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Found 6 results

  1. Celiac.com 09/21/2017 - Current guidelines by the British Society of Gastroenterology recommend that doctors take at least four duodenal biopsy specimens at the time of upper gastrointestinal (UGI) endoscopy when looking for celiac disease. The practice has been shown to increase celiac diagnoses, and to reduced missed diagnoses. The Society recently sought to assess compliance with their own guidelines within their institution. They then sought to apply measures to improve their compliance rate, and to assess the resulting impact on our diagnostic rate for celiac disease. The research team included Nilofer Husnoo; Wafaa Ahmed; and Muhammad Hanif Shiwani. They are variously affiliated with the Urology Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK, the Gastroenterology Department, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK, and the General Surgery Department, Barnsley General Hospital NHS Foundation Trust, Barnsley, UK. The team performed a retrospective audit of electronic records for patients with no prior celiac diagnosis, who underwent UGI endoscopy with duodenal biopsies between August 2014 and May 2015. They then used the information to raise awareness among endoscopy users at the Society, and conducted a follow-up audit between February and May 2016. They found and registered a total of 924 eligible patients for the first part of the study, and 278 for the second part. The proportion of patients who had ≥4 biopsy specimens submitted increased from 21.9% to 60.8% (p<0.001). The study by the BSG suggests that taking less than four duodenal biopsy specimens can result in missed celiac diagnoses. However, a few simple steps can help doctors avoid such missed diagnoses. Since atypical symptoms are more common in patients these days, and since the lifetime risk of malignancy, especially intestinal lymphoma and other gastrointestinal cancers, is higher in celiac patients, it's important that doctors conduct a thorough investigation when they suspect celiac disease to avoid missing the diagnosis. For the BSG, that means taking 4 or more biopsy samples. Source: BMJ Open Gastro. 2017;4(1):e000140
  2. Celiac.com 06/15/2016 - Every so often, a medical case comes along that puzzles or interests clinicians. One recent case of celiac disease fits that bill. The patient in this case is a 61-year-old obese woman who developed severe diarrhea that started soon after bariatric surgery and did not respond to standard medical treatment. The team treating the woman reports that, to their knowledge, this is the first reported case of clinical onset of celiac disease (celiac disease) following duodenal switch surgery. The research team included A Pané, A Orois, M Careaga, A Saco, E Ortega, J Vidal, P Leyes, and AJ Amor. They are variously affiliated with the Department of Endocrinology and Nutrition, and the Department of Anatomic Pathology at the Hospital Clínic in Barcelona, Spain. After the team ruled out the most common post-operative causes of diarrhea, they ran some blood tests, and made a final diagnosis based on positive results for anti-tissue transglutaminase antibody. In light of this case report, the team proposes that celiac disease should be ruled out in any patient presenting with typical or atypical symptoms after bariatric surgery, regardless of the latency of onset. Read more on this case in the Eur J Clin Nutr. 2016 Apr 20. doi: 10.1038/ejcn.2016.65.
  3. Celiac.com 03/08/2010 - Celiac, a genetic autoimmune disease, has long been associated with a medical picture of patients that lookunderweight, and malnourished. However, recent studies are findingthat obesity and a high BMI (Body Mass Index) may also be prominentin celiac patients. New studies were conducted to determine BMIchanges after initiation of a gluten-free diet, and they offer cluesto the importance of eating gluten free after being diagnosed withceliac disease. Doctors at the Celiac Disease Center ofColumbia University studied the BMI of 369 patients proven throughbiopsy to have celiac disease, spanning from 1981 to 2007. Men andwomen were evaluated separately for the sake of this study and thetest patients were classified as “classical” meaning diarrheaprominent, or “atypical” meaning they had no diarrhea at the timeof celiac diagnosis. Atypical patients were further divided intogroups of 'anemia present' and 'no anemia present' at time ofdiagnosis. Body Mass Index was then categorized into four groupsbased on the criteria of the World Health Organization. The BMI of all test celiac patientswere compared to the general United States population. Using theregression model, the study found that there are obvious predictorsfor low BMI; patients classified as “classical” celiac,female, and with severe villous atrophy, were all revealed aspredictors for low BMI. These findings further exemplify that themost dramatic changes in BMI rates were in underweight females withceliac disease. Celiac females had a considerably lower mean BMIthan the general population, thereby indicating an importantassociation between females with celiac disease and low BMI. In fact,celiac females that tested with a normal or low BMI were also foundto have higher rates of critical villous atrophy than those with ahigher BMI. However, more males with celiac were found to beoverweight compared to the general population. After initiating a gluten free diet,most BMI changes were shown to be directly associated with an initialbaseline appearance of “classical” symptoms. While on a glutenfree diet, over 50% of the overweight and obese patients lostweight, and of the group who initially had a low BMI, 42.4% attaineda normal weight. Thereby concluding that treatment of a gluten freediet after celiac diagnosis provides advantageouschanges in BMI results. Further evidence of the importance in earlydiagnosis and prompt treatment of celiac disease. Of course it is critical to note that,all the patients utilized for this study were monitored closely by a care center dedicated to celiac disease, and continually followed byan experienced dietician with expert knowledge of celiac disease. And, while you may not be able to afford the kind of dietician thesepatients were provided with, it is always very important to be underthe care of a doctor or clinic dedicated to treating celiac disease,as well as to be receiving experienced dietary counseling whentransitioning to a gluten free diet. Source: http://www.ncbi.nlm.nih.gov/pubmed/19779362
  4. Celiac.com 02/23/2011 - In most adults with celiac disease, clinical symptoms disappear with a gluten-free diet. However, the exact effects of a gluten-free diet on rates of mucosal recovery in adults with celiac disease is less certain. A group of clinicians recently set out to assess rates of mucosal recovery under a gluten-free diet in adults with celiac disease, and to gauge the clinical prospects of ongoing mucosal damage in celiac patients who follow a gluten-free diet. The study group included Alberto Rubio-Tapia, MD; Mussarat W. Rahim, MBBS; Jacalyn A. See, MS, RD, LD; Brian D. Lahr, MS; Tsung-Teh Wu, MD; and Joseph A. Murray, MD. Each patient in the study had biopsy-proven celiac disease, and was assessed at the Mayo Clinic. Also, each patient received duodenal biopsies at diagnosis. After beginning a gluten-free diet, each patient had at least one follow-up intestinal biopsy to assess mucosal recovery. The study team focused on mucosal recovery and overall mortality. Of 381 adult patients with biopsy-proven celiac disease, a total of 241 (175 women - 73%) had both a diagnostic and follow-up biopsy available for re-review. Using the Kaplan–Meier rate of confirmed mucosal recovery to assess these 241 patients, the study group found that 34% of the patients enjoyed mucosal recovery at 2 years after diagnosis (95% with a confidence interval (CI): 27–40 % ), and 66% of patients enjoyed mucosal recovery at 5 years (95% CI: 58–74 % ). More than 80% of patients showed some clinical response to the gluten-free diet, but clinical response was not a reliable marker of mucosal recovery ( P = 0.7). Serological response was, by far, the best marker for confirmed mucosal recovery ( P = 0.01). Patients who complied poorly with a gluten-free diet ( P < 0.01), those with severe celiac disease defined by diarrhea and weight loss ( P < 0.001), and those with total villous atrophy at diagnosis ( P < 0.001) had high rates of persistent mucosal damage. With adjustments for gender and age, patients who experienced confirmed mucosal recovery had lower mortality rates overall (hazard ratio = 0.13, 95 % CI: 0.02 – 1.06, P = 0.06). One of the most important findings from this study was that a large number of adults with celiac disease have no mucosal recovery, even after treatment with a gluten free diet. Compared to those patients who suffered persistent damage, patients who experienced confirmed mucosal recovery had lower rates of mortality independent of age and gender. The group notes that systematic follow-up via intestinal biopsy may be advisable for adults with celiac disease. Source: Am J Gastroenterol. 9 February 2010; doi: 10.1038/ajg.2010.10
  5. Celiac.com 08/11/2009 - While the use of anti-tTG antibodies is common practice in the diagnosis of celiac disease, their value in long-term follow-up remains controversial. A team of researchers recently set out to assess the value of anti-tTG antibodies in long-term follow-up. The research team was made up of C.R. Dipper, S. Maitra, R. Thomas, C.A. Lamb, A.P.C. McLean-Tooke, R. Ward, D. Smith, G. Spickett, and J.C. Mansfield. Their goal was to see if they could use serial anti-tTG antibody levels to gauge adherence to a gluten-free diet (GFD) and to spot patients facing complications from celiac disease. Researchers conducted a cohort follow-up study of 182 adult subjects over 54-months. The team charted patient self-assessment of gluten-free diet adherence; anti-tTG antibody concentration and serum ferritin, vitamin B12 and folate. When possible, they measured bone mineral density (BMD) and duodenal histology. The team found that patients with persistently high anti-tTG antibody levels commonly showed abnormal duodenal histology (P < 0.001), low ferritin (P < 0.01) and poor adherence to the GFD (P < 0.001). Anti-tTG antibody specificity was > 85% while the sensitivity was 39–60%. Anti-tTG antibody concentrations fell rapidly following successful implementation of a gluten-free diet, and remained normal in those who faithfully followed the gluten-free diet. From these results, the team advocates the use of anti-tTG antibody concentrations to monitor newly diagnosed and established patients with celiac disease, and to target dietary intervention accordingly to reduce the risk of long-term problems. Alimentary Pharmacology & Therapeutics. 2009;30(3):236-244.
  6. Those patients for whom there is a high suspicion for celiac disease should have a small bowel biopsy which can be obtained by an experienced endoscopist in the distal duodendum. The best noninvasive tests available for screening for asymptomatic celiac disease are the specific serological tests. These are of several varieties: the anti-gliadin, anti-endomysial, or anti-reticulin antibodies. Our experience and the literature support the use as of endomysial antibody test as the single most specific and probably most sensitive for celiac disease. This test has now become available in specialty laboratories as well as in a small number of academic institutions. All of the tests should be done with the subjects on a normal gluten containing diet. A combination of endomysial and gliadin testing would seem to be the most sensitive as a screening method. A positive test is not, however, considered to be diagnostic and would usually require a small bowel biopsy for confirmation. A trial of dietary exclusion of gluten is *not* recommended as a diagnostic test without a prior abnormal biopsy. Because the body will recover when one goes gluten-free, the tests will then come up negative. Without a definitive test one may then stray from the diet, as one will feel well and was never sure that they had it in the first place. As for the two tests: The biopsy will look for flattened villi on the intestinal wall. After one goes gluten-free they will grow back. The blood antibodies are formed as a bodys reaction to the presence of the gluten. If no gluten, then no antibodies are present.
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