia Cryptogenic cirrhosis Patients with auto-immune hepatitis Patients with irritable bowel syndrome Patients with osteoporosis Possible Indications for Celiac Disease Screening: Patients with dyspepsia Women with infertility Women with unexplained or idiopathic infertility Women with “all-cause infertility” Patients with idiopathic cardiomyopathy Patients with autoimmune thyroid diseases Patients with idiopathic epilepsy Patients with idiopathic cerebellar ataxia Patients with dental enamel defects Furthermore, the review provides insights into the diagnostic performance and limitations of various screening tests for celiac disease. It discusses specific antibodies, including IgA anti-tissue transglutaminase antibodies, anti-endomysial antibodies, and anti-deamidated gliadin antibodies. The team proposes a diagnostic algorithm based on current recommendations for patients suspected of having celiac disease. In conclusion, the review serves as a comprehensive guide for healthcare professionals, offering a nuanced understanding of who should be screened and how. By delineating atypical manifestations and considering special scenarios, it encourages a more proactive approach to celiac disease diagnosis. The proposed diagnostic algorithm aims to streamline the process, ensuring that individuals with suspected celiac disease receive timely and accurate assessments. Lastly, the review underscores the importance of broadening the perspective on celiac disease beyond its classical gastrointestinal symptoms, contributing to improved healthcare outcomes for affected individuals. Read more at: World J Gastroenterol 2022; 28(32): 4493-4507

Celiac.com 11/15/2023 - Imagine enjoying your favorite pasta dish one day, and the next day, experiencing mysterious and uncomfortable symptoms like stomach pain, vomiting, fatigue, or skin rashes. What could be causing these problems? One possibility might be celiac disease. Celiac disease is a relatively common autoimmune disorder that affects the small intestine. It's triggered by the consumption of gluten, a protein found in wheat, barley, and rye. When someone with celiac disease eats gluten, their immune system reacts by damaging the lining of the small intestine, which can lead to a wide range of symptoms and complications. Getting the diagnosis correct is important, because celiac disease is often misdiagnosed. Symptoms of Celiac Disease The symptoms of celiac disease can vary greatly from person to person, and some individuals may not experience any symptoms at all. Here are some common signs to watch out for: Digestive Troubles: Symptoms often involve the digestive system, such as diarrhea, constipation, bloating, gas, and abdominal pain. Fatigue: Many people with celiac disease report feeling excessively tired, even after a full night's sleep. Weight Loss: Unintended weight loss can occur due to malabsorption of nutrients caused by intestinal damage. Skin Issues: Some individuals develop skin conditions, itchy rashes, like dermatitis herpetiformis, which is closely linked to celiac disease. Joint Pain: Joint pain and inflammation may affect those with celiac disease. Mood Changes: Mood swings, depression, or anxiety can be related to the condition. Delayed Growth in Children: Celiac disease can hinder proper growth and development in children. Diagnosis of Celiac Disease Getting a proper diagnosis is crucial for managing celiac disease effectively. Here's how doctors typically diagnose it: Blood Tests: Initially, blood tests are done to check for elevated levels of certain antibodies, such as anti-tissue transglutaminase (tTG) and anti-endomysial antibodies (EMA). Higher levels of these antibodies can be a sign of celiac disease. Biopsy: If blood tests indicate celiac disease, a small intestine biopsy may be performed. During this procedure, a tiny sample of the intestinal lining is taken and examined under a microscope. Damage to the lining is a key indicator of the disease. In more and more cases, celiac disease can be diagnosed without biopsy. Treatment of Celiac Disease The primary treatment for celiac disease is a strict gluten-free diet. Once diagnosed, individuals need to eliminate all sources of gluten from their diet, including bread, pasta, cakes, and even certain sauces. This can be challenging, as gluten can hide in unexpected places, so reading food labels and avoiding gluten ingredients is a must. Most people with celiac disease notice significant improvements in their symptoms once they adopt a gluten-free lifestyle. Over time, the intestinal lining often heals, allowing for better nutrient absorption. In some cases, complications of celiac disease may require additional medical attention. For instance, individuals with severe malabsorption may need vitamin and mineral supplements. Dermatitis herpetiformis may be treated with medications. Living with Celiac Disease While a gluten-free diet is the cornerstone of managing celiac disease, it's also essential to be vigilant about cross-contamination. This means avoiding utensils, kitchen appliances, and cooking surfaces that have come into contact with gluten-containing foods. Celiac.com offers numerous forums for discussing celiac disease and gluten-free challenges with other celiacs who can share experience and help guide your celiac and gluten-free journey. Support groups and dietary counselors can be incredibly helpful for those newly diagnosed with celiac disease. They provide practical tips for maintaining a gluten-free lifestyle and offer emotional support during the transition. In conclusion, celiac disease is a common but manageable condition. By recognizing its symptoms, seeking a proper diagnosis, and committing to a gluten-free diet, individuals with celiac disease can lead healthy and fulfilling lives. If you suspect you have celiac disease, don't hesitate to consult a healthcare professional for guidance and testing. Your well-being is worth it!

Celiac.com 04/15/2023 - Celiac disease is a chronic autoimmune disorder that affects the small intestine, triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. One often overlooked consequence of untreated and undiagnosed celiac disease is the potential for nutrient deficiencies. Due to the damage caused to the lining of the small intestine, absorption of various essential nutrients may be impaired, leading to deficiencies that can have wide-ranging health effects. In this article, we will explore the connection between celiac disease and nutrient deficiencies, focusing on several key vitamins, minerals, and other essential nutrients. The most common nutrient deficiencies associated with celiac disease that may lead to testing for the condition include iron, vitamin D, folate (vitamin B9), vitamin B12, calcium, zinc, and magnesium. Celiac disease can disrupt the absorption of these essential nutrients, potentially leading to anemia, bone health issues, and other health complications. After a celiac disease diagnosis it is important to do follow up testing for these nutrient deficiencies, as well as a follow-up endoscopies/biopsies to make sure that a patient's damaged villi are healing properly. Many of those with celiac disease will need to take vitamin and mineral supplements at the time of their diagnosis, and some will need to continue taking them for life. Note that having nutrient deficiencies alone would not be enough for a definitive diagnosis of celiac disease, and further testing is required to make a formal diagnosis. Boron Boron is a trace mineral that plays a role in bone health, brain function, and metabolism of certain nutrients. Deficiency in boron is rare, but it can lead to symptoms such as muscle weakness, joint pain, and impaired cognitive function. Untreated and undiagnosed celiac disease can cause malabsorption of boron due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of boron may be needed for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency. Calcium Calcium is an essential mineral that is crucial for bone health, nerve function, and muscle contraction. Deficiency in calcium can lead to symptoms such as weakened bones, muscle cramps, and numbness and tingling in the extremities. Malabsorption of calcium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of osteoporosis and other bone-related complications in individuals with celiac disease. Measuring blood levels of calcium alone is not always an accurate indicator of calcium deficiency because the body will leach calcium from the bones to maintain normal blood levels of calcium. Therefore, bone density loss and other secondary indicators are often better diagnostic tools for detecting calcium deficiency. Calcium supplementation, along with a calcium-rich diet, may be necessary for individuals with celiac disease to maintain adequate calcium levels and support bone health. Chloride Chloride is an electrolyte that is involved in maintaining proper fluid balance, nerve function, and acid-base balance in the body. Deficiency in chloride is rare, but it can lead to symptoms such as muscle weakness, lethargy, and irregular heartbeat. Malabsorption of chloride can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can disrupt the body's fluid balance and electrolyte levels, further complicating the health of individuals with celiac disease. Proper monitoring of chloride levels and supplementation may be necessary for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency. Choline Choline is an essential nutrient that plays a role in brain development, nerve function, and liver health. Deficiency in choline can lead to symptoms such as cognitive decline, liver dysfunction, and muscle damage. In celiac disease, malabsorption of choline can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of choline may be necessary for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency. Image: CC BY-SA 2.0--User: Pumbaa (original work by commons:User: Greg Robson Chromium Chromium is a trace mineral that is important for glucose metabolism and insulin function. Deficiency in chromium can lead to symptoms such as impaired glucose tolerance, increased insulin resistance, and poor blood sugar control. Malabsorption of chromium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of chromium may be needed for individuals with celiac disease, especially if they have poor blood sugar control or other risk factors for deficiency. Copper Copper is an essential trace mineral that plays a role in various processes in the body, including energy production, connective tissue formation, and immune function. Deficiency in copper can cause symptoms such as anemia, bone abnormalities, and impaired immune function. In celiac disease, malabsorption of copper can occur due to damage to the small intestine lining, potentially leading to a deficiency. This can further compromise the overall health of individuals with celiac disease and increase the risk of related complications. Supplementation of copper may be necessary for individuals with celiac disease to maintain adequate copper levels and support overall health. Iodine Iodine is a trace mineral that is essential for thyroid function, metabolism, and brain development. Deficiency in iodine can cause symptoms such as goiter, fatigue, weight gain, and impaired cognitive function. Malabsorption of iodine can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further disrupt thyroid function and metabolism, and impair cognitive development in individuals with celiac disease, especially in children. Iodine supplementation, along with a well-balanced diet that includes iodine-rich foods such as seafood and iodized salt, may be necessary for individuals with celiac disease to maintain adequate iodine levels and support overall health. Iron Iron is an essential mineral that is required for the production of hemoglobin, the protein in red blood cells that carries oxygen to all parts of the body. Deficiency in iron can cause symptoms such as anemia, fatigue, weakness, and pale skin. Malabsorption of iron can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further exacerbate the risk of anemia and related health issues in individuals with celiac disease. Iron supplementation, along with a well-balanced diet that includes iron-rich foods such as meat, poultry, beans, and fortified cereals, may be necessary for individuals with celiac disease to maintain adequate iron levels and support overall health. Lutein Lutein is a carotenoid antioxidant that is important for eye health and vision. Deficiency in lutein can cause symptoms such as blurred vision, macular degeneration, and increased risk of eye-related disorders. Malabsorption of lutein can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of eye-related issues and compromised vision in individuals with celiac disease. Lutein supplementation, along with a diet rich in lutein-containing foods such as leafy green vegetables, egg yolks, and corn, may be necessary for individuals with celiac disease to maintain adequate lutein levels and support overall eye health. Lycopene Lycopene is a carotenoid antioxidant that is known for its role in prostate health and reducing the risk of certain cancers. Deficiency in lycopene can cause symptoms such as increased risk of prostate cancer, cardiovascular disease, and oxidative stress. Malabsorption of lycopene can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of prostate cancer, cardiovascular issues, and other health complications in individuals with celiac disease. Lycopene supplementation, along with a diet rich in lycopene-containing foods such as tomatoes, watermelon, and red bell peppers, may be necessary for individuals with celiac disease to maintain adequate lycopene levels and support overall health. Image: CC BY-SA 2.0--User: Pumbaa (original work by commons: User: Greg Robson) Magnesium Magnesium is a vital mineral that plays a critical role in numerous physiological processes, including nerve function, muscle contraction, and bone health. Deficiency in magnesium can cause symptoms such as muscle weakness, tremors, irregular heartbeat, and bone loss. Malabsorption of magnesium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of muscle weakness, nerve-related issues, and compromised bone health in individuals with celiac disease. Magnesium supplementation, along with a diet rich in magnesium-containing foods such as leafy green vegetables, nuts, seeds, and whole grains, may be necessary for individuals with celiac disease to maintain adequate magnesium levels and support overall health. Manganese Manganese is an essential trace mineral that is involved in various metabolic processes, including carbohydrate metabolism and bone formation. Deficiency in manganese can cause symptoms such as impaired glucose tolerance, bone abnormalities, and altered cholesterol levels. Malabsorption of manganese can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of metabolic issues, bone-related complications, and altered cholesterol levels in individuals with celiac disease. Manganese supplementation, along with a diet rich in manganese-containing foods such as whole grains, nuts, seeds, and legumes, may be necessary for individuals with celiac disease to maintain adequate manganese levels and support overall health. Molybdenum Molybdenum is a trace mineral that is essential for various enzymatic reactions in the body, including detoxification processes and metabolism of certain nutrients. Deficiency in molybdenum is rare but can cause symptoms such as rapid heartbeat, neurological issues, and growth retardation. Malabsorption of molybdenum can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of cardiovascular issues, neurological complications, and growth retardation in individuals with celiac disease. Molybdenum supplementation, along with a diet rich in molybdenum-containing foods such as legumes, whole grains, and nuts, may be necessary for individuals with celiac disease to maintain adequate molybdenum levels and support overall health. Nickel Nickel is a trace mineral that is required in very small amounts for various enzymatic reactions in the body. Deficiency in nickel is rare and typically occurs in individuals with specific health conditions. Malabsorption of nickel can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised enzymatic reactions and related health issues in individuals with celiac disease. Nickel supplementation is not typically necessary, as the body requires only trace amounts of nickel. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes nickel-containing foods such as nuts, legumes, and whole grains to support overall health. Phosphorus Phosphorus is an essential mineral that plays a crucial role in bone formation, energy metabolism, and cellular function. Deficiency in phosphorus is rare and usually occurs in individuals with specific health conditions or imbalanced diets. Malabsorption of phosphorus can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised bone health, energy metabolism, and cellular function in individuals with celiac disease. Phosphorus supplementation is not typically necessary, as phosphorus is abundant in many foods. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes phosphorus-containing foods such as dairy products, meat, fish, nuts, seeds, and whole grains to support overall health. Image: CC BY-SA 2.0--User: Pumbaa (original work by commons: User: Greg Robson) Potassium Potassium is a crucial mineral that is involved in numerous physiological processes, including nerve function, muscle contraction, and heart health. Deficiency in potassium can cause symptoms such as muscle weakness, fatigue, irregular heartbeat, and increased blood pressure. Malabsorption of potassium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of nerve-related issues, muscle weakness, and cardiovascular complications in individuals with celiac disease. Potassium supplementation, along with a diet rich in potassium-containing foods such as fruits, vegetables, dairy products, meat, and legumes, may be necessary for individuals with celiac disease to maintain adequate potassium levels and support overall health. Selenium Selenium is an essential trace mineral that is involved in various antioxidant and immune functions in the body. Deficiency in selenium can cause symptoms such as compromised immune function, muscle weakness, fatigue, and hair loss. Malabsorption of selenium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of impaired immune function, muscle weakness, and related health issues in individuals with celiac disease. Selenium supplementation, along with a diet rich in selenium-containing foods such as fish, meat, dairy products, nuts, and seeds, may be necessary for individuals with celiac disease to maintain adequate selenium levels and support overall health. Silicon Silicon is a trace mineral that is involved in various processes such as bone formation, connective tissue health, and hair, skin, and nail health. Deficiency in silicon is rare, as it is found in many foods, but it can cause symptoms such as compromised bone health, weak connective tissue, and brittle nails. Malabsorption of silicon can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised bone health, connective tissue issues, and related health concerns in individuals with celiac disease. Silicon supplementation is not typically necessary, as silicon is abundant in many foods. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes silicon-containing foods such as whole grains, fruits, vegetables, nuts, and seeds to support overall health and prevent deficiency. Vanadium Vanadium is a trace mineral that has been suggested to play a role in blood sugar regulation and bone health, although its exact functions are not yet fully understood. Vanadium deficiency is rare, as it is found in small amounts in many foods, and its requirement in the body is low. However, malabsorption of vanadium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised blood sugar regulation and bone health in individuals with celiac disease. Vanadium supplementation is not typically necessary, as the body's requirement for vanadium is minimal, and excessive intake can be toxic. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes foods rich in vanadium, such as seafood, mushrooms, whole grains, and vegetable oils, to support overall health. Vitamin A (Preformed) Vitamin A is a fat-soluble vitamin that plays a crucial role in vision, immune function, and cellular growth. Deficiency in vitamin A can lead to night blindness, dry skin, and increased susceptibility to infections. Untreated celiac disease can cause malabsorption of vitamin A due to damage to the small intestine lining, leading to a deficiency. It is important for individuals with celiac disease to monitor their vitamin A levels and consider supplementation if necessary. Vitamin A (Betacarotenes) Vitamin A in the form of betacarotenes is a precursor that is converted to vitamin A in the body as needed. Betacarotenes are found in colorful fruits and vegetables, and they play a role in maintaining healthy skin, vision, and immune function. Deficiency in betacarotenes can result in similar symptoms as vitamin A deficiency, including impaired vision and weakened immune system. In celiac disease, impaired absorption of betacarotenes can occur due to damage to the small intestine lining, leading to a potential deficiency. Vitamin B1 (Thiamine) Vitamin B1, also known as thiamine, is a water-soluble vitamin that is essential for energy metabolism, nerve function, and brain health. Deficiency in thiamine can cause symptoms such as muscle weakness, fatigue, and mental confusion. Severe, prolonged thiamine deficiency can result in beriberi, and symptoms include loss of sensation in extremities, symptoms of heart failure, swelling of the hands and feet, chest pain, feelings of vertigo, double vision, and memory loss. Untreated celiac disease can impair thiamine absorption due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their thiamine levels and consider supplementation if needed. Vitamin B2 (Riboflavin) Vitamin B2, also known as riboflavin, is another water-soluble vitamin that plays a key role in energy production, growth, and red blood cell formation. Deficiency in riboflavin can lead to symptoms such as cracked lips, sore throat, and skin rash. Celiac disease can cause impaired absorption of riboflavin due to damage to the small intestine lining, leading to a potential deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate riboflavin levels. Vitamin B3 (Niacin) Vitamin B3, also known as niacin, is essential for energy metabolism, nervous system function, and DNA repair. Deficiency in niacin can result in a condition known as pellagra, characterized by symptoms such as diarrhea, dermatitis, and mental confusion. Malabsorption of niacin can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their niacin levels and consider supplementation if necessary. Vitamin B5 (Pantothenic Acid) Vitamin B5, also known as pantothenic acid, is involved in energy production, hormone synthesis, and nerve function. Deficiency in pantothenic acid can lead to symptoms such as fatigue, numbness and tingling in the hands and feet, and difficulty in coordination. In celiac disease, malabsorption of pantothenic acid can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate pantothenic acid levels. Vitamin B6 Vitamin B6, also known as pyridoxine, is a water-soluble vitamin that is important for brain development, immune function, and protein metabolism. Deficiency in vitamin B6 can cause symptoms such as depression, irritability, and weakened immune system. Untreated celiac disease can impair the absorption of vitamin B6 due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their vitamin B6 levels and consider supplementation if needed. Vitamin B7 (Biotin) Vitamin B7, also known as biotin, is essential for healthy skin, hair, and nails, as well as for metabolism of carbohydrates, fats, and proteins. Deficiency in biotin can result in symptoms such as hair loss, brittle nails, and skin rash. Malabsorption of biotin can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate biotin levels. Vitamin B8 (Inositol) Vitamin B8, also known as inositol, is involved in cell signaling, nerve function, and brain health. Deficiency in inositol can lead to symptoms such as mood swings, anxiety, and difficulty in concentration. In celiac disease, impaired absorption of inositol can occur due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their inositol levels and consider supplementation if necessary. Vitamin B9 (Folate) Vitamin B9, also known as folate, is important for DNA synthesis, red blood cell formation, and fetal development during pregnancy. Deficiency in folate can result in symptoms such as anemia, fatigue, and neural tube defects in newborns. Malabsorption of folate can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of folate may be necessary for individuals with celiac disease, especially during pregnancy. Vitamin B9 (Folic Acid) Folic acid is the synthetic form of folate, often used in dietary supplements and fortified foods. It is converted to folate in the body and plays similar roles in DNA synthesis, red blood cell formation, and fetal development during pregnancy. Deficiency in folic acid can lead to the same symptoms as folate deficiency, including anemia and neural tube defects in newborns. Malabsorption of folic acid can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their folic acid levels and consider supplementation if needed. Vitamin B12 ( Cobalamin) Vitamin B12, also known as cobalamin, is essential for nerve function, DNA synthesis, and red blood cell formation. Deficiency in vitamin B12 can cause symptoms such as fatigue, weakness, and numbness and tingling in the hands and feet. In celiac disease, malabsorption of vitamin B12 can occur due to damage to the small intestine lining, potentially leading to a deficiency. This can further exacerbate the symptoms of celiac disease and affect overall health. Supplementation of vitamin B12 may be necessary for individuals with celiac disease to maintain adequate levels and prevent deficiency-related complications. Vitamin C (Ascorbic Acid) Vitamin C, also known as ascorbic acid, is a powerful antioxidant that plays a critical role in immune function, collagen synthesis, and wound healing. Deficiency in vitamin C can cause symptoms such as fatigue, weakened immune system, and slow wound healing. A severe vitamin C deficiency can also result in scurvy, and early symptoms of scurvy include weakness, feeling tired and having sore arms and legs. In celiac disease, malabsorption of vitamin C can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of vitamin C may be necessary for individuals with celiac disease to maintain adequate levels and support immune function. Vitamin D3 Vitamin D3, also known as the "sunshine vitamin," is crucial for bone health, immune function, and mood regulation. Deficiency in vitamin D3 can cause symptoms such as bone pain, muscle weakness, and increased susceptibility to infections. Malabsorption of vitamin D3 is common in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of osteoporosis, weakened immune system, and mood disorders in individuals with celiac disease. Vitamin D3 supplementation, along with adequate sunlight exposure and a vitamin D-rich diet, may be necessary for individuals with celiac disease to maintain adequate vitamin D levels and support overall health. Vitamin E (Food Sourced) Vitamin E is a powerful antioxidant that protects cells from damage, supports immune function, and helps with DNA repair. Deficiency in vitamin E can cause symptoms such as muscle weakness, impaired vision, and increased oxidative stress. Malabsorption of vitamin E can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of oxidative stress and related health issues in individuals with celiac disease. Vitamin E supplementation, along with a vitamin E-rich diet, may be necessary for individuals with celiac disease to maintain adequate vitamin E levels and support overall health. Vitamin E (Alpha-Tocopherol) Vitamin E, specifically alpha-tocopherol, is the most active and common form of vitamin E in the body. It plays a crucial role in protecting cells from damage, supporting immune function, and maintaining cardiovascular health. Deficiency in alpha-tocopherol can cause symptoms such as muscle weakness, vision problems, and increased risk of cardiovascular disease. Malabsorption of alpha-tocopherol can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of cardiovascular issues and other health complications in individuals with celiac disease. Supplementation of alpha-tocopherol, along with a vitamin E-rich diet, may be necessary for individuals with celiac disease to maintain adequate alpha-tocopherol levels and support overall health. Vitamin K Vitamin K is a fat-soluble vitamin that plays a crucial role in blood clotting and bone metabolism. Deficiency in vitamin K can cause symptoms such as easy bruising, prolonged bleeding, and weakened bones. Malabsorption of vitamin K can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of bleeding disorders and weakened bones in individuals with celiac disease. Vitamin K supplementation, along with a well-balanced diet that includes vitamin K-rich foods such as leafy green vegetables, may be necessary for individuals with celiac disease to maintain adequate vitamin K levels and support overall health. Zinc Zinc is an essential mineral that is involved in various enzymatic reactions, immune function, and wound healing. Deficiency in zinc can cause symptoms such as impaired immune function, delayed wound healing, hair loss, and skin issues. Malabsorption of zinc can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised immune function, delayed wound healing, and related health issues in individuals with celiac disease. Zinc supplementation, along with a diet rich in zinc-containing foods such as meat, fish, dairy products, nuts, and seeds, may be necessary for individuals with celiac disease to maintain adequate zinc levels and support overall health. Conclusion In conclusion, untreated and undiagnosed celiac disease can lead to deficiencies in various nutrients due to malabsorption caused by damage to the small intestine lining. These deficiencies can result in a wide range of symptoms and health effects, including compromised bone health, impaired immune function, nerve-related issues, skin, hair, and nail problems, and other related health concerns. Therefore, it is crucial for individuals with celiac disease to be vigilant about their nutrient intake and work with healthcare professionals to ensure proper monitoring and management of their nutrient levels through a well-balanced diet and, if necessary, appropriate supplementation. Proper management of celiac disease, including adherence to a gluten-free diet, regular monitoring of nutrient levels, and appropriate supplementation when needed, can help individuals with celiac disease maintain optimal health and prevent nutrient deficiencies. Vitamins and Minerals Generally Safe in Excess of Recommended Daily Allowance (RDA): Vitamin C (Ascorbic Acid): Excess vitamin C is usually excreted in the urine and is considered safe in higher doses. However, very high doses may cause digestive upset in some individuals. Vitamin B1 (Thiamine): Water-soluble, excess thiamine is generally excreted through urine. It is considered safe in higher doses but consult with a healthcare professional. Vitamin B2 (Riboflavin): Water-soluble, excess riboflavin is excreted in the urine and is generally safe in higher doses. Vitamin B3 (Niacin): Water-soluble, niacin has a well-defined upper limit, but moderate excess is often excreted. Consultation with a healthcare professional is advisable. Vitamin B5 (Pantothenic Acid): Water-soluble, excess pantothenic acid is generally excreted through urine and considered safe in higher doses. Vitamin B6 (Pyridoxine): While excessive intake from supplements can lead to nerve damage, moderate overages are generally excreted through urine. Vitamin B7 (Biotin): Water-soluble, excess biotin is typically excreted and is considered safe in higher doses. Vitamin B9 (Folate): Excess folate is usually excreted, but extremely high levels from supplements may have potential risks. It's generally safe when consumed through natural food sources. Vitamin B12 (Cobalamin): Water-soluble, excess B12 is typically excreted in the urine and is considered safe in higher doses. Consultation with a healthcare professional is advisable. Choline: While not a true vitamin, choline is water-soluble, and excess is usually excreted. It's considered safe in higher doses but consult with a healthcare professional. Vitamins and Minerals with Potential for Toxicity in Excess of Recommended Daily Allowance (RDA): Vitamin A (Retinol): Excessive vitamin A intake, especially from supplements, can lead to toxicity, causing symptoms like nausea, dizziness, and, in severe cases, organ damage. Vitamin D - While moderate excess may be excreted, prolonged high doses can lead to vitamin D toxicity, resulting in hypercalcemia, kidney damage, and other complications. Vitamin E (Tocopherols): Excess vitamin E is usually excreted, but high doses from supplements may have adverse effects. Obtaining it through a balanced diet is preferable. Vitamin K: Excess vitamin K from supplements can interfere with blood thinning medications and cause issues in some individuals. Iron: Excessive iron intake, especially from supplements, can lead to iron toxicity, causing symptoms like nausea, abdominal pain, and, in severe cases, organ failure. Zinc: While zinc is essential, excessive intake can lead to zinc toxicity, affecting the immune system and causing digestive issues. Copper: High copper levels, often from supplements, can lead to toxicity, causing symptoms such as nausea, vomiting, and liver damage. Selenium: Excessive selenium intake, especially from supplements, can lead to selenosis, causing symptoms like hair loss, gastrointestinal issues, and neurological problems. It's crucial to note that individual tolerances can vary, and supplementation should be done under the guidance of a healthcare professional. Sources: National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Celiac Disease. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). ACG clinical guidelines: Diagnosis and management of celiac disease. The American Journal of Gastroenterology, 108(5), 656-676. doi:10.1038/ajg.2013.79 Complementary Medicine, Penn State Hershey. (n.d.). B vitamins. Retrieved from https://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000336 National Institutes of Health, Office of Dietary Supplements. (2021). Vitamin B5 (Pantothenic Acid) - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Vitamin B12 - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Chloride - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Iodine - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Magnesium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Phosphorus - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Silicon - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Vanadium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Manganese - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Lycopene - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Lutein and Zeaxanthin - Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Nickel - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Selenium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Iron - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Calcium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Zinc - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Chromium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/

09/18/2023 - Vomiting and nausea are considered common symptoms related to gluten ingestion in treated celiac disease. However, the overall rates and associated factors of these symptoms after chronic gluten exposure, and acute re-exposure during gluten challenge, remain poorly understood. A team of researchers recently set out to explore the rates and factors associated with vomiting and nausea in individuals with celiac disease, both at the time of diagnosis and during gluten challenges. The research team included Iida Ahonen, Pilvi Laurikka, Sara Koskimaa, Heini Huhtala, Katri Lindfors, Katri Kaukinen, Kalle Kurppa, and Laura Kivelä. They are variously affiliated with the Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; the Department of Internal Medicine, Tampere University Hospital, Tampere, Finland; the Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland; the Faculty of Social Sciences, Tampere University, Tampere, Finland; and the University Consortium of Seinäjoki, Seinäjoki, Finland. For their study, the researchers collected medical data from 815 adult celiac disease patients at the time of their diagnosis, and an additional 74 patients underwent a three-day gluten challenge. Here are the team's key findings: At The Time of Celiac Disease Diagnosis About one in three patients presented with vomiting at the time of their celiac disease diagnosis. These patients were less likely to have been identified through screening, and more likely to experience various other symptoms. Specifically, patients who suffered from vomiting had about a 20% higher occurrence of abdominal pain, diarrhea, and weight loss, along with a nearly 30% higher rates of childhood symptoms, compared to those without vomiting. During a Gluten Challenge During the short-term gluten challenge, nearly 20% of patients experienced vomiting/nausea. Interestingly, those who consumed gluten-free oats less frequently were about 30% more likely to experience these symptoms. There were no significant differences between the two groups in terms of other clinical-demographic characteristics, duration of a gluten-free diet, or other symptoms. Literature Review The study also conducted a literature review, which revealed a wide range in the prevalence of vomiting/nausea in celiac disease patients, both at diagnosis (ranging from 3% to 46%), and during gluten challenges (ranging from 13% to 61%). Overall, vomiting and nausea appear to be relatively specific symptoms associated with gluten ingestion in individuals with treated celiac disease. At diagnosis, those experiencing vomiting tended to have a higher rates of other gastrointestinal symptoms and an earlier onset of symptoms in childhood. During a gluten challenge, reduced consumption of gluten-free oats was linked to a higher likelihood of vomiting/nausea. The prevalence of these symptoms varied widely in the existing literature. This research provides valuable insights into the presentation of symptoms in celiac disease patients, shedding light on factors associated with vomiting and nausea both at diagnosis and during gluten challenges. Read more at bmcgastroenterology.com

Celiac.com 09/27/2023 - A team of researchers recently set out to explore duodenal villous atrophy in adults with suspected celiac disease without IgA deficiency. The research team included Prof Carolina Ciacci, MD, Prof Julio Cesar Bai, MD, Geoffrey Holmes, MD, Abdulbaqi Al-Toma, MD, Prof Federico Biagi, MD, Prof Antonio Carroccio, MD, Rachele Ciccocioppo, MD, Prof Antonio Di Sabatino, MD, Rachel Gingold-Belfer, MD, Mariana Jinga, MD, Prof Govind Makharia, MD, Sonia Niveloni, MD, Gary L Norman, PhD, Kamran Rostami, MD, Prof David S Sanders, MD, Edgardo Smecuol, MD, Vincenzo Villanacci, MD, Santiago Vivas, MD, and Fabiana Zingone, MD, on behalf of theBi.A.CeD study group. The team conducted a multi-center, prospective cohort study to assess the accuracy of serum anti-tissue transglutaminase IgA (tTG-IgA) in diagnosing celiac disease in adults. The study included adult participants aged 18 years or older, with suspected celiac disease, who were not on a gluten-free diet, and did not have IgA deficiency. The participants were enrolled from 14 tertiary referral centers across different regions from February 27, 2018, to December 24, 2020. The main objective was to determine whether serum tTG-IgA tests could reliably diagnose celiac disease based on duodenal villous atrophy. The study included 436 participants (296 women and 140 men) with complete data on serum tTG-IgA and duodenal histology. Of these, 363 participants had positive serum tTG-IgA results, and 73 had negative results. After local review, it was found that 341 of the participants with positive serum tTG-IgA had positive histology (true positives), while 22 had negative histology (false positives). Among the 73 participants with negative serum tTG-IgA, seven had positive histology (false negatives), and 66 had negative histology (true negatives) after local review. Study Findings: Positive Predictive Value of 95.9% for Celiac Disease Serum tTG-IgA The study's findings showed a positive predictive value of 93.9% and a negative predictive value of 90.4% for serum tTG-IgA in diagnosing celiac disease. The sensitivity was 98.0%, indicating the test's ability to correctly identify true positive cases, while the specificity was 75.0%. After central re-evaluation of duodenal histology in discordant cases, the positive predictive value increased to 95.9%, and specificity improved to 81.5%. The sensitivity remained high at 98.0%. The study also found that the positive predictive value of serum tTG-IgA increased as the serological threshold was defined at higher multiples of the upper limit of normal (ULN). The area under the receiver operating characteristic curve (AUC) for serum tTG-IgA was 0.87 for the categorical definition (positive vs. negative) and 0.93 for the numerical definition (multiples of the ULN) in predicting duodenal villous atrophy. Conclusion Based on the data, the study suggests that in adults with a reliable suspicion of celiac disease and high serum tTG-IgA levels, a biopsy may reasonably be avoided in the diagnostic process. This information can be valuable in improving the efficiency and accuracy of diagnosing celiac disease in certain cases, reducing the need for biopsy. Read more in The Lancet Gastroenterology and Hepatology Note: The researchers are variously affiliated with the Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy; the Research Institutes, Universidad del Salvador, Buenos Aires, Argentina; the Small Bowel Section, Dr C Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina; Department of Gastroenterology, Royal Derby Hospital, Derby, UK; the Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands; the Department of Internal Medicine and Medical Therapy, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy; the Gastroenterology Unit of Pavia Institute, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy; the Unit of Internal Medicine, Cervello Hospital, University of Palermo, Palermo, Italy; the Gastroenterology Division, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; the Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital, Bucharest, Romania; the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India; the Research and Development, Headquarters and Technology Centre for Autoimmunity, Werfen, San Diego, CA, USA; the Gastroenterology Unit, MidCentral DHB, Palmerston North, New Zealand; the Academic Unit of Gastroenterology, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK; the Institute of Pathology, Spedali Civili University of Brescia, Brescia, Italy; the Gastroenterology Unit, University Hospital of Leon, Leon, Spain; and the Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy, on behalf of the Bi.A.CeD study group.

Celiac.com 08/11/2023 - Celiac disease is a chronic autoimmune disorder marked by an immune-mediated response to gluten, resulting in small intestinal mucosal damage. Every so often, we share reports of individual cases that are relevant to celiac disease. Here, we share the case of a 52-year-old woman who was discovered to have celiac disease after being treated for extreme thrombocytosis and severe anemia. While gastrointestinal symptoms are commonly associated with celiac disease, atypical presentations can pose diagnostic challenges, particularly when hematological abnormalities are the primary manifestation. A team of clinicians report the case of a 52-year-old female patient who presented with unusual symptoms, including numbness in her hands and feet, extreme thrombocytosis, extreme thinness, severe anemia, high platelet count, and mild electrolyte imbalance. The Research Team The clinical team included Cuauhtemoc Jeffrey Soto, Lokeshwar Raaju Addi Palle, Mefthe Berhanu, Yordanos G. Negassi, Saima Batool, and Shaniah S. Holder. They are variously affiliated with the department of Research and Development at the Universidad Juarez del Estado de Durango, Mexico, the department of General Surgery, Hackensack Meridian Health-Palisades Medical Center, North Bergen, USA; the Department of Surgery, Kamala Children's Hospital in Chennai, India; the Health Science Department, University of Texas Health Science Center at Houston, Texas, USA; the department of Internal Medicine, Orotta, California, USA; the department of Internal Medicine, Hameed Latif Hospital in Lahore, Pakistan; and the department of Medicine, American University of Barbados School of Medicine in Bridgetown, Barbados. Physical examination of the patient showed nothing remarkable, except for notable thinness. The patient showed no gastrointestinal symptoms, and had no family history of gastroenterological diseases. Diagnostic tests, including blood tests and duodenal biopsy, confirmed the diagnosis of celiac disease with grade 4 Marsh 3C classification, even though the patient lacked typical gastrointestinal symptoms. Celiac Disease as a Cause of Thrombosis This case highlights the importance of considering celiac disease as a potential cause for atypical hematological manifestations, such as extreme thrombocytosis resulting from severe anemia. Prompt recognition and appropriate management, such as adhering to a gluten-free diet, can lead to symptom improvement and the resolution of hematological abnormalities. Identifying celiac disease even in the absence of typical gastrointestinal symptoms can lead to important treatment and improved quality of life for patients. Healthcare professionals need to be aware of such atypical presentations to ensure early diagnosis and better patient outcomes. Read more at cureus.com