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      Frequently Asked Questions About Celiac Disease   04/24/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What is Celiac Disease and the Gluten-Free Diet? What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes

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  1. Celiac.com 10/23/2017 - What's the relationship between celiac disease and liver histology, serology and treatment response? Celiac disease is diagnosed on the basis of ESPGHAN criteria, and clinical response to gluten-free diet. Researchers have noted histological abnormalities on liver biopsies in patients with celiac disease, but have rarely described the abnormalities in detail. A team of researchers recently set out to assess the histological spectrum of 'celiac hepatitis' and to see if a gluten-free diet can reduce such features. The research team included K Majumdar, P Sakhuja, AS Puri, K Gaur, A Haider, and R Gondal. They are variously affiliated with the Department of Pathology, and the Department of Gastroenterology at the G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India. Their team analyzed twenty-five patients with concomitant celiac disease and hepatic derangement for clinical profile, laboratory investigations and duodenal and liver biopsy. They then made a histological comparison of pre- and post-GFD duodenal and liver biopsies, where possible. They found that fifteen patients with celiac disease later developed abnormal liver function tests. They also found that 7 out of 10 patients with liver disease showed tissue positive transglutaminase, while 6 of the 10 had antigliadin antibodies. Eight patients showed serological markers for autoimmune liver disease (AILD). Liver histology ranged from mild reactive hepatitis, chronic hepatitis, and steatosis to cirrhosis. They found six patients with liver biopsies made after a gluten-free diet. Five of these patients showed a decrease in steatosis, portal and lobular inflammation and fibrosis score. From these results, they concluded that celiac hepatitis could be a distinct condition, and that patients may present with either celiac disease, or with secondary hepatic derangement. They recommend celiac evaluations for patients with AILD, unexplained transaminasaemia or anemia. This is one of the few studies to show the range of histological changes to the liver in patients with 'celiac hepatitis'. They note that the adoption of a gluten-free diet in such patients may help to improve symptoms of 'celiac hepatitis'. Source: J Clin Pathol. 2017 Sep 29. pii: jclinpath-2017-204647. doi: 10.1136/jclinpath-2017-204647.
  2. Celiac.com 09/19/2016 - At the time of diagnosis, some celiac patients suffer also from what is called celiac hepatitis, which is liver damage in patients with celiac disease that resolves after a gluten-free diet. A team of researchers recently set out to evaluate predictive factors of celiac hepatitis at the celiac disease diagnosis stage. To do so, they conducted a retrospective study that included 46 adult patients with clinically diagnosed celiac disease. The research team included Andreia Albuquerque, Susana Rodriguesa, and Guilherme Macedoa of the Department of Gastroenterology at Centro Hospitalar São João, in Porto, Portugal. Of the 46 patients, eighty-seven percent were women, with an average age of 33 ± 11 years, 87% showed Marsh 3, and 21 patients (46%) had celiac hepatitis. At the time of diagnosis, these patients had average Immunoglobulin A anti-tissue transglutaminase antibody (TTG-IgA) levels of 208.0 U/ml (p25–p75: 89–1316 U/ml), a mean aspartate aminotransferase of 42 ± 24 U/L, alanine aminotransferase 50 ± 28 U/L, alkaline phosphatase 111 ± 64 U/L. One year after diagnosis, the median average TTG-IgA was 9U/ml (p25–p75: 4.5–30.5 U/ml) and one-third of the patients had normal values. At diagnosis, patients without celiac hepatitis had an average TTG-IgA of 77U/ml (p25–p75: 24–288 U/ml), average aspartate aminotransferase of 23 ± 4 U/L, alanine aminotransferase 20 ± 6 U/L, alkaline phosphatase 69 ± 17 U/L. One year after diagnosis, median TTG-IgA was 6 U/ml (p25–p75: 3–19 U/ml) and nearly half of the patients showed normal values. At diagnosis, patients with celiac hepatitis had higher values of TTG-IgA (p = 0.007). Also, at diagnosis, there was a statistically significant positive correlation between TTG-IgA and alanine aminotransferase (r = 0.324, p = 0.028). For patients with a TTG-IgA level higher than 310 U/ml (OR = 4.8, 95%CI = 1.213–18.781, p = 0.025), the risk of having celiac hepatitis was nearly 5-times higher. From this, the team concludes that higher TTG-IgA levels can help predict celiac hepatitis in adult patients with celiac disease at diagnosis. Source: Scandinavian Journal of Gastroenterology. DOI:10.1080/00365521.2016.1203017
  3. Celiac.com 07/01/2015 - Children with celiac disease show an impaired immune response to the hepatitis B vaccine, and neither a gluten-free diet, nor additional vaccine boosters seem to change that, according to research presented at the 33rd Annual Meeting of the European Society for Paediatric Infectious Diseases. Although a number of studies have documented this reduced response, most have been limited by low numbers of patients with celiac disease, and/or lower numbers of control patients, said Maria José Pérez, MD, from Henares Hospital in Coslada, Spain. Two of those prior studies that implicated gluten in the impaired vaccine response, showed that celiac patients who follow a gluten-free diet have a hepatitis B vaccine response that is similar to that in the general population after celiac patients switch to a gluten-free diet. In their study, Dr. Pérez and her colleagues looked at the immune response to the vaccine in children with celiac disease. The team evaluated 214 children with celiac disease and 346 control patients who had completed the hepatitis B vaccine regimen in the first year of life. All patients were vaccinated before gluten was introduced into their diets. They measured gluten antibody levels for each child to determine vaccine response. Kids who showed levels of hepatitis B surface antibody under 10 mUI/mL were defined as non-responsive to the vaccine. Overall, non-response was 8% higher in children with celiac disease than in control subjects (68.7% vs 60.7%). For children younger than 5 years, this difference was a whopping 20%, with a rate of 50.0% for celiac children, compared with 30.1% for the control group (P = .015). In children with celiac disease, the researchers found no relation between level of antibody and time since the last intake of gluten. So, one important takeaway is that gluten consumption or avoidance does not change the immune response to hepatitis B vaccine in patients with celiac disease. Over time, levels of antibody decreased in both groups, so doctors assessing immune response to hepatitis B vaccine should factor in the amount of time elapsed since vaccination, says Dr. Pérez. The prospective study involved 72 children with celiac disease who were vaccinated in the first year of life and whose antibody levels were below 10 mUI/mL. The researchers found no change in levels after the children received a single vaccine booster. In light of these results, the research team advises that children with celiac disease and undetectable levels of antibody be revaccinated with a full series of the vaccine. Source: 33rd Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID): Abstracts 463 and 464 and poster MPW06. Presented May 15, 2015.
  4. Celiac.com 10/20/2014 - Researchers don’t have much data on rates of celiac disease in patients with autoimmune hepatitis (AIH). To better understand any connections between the two conditions, a Dutch research team recently set out to examine the rates of celiac disease in patients with autoimmune hepatitis. Specifically, the team set out to investigate the relationship between AIH and celiac disease by assessing the prevalence of IgA tissue antitransglutaminase antibodies (TGA) and antiendomysium antibodies (EMA) in a large group of AIH patients. The research team N.M. van Gerven, S.F. Bakker, Y.S. de Boer, B.I. Witte, H. Bontkes, C.M. van Nieuwkerk, C.J Mulder, G. Bouma; and the Dutch AIH working group. They are variously affiliated with the Departments of Gastroenterology and Hepatology, Epidemiology and Biostatistics, and Medical Immunology at the VU University Medical Centre in Amsterdam, The Netherlands. For the first step in their study, the team used TGA antibody serology to determine the frequency of celiac disease in a group of 460 AIH patients. The team conducted EMA screens on any patients showing TGA positivity. They then used digital and written medical records to collect retrospective data on previously diagnosed celiac disease and patient characteristics, and compared those findings with archival data on the prevalence of celiac disease in the Netherlands. They found that six patients had a known history of celiac disease, but were currently in remission, as shown by negative TGA blood screens. In addition, ten of the 460 AIH patients (2.2%) showed positive IgA TGA. Positive EMA antibodies in these patients served to confirm celiac disease diagnosis. Overall, the team found celiac disease in 3.5% of AIH patients compared with just 0.35% in the general Dutch population (P<0.001). Discounting patients with either a primary biliary cirrhosis or primary sclerosing cholangitis overlap, the team found celiac disease in 11 (2.8%) AIH patients. This is the largest serological study to examine connections between AIH and celiac disease, and shows that patients with AIH have rates of celiac disease that are higher than those of the general population, but not as high as some studies have suggested. Still, the team advises doctors to consider the possibility of concurrent celiac disease in all AIH patients. Source: Eur J Gastroenterol Hepatol. 2014 Oct;26(10):1104-7. doi: 10.1097/MEG.0000000000000172.
  5. Celiac.com 06/07/2013 - A number of studies have indicated that people with celiac disease have an inadequate response to hepatitis B vaccination. In an effort to better understand the issue, a team of researchers recently set out to assess hepatitis B vaccination response in relation to gluten exposure status in patients with celiac disease. The research team included F. Zingone, P. Capone, R. Tortora, A. Rispo, F. Morisco, N. Caporaso, N. Imperatore, G. De Stefano, P. Iovino, and C. Ciacci. They are affiliated with the Department of Medicine and Surgery at the University of Salerno in Salerno, Italy. To measure the gluten exposure status at the time of vaccination, they compare three groups of patients, along with a control group. In all, the study included 163 celiac patients. Group A contained 57 patients exposed to gluten, including patients vaccinated as 12-year-old adolescents, for whom celiac disease diagnosis was established after vaccination. Group B contained 46 patients not exposed to gluten, including patients vaccinated as 12-year-old adolescents and on a gluten-free diet at the time of vaccination. Group C was composed of 60 infants, including those vaccinated at birth. Group D included 48 healthy, vaccinated, non-celiac subjects. The researchers then compared the response of celiac patients to hepatitis B vaccination with the response by healthy subjects. They found that 43.9% of patients in group A, 34.8% of patients in group B, 58.3% of patients in group C, and 8.3% of patients in group D showed inadequate response to hepatitis B immunization. Overall, group A versus group D, P less than 0.001; group B versus group D, P = 0.002; group C versus group D, P = 0.001, while they found no significant difference for group A versus group B and group A versus group C. This study suggests that gluten exposure does not influence the response to hepatitis B immunization, and that the human leukocyte antigen likely plays the main immunological role in poor responses to hepatitis B-vaccinated celiac patients. Source: Clin Vaccine Immunol. 2013 May;20(5):660-2. doi: 10.1128/CVI.00729-12. Epub 2013 Feb 27.
  6. A team of researchers recently took a look at how well the hepatitis B vaccine protected people with celiac disease over time. Specifically, they evaluated what is called long-term antibody persistence and immune memory to hepatitis B virus in adult celiac patients vaccinated as adolescents. The research team included F. Zingone, F. Morisco, A. Zanetti, L. Romanò, G. Portella, P. Capone, P. Andreozzi, R. Tortora, and C.Ciacci. They are affiliated with the Department of Clinical and Experimental Medicine of Federico II University of Naples in Italy. They set out to investigate the anti-HBs antibody persistence and immune memory to hepatitis B virus in adult celiacs vaccinated as adolescents, along with the effects of a booster administration in non-protected individuals. They found that, eleven years after receiving the initial vaccine dose, the percentage of vaccinees with blood levels ≥ 10 mIU/ml and antibody geometric mean concentrations (GMCs) were lower among celiac patients than among control subjects (68.6% vs 91.7%, p Patients with anti-HBs below 10 mIU/ml received a booster dose and were retested after two weeks to measure response levels. Post-booster anti-HBs levels were still The study shows that, compared with healthy control subjects, people with celiac disease have lower seroprotective levels of anti-HBs eleven years after main vaccination, in addition to having a substantially lower response rate to a booster dose of the hepatitis B vaccine. Do you have celiac disease? Have you had a hepatitis B vaccine? Have you had trouble getting proper immunity levels with the hepatitis B vaccine? Is this news to you? Share your comments below. Source: Vaccine. 2011 Jan 29;29(5):1005-8. doi: 10.1016/j.vaccine.2010.11.060.
  7. Celiac.com 02/10/2012 - The HBV vaccine is usually effective against common hepatitis B virus (HBV) infection, with just 4-10% of vaccine recipients failing to respond to standard immunization. Some studies suggest that people with celiac disease may have high levels of resistance to the HBV vaccine, compared to the general population. A team of researchers recently took a look at the issue of HBV vaccine reliability in people with celiac disease. The study team included Mohammad Rostami Nejad, Kamran Rostami, and Mohammad Reza Zali. They are variously affiliated with the Research Center for Gastroenterology and Liver Disease at Shahid Beheshti University of Medical Sciences in Tehran, Iran, and with Acute Medicine at Dudley Group of Hospital in Dudley, UK. Together, they reviewed data from previous studies. The ability to respond to recombinant HBV vaccine is associated with certain gene sites. At those sites, certain HLA haplotypes, such as B8, DR3, and DQ2 are common genetic markers among non-responders. Since HLA genotypes play an important role in unresponsiveness to the HBV vaccine, and since 90-95% of people with celiac disease have HLA-DQ2, celiac disease may be a factor in this failure to respond to the HBV vaccine. For one study, Ertekin et al., a research team gave HBV vaccinations, according to a standard immunization schedule, to 52 children with celiac disease, and another twenty matched for age and sex. The average age of the celiac disease patients was 10.7 ± 4 years (range, 4-18 years). Anti-HBs titers were positive in 32 (61.5%) patients and negative in 20 (38.5%) patients, while they were positive in 18 (90%) of the children in the control group (P < 0.05). The review team found statistically significant differences between negative anti-HBs titers, clinical presentation of celiac disease, and dietary compliance in patients with celiac disease (P < 0.05). In all, 32 of the 52 children with celiac disease responded favorably to HBV vaccination. This was a substantially lower percentage that the 18 of 20 control subjects responded (P < 0.05). Ertekin et al. concluded that a significantly higher percentage of children with celiac disease failed to respond to hepatitis B vaccination, as compared with the control group. They concluded that response to the HBV vaccine in children with celiac disease should be investigated, and a different immunization schedule should be developed for them. They suggested that celiac children who follow a gluten-free diet may have a better immune response to the HBV vaccine. The data fits with previous studies that confirm the findings that children with celiac disease fail to respond to the HBV vaccine at significantly higher rates than do healthy children. In fact, the researchers point out a similar study on adults, Noh et al., revealed that, of 23 adults with celiac disease who had completed a full course of HBV vaccination, 19 tested positive for HBsAb and 13 failed to acquire proper long-term immunity. Another study, by Stachowski et al., further cemented this connection between HLA and non-responsiveness to HBV vaccine. In that study, 34 out of 153 patients with end-stage renal disease failed to respond to HBV vaccine, and HLA-DQ2 was found almost exclusively in the non-responder group. Long stretches of time between vaccination and antibody testing might be one reason even celiac disease patients who follow a gluten-free diet have significantly reduced post-vaccination levels of HBV antibody. Therefore, current guidelines recommend revaccinating celiac patients once they have established a reliable gluten-free diet. This study was not designed to assess the presence of HLA-DQ2 and HLA-DQ8 in the groups. Therefore, future studies assessing HLA haplotypes in celiac disease should seek to describe the role of HLA typing in response to HBV vaccination. The evidence indicates that early diagnosis of celiac disease, and treatment with a gluten-free diet may increase the overall percentage of patients responding favorably to the HBV vaccine. Treatment of celiac disease with a strict, gluten-free diet seems to play a positive role in the development of antibody memory. The review team points out that the high prevalence of celiac disease in the general population and a lack of response to HBV vaccine in untreated patients, invites routine assessment in patients with celiac disease receiving the HBV vaccine. Lastly, the review team notes that non-responsiveness to HBV vaccine may indicate undiagnosed celiac disease or noncompliance with gluten-free diet. SOURCE: Hepat Mon. 2011 August 1; 11(8): 597–598. doi: 10.5812/kowsar.1735143X.761
  8. Celiac.com 09/21/2009 - Failure of the hepatitis B vaccine in people with celiac disease is common. In fact, vaccine failure occurs in about 50% of all attempts to vaccinate people with celiac disease against hepatitis B. Research shows that age at celiac diagnosis and other factors can influence response rates. The August 12 issue of the medical journal Vaccine features a timely article on failure of the hepatitis B vaccine in people with celiac disease, which asks the very sensible question of whether it is time to reevaluate our current vaccine procedures. One of the most important signs of non-responsiveness to the hepatitis B vaccine is a genetic marker called human leukocyte antigen (HLA) phenotype DQ2. It's interesting that people with celiac disease often carry these same genetic markers, and that fact is at the center of one hypothesis about why celiac patients are less able to respond to the hepatitis B vaccine. A team of researchers recently set out to assess responsiveness rates to the hepatitis B vaccine among patients with celiac disease. The team was made up of S. Leonardi, M. Spina, L. Spicuzza, N. Rotolo, and M. La Rosa of the Broncho-Pneumology & Cystic Fibrosis Unit of the Department of Pediatrics at the University of Catania, in Catania, Italy. The team describes the results of a retrospective study on celiac patients vaccinated with three intramuscular injections of recombinant hepatitis B vaccine (Engerix in doses of 10mug at 3, 5 and 11 months of age. Their results showed that half of the celiac disease patients (50%) failed to respond to the vaccine course, and that those who did best were less than 18 months of age at the time of diagnosis for celiac disease; that group showed a significantly higher response rate to the vaccine. The study confirms that celiac patients have a far higher failure rate for hepatitis B vaccination than healthy control subjects. These results strengthen the call to re-evaluate current hepatitis B vaccine strategies for patients with celiac disease and to assess whether to recommend a course of re-vaccination. Source: Vaccine - August 12, 2009.
  9. Celiac.com 06/30/2008 - The results of a Hungarian study published recently in the June issue of Pediatrics suggest that people with untreated celiac disease show abnormal resistance to the hepatitis B (HBV) vaccine, while celiac patients on a gluten-free diet show a near normal response to the vaccine. A team of doctors led by Dr. Eva Nemes, at the University of Debrecen, administered 2 to 3 doses of recombinant HBV vaccine to 128 patients with celiac disease and an age matched control group of 113 non-celiac patients within a 6-month period. Twenty-two of the celiac patients were following a gluten-free diet when they received the vaccine. One month after the last HBV vaccination, the team took blood samples to look for anti-HBV antibodies. The group of 22 patients who received the vaccination while on a gluten-free diet had a sero-conversion rate of 95.5%, which means that more than 9 out of 10 patients developed the desired resistance to hepatitis B. The other 106 patients with celiac disease, as well as the control group, were vaccinated at approximately 14 years of age, and their immune response was evaluated by measuring anti-HBV titers about two years later. Of the 106 subjects with celiac disease, seventy had been diagnosed and were maintaining a strict gluten-free diet when they were vaccinated, twenty-seven were undiagnosed and untreated, and nine were diagnosed, but not following a gluten-free diet. The seventy subjects with celiac disease that was diagnosed and treated showed a sero-conversion rate of 61.4%. Given the size of the study samples, that’s not significantly different from the 75.2% sero-conversion rate for the control group. The big difference arose in those subjects with undiagnosed celiac disease, who showed a response rate of just below 26%, which was substantially lower than the control group and the treated celiac patients. The nine patients with active celiac disease who were not faithfully following a gluten-free diet showed a response rate of 44.4%. The thirty-seven subjects with celiac disease who had failed to respond to the vaccine were placed on a gluten-free diet and given a follow-up vaccine. One month later 36 of them (over 97%) showed a positive response to the vaccine. The team concluded that the positive response to the vaccine by celiac patients who were following a gluten-free diet, and the high resistance shown by subjects with undiagnosed celiac disease, and those not following a gluten-free diet, indicates that active celiac disease may play a major role in a failure to respond to the vaccine. The team recommends that newly diagnosed patients be checked for resistance to the HBV vaccine, and that those showing resistance be placed on a gluten-free diet before receiving a follow-up dose. They did not go so far as to suggest that those showing resistance to the HBV vaccine be screened for celiac disease, but that would not seem unreasonable, given their results. Pediatrics 2008; 121:e1570-e1576.
  10. Am J Gastroenterol. 2003 Oct;98(10):2289-92 Celiac.com 11/26/2003 - The results of a study conducted by Dr. Joseph Murray and colleagues at the Mayo Clinic in Rochester, Minnesota indicate that an unusually high number of those with celiac disease do not develop immunity from the hepatitis B vaccine. The team looked at 23 clinically diagnosed celiacs who had been given a full series of hepatitis B vaccines. Out of this group they identified 19 who had been tested for hepatitis B Vaccine response, and of the 19 tested, 13 subjects did not develop long-term immunity to the vaccine, which was determined by utilizing the negative qualitative or quantitative anti-HBs antibody titer. The researchers note a strong association in celiac disease with a particular HLA genotype of DQ2, which is also seen in nonresponders to the hepatitis B vaccine. Each of the subjects in the study was either homozygous or heterozygous for DQ2. The researchers postulate that a majority of celiacs may be non-responsive to the vaccine because they have "a failure of induction of humoral immune response needed for development of long term immunity." The researchers are still uncertain of the specific cause of the failed immune system response in those with celiac disease.