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Latent Celiac Disease Can Increase Reproductive Problems
Jefferson Adams posted an article in Fertility, Pregnancy, Miscarriage and Celiac Disease
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 -
Low Risk of Gastrointestinal Cancer Among Patients with Celiac Disease, Inflammation, or Latent Celiac Disease
Jefferson Adams posted an article in Cancer, Lymphoma and Celiac Disease
Celiac.com 01/18/2012 - A number of small studies have shown a connection between celiac disease and various gastrointestinal (GI) cancers, but the results haven't been corroborated by larger studies, or by blood and biopsy analysis of large populations. That means that researchers just haven't been able to say with certainty what the results of those smaller studies might mean about cancer risks for the larger population. Recently, a clinical team set out to assess GI cancer risks for a larger population. The study team included Peter Elfström, Fredrik Granath, Weimin Ye, and Jonas F. Ludvigsson. They assessed risk GI cancers by using data from large groups of patients with either celiac disease, inflammation, or latent celiac disease. They assessed data from 28,882 patients with celiac disease, all with villous atrophy, and Marsh scores of 3. They also assessed data for 12,680 patients with inflammation, all with Marsh scores of 1–2. They evaluated biopsy samples at 28 different pathology centers. They assessed a third group of 3705 patients with latent celiac disease, that is, with normal mucosa, but positive blood tests. The team then compared the results against data from an age- and sex-matched population. They found that 372 of the patients with celiac disease developed incident GI cancers, while 347 patients with inflammation, and 38 with latent celiac disease developed GI cancers. That means that the first year after diagnosis and initial biopsy, celiac disease carried a 5.95-times greater risk of incident GI cancer, with a 95% confidence interval [CI], 4.64–7.64). The hazard ratio for inflammation was 9.13 (95% CI, 7.19–11.6) and for latent celiac disease was 8.10 (95% CI, 4.69–14.0). After the first year, patients showed no significant increase in GI cancer risk. The HR for celiac disease was 1.07 (95% CI, 0.93–1.23), for inflammation it was 1.16 (95% CI, 0.98–1.37). HR for latent celiac disease it was 0.96 (95% CI, 0.56–1.66). The absolute risk for any GI cancer in people with celiac disease was 101/100,000 person-years, with an excess risk of 2/100,000 person-years. The results carried some relatively good news. That is, even though celiac disease, inflammation, and latent disease all increase a person's risk for GI cancers in the first year after diagnosis, there is no increase in risk beyond the first year. Source: Clinical Gastroenterology and Hepatology. Volume 10, Issue 1 , Pages 30-36, January 2012 -
Latent Celiac Disease Afflicts Many Who Tolerate Gluten
Jefferson Adams posted an article in Celiac Disease & Gluten Intolerance Research
Celiac.com 11/08/2007 - A team of doctors led by Christophe Cellier from the Hopital European Georges Pompidou in Paris examined a group people who were diagnosed with celiac disease as children and who tolerated the introduction of gluten into their diets, and continued to consume gluten into their adult years. A total of 61 patients were evaluated with a bowel biopsy. 13 of the subjects exhibited no indications of the disease, a condition known as latent celiac disease. 48 of the patients without symptoms showed celiac-related intestinal damage, a condition known as silent celiac disease. The study team observed that a similar ratio of patients with both latent celiac and silent celiac disease exhibited minor symptoms of celiac disease. Both patients with symptoms and those without symptoms had similar indications of malabsorption and similar body mass idices. Loss of bone density was more common in those with silent celiac disease than in those with latent celiac disease. Patients with silent celiac disease more regularly showed elevated levels of celiac-positive antibodies. As far as clinical symptoms of celiac disease, such as blood and antibody tests, the two groups showed no major differences. The researchers concluded that even with no symptoms, most people diagnosed with celiac disease as children go on to develop active celiac disease as adults. Such patients should undergo screening for villous atrophy, and osteopenia, and should be encouraged to resume their gluten-free diet in the event that villous atrophy is detected. Colleagues at Finland’s University of Tampere go so far as to say that even patients with latent celiac disease should follow a strict gluten-free diet. They feel that villous atrophy is only a small part of the equation, and a sign of well-advanced celiac, and that the use of mucosal damage as a standard for diagnosing celiac disease is incomplete and can lead to missed diagnosis and otherwise preventable damage. Gut 2007; 56: 1379-1386, 1339-1340 -
Better Methods for Diagnosing People with Latent Celiac Disease
Scott Adams posted an article in Celiac Disease & Gluten Intolerance Research
Troncone R, Greco L, Mayer M, Mazzarella G, et. al. Gastroenterology, 1996; 111: 318-324 The final paragraph says: In conclusion, our data show that approximately half of the siblings of patients with celiac disease show signs of sensitization to gluten as they mount an inflammatory local response to rectal gluten challenge. The genetic background and the clinical meaning of such gluten sensitivity need to be established. Further studies, particularly at the jejunal level, are necessary before deciding if any action is to be taken in this subset of first-degree relatives.