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Celiac.com 04/12/2011 - Paul Seelig was found guilty today of 23 counts of obtaining property by false pretense after a two-week trial in Durham, NC. The jury found that he illegally represented baked goods as gluten-free, but they actually contained gluten. Mr. Seelig received an 11 year prison sentence for his crimes, which included the sickening of more than two dozen customers, one of whom had a premature delivery that was possibly caused by her involuntary gluten consumption. Seelig's company, Great Specialty Products, purchased regular gluten-containing items from companies in New Jersey such as Costco, and then repackaged them in his home kitchen and sold them as "gluten-free" at the NC State Fair, various street fairs and via home delivery. Seelig claimed that his baked items were homemade in his company's 150,000-square-foot commercial kitchen, and that his company raised its own grains on its 400-acre farm. High gluten levels were detected by both customers and investigators in Seelig's supposedly gluten-free bread, even though he claimed that he tested his bread weekly for gluten and found none. Mr. Seelig could not produce any of his test results at trial. Source: Open Original Shared Link -
Celiac.com 08/19/2016 - Gwyneth Paltrow, Miley Cyrus and the clean-eating bloggers of Instagram have all helped propel gluten-free foods out of health-food stores and into the aisles of Whole Foods and Wal-Mart. Anyone who has ever tried a gluten-free bread or cake has likely found what sufferers of celiac disease have long known. They often don't taste very good. Gluten-free baked goods are often dry, crumbly and flat tasting. As long as there has been gluten-free bread, there has been mediocre gluten-free bread. This is not the fault of bakers. The problem is structural, chemical. Gluten, the protein found in wheat, rye, and barley, triggers adverse immune reactions in people with celiac disease. But that same gluten also has uniquely elastic properties that make it perfect for mixing with water, kneading into dough, and baking into chewy delicious bread. Gluten is what makes our breads spongy, and chewy, and delicious. Cereals and grains like rice, sorghum, buckwheat, which are often milled into gluten-free flours, lack this important component. Now two inventive Italian food scientists, Virna Cerne and Ombretta Polenghi, are being lauded for their isolation of a protein called zein, that is found in corn. Under the right temperature, humidity, and pH, zein forms an elastic network similar to gluten. These days, says Cerne, "gluten-free products include a lot of fiber but the fiber cannot be really elastic." Added to different gluten-free flours like rice or corn flour, Cerne adds, isolated zein protein "solves the problem of no elasticity." That means that products using zein protein can be used to develop gluten-free products with many of the same chewy, flaky attributes as bread and baked goods made from wheat flour. Currently, products using isolated zein protein are still in the research and development phase, but food scientists hope the abundance of low-priced corn will allow the protein to be made cheaply, and thus give rise to more affordable gluten-free alternatives. Cerne and her co-inventor Polenghi, who both work with Italian-based food company Dr Schär, say that their research remains focused on people with serious medical reasons to avoid gluten. Stay tuned to see how Cerne and Polenghi's work develops and what food breakthroughs might result from their efforts. Read more at Quartz.com. -
Celiac.com 08/08/2016 - Celiac-associated duodenal dysbiosis has not yet been clearly defined, and the mechanisms by which celiac-associated dysbiosis could concur to celiac disease development or exacerbation are unknown. To clarify the situation, a research team recently analyzed the duodenal microbiome of celiac patients. The research team included V D'Argenio, G Casaburi, V Precone, C Pagliuca, R Colicchio, D Sarnataro, V Discepolo, SM Kim, I Russo, G Del Vecchio Blanco, DS Horner, M Chiara, G Pesole, P Salvatore, G Monteleone, C Ciacci, GJ Caporaso, B Jabrì, F Salvatore, and L Sacchetti. They are variously affiliated with CEINGE-Biotecnologie Avanzate, Naples, Italy, the Department of Molecular Medicine and Medical Biotechnologies and the Department of Medical Translational Sciences and European Laboratory for the Investigation of Food Induced Diseases at the University of Naples Federico II, Naples, Italy, the Department of Medicine and the University of Chicago Celiac Disease Center, University of Chicago, Chicago, Illinois, USA, the Department of Medicine and Surgery, University of Salerno, Salerno, Italy, the Department of System Medicine, University of Rome Tor Vergata, Rome, Italy, the Department of Biosciences, University of Milan, Milan, Italy, the Institute of Biomembranes and Bioenergetics, National Research Council, Bari, Italy, the Department of Biochemistry and Molecular Biology, University of Bari A. Moro, Bari, Italy, the Northern Arizona University, Flagstaff, Arizona, USA, the IRCCS-Fondazione SDN, Naples, Italy. The team used DNA sequencing of 16S ribosomal RNA libraries to assess duodenal biopsy samples from 20 adult patients with active celiac disease, 6 celiac disease patients on a gluten-free diet, and 15 control subjects. They cultured, isolated and identified bacterial species by mass spectrometry. Isolated bacterial species were used to infect CaCo-2 cells, and to stimulate normal duodenal explants and cultured human and murine dendritic cells (DCs). They used immunofluorescence and ELISA to assess inflammatory markers and cytokines. Their findings showed that proteobacteria was the most abundant, and Firmicutes and Actinobacteria the least abundant, phyla in patients with active celiac disease. In patients with active celiac disease, bacteria of the Neisseria genus (Betaproteobacteria class) were substantially more abundant than it was in either of the other groups (P=0.03), with Neisseria flavescens being most prominent Neisseria species. Whole-genome sequencing of celiac disease-associated Neisseria flavescens and control-Nf showed genetic diversity of the iron acquisition systems, and of some hemoglobin-related genes. Neisseria flavescens was able to escape the lysosomal compartment in CaCo-2 cells and to induce an inflammatory response in DCs and in ex-vivo mucosal explants. Marked dysbiosis and the pronounced presence of a peculiar strain characterize the duodenal microbiome in active celiac disease patients. This suggests that celiac-associated Neisseria flavescens could contribute to the many inflammatory signals in celiac disease. Source: Am J Gastroenterol. 2016 Jun;111(6):879-90. doi: 10.1038/ajg.2016.95. Epub 2016 Apr 5.
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Celiac.com 02/23/2016 - Rather than enjoying the youth of my 20's, some of the 'best years of my life,' I suffered from over a decade of chronic illness—everything from Lyme disease to C-diff colitis to hypothyroidism and chronic systemic candida. It started with severe leg swelling and chronic pain on a daily basis. By mid-afternoon, I carried what felt like bricks of water in my legs. On top of that, I was plagued by horrible digestive issues that left me feeling sick, lethargic and just plain gross. This was what I suffered with before I started my journey of detox, which led me to feeling younger and more energetic than I had felt since I was a kid. During my decade of chronic illness, on a daily basis I focused on eating clean and detoxing my body by eating lots of fresh, organic foods such as fresh herbs, raw nuts, seeds and tons of veggies that helped support my thyroid, gut and liver function and to support the removal of toxins in my body. When you're trying to detox, organic salads filled with fresh, whole ingredients are always a good idea! 'Eating Clean' is all about adding in whole, organic fresh foods to your lifestyle and feeling good about what you are putting into your body. It's not about feeling deprived or going on a diet. Wellness is more than just calories, it's nourishment for your body to keep you healthy and strong. At this point in my life, I can honestly say that after reading almost every detox and medical book, seeing over 500 doctors including an entire week at Mayo Clinic, I've learned that the answers were within me the whole time. I had to be my own doctor and put the missing pieces together. My doctors could only do so much and they didn't communicate with each other, plus they didn't understand anything outside of their specialized field, which left me feeling hopeless and lost. Whether you're suffering from chronic illness or just the occasional headache or bloated belly, I hope to inspire you to be your own doctor and realize that wellness starts with what's on your plate. Start tossing out the processed foods in your fridge and pantry today, add in beautiful, fresh foods and I promise you'll feel better just looking at the beautiful colors and tasting their amazing flavors. Get creative, go out and pick up a bunch of fresh herbs and start adding them to your meals—you will be amazed at how much flavor they can add to your them without having to add refined, unhealthy oils or other processed ingredients. This is a fun recipe to pack in a mason jar with a lid and take to work for lunch, or you can toss it all together and serve it in a big bowl for a quick weeknight for dinner. I love to cook quinoa in large batches on Sunday nights for myself and my clients, so that I always have it ready in my fridge to add to quick salads for lunch, stir-fry's for dinner, and even warmed up on the stove top for breakfast with almond milk and cinnamon. Simple Honey Sunflower Quinoa Bowl Serves 4 Ingredients: ½ cup quinoa 2 medium yellow summer squash or zucchini, thinly sliced or diced 1/3 cup thinly sliced jicama or peeled apple 2 tsp. finely chopped fresh basil, plus more if desired 2 Tbsp. sunflower seeds Juice of 2 medium lemons ½ tsp. honey 2-3 Tbsp. extra-virgin olive oil Sea salt and pepper, to taste Pinch crushed red pepper flakes, optional Directions: Cook quinoa according to package directions. Remove from heat; fluff with a fork, cover and set aside. Meanwhile, steam squash in a steamer basket over medium heat for about 5-7 minutes or until tender. Add to quinoa mixture and toss to combine. Add jicama, basil and sunflower seeds; toss again. In a small bowl, whisk lemon juice, honey, olive oil, sea salt and pepper. Drizzle over quinoa mixture and toss to combine. Season to taste and transfer mixture to a sealed container and place in the lunchbox with a spoon and napkin. Amie Valpone, founder of TheHealthyApple.com, wrote her first cookbook, over 200 recipes free of gluten, dairy, soy, eggs, corn, sugar, peanuts and processed foods, Eating Clean: Detox, Fight Inflammation, Reset Your Body & Get to the Root Cause of Illness, which is available for pre-order now on Amazon.com. -
Celiac.com 04/23/2007 - The results of a recent Dutch study published in the World Journal of Gastroenterology have confirmed a connection between Hashimotos Thyroiditis and celiac disease. In the study, 104 individuals with Hashimotos Thyroiditis were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies, IgA anti-endomysial antibodies (EMA) and HLA-DQ typing. Those who tested positive for any of the serological tests were given an intestinal biopsy. Sixteen patients (15%) showed positive celiac serology and five patients clear villous atrophy were diagnosed with celiac disease (4.8%; 95% CI 0.7-8.9). All five patients diagnosed with celiac disease, and 53 patients with Hashimotos thyroiditis (50%; 95% CI 43-62), showed the presence of HLA-DQ2 (and/or -DQ8). In a separate test within the study, 184 Individuals with known celiac disease were given a serological test for thyroglobulin and thyroid peroxidase Antibodies, after first being given thyroid biochemical, a thyroxine-free thyroid stimulating hormone. 39 patients (21%) showed positive thyroid serology. According to thyroid biochemistry results, ten patients showed euthyroidism (5%; 95% CI 2-9), seven showed sub-clinical hypothyroidism (3.8%; 95% CI 1.8-7.6), and 22 patients showed overt hypothyroidism, Hashimotos thyroiditis (12%; 95% CI 8-16). Furthermore, four patients with celiac disease had Graves disease (2%; 95% CI 0.8-5) and one patient had post-partum thyroiditis. The study concludes that there is a clear association between Hashimotos thyroiditis and celiac disease. Accordingly, it is recommended that patients with Hashimotos thyroiditis be screened for celiac disease and that patients with known celiac be screened for Hashimotos thyroiditis. World Journal of Gastroenterology 2007; 13(10). health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
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Celiac.com 05/18/2015 - It is well known that fermenting wheat flour with sourdough lactobacilli and fungal proteases reduces the amount of gluten. A team of researchers recently assessed whether patients with celiac disease can safely consume baked goods made from this hydrolyzed kind of wheat flour. The research team included Luigi Greco, Marco Gobbetti, Renata Auricchio, Raffaella Di Mase, Francesca Landolfo, Francesco Papro, Raffaella Di Cagno, Maria De Angelis, Carlo Giusseppi Rizzello, Angela Cassone, Gaetano Terrone, Laura Timpone, Martina D’Aniello, Maria Maglio, Riccardo Troncone, and Salvatore Auricchio. They are variously affiliated with the Department of Pediatrics and European Laboratory for the Study of Food Induced Diseases at the University of Naples, Federico II in Naples, and with the Department of Plant Protection and Applied Microbiology at the University of Bari in Bari, Italy. For their study, the team randomly assigned patients to receive 200 grams per day of natural flour baked goods (NFBG) (80,127 ppm gluten; n 6), extensively hydrolyzed flour baked goods (S1BG) (2480 ppm residual gluten; n 2), or fully hydrolyzed baked goods (S2BG) (8 ppm residual gluten; n 5) for 60 days. Two of the 6 patients who consumed natural flour baked goods discontinued the challenge due to adverse symptoms; all patients showed increased levels of anti–tissue transglutaminase (tTG) antibodies and mucosal damage to the small bowel. The 2 patients who ate the S1BG goods had no complaints and showed no symptoms, but developed subtotal atrophy. The 5 patients who ate the S2BG had no clinical symptoms or complaints. They showed no increase in anti-tTG antibodies, and their Marsh grades indicated no damage to small intestinal mucosa. The results showed that a 60-day diet of baked goods made from hydrolyzed wheat flour, manufactured with sourdough lactobacilli and fungal proteases, was not toxic to patients with celiac disease. Obviously further study is needed, along with a combined analysis of serologic, morphometric, and immunohistochemical parameters, which is the most accurate way to assess new celiac therapies. However, hydrolyzing wheat flour and treating it with sourdough lactobacilli and fungal proteases is not especially complicated. If these results stand, researchers may have developed the first wheat products that are safe for people with celiac disease. What do you think? Exciting news? Or one more thing to be skeptical about? Share your comments below. Source: CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2011;9:24 –29
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Celiac.com 11/22/2009 - Celiac disease has been associated with numerous other auto-immune disorders. Recently, there appeared the case of a 40-yr-old competitive strongman with celiac disease, who responded to a gluten-free diet, but developed profound and generalized motor weakness with acetylcholine receptor antibody positive myasthenia gravis, a disorder reported to occur in about 1 in 5000 people. A team of researchers set out to further explore this possible relationship between myasthenia gravis and celiac disease via serological study. The research team was made up of Hugh J Freeman, Helen R Gillett, Peter M Gillett, Joel Oger of the Department of Medicine (Gastroenterology and Neurology) at Canada's University of British Columbia. The researchers performed celiac disease screens on frozen stored serum samples from 23 acetylcholine receptor antibody positive myasthenia gravis patients with no intestinal symptoms. They examined both endomysial and tissue transglutaminase antibodies. One in 23 samples (or, about 4.3%) tested positive for both IgA-endomysial and IgA tissue transglutaminase antibodies. Subsequent endoscopic study showed duodenal mucosal scalloping, while biopsies confirmed the histopathological changes of celiac disease. From this, they concluded that celiac disease and myasthenia gravis may occur together more often than is currently understood. Muscle weakness in celiac disease may be a sign of possible occult myasthenia gravis, even in the absence of intestinal symptoms. Source: World J Gastroenterol 2009 October 14; 15(38): 4741-4744
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Brain. 2003 Mar;126(Pt 3):685-91. Celiac.com 08/11/2005 – Researchers in the United Kingdom screened 224 patients with various forms of ataxia (59 with familial, 132 sporadic idiopathic, and 33 with clinically probable cerebellar variant of multiple system atrophy MSA-C) for the presence of antigliadin antibodies and found that 24% of the ataxia patients were sensitive to gluten, and 72% of them had the HLA DQ2 genetic marker. Their results were compared with those of 1,200 healthy controls. Among the familial ataxia group 8 or 59 (14%), 54 of 132 (41%) of the sporadic idiopathic group, 5 of 33 (15%) in the MSA-C group, and 149 of the 1,200 (1.24%) controls, screened positive for antigliadin antibodies. The difference in prevalence between the idiopathic sporadic groups and the other groups was highly significant. Gastrointestinal symptoms were present in only 13% of the ataxia patients. MRI testing found atrophy of the cerebellum in 79% and white matter hyperintensities in 19% of the ataxia patients, and 45% of patients had neurophysiological evidence of a sensorimotor axonal neuropathy. The researchers conclude that gluten ataxia is the single most common cause of sporadic idiopathic ataxia, and antigliadin antibody testing is should be done immediately on everyone with symptoms of sporadic ataxia. -
Scand J Gastroenterol. 2003 Jul;38(7):742-6 Celiac.com 08/25/2003 – A recent study published in the July edition of the Scandinavian Journal of Gastroenterology demonstrates that avenin oat prolamines can be detected at higher levels in children with celiac disease compared to those without celiac disease. The researchers prepared a crude avenin extract using an ethanol and salt solution, and used it as an antigen in a three step ELISA test. The blood of 81 children, including 34 with celiac disease, were analyzed for both IgA and IgG antibodies to avenin and gliadin. The researchers found that: Children with coeliac disease on a normal diet had significantly higher levels of antibodies to avenin, both IgG and IgA, than reference children (P The researchers conclude: Children with coeliac disease have antibodies to oat proteins at significantly higher levels than reference children. The absorption test did not indicate a cross-reactivity between the prolamines of wheat and oats. The method will be employed for repeated sampling of anti-avenin antibodies during a prospective interventional study with a gluten-free diet supplemented with oats. An emphasis should be added to the last sentence, as it appears that they will now perform a study on celiac children who actually eat oats, and most other major studies of this type have shown no intestinal damage caused by the avenin oat prolamines in people with celiac disease. It is interesting that this study shows a different response to oats in those with celiac disease, but it remains to be seen if this response is actually harmful to celiacs.
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Aliment Pharmacol Ther 19(11):1199-1210, 2004. Celiac.com 06/08/2004 - Researchers at the University of California, San Francisco have determined that everyone with Irritable Bowel Syndrome (IBS) should also be screened for celiac disease. The researchers used decision analysis to estimate the number of celiac disease cases detected, quality-adjusted life-years gained, and costs resulting from screening suspected IBS patients for tissue transglutaminase antibody and antibody panel. Positive tests were followed up with an endoscopic biopsy. A gluten-free diet was initiated to improve the quality of life in those with celiac disease. The results of this study indicate that 3% of the 1,000 patients with suspected IBS have celiac disease. Based on these results the researchers analyzed the costs of several celiac disease screening methods used a decision analysis formula to determine whether or not the screening is cost effective. The researchers conclude that celiac disease screening in patients with suspected irritable bowel syndrome is likely to be cost-effective even at a relatively low celiac disease prevalence. Perhaps the researchers should have taken their analysis one step further and concluded that it would make good economic sense to screen the entire population of the USA (as well as that of other countries) for celiac disease, rather than just those with IBS, given the fact that it affects approximately 1% of the population--which is the only conclusion that I could reach after my review of their good work. -Scott Adams
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Am J Gastroenterol. 2006;101(7):1597-1600. Celiac.com 08/14/2006 – In an effort to increase the diagnosis rate of celiac disease, researchers in Italy conducted a study to determine the accuracy of two of the new "at home" type rapid commercial celiac disease test kits--both of which require only one drop of whole blood to gain results. Both of the kits detect IgA-IgG anti-human-transglutaminase antibodies (anti-h-tTG) in serum and IgA anti-h-tTG antibody in a single drop of whole blood. The researchers analyzed the serum samples of 114 biopsy-confirmed celiacs, 120 healthy controls, 20 first-degree relatives of celiacs, and 75 diseased controls, and compared them to the standard enzyme-linked immunosorbent assay testing method. Whole blood samples were taken in 51 of the biopsy-confirmed celiacs and 100 controls. The serum-based test was found to be positive in all 114 celiac patients, or 100% sensitivity, and among the controls which included three with celiac disease there was 94.9% sensitivity. The accuracy of the blood drop-based assay testing was positive in 46 of the 51 celiacs tested, which equals 90.2% sensitivity. The accuracy, however, is actually higher because five of the patients who tested negative had total IgA deficiency, so the real sensitivity level is actually 95.8%. All 100 controls tested negative which equals 100% specificity. Given the high degree of accuracy of the two commercial test kits that were evaluated the researchers conclude that general practitioners should utilize these low cost kits during standard office visits whenever celiac disease is suspected.
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Clinical Endocrinology, March 2005, vol. 62, no. 3, pp. 372-375(4) Celiac.com 04/29/2005 – In an effort to determine the occurrence of growth hormone deficiency (GFD) in children with celiac disease, Italian researchers evaluated 1,066 children who were diagnosed with short stature. All patients were screened for celiac disease using anti-endomysial antibodies (EMA), and those with positive results were given a follow-up biopsy. The researchers found that 210 or 19.7% of the children had GHD, and of these12 also had positive EMA and biopsy and were diagnosed with celiac disease. After one year on a gluten-free diet 9 of these 12 children showed marked growth improvement, while the remaining 3 showed no catch-up growth. Additional tests found an isolated GHD in one of the children, and multiple GHDs in the other 2 children. Growth hormone therapy was initiated in addition to a gluten-free diet in these 3 children, which led to an increase in their growth rate. The researchers conclude that growth hormone should be evaluated in those with celiac disease whose growth does not improve on a gluten-free diet, and growth hormone therapy should be started in these individuals while on a gluten-free diet.
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Eur J Gastroenterol Hepatol. 2004 Oct;16(10):961-8. Celiac.com 07/12/2005 - In an effort to determine the role of T-cells in celiac disease, researchers in Ireland examined the cells taken from the duodenal biopsies of both treated and untreated celiac disease patients. An assessment was made of the samples cell yields, and analyses were done to determine their viability and flow cytometric characteristics to quantify CD8 expression in the CD4CD8 T-cells. The researchers were surprised to find that T-cell yields in the epithelial layer were not elevated in active, untreated celiac disease, although enterocyte counts decreased significantly, which gave the appearance of T-cell infiltration. There was a dramatic decrease in the number of CD4CD8 T-cells in untreated patients in both the epithelial layers and in the lamina propria regions, and the levels of CD8 expression by CD4CD8 T-cells in the epithelial layer were also significantly decreased—and these levels did not return to normal even after treatment with a gluten-free diet and the return to normal of their intestinal architecture. According to the researchers: "No increase of intraepithelial lymphocytes in the celiac lesion may require us to reconsider the definition of celiac disease as an inflammatory condition. Low CD4CD8 populations in treated as well as untreated coeliac patients indicate that these T-cells are inherently absent in individuals genetically predisposed to celiac disease." The reduced levels of CD4CD8 T-cell populations could be the initial trigger of oral gluten tolerance in genetically susceptible individuals, and play a key role in the mucosal damage caused by celiac disease. More research in this area is needed to determine the full implications of these findings.
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Clin Chem Lab Med. 2004;42(10):1092-7 Celiac.com 01/22/2005 - A study by Italian researchers has found that anti-tissue transglutaminase (tTG) antibodies, once considered to be identical to anti-endomysial antibodies (EMA) in celiac disease, can also be found in patients with inflammatory bowel disease. The researchers looked at serum and intestinal tTG levels in 49 patients with Crohns disease, 29 patients with ulcerative colitis, 45 patients with celiac disease, 85 autoimmune patients as disease controls, and 58 volunteers as healthy controls. Additionally, Immunoglobulin A (IgA) anti-recombinant human tissue transglutaminase and anti-endomysial antibody detection in sera and fecal supernatants, along with adsorption of positive sera with recombinant human tissue transglutaminase, were performed on all patients. The researchers detected an increase in tTG concentration in all patients with celiac disease, and also low positive values in those with Crohns disease and ulcerative colitis, however the EMA were only detected in those with celiac disease. According to the researchers, the "Data highlight that both circulating and intestinal anti-tissue transglutaminases are detectable in inflammatory bowel disease, and that they are related to disease activity. These features underline that, in addition to anti-tissue transglutaminase, an anti-endomysial antibody test is necessary in the diagnostic work-up of celiac sprue, especially in patients with known inflammatory bowel disease." This study supports others that have found that the sole use of tTG to diagnose celiac disease may lead to misdiagnoses, and EMA testing must be performed to make an accurate celiac disease diagnosis.
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Mayo Clin Proc 2004;79:476-482. Celiac.com 05/25/2004 - The results of a study conducted by Dr. G. Richard Locke III and colleagues at the Mayo Clinic College of Medicine in Rochester, Minnesota do not show an association between irritable bowel syndrome (IBS) and celiac disease. The case-control study was based on the respondents of a bowel disease questionnaire that was sent to random Olmsted County residents who were 20 to 50 years old. The researchers evaluated 150 subjects, 72 of whom reported having symptoms of IBS and dyspepsia, and 78 controls with no gastrointestinal symptoms. In the group with symptoms they found that 50 had IBS, 24 had dyspepsia and 15 had both conditions. Serological screening of both groups for celiac disease showed no significant difference between them—two controls, two IBS subjects and two people with dyspepsia tested positive for celiac disease. The researchers conclude that celiac disease alone cannot explain the presence or IBS or dyspepsia in the subjects. The results of this study are interesting, but probably not large enough to be statistically significant. The total number of people with celiac disease in each group was astounding: 2 out of 50 with IBS (4%) 2 out of 24 with dyspepsia (6%) 2 of the 78 controls (2.6%) These findings do not necessarily contradict previous IBS/celiac disease studies that looked at hospital outpatients who are more likely to have more severe and prolonged symptoms than a group that selects itself from the general public by responding to a questionnaire. Additionally most of the earlier studies that concluded that there was a connection between celiac disease and IBS were conducted before more recent epidemiological studies that have shown just how high the incidence of celiac disease in the general population is--now estimated between 0.8% and 1.3%--this study suggests 2 -3%. These recent epidemiological studies have also shown that a large percentage of celiacs have little or no symptoms, perhaps due to the length of time or the severity of the disease. A 1 in 20 diagnosis of celiac disease in patients with IBS/dyspepsia is consistent with other studies, and is still high and suggests that testing for celiac disease should be done routinely on these patients. No studies have ever suggested that all or even most IBS patients have celiac disease, just that the incidence is higher than that of the normal population. I propose that if this study had been done on exactly the same people several years from now, the 2 people in the control group who were found to have celiac disease may well develop symptoms that would put them in either the IBS or dyspepsia group, which would create a statistically significant result that would contradict this studys result. Last, perhaps the results of this study really support a more broad conclusion: Everyone ought to be screened for celiac disease, not just those with symptoms.
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Am J Gastroenterol. 2002;97(11):2702-2704, 2785-2790 Celiac.com 04/30/2003 - The results of a population-based study published in the November 2002 edition of the American Journal of Gastroenterology indicate that it is time to change celiac disease screening methods. Karoly Horvath, MD, PhD, from the University of Maryland School of Medicine in Baltimore, and Ivor D. Hill, MD, from Wake Forest University School of Medicine in Winston-Salem, North Carolina, found that testing first for tissue transglutaminase (tTG) antibodies followed by endomysial antibodies may eliminate the need to screen using antigliadin IgA. Using a community-based population the researchers screened the blood of 1,000 consecutive subjects (age 16 to 71 years, 497 women) using the three tier classic screening which looks at IgG and IgA antigliadin antibodies, followed by endomysial antibodies (EmA) and total serum IgA in positive patients, and finally at intestinal biopsies of patients with positive EmA. The study screening protocol consisted of the use of a commercial guinea pig anti-tTG antibodies and total serum IgA, the with EmA (IgA and/or IgG) for positive patients followed by intestinal biopsies. The classic screening found five patients who were eligible for intestinal biopsy, and celiac disease was confirmed in all five. The study group yielded the five patients identified in the classic screening, plus two more with positive IgG antigliadin antibodies and normal total serum IgA (both were positive for EmA). Juan C. Gomez, MD, and colleagues from San Martin Hospital in La Plata, Argentina write: "Our data showed that a new screening protocol using [anti-tTG] as first line followed by endomysial antibodies is a cost-effective screening and yielded more realistic figures of prevalence for celiac disease in a community setting than the classic three-level sequential evaluation using antigliadin antibodies." In addition to being more sensitive than the classic method of detection, the new screening protocol is cheaper: $3,006 per new patient detected vs. $4,687. Further: Although we still did not perform intestinal biopsy on all those subjects with positive anti-tTG tests but negative EmA, current evidence appears to suggest that the addition of EmA to the seropositive anti-tTG patients might have a key role in the simplified screening avoiding unnecessary biopsies, although the researchers still recommend using a biopsy to confirm diagnosis until the new protocol can be standardized. In conclusion: We recommend using the anti-tTG as the initial test in both population screening studies and for individual cases suspected of having celiac disease on the basis of symptoms or conditions associated with the condition...(T)hose with positive results should be tested for EmA as a second step in the screening process and, if positive, should undergo an intestinal biopsy for confirmation of the diagnosis.
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Celiac.com 2/13/2003 - According to a recently published large-scale multi-year and multi-center study, 1 in 133, or a total of 2,131,019 Americans have celiac disease. Alessio Fasano, MD, et. al., and colleagues screened 13,145 subjects using serum antigliadin antibodies and anti–endomysial antibodies (EMA). Those who had positive EMA results were screened again for human tissue transglutaminase IgA antibodies and celiac disease-associated human leukocyte antigen DQ2/DQ8 haplotypes, and when possible, intestinal biopsies were also given. Additionally, for those with biopsy-proven celiac disease, 4,508 first-degree relatives and 1,275 second-degree relatives were also screened for the disease. A total of 3,236 symptomatic patients and 4,126 not-at-risk individuals were screened. The study determined the following: Group Prevalence First degree relatives 1 in 22 Second-degree relatives 1 in 39 Symptomatic patients 1 in 56 Not-at-risk individuals (overall prevalence) 1 in 133 These results are much higher than previous studies have found, and they indicate that celiac disease is perhaps the most common genetic disorder in the United States, as well as one of the most poorly diagnosed diseases. February 10, 2003 edition of Archives of Internal Medicine
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Gut 2002;50:624-628 Celiac.com 05/02/2002 – Results of the first large population-based twin study of celiac disease were recently published in the April edition of the journal Gut. The study was conducted by Professor L Greco and colleagues at the Università di Napoli Federico II, Dipartimento di Pediatria. The study compared identical twins (genetically identical) to fraternal twins (genetically not identical) who share only the same number of genes as non-twin siblings. This methodology allowed the researchers to determine what role a shared environment plays in the onset of celiac disease in comparison to a genetic role. The researchers matched the Italian Twin Registry with the membership lists of a patient support group for celiacs. Forty seven twin pairs were found and screened for antiendomysial (EMA) and antihuman-tissue transglutaminase (anti-tTG) antibodies. Identical twins were verified using DNA fingerprinting and fraternal twins were typed for HLA class II DRB1 and DQB1 molecules. Their results indicate that 38% of the combined twin pairs showed signs of celiac disease, which breaks down to 75% of the identical twin pairs and 11% of the non-identical twin pairs. Additionally, females who had a twin with celiac disease were 30% more likely to develop it themselves, in comparison to an unaffected male twin. Further, the results of the study indicate that environmental factors have little or no effect on the acquisition of celiac disease, and that there is substantial evidence of a very strong genetic component that is only partially related to the HLA region. The researchers suggest that several genes work collectively to cause celiac disease, and a single missing or altered gene is probably not its cause.
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