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Found 16 results

  1. Celiac.com 10/30/2013 - Rates of celiac disease and the use of drugs to inhibit the secretion of stomach acid have both increased in recent decades. A research team recently set out to explore the association between anti-secretory medication exposure and subsequent development of celiac disease. The research team included Benjamin Lebwohl, Stuart J. Spechler, Timothy C. Wang, Peter H.R. Green, and Jonas F. Ludvigsson. They are affiliated with the Celiac Disease Center at the Department of Medicine at Columbia University College of Physicians and Surgeons in New York, NY. For their population-based case control study, the research team looked at data for celiac disease patients diagnosed at any of the pathology departments in Sweden from July 2005 through February 2008. They matched each patient by age and gender with up to 5 control subjects. They found prior prescriptions for proton pump inhibitors and histamine-2 receptor antagonists in all subjects. Using conditional logistic regression to measure the association between these prescriptions and the subsequent diagnosis of celiac disease, they also found that patients with proton pump inhibitor prescriptions were much more likely to have celiac disease (OR 4.79; 95% CI 4.17–5.51). Patients prescribed both proton pump inhibitors and histamine-2 receptor antagonists had an even higher risk for celiac disease (OR 5.96; 95% CI 3.58–9.91) than those who received proton pump inhibitors alone (OR 4.91; 95% CI 4.26–5.66) or histamine-2 receptor antagonists alone (OR 4.16; 95% CI 2.89–5.99). The data clearly show that patients who use anti-secretory medications are at much greater risk for developing celiac disease following the use of these medicines. The fact that this connection persisted even after the team excluded prescriptions for anti-secretory medicines in the year preceding the celiac disease diagnosis suggests a causal relationship. Source: Digestive and Liver Disease
  2. Celiac.com 11/23/2015 - A new study looks at the impacts of introducing gluten to infants and the development of celiac disease. A research team recently set out to assess the evidence regarding the effect of time of gluten introduction and breastfeeding on the risk of developing celiac disease. The research team included MI Pinto-Sánchez, EF Verdu, E Liu, P Bercik, PH Green, JA Murray, S Guandalini, and P Moayyedi. Their team conducted a comprehensive review of studies from the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (Ovid); EMBASE (Ovid); and System for Information on Grey Literature in Europe (SIGLE). Two independent authors collected the data. Their analysis included randomized controlled trials and observational studies that assessed proper timing for introducing gluten to the infant diet, appropriate quantity of gluten consumption at weaning, and the effect of breastfeeding on celiac disease risk. Out of a total of 1982 studies they identified, 15 matched their criteria for data extraction. The team performed a meta-analysis on 2 randomized controlled trials, 10 cohort studies, and 1 case-control study. That analysis showed a 25% increase in celiac disease risk with gluten-introduction after 6 months, compared to the recommended 4 to 6 months (risk ratio [RR], 1.25; 95% CI, 1.08-1.45). There was no difference between breastfeeding vs no breastfeeding on celiac disease risk (OR, 0.55; 95% CI, 0.28-1.10), with substantial heterogeneity (I2 = 92%) among studies. There is currently no evidence to support that early introduction of gluten to the infant diet increases the risk of celiac disease. However, introduction of gluten after six months of age might promote an increased risk of celiac disease. More studies are needed that control for potential confounders and that evaluate environmental factors in low-risk families. Source: J Pediatr. 2015 Oct 20. pii: S0022-3476(15)01045-8. doi: 10.1016/j.jpeds.2015.09.032.
  3. Celiac.com 01/29/2018 - Researchers suspect that certain environmental factors, including infectious agents, might play a role in making celiac disease more prevalent and more widespread. Researchers in the USA and Sweden studying regional variation in the frequency of celiac disease have found similarities in the geographic distribution of Lyme disease, an emerging multisystemic infection caused by Borrelia burgdorferi spirochete, which invites questions about a possible connection with celiac disease. One research team recently set out to determine if infection with Borrelia contributes to an increased risk of celiac disease. The research team included Armin Alaedini, Benjamin Lebwohl, Gary P. Wormser, Peter H. Green, and Jonas F. Ludvigsson. They are variously affiliated with the Department of Medicine, Columbia University Medical Center, New York, NY USA; the Celiac Disease Center, Columbia University Medical Center, New York, NY USA; the Institute of Human Nutrition, Columbia University Medical Center, New York, NY USA; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, NY USA; the Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; and with the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK. Using biopsy reports, the team identified 15,769 individuals with celiac disease. By linking to the nationwide Patient Register, they were able to compare the rate of earlier occurrence of Lyme disease in the patients with celiac disease to that in 78,331 matched controls. To further assess the temporal relationship between Borrelia infection and celiac disease, they also examined the risk of subsequent Lyme disease in patients with a diagnosis of celiac disease. The team found that twenty-five patients with celiac disease had a prior diagnosis of Lyme disease (0.16%), whereas 79 had a subsequent diagnosis of Lyme disease (0.5%). This showed a modest association between Lyme disease and celiac disease was seen both before and after celiac diagnosis, with celiac risk being highest in the first year of follow-up. So, only a small portion of the celiac disease patients had a prior diagnosis for Lyme disease. The research team asserts that the supposed association between Lyme disease and celiac disease, both before and after the diagnosis of celiac disease, is likely driven by surveillance bias, at least in part. These data show that patients with Borrelia infection do not face a substantially higher risk for developing celiac disease. Source: BMC Med. 2017; 15: 169. doi: 10.1186/s12916-017-0926-1. PMCID: PMC5599869
  4. Celiac.com 09/18/2017 - Many researchers feel that the rising number of celiac disease cases supports the idea that common infections prior to the onset of autoimmune diseases could play a role in triggering the immune response. Do more respiratory infections in childhood mean a greater likelihood of celiac disease later in life? To answer that question, a team of researchers recently set out to explore the relationship between early clinical events and the development of celiac disease in genetically predisposed infants. The research team included Renata Auricchio, Donatella Cielo, Renato de Falco, Martina Galatola, Valentina Bruno, Basilio Malamisura, Maria Giovanna Limongelli, Riccardo Troncone, Luigi Greco. They are variously affiliated with the Department of Translational Medical Science, and the European Laboratory for the Investigation of Food Induced Diseases, University of Naples Federico II, Naples, Italy; the Department of Pediatrics, University Hospital of Salerno, Salerno, Italy; and Azienda Ospedaliera Gaetano Rummo Via dell'Angelo, Benevento, Italy. The team studied 373 newborns from families with at least 1 relative with celiac disease. They tested participants for human leukocyte antigen DQ2- or DQ8- and followed-up positive infants with clinical and serological assessments. They used cross tabulation and odds ratios to explore the risk associated with single variables, and logistic regression analysis was performed to determine the variables that contributed to the risk of developing celiac disease. They also used stepwise discriminant analysis to determine which variables could distinguish case patients from controls before diagnosis. The overall rate of celiac disease in this group was 6% at 3 years and 13.5% at 5 years of age, while a total of 34 children, developed celiac disease before the sixth year of life, a rate of 14%. According to analysis of adverse events, people with celiac disease shoed a higher frequency of respiratory tract infections in their first 24 months of life. In a stepwise discriminant analysis, which included sex and human leukocyte antigen risk class, only respiratory infections in the second and first years of life significantly contributed to discrimination of case patients versus controls. The team's analysis showed that the frequency of respiratory infections in the first 2 years of life can be used to identify children who later developed celiac disease. Kids with more infections were much more likely to develop celiac disease later on. Clinicians may use this information during diagnosis to help zero in on patients likely to have celiac disease. Source: Pediatrics, September 2017
  5. Celiac.com 05/02/2016 - Even with endoscopies, physicians can still miss some cases of celiac disease. A team of researchers recently set out to determine if I-Scan, or virtual chromo-endoscopy, could improve sensitivity of endoscopy to detect markers of villous atrophy in patients with celiac disease. The research team included Hugo A. Penny, Peter D. Mooney, Mitchell Burden, Nisha Patel, Alexander J. Johnston, Simon H. Wong, Julian Teare, and David S. Sanders. They are variously affiliated with Royal Hallamshire Hospital in Sheffield, UK, and with St Mary's Hospital in London, UK. For their study, the team assessed patients from two UK hospitals in 3 groups. For Group 1, they used standard high definition, white light endoscopy (WLE). For Group 2, they used WLE plus I-Scan. For Group 3, they used a non-high definition control group. They recruited an initial group of 758 patients. That group was 62% female, with an average age of 52. They recorded the presence of endoscopic markers, and took at least 4 duodenal biopsies from all patients. They also made concurrent blood tests, and compared observations with patient histology. The patient breakdown was as follows: Group 1: 230; Group 2: 228; Group 3: 300. The team made 135 new diagnoses of celiac disease, with 21 cases in Group 1, 24 in Group 2, and 89 in Group 3. The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 at 85.7% and Group 2 at 75%, compared to non-high definition controls at 41.6%. There was no significant difference between high definition only and I-Scan groups. In non-high definition endoscopy, they found that missed diagnosis was mainly due to lesser degrees of villous atrophy (p = 0.019) and low tTG titre (p = 0.007). From their data, the team concluded that high definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy. Source: Digestive and Liver Disease.
  6. Celiac.com 08/27/2014 - Can antibiotic exposure in pregnancy increase the risk of celiac disease in children? Some researchers suspect that infant microbiota play a pathogenic role in celiac disease. The idea that antibiotic treatment in pregnancy could significantly impact the infant microbiota, and thus influence the development of celiac disease, has led many to ponder the possible connection. To get a clearer picture, a research team recently set out to study the effects on offspring of antibiotic exposure in pregnancy. The team included Karl Mårild, Johnny Ludvigsson, Yolanda Sanz, and Jonas F. Ludvigsson. They are variously affiliated with the Deptartment of Medical Epidemiology and Biostatistics, Karolinska Institutet in Stockholm, the Astrid Lindgren Children's Hospital at Karolinska University Hospital in Solna, Sweden, the Division of Paediatrics in the Department of Clinical and Experimental Medicine at Linköping University, Östergötland County Council in Linköping, Sweden, the Department of Paediatrics of Örebro University Hospital in Örebro, Sweden, and the Microbial Ecology and Nutrition Research Group at the Institute of Agrochemistry and Food Technology of the National Research Council (IATA-CSIC) in Valencia, Spain. The team started by reviewing existing data on antibiotic exposure in pregnancy in 8,729 children recorded in the All Babies in Southeast Sweden (ABIS) cohort study. Through December 2006, 46 of the 8,729 had developed celiac disease. The team then used Cox regression to estimate celiac disease hazard ratios (HRs) in children whose mothers received antibiotics during pregnancy. The ratios were adjusted based on parent-reported diary data on breastfeeding, age at gluten introduction, and the number of infections in the child's first year of life. Of the 1,836 children exposed to antibiotics during pregnancy, 12 (0.7%) children developed celiac disease as compared with 34/6893 (0.5%) unexposed children (HR = 1.33; 95% CI = 0.69–2.56). Risk estimates remained unchanged after adjustment for breastfeeding, age at gluten introduction and infection load in the child's first year of life (HR = 1.28; 95% CI = 0.66–2.48). When all the data were factored, the team found no statistically significant connection between antibiotic exposure during pregnancy and celiac disease in offspring. The team suggests that this data may present an accurate picture, or it may be that they simply lack the statistical power to make a clear connection. Further studies are likely needed before researchers can confidently conclude that there is no connection between antibiotic exposure in pregnancy and celiac disease in offspring. Source: BMC Gastroenterol. 2014;14(75)
  7. Celiac.com 07/10/2013 - Some doctors and nutritionists have expressed concern that a gluten-free diet might increase the risk of cardiovascular problems in patients with celiac disease. To get closer to an answer for this question, a team of researchers set out to assess changes of multiple cardiovascular risk factors in celiac patients evaluated before and during a gluten-free diet. The research team included B. Zanini, E. Mazzoncini, F. Lanzarotto, C. Ricci, B.M. Cesana, V. Villanacci, and A. Lanzini of the Gastroenterology Unit at the University and Spedali Civili in Brescia, Italy. For their study, the researchers undertook a retrospective analysis of the effects of 1-5 years of gluten-free diet on indicators of cardiovascular risk and on distribution in cardiovascular risk categories in 715 celiac patients. Compared to baseline, those following a gluten-free diet showed significantly higher body mass index (21.4±3.4 vs. 22.5±3.5; p While on the gluten-free diet, they also showed significantly lower levels in serum triglycerides (87.9±49.5 vs. 80.2±42.8mg/dL; p Interestingly, the gluten-free diet patients that the team categorized as falling into "lowest cardiovascular risk profile" fell from 58% at baseline to 47% during gluten-free diet, which may indicate some adverse effect of a gluten-free diet. However, their final takeaway was that a gluten-free diet causes substantial changes to cardiovascular risk factors in celiac patients, but does not consistently point to worse or better risk profiles overall, which suggests that the diet is unlikely to contribute to the development of atheromatous plaques, or "hardening" in the walls of the arteries. So, the short of it is that eating a gluten-free diet doesn't appear to create any added heart disease risk for people with celiac disease. Source: Dig Liver Dis. 2013 May 17. pii: S1590-8658(13)00147-3. doi: 10.1016/j.dld.2013.04.001.
  8. Celiac.com 02/20/2013 - Scientific evidence indicates that the risk of developing celiac disease cannot be explained solely by genetic factors. There is some evidence to support the idea that the season in which a child is born can influence the risk for developing celiac disease. It is known that babies born in summer months are likely to be weaned and introduced to gluten during winter, when viral infections are more frequent. A number of studies indicate that early viral infections can increase risk levels for celiac disease, however, earlier studies on birth season and celiac disease have been small, and their results have been contradictory. To better answer the question, a research team recently set out to conduct a more thorough study of the relationship between birth month and celiac disease. The research team included B. Lebwohl, P.H. Green, J.A. Murray, and J.F. Ludvigsson. The study was conducted through the Department of Paediatrics at Örebro University Hospital in Örebro, Sweden. To conduct the study, the team used biopsy reports from all 28 Swedish pathology departments to identify individuals with celiac disease, which they defined as small intestinal villous atrophy (n=29 096). Using the government agency Statistics Sweden the team identified 144,522 control subjects, who they matched for gender, age, calendar year and county. The team then used conditional logistic regression to examined the association between summer birth (March-August) and later celiac disease diagnosis (outcome measure). They found that 54.10% of people with celiac disease were born in the summer months compared with 52.75% of control subjects. So, being born in the summer is associated with a slightly higher risk of later celiac disease (OR 1.06; 95% CI 1.03 to 1.08; p). While summer birth was not associated with a higher rates of celiac diagnosis in later childhood (age 2-18 years: OR 1.02; 95% CI 0.97 to 1.08), it did show a slightly higher risk of developing celiac disease in adulthood (age ≥18 years: OR 1.04; 95% CI 1.01 to 1.07). In this study, the data show that people born during the summer months had a slightly higher risk of developing celiac disease, but that excess risk was small, and general infectious disease exposure early in life were not likely to increase that risk. Source: Arch Dis Child. 2013 Jan;98(1):48-51. doi: 10.1136/archdischild-2012-302360.
  9. Pediatrics 2001;108:e89 Celiac.com 01/14/2002 - According to a report in the electronic version of Pediatrics for November 2001, Osteopenia is often found in children with untreated celiac disease. A strict gluten-free diet will promote an increase in bone mineral density (BMD) values, but even after a year of treatment they may not return to normal. In their study, Dr. Ayhan Gazi Kalayci, of Ondokuz Mayia University, Samsun, Turkey, and colleagues evaluated 32 children with celiac disease and 82 healthy control subjects. The patients were separated into two groups of 16, one that consisted of patients who had been recently diagnosed (within the average of 3.2 years), and the other which consisted of patients who had followed a strict gluten-free diet for 19 to 84 months. Results: Patients with recently diagnosed celiac disease had significantly lower BMD and bone mineral content levels than control subjects, and the BMD levels increased significantly after one year on a gluten-free diet. According to Dr. Kalayci, more follow-up studies will be needed to determine whether re-mineralization will continue in the subjects, and a complete recovery of bone mass can be achieved.
  10. Celiac.com 01/17/2011 - Women with latent celiac disease, those who test positive for celiac antibodies but show normal small bowel biopsies, may develop more reproductive problems, according to a report by Indian published in the World Journal of Gastroenterology. "Women having unexplained infertility, recurrent abortions, stillbirths or intrauterine growth retardation could have subclinical celiac disease, which can be detected by serological screening tests," Dr. Ashok Kumar told Reuters Health by email. Improved diagnostic tools, and greater access to screening have led to greater meant more latent or subclinical celiac disease, says Dr. Kumar, of Maulana Azad Medical College & Lok Nayak Hospital in New Delhi. Doctors know that women with full, biopsy-proven, untreated celiac disease have more reproductive problems if they don't follow a gluten-free diet. Until now, there have been "very few studies regarding the effect of latent celiac disease on reproductive performance; the association has never before been investigated in India," say the authors. To study the effect of latent celiac disease on reproductive performance, the researchers examined 893 women. They found that a total of 104 women had undergone idiopathic recurrent abortion, 104 had unexplained stillbirth, 230 had unexplained infertility, and 150 were pregnant, but showed idiopathic intrauterine growth restriction. The remaining 305 women, with normal obstetric histories, and served as control subjects. Based on IgA tTG antibody titers, latent celiac disease was 5.43 times more common in the group with recurrent spontaneous abortion than in the control group. Rates of latent celiac disease for the group with stillbirth were 4.61 times greater than the control group. Rates for the group with intrauterine growth restriction were 7.75 times greater than control subjects, while rates for those with unexplained infertility were 4.51 higher. The researchers also found that women with positive blood screens showed higher rates of previous early births, low-weight births, and cesarean sections than did seronegative subjects. Not every study shows a clear reduction in fertility, the researchers admit, but a number do show a higher risk of adverse pregnancy outcomes for women with latent celiac disease. Spotting the celiac disease and treating it with a gluten free diet may reduce these associated risks. Moreover, the researchers note that "the classic presentation of diarrhea and malabsorption is now less common, and atypical and silent presentations are increasing." As a result of their findings, Dr. Kumar and his colleagues are recommending celiac disease blood screens for women with idiopathic cases of poor reproductive performance. Source: World J Gastroenterol. 2010 Dec 14;16(46):5810-4
  11. Lancet 2001; 358: 356-61 Celiac.com 08/10/2001 - In line with past studies on the mortality rate of people with celiac disease, the results of a new study conducted by Dr. Giovanni Corrao (Cattedra di Statistica Medica, Università di Milano-Bicocca, 20126 Milano, Italy), et. al., indicate that the death rate among people with celiac disease is double that of the normal population. The prospective cohort study examined 1,072 adults who were diagnosed with celiac disease between 1962 and 1994, and their 3,384 first-degree relatives. The mortality rates by 1998 among both groups were compared to that of the normal population. Their findings show that 53 people in the celiac disease group died compared with the 25.9 deaths that were expected (Standardized Mortality Ratio - SMR). Unlike past studies, however, this one also looked for different patterns of clinical presentation of the disease. For example, the results indicate that within three years of diagnosis there was a significant increase in the mortality rate for those who presented symptoms of malabsorption. This same increase was not seen in those who were originally diagnosed because of minor symptoms, or via an antibody screening. The SMR also increased when there was a delay in diagnosis, and when a gluten-free diet was not followed. Non-Hodgkin lymphoma was the main cause of death, and no excess in mortality rate was seen in the groups first-degree relatives. Conclusion: Prompt diagnosis and dietary treatment will decrease the mortality rate of people with celiac disease. More studies are needed regarding asymptomatic people with celiac disease and their risk of intestinal lymphoma.
  12. Celiac.com 11/16/2011 - Researchers still don't know very much about the natural history of celiac disease and whether it may increase or decrease in prevalence over time. A research team recently set out to determine whether loss of tolerance to gluten may develop at any age, to investigate possible long-term changes in celiac disease prevalence, and to better understand other celiac-related issues. The research team consisted of C. Catassi, D. Kryszak, B. Bhatti, C. Sturgeon, K. Helzlsouer, S. L. Clipp, D. Gelfond, E. Puppa, A. Sferruzza, A. Fasano. They are affiliated with the Center for Celiac Research and Mucosal Biology Research Center at the University of Maryland School of Medicine in Baltimore. The team analyzed 3,511 subjects with matched samples from 1974 (CLUE I) and 1989 (CLUE II). For their study, the team chose and followed 3,511 subjects from two large groups of more than 20,000 Americans aged 13-80 in 1974 and 1989. To see if there was an observable change in rates of celiac disease among the subjects over time, they took blood samples in 1974 and again 15 years later in 1989. They gave follow-up questionnaires to the subjects every 2 or 3 years from 1996 to 2007 to compile health status updates on the participants. Researchers conducted antibody testing on the blood samples. These tests showed just seven subjects with antibodies specific to celiac disease in 1974, for a disease rate of 1 in 501 subjects. By 1989, nine more samples showed markers for celiac disease, for a rate of 1 in 219 subjects; more than double the 1974 rate. The study also looked at another 804 samples from subjects who died after the 1974 survey and found two more likely cases of celiac disease. To counter any selection bias regarding survival, the team also assessed 840 CLUE I participants who died after the 1974 survey. Since the individuals who provided the original samples did not undergo biopsy, and thus cases of celiac disease remain unconfirmed. Also, the study sample was not nationally representative by age, race, and gender, which may also have impacted the findings. The researchers state that this increase may be partly due to increased awareness of the disease. Still, many cases continue to go undiagnosed. In fact, only 11% of the study subjects who had celiac disease-specific antibodies in both the 1974 and 1989 surveys had actually been clinically diagnosed with the disease by their doctors. Also, the study found two subjects in their 50s who tested negative in 1974, but positive in 1989, when in their 60s. This indicates that the disease can strike at any age. This finding is supported by a study from Finland that found that celiac disease was more common among the elderly. Source: Ann Med. 2010 Oct;42(7):530-8.
  13. Celiac.com 04/22/2009 - Not many studies have looked at prevalence and long-term outcome of undiagnosed celiac disease, and so not much is known about this aspect of the disease. Recently, a team of Mayo Clinic researchers conducted an assessment of the long-term outcome of undiagnosed celiac disease, and whether the prevalence of undiagnosed celiac disease has changed during the past 50 years. The research team was made up of Alberto Rubio-Tapia, MD; Robert A. Kyle, MD; Edward L. Kaplan, MD; Dwight R. Johnson, MD; William Page, PhD; Frederick Erdtmann, MD, MPH; Tricia L. Brantner, MD; W. Ray Kim, MD, Tara K. Phelps, MS; Brian D. Lahr, MS; Alan R. Zinsmeister, PhD; L. Joseph Melton III, MD; and Joseph A. Murray, MD. For the study the team looked at blood samples taken from 9,133 healthy young adults at Warren Air Force Base between 1948 and 1954, along with samples from 12,768 sex-matched subjects from 2 recent cohorts from Olmsted County, Minnesota. Subjects from the Minnesota cohorts were matched for date of birth (n=5,558) or age at sampling (n=7,210) with the Air Force study. The research team tested the blood samples for tissue transglutaminase and, if abnormally high, for endomysial antibodies. They charted survival rates in a 45 year follow-up period in the Air Force and compared rates of undiagnosed celiac between the Air Force data and the recent cohorts. Of 9,133 Air Force subjects, 14 had undiagnosed celiac disease--a rate of 0.2%. In that cohort, persons with undiagnosed celiac disease had higher mortality rates across the board than those who had tested negative (hazard ratio=3.9; 95% CI, 2.0-7.5; P <.001). In the case of the Minnesota cohorts, the team found undiagnosed celiac disease in 68 persons with similar age at sampling (0.9%), and 46 persons with similar years of birth (0.8%). These recent cohorts showed rates of undiagnosed celiac disease that were 4.5-times and 4-times greater than the Air Force cohort (both P=.0001). The research team found that data from the 45 year of follow-up of Air Force subjects showed that people with undiagnosed celiac disease have a 400% higher risk of death than seronegative subjects ("non-celiacs"). They also concluded that rates of undiagnosed celiac disease seem have increased dramatically in the United States over the last 50 years. Gastroenterology - 13 April 2009 (10.1053/j.gastro.2009.03.059).
  14. Celiac.com 09/28/2007 - Celiac disease is one of the most common lifelong disorders in western countries. However, most cases in North America remain currently undiagnosed, mostly because they present unusual symptoms and because of the low number of doctors who have a sound awareness of celiac disease. In a large European survey, the ratio between diagnosed and undiagnosed cases, found by mass serological screening, was as high as 1 to 7 , an effect termed the ‘celiac iceberg’. In addition to having chronic symptoms that might otherwise respond to a gluten-free diet, undiagnosed patients are exposed to the risk of long-term complications of celiac disease, such as anemia, infertility, osteoporosis, or cancer, particularly an intestinal lymphoma. Celiac Disease is diagnosed by confirming the presence of intestinal damage to the small intestine through a biopsy, along with a clinical response to the gluten-free diet. However, serological markers, e.g., the IgA class anti-tissue transglutaminase (tTG) antibodies, are useful screening tests. The sensitivity and the specificity of the IgA anti-tTG test are 94% and 97%, respectively. To address the large number of undiagnosed cases, a team of researchers recently set out to assess whether an active case-finding strategy in primary care could lead to increased frequency of celiac disease diagnosis, and to assess the most common clinical manifestations of the condition. The team was made up of Carlo Catassi, M.D., M.P.H.; Deborah Kryszak, B.S.; Otto Louis-Jacques, M.D.; Donald R. Duerksen, M.D.; Ivor Hill, M.D.; Sheila E. Crowe, M.D.; Andrew R. Brown, M.D.; Nicholas J. Procaccini, M.D.; Brigid A Wonderly, R.N.; Paul Hartley, M.D.; James Moreci, M.D.; Nathan Bennett, M.D.; Karoly Horvath, M.D., Ph.D.; Margaret Burk, R.N.; Alessio Fasano, M.D. 737 women and 239 men, with a median age of 54.3 years, who attended one of the practices participated in a multi-center, prospective study involving adult subjects during the years 2002-2004. All individuals with celiac-associated symptoms or conditions were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies. Those with elevated anti-tTG were then tested for IgA antiendomysial antibodies (EMA). All who were positive for EMA were advised to undergo an intestinal biopsy and HLA typing. 30 out of 976 study subjects showed a positive anti-tTG test (3.07%, 95% CI 1.98-4.16). 22 patients,18 women, 4 men, were diagnosed with celiac disease. In these 22 cases the most common reasons for screening for celiac disease was: bloating (12/22), thyroid disease (11/22), irritable bowel syndrome (7/22), unexplained chronic diarrhea (6/22), chronic fatigue (5/22), and constipation (4/22). The prevalence of celiac disease in the serologically screened sample was 2.25% (95% CI 1.32-3.18). The diagnostic rate was low at baseline (0.27 cases per thousand visits, 95% CI 0.13-0.41) and rose sharply to 11.6 per thousand visits (95% CI 6.8-16.4, P This study shows that the diagnosis rate for celiac disease can be significantly increased through the implementation of a strategy of active case-finding. Am J Gastroenterol. 2007;102(7):1454-1460.
  15. Celiac.com 04/23/2007 - A recent study published in the American Journal of Gastroenterology suggests that individuals afflicted with celiac disease in childhood suffer long-term mortality rates that are three times higher than those of the general population The study set out to determine the most common celiac symptoms faced by clinicians, and to determine how effective an active case-finding strategy might be in raising the levels of diagnosis. Researchers led by Dr. Masoud Solaymani-Dodaran of Queens Medical Centre, Nottingham, UK, compared differences in long-term mortality in celiac patients diagnosed as children or adults against long-term mortality rates for the general population. The results showed that standardized mortality ratios for celiac patients more than 5 years after childhood diagnosis were 3.32, while ratios for those diagnosed as adults were 1.38. Deaths from accidents, suicide, and violence, malignancies, and cerebrovascular diseases largely accounted for the elevated mortality risk among celiacs diagnosed as children. For those diagnosed as adults, excess mortality rates were largely due to malignant neoplasms. Researchers said that nature of, and the increase in, mortality rates suffered by children with celiac was both largely unexpected, and surprising, when compared to those of adults. Noting that celiacs diagnosed as adults faced only a "reassuringly small increase" in long-term mortality rates; rates that are approximately half of those of patients with Crohn's disease, for example. They contrasted the adult rates to the markedly higher mortality rates faced by celiacs diagnosed as children, which, they said was "difficult to attribute directly to the disease itself." They concluded that even though the increased risk of mortality for faced by celiacs diagnosed as children was small overall, the excess of deaths from accidents, suicides, and violence, were, nonetheless, a "cause for concern." American Journal of Gastroenterology. April, 2007; 102:864-870
  16. Dig Dis Sci. 2004 Apr;49(4):546-50 Celiac.com 08/27/2004 – Dr. Peter Green and colleagues at the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, conducted a study designed to determine the sensitivity of the various serological tests used to diagnose celiac disease. To do this they looked at 115 adults with biopsy-proven celiac disease who fulfilled strict criteria which included serological testing at the time of their diagnosis, and a positive response to a gluten-free diet. Out of those studied, 71% had total villous atrophy, and 29% had partial villous atrophy. Serological results indicated that only 77% of those with total and 33% of those with partial villous atrophy actually tested positive for celiac disease, and it did not matter whether the patients presented with classical or silent symptoms. All patients who were positive for anti-tissue transglutaminase had total villous atrophy. The researchers conclude: Seronegative celiac disease occurs. Endomysial antibody positivity correlates with more severe villous atrophy and not mode of presentation of celiac disease. Serologic tests, in clinical practice, lack the sensitivity reported in the literature.
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