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Celiac.com 08/16/2012 - Tests for blood antibodies against native gliadin (anti-nGli) are still often assumed to perform better in the diagnosis of celiac disease in young children than tests for antibodies to deamidated gliadin (anti-dGli), tissue transglutaminase (anti-tTG), and endomysium (EmA). A team of researchers recently set out to determine whether testing IgG and IgA antibodies Against native gliadin was best for diagnosing celiac disease in children under 2-years old. Specifically they wanted to compare the performance of assays for anti-nGli, anti-dGli, anti-tTG, and EmA in this age group. The research team included T. Richter, X. Bossuyt, P. Vermeersch, H.H. Uhlig, M. Stern, A. Hauer, K.P. Zimmer, L. Mearin, J.H. Roo, C. Dähnrich, and T. Mothes. They are affiliated with the University Children's Hospital, the Children's Hospital of the Clinical Centre, "Sankt Georg," and the Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics at University Hospital in Leipzig, Germany; with the Department Laboratory Medicine of University Hospital in Leuven, Belgium, the University Children's Hospital in Tübingen, Germany, the University Children's Hospital in Graz, Austria, the University Children's Hospital in Giessen, Germany, the Department of Paediatrics at Leiden University Medical Centre in Leiden, The Netherlands, and with EUROIMMUN Medizinische Labordiagnostika GmbH in Lübeck, Germany. For their study, they conducted a retrospective analysis of 184 children. The study group included 42 children with celiac disease under normal diet, and a control group of 142 children up to 2 years of age. The team measured immunoglobulin (Ig) A- and IgG-anti-dGli, IgA- and IgG-anti-nGli, IgA- and IgG-anti-tTG, and IgA-EmA in blood samples. They calculated areas under receiver operating characteristics curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, as well as diagnostic odds ratios. When all the data was complete, they found that only tests for IgG-anti-dGli, IgA-anti-tTG, and IgA-EmA had high specificity (≥0.96) connected with high sensitivity (≥0.86), with high positive predictive values (≥0.52 and ≥0.69 at pretest probabilities of 0.05 and 0.1, respectively) and negative predictive values (≥0.99 and ≥0.98 at pretest probabilities of 0.05 and 0.1, respectively). These tests also showed high positive likelihood ratio (≥24) at low negative likelihood ratio (≤0.15) and high diagnostic odds ratios (≥136). From their data, the team concluded that using anti-nGli tests to diagnose celiac disease in young children was not helpful. They maintain that IgA-anti-tTG, IgA-EmA, and IgG-anti-dGli provided much more reliable results than anti-nGli in diagnosing celiac disease in young children. Source: J Pediatr Gastroenterol Nutr. 2012 Jul;55(1):21-25.

Celiac.com 11/21/2008 - Not much is known about what effects, if any, a gluten-free diet might have upon gastroesophageal reflux disease-related symptoms (GERD-rs) in people with celiac disease. A team of researchers recently set out to assess the recurrence of GERD-rs, in celiac patients with nonerosive reflux disease (NERD). Out of a total of 105 adult patients with celiac disease, the team found 29 with celiac disease who presented with the NERD. Those 29 were enrolled in the study, and compared against a control group of thirty non-celiac patients with NERD. After 8 weeks of PPI treatment the team found that 25 (86.2%) celiac patients saw GERD-rs resolve, compared to just 20 (66.7%) control subjects. The team used clinical means to assess recurrence of GERD-rs at 6, 12, 18, and 24-month intervals after initial proton-pump inhibitor (PPI) treatment were withdrawn for 8 weeks. In the celiac disease group, just five patients (20%) had a recurrence of GERD-rs at 6 months, but none had recurrence at 12, 18, and 24 months, while the control group showed recurrence in six of 20 controls (30%) at 6 months, in another six (12/20, 60%) at 12 months, in another three (15/20, 75%) at 18 months, and in another two (17/20, 85%) at 24 months. This is the first study to evaluate the effect of a gluten free diet in the nonerosive form of GERD in patients with celiac disease, via a clinical long-term follow-up, and the results suggest that a gluten free diet could be helpful reducing GERD symptoms and in preventing of their recurrence. J Gastroenterol Hepatol. 2008;23(9):1368-1372.

Celiac.com 09/25/2008 - Mucosal inflammation of the small intestine, coupled with damage to intestinal villi, is a classic indication of celiac disease. Recently, doctors have begun to embrace the idea that some patients with positive celiac blood tests may have mucosal lesions that are too small to appear on routine histopathological analysis. In the first study of its kind, a team of researchers based in Ireland set out to analyze enterocyte morphology and cytoskeletal structures using a high content analysis technology. The research team was made up of doctors Bashir M. Mohamed, Conleth Feighery, Yvonne Williams, Anthony Davies, Dermot Kelleher, Yuri Volkov, Jacinta Kelly and Mohamed Abuzakouk. The team examined duodenal biopsies from 14 untreated and 10 treated celiac patients and from 20 non-celiac control subjects. They also investigated tissue sections from six study group subjects before and after the development of gluten-sensitive enteropathy. The research team used an anti-α-tubulin antibody to conduct immunohistochemical studies on paraffin-embedded tissue sections. They found important differences in enterocyte morphology and intracellular cytoskeletal structures in the patients with proven celiac disease and those in the study group. Moreover, the team observed that these changes existed in the study group prior to any indication of enteropathy, as determined by standard microscopy. This is the first time researchers have used high content analysis to show specific details of enterocyte morphology. Such an approach permits doctors to quantitatively analyze enterocyte intracellular structure from standard biopsy samples and allows for detection of minute changes that develop before the classic histological lesion. This process could become important for improving the diagnosis of celiac disease. If doctors can spot celiac-related intestinal lesions before they develop, they can begin to prevent celiac disease before it develops and thereby save lives. Central European Journal of Biology Volume 3, Number 3 / September, 2008

Celiac.com 04/13/2009 - A team of Spanish researchers recently set out to determine rates and clinical status of gluten sensitive enteropathy (GSE) detected by mass blood screens. The researchers also sought to determine sensitivity of anti-transglutaminase (tTGA) and anti-endomysium antibodies (EmA) in diagnosis, and compliance with a gluten-free diet (GFD) and follow-up. The research team was made up of doctors Meritxell Mariné, Fernando Fernández-Bañares, Montserrat Alsina, Carme Farré, Montserrat Cortijo, Rebeca Santaolalla, Antonio Salas, Margarita Tomàs, Elias Abugattas, Carme Loras, Ingrid Ordás, Josep M Viver, and Maria Esteve. Researchers recruited one thousand, eight hundred and sixty eight subjects, who were the screened for tTGA and EmA. Positive screens were referred for duodenal biopsy, DQ2/DQ8 genotyping, clinical feature charting, blood tests, and densitometry. More than 98% of subjects showed tTGA levels below 2 U/mL, so researchers designated this as the baseline level for normality, and deemed results positive at or above this level if confirmed twice in a single sample. Researchers also charted adherence to a GFD and follow-up results. A total of 26 subjects (1.39%) showed positive tTGA and/or EmA results, Of those, 21 underwent biopsy, with results showing six Marsh â…¢ (one â…¢a, four â…¢b, one â…¢c), nine Marsh â… and six Marsh 0, with a GSE rate of 1:125. EmA sensitivity for GSE was 46.6% (11.1% for Marsh â… , 100% for Marsh â…¢), while tTGA, sensitivity was 93.3% (88.8% for Marsh â… , 100% for Marsh â…¢). All 15 patients with abnormal blood tests showed clinical manifestations related to GSE. Marsh â… and â…¢ subjects showed more abdominal pain than Marsh 0 (P = 0.029), and also showed more distention and diarrhea. The team saw no differences in the rates of osteopenia between Marsh â… and â…¢ (P = 0.608). They found that 66.7% of the 15 GSE patients complied with a gluten-free diet, and that 80% responded positively to the diet. 69.2% participated in follow-up study. This study showed positive blood screens in nearly 1.4% of those tested. The study showed frequent and clinically relevant rates of GSE among the general population. This confirms that celiac disease and related conditions are at least as common as the 1% figure commonly quoted, and indicate that when criteria are expanded to include less severe cases, they may be even higher. The study confirmed tTGA as the marker of choice, and showed that mass screening programs such as this one are helpful in spotting celiac disease early, and in referring people for treatment and follow-up before the disease develops into more costly and debilitating conditions often associated with untreated celiac disease. World J Gastroenterol. 2009 March 21; 15(11): 1331–1338.