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Vanessa Maltin Weisbrod posted an article in Autumn 2012 IssueCeliac.com 11/11/2017 - (NOTE: This article is from 2012 and is being made available as Celiac.com rolls our past issues of Journal of Gluten Sensitivity) It's just like being a little kid with a super sore throat and your mom taking you to the doctor to get a test for strep throat. The doctor swabs your throat with two sticks to find out what nasty bacteria is camping out. In just moments you've got a diagnosis of strep throat and can start antibiotics to miraculously make the pain go away. You go home with a prescription, get in bed and eat mom's homemade chicken rice soup until you feel better in a couple of days. How cool would it be if getting diagnosed with celiac disease was this easy? The wonderful news is that we're getting closer to having a test that will diagnose celiac disease with just a simple prick of a finger and a 10-minute wait. The CeliacSure Test Kit measures (anti-tTG) IGA antibodies from a fingertip blood sample. It works by taking a small drop of blood, mixing it with a buffer and applying the mixture onto a test cartridge. Within moments two red lines appear if the test is positive, while only one line appears if the result is negative. And, you can take the test at home without ever getting out of your pajamas! "The test kit is a point-of-care, at-home test that's very similar to reading results of a pregnancy test," said Dr. Daniel Leffler of the Celiac Disease Center at Beth Israel Deaconess Medical Center in Boston. Dr. Leffler, a gastroenterologist by training with a background in nutrition, has a long-standing interest in celiac disease. Several years ago he teamed up with Dr. Ciaran Kelly and Dietitian Melinda Dennis to found the Celiac Disease Center at Beth Israel Deaconess Medical Center where they focus not only on providing top notch patient care, but also on high level disease research. The latest project: studying the efficacy of the CeliacSure test for celiac disease diagnosis. Dr. Leffler said his team got involved with the finger prick test study because they feel it's important to take down barriers to patients getting diagnosed with celiac disease. "We do a lot with educating other medical providers about offering in-clinic testing, but I think it's really important to put a tool in the hands of the people." "We've teamed up with the [marketers] of the test kit at GlutenPro/Biocard CeliacSure Test to see how effective this test is in the USA. We're providing 2 kits per family to use on first-degree relatives of people with celiac disease. To qualify, participants in the study must not be on a gluten-free diet. We send them the test kit to take as well as a survey about their ability to use and understand the test. The goal is that this small study comes out favorable [sic] so we can move on to large scale studies that will compare the finger prick test to the gold standard laboratory serology testing." Dr. Leffler says he's really excited about the potential of this point-of-care test because it will "allow us to reach a population that might not otherwise come in to get tested, mainly first degree relatives of patients already diagnosed with celiac disease." It's important to note that right now the CeliacSure test is only for research purposes, not actual diagnosis. It is available in Canada and other countries, but it's still under evaluation here in the United States. And, while the strep throat analogy is a great way to think about how this test will work, it's extremely important to understand that if you get a positive result with the CeliacSure test, do not start a gluten-free diet until you have followed up with a doctor to confirm the diagnosis. As with all medical studies there's some fine print you need to know about. Participants in the study must meet all of the following criteria: 1. Over the age of 18 2. A first or second degree relative with celiac disease 3. Not previously diagnosed with celiac disease 4. Not on a gluten-free diet or low-gluten diet within the past 3 months 5. Able and willing to self administer the test, complete a short survey form and return both in the envelope provided 6. Willingness to have follow up medical evaluation in the event of a positive test 7. A resident of the United States Listen to a full interview with Dr. Leffler about the CeliacSure study on the Hold the Gluten Podcast (http://traffic.libsyn.com/holdthegluten/050_HoldTheGluten-05Apr2012.mp3) with Vanessa Maltin Weisbrod and Maureen Stanley now! And, if you would like to participate in the study, please contact Dr. Toufic Kabbani at email@example.com or by phone at 617-667-0528.
Celiac.com 01/04/2017 - A team of researchers recently set out to investigate the impact of celiac disease diagnosis on anthropometric measures at late adolescence, and to assess trends in the prevalence of diagnosed celiac disease over time. The research team included Amit Assa, Yael Frenkel-Nir, Ya'ara Leibovici-Weissman, Dorit Tzur, Arnon Afek, Lior H Katz, Zohar Levi, and Raanan Shamir. They are variously affiliated with the Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petach Tikva, Israel, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, the Medical Corps of the Israel Defense Forces, Ramat-Gan, Israel, the Institute of Gastroenterology, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel, and with the Ministry of Health in Jerusalem, Israel. Around 17â€…years of age, most of the Israeli Jewish population undergoes a general health examination, before enlistment in the Defense Forces. Individual medical information, diagnoses, etc., are entered into a structured database. For their population based study, the research team reviewed the enlistment data base for celiac disease cases between the years 1988 and 2015. In all, the team reviewed the medical records of 2,001,353 individuals, focusing on body measurements and physical health at the age of 17â€…years. Overall, they found and assessed 10,566 cases of celiac disease (0.53%). Multivariable analysis showed that adolescent boys with celiac disease were leaner (Body Mass Index 21.2±3.7 vs 21.7±3.8, p=0.02), while girls with celiac disease were shorter (161.5±6â€…cm vs 162.1±6â€…cm, p=0.017) than the general population. The prevalence of diagnosed celiac disease increased from 0.5% to 1.1% in the last 20â€…years, mainly among females, who saw a rise of 0.64% vs 0.46% for males. Celiac disease rates were far lower in people of lower socioeconomic status, and those of African, Asian and former Soviet Union origin. However, the clinical relevance of the small differences suggests that when celiac disease is diagnosed during childhood, final weight and height are not severely impaired. The team's cohort supports an observed rise in celiac disease diagnoses in the last couple of decades. Source: Arch Dis Child doi:10.1136/archdischild-2016-311376
Jefferson Adams posted an article in Celiac Disease Diagnosis, Testing & TreatmentCeliac.com 12/08/2010 - A team of researchers recently compiled an overview of prevention measures and exploratory pharmacological treatments of celiac disease. Maud Pinier, Gregor Fuhrmann, Elena Verdu and Jean-Christophe Leroux comprised the research team. First, a bit of background. Human leukocyte antigens (HLAs) is the name scientists give to the major histocompatibility complex (MHC) in humans. HLAs are host to a group of genes that influence human immune system function. The HLA group of genes on chromosome 6 encodes cell-surface antigen-presenting proteins, along with numerous other genes. The proteins encoded by certain genes are also known as antigens. The major HLA antigens are key components of immune function. HLA DP,DM, DOA,DOB,DQ, and DR present antigens from outside of the cell to T-lymphocytes. Celiac disease is common worldwide, and 90–95% of people with celiac disease exhibit HLA-DQ2 molecules and the rest exhibit HLA-DQ8. Celiac disease affects about 1 in 100 individuals in the general population, but recent studies show a substantial increase in American and Finnish populations in the recent years. This rise in celiac disease rates cannot be explained by better screening methods, and other factors have been suggested including environmental factors such as breast-feeding, time of gluten introduction, and infections. Celiac disease patients can present a wide variety of pathological and clinical symptoms, ranging from severe to subtle, and the clinical expression is not always indicated by the presence of intestinal atrophy. Classic celiac symptoms include diarrhea, abdominal bloating, and discomfort. However, numerous people with celiac disease go undiagnosed because their symptoms are not apparent, as in cases of silent celiac disease, or because their symptoms are atypical. Complications of celiac disease include refractory celiac disease, a rare, but complex disorder with severe and recurrent symptoms, in which patients remain unresponsive after at least 6 months on a strict gluten-free diet. It's rare for patients with non-responsive celiac disease to develop enteropathy-associated T-cell lymphoma, a complication of celiac disease that requires drug-based therapies. Only about 0.5–1/1.000.000 celiac patients develop this rare disorder. Other autoimmune disorders, such as autoimmune thyroiditis and type 1 diabetes, are also more common in people with celiac disease. Among siblings of children with type I diabetes, rates of celiac disease have been shown to correlate with the prevalence of celiac disease-associated HLA-DQB1 alleles. Moreover, the risk of celiac disease is significantly higher in children with type 1 diabetes who also carry the HLA-DQB1*02–DQA1*05 genotype. A recent genotyping study comparing 8,064 people with type 1 diabetes with 9,339 control subjects showed that patients with type 1 diabetes and celiac disease share seven common alleles that regulate autoimmune responses. Recent data also confirm an elevated risk of mortality in individuals with mild gluten-induced inflammation who show no villous atrophy. The team concludes by noting that, due to the high prevalence of celiac disease, and its rising numbers, early prevention may represent a cost-effective strategy. Source: The American Journal of Gastroenterology , (28 September 2010) | doi:10.1038/ajg.2010.372
Jefferson Adams posted an article in Celiac Disease Diagnosis, Testing & TreatmentCeliac.com 06/04/2010 - A team of researchers recently set out to assess the positive predictive value of blood test screening for possible cases of celiac disease. The team included Peter Toftedal, Christian Nielsen, Jonas Trolle Madsen, Kjell Titlestad, Steffen Husby, and Søren Thue Lillevang. They are affiliated with the Hans Christian Andersen Children's Hospital, and the Department of Clinical Immunology of Odense University Hospital in Denmark. P. Toftedal and Ch. Nielsen made contributions to the final published article. In deciding which possible celiac disease cases might require duodenal biopsy, doctors rely mainly on tests for celiac disease antibodies, such as immunoglobulin A (IgA) anti-tissue transglutaminase (anti-tTG), IgA endomysium antibody (EMA), IgA and IgG anti-gliadin antibodies (IgA and IgG AGA). For their study, the research team wanted to assess the diagnostic quality of blood testing for possible cases of celiac disease. They did this by performing celiac disease blood tests (IgA and IgG AGA, anti-tTG and EMA) on 11,915 subjects. They then combined the serological data with clinical data and duodenal biopsy results using a unique Danish personal identification number. They found that positive predictive value (PPV) fluctuated in accordance with various combinations of positive celiac disease antibodies. They found the highest predictive value (97.6%) when results for IgA and IgG AGA, anti-tTG and EMA antibodies were all positive. The team used a logistic regression model at initial blood screening to predict the probability of later biopsy-proven celiac disease in relation to concentrations of IgA AGA and anti-tTG. They found that anti-tTG concentrations correlated strongly with EMA positivity, number of additional positive antibodies, and higher PPV. The anti-tTG concentration upon first blood screening for celiac disease was highly informative in relation to EMA positivity, number of additional celiac disease specific antibodies and PPV. Lastly, results for the high-risk patient group showed that anti-tTG and IgA AGA concentrations at initial serological screening accurately predicted probability of future biopsy-proven celiac disease. Source: Clin Chem Lab Med 2010;48:685–91. DOI: 10.1515/CCLM.2010.136