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Celiac.com 11/11/2022 - You are either diagnosed with celiac disease, are gluten sensitive, or perhaps you have latent or silent celiac disease, which may mean that you seem to have few or even no health problems at all, yet you sill are a celiac. Latent and silent celiac disease seem to occur more often in adults, but they can also affect children as well. Did you know that there are several types of celiac disease, and experts don't always agree on how to deal with each type? Researchers Now Recognize Several Types of Celiac Disease: Classic Celiac Disease This version manifests with the classical GI symptoms of abdominal pain, diarrhea, nausea, and possible vomiting, which can also cause dehydration, dizziness, and lead to vitamin and mineral deficiencies. This type of celiac disease is usually the easiest form to diagnose. People in this category will end up having positive blood antibody and endoscopy (biopsy) test results for celiac disease, and all doctors should recommend that they go on a gluten-free diet for life. Atypical Celiac Disease People with atypical celiac disease generally do not have GI symptoms, but they may have other health issues, for example autoimmune thyroid problems, unexplained skin rashes, undefined bleeding, and/or nerve damage like ataxia. Those with this form of celiac disease can often go undiagnosed for years, and many have to go from doctor to doctor before they finally get the proper tests done and get diagnosed. Those in this category will end up having positive blood antibody and endoscopy (biopsy) test results for celiac disease, and all doctors should recommend that they go on a gluten-free diet for life. Asymptomatic Celiac Disease or Silent Celiac Disease This category is also a form of atypical celiac disease, and it is categorized by those who have little or no symptoms, but it can still affect different parts of their body. Since celiac disease, in any form is a skin, gut, and brain/nerve disease, it can often be difficult to diagnose silent or asymptomatic celiac disease, and it is often found by accident while running other medical tests. Some may have abnormal liver tests, or low iron and/or B12 or other nutrient levels, and even though they may not have any symptoms they will still have various levels of villous atrophy of the small intestines. Many in this group are sent to numerous specialists, and end up having many medical tests done before discovering that they have celiac disease. Those in this group will end up having positive blood antibody and endoscopy (biopsy) test results for celiac disease, and all doctors should recommend that they go on a gluten-free diet for life. Silent or asymptomatic celiac disease tends to be the most difficult form of celiac disease to diagnose, and many in this category are totally surprised at the time of their diagnosis, and can often be skeptical about needing to go on a gluten-free diet. A minority of doctors may even tell silent celiac disease patients that a gluten-free diet is optional, however, all patients in this group should go gluten-free. Potential Celiac Disease or Latent Celiac Disease People in either of these groups may have positive blood tests for celiac disease yet a negative biopsy. Some experts believe that this may be an early stage of celiac disease, before the villi are damaged. Some doctors tell patients in this group that they do not need to be on a gluten-free diet, however, anyone who has abnormally high celiac disease antibody levels likely falls into the “non-celiac gluten sensitivity” (NCGS) category, and many experts agree that this could represent a pre-celiac disease stage, and if so it would be best to avoid uncomfortable symptoms and other possible related health issues, so people in this group should also consider going on a gluten-free diet for life. I used to feel very sorry for the atypical and silent celiac disease folks, but I stopped feeling so sorry for them because they usually don't have dermatitis herpetiformis, which I have, and my dermatitis herpetiformis symptoms can be horrible. While the some people in the asymptomatic or silent category may not want to go gluten-free, even though they should, I knew within twenty-four hours that I had been "bitten" with gluten because my dermatitis herpetiformis sores would itch and drive me crazy, but at least I knew I had ingested gluten. Whenever this happens I'm in for a tough itchy time for a ten day period, and need to use Dapsone for the itch and Atarax to help eliminate me continually scratching my scalp, arms and thighs. A big warning to those with potential celiac disease and latent celiac disease: If you continue ingesting gluten, one day you may be surprised that you have graduated to the classic form of celiac disease and end up with malabsorption issues and a host of related health issues, perhaps even dermatitis herpetiformis. Again, many experts agree that patients in these groups should remain gluten-free, which may help some to escape getting full blown celiac disease, while allowing others to avoid the many issues that can be associated with non-celiac gluten sensitivity.

Celiac.com 09/03/2014 - What’s potential celiac disease, and what happens to kids who have it and continue to eat a gluten-containing diet? Researchers define potential celiac disease as the presence of serum anti-tissue-transglutaminase (anti-TG2) antibodies with normal duodenal mucosa. That is, a positive blood screen, but no intestinal damage. However, not much is known about potential celiac disease because people who have it often show no obvious symptoms. Patients with potential celiac disease present some challenges for doctors trying to determine how likely it is that these patients will develop villous atrophy, the gut damage common in celiac disease patients exposed to gluten. A research team conducted a prospective longitudinal cohort study to follow patients with potential celiac disease up to 9 years, and explore the risk factors tied to mucosal damage. The research team included Renata Auricchio MD, PhD, Antonella Tosco MD, Emanuela Piccolo MD, Martina Galatola PhD, Valentina Izzo PhD, Mariantonia Maglio PhD, Francesco Paparo PhD, Riccardo Troncone MD, PhD, and Luigi Greco MD, PhD. They are affiliated with the Department of Medical Translational Science, European Laboratory for the Investigation of Food Induced Disease (ELFID), University Federico II, Naples, Italy. For their study, the team found two hundred and ten asymptomatic children with potential celiac disease. They kept 175 of them on a gluten-containing diet. To evaluate histological, immuno-histochemical, and anti-TG2 status, they checked blood antibody levels and clinical symptoms every 6 months, and took a small bowel biopsy every two years. They also genotyped all patients for HLA and non-HLA celiac-associated genes. Forty-three percent of patients showed persistently elevated anti-TG2 levels, 20% became negative during follow-up, and 37% showed variations in anti-TG2 course, with many patients testing at zero anti-TG2. After three years of follow-up, 86% of study patients continued to have potential celiac disease. After 6 and 9 years, respectively, 73% and 67% of study patients still had normal duodenal structure. Individuals prone to develop mucosal damage during the test period were predominantly male, had slight mucosal inflammation at study’s start, and fit a peculiar genetic profile. Nine years after follow-up, a large number of patients with asymptomatic potential celiac disease showed reduced antibody production, many even showing zero production, and many of these, with persistently positive anti-TG2, showed no mucosal damage. Given the results of this study, and noting that the celiac population is in fact made up of numerous individuals with diverse genetic and phenotypic makeup, the researchers are advising doctors to be cautious in prescribing a strict lifelong gluten-free diet for asymptomatic individuals with potential celiac disease. Source: The American Journal of Gastroenterology

Celiac.com 08/15/2011 - People with potential celiac disease have similar HLA, and positive anti-transglutaminase antibodies, but do not suffer damage to small intestinal mucosa. Very few of these patients develop mucosal lesions. So far, scientists know of more than forty genes associated with celiac disease, but exactly how these pathways act to trigger celiac disease in genetically predisposed individuals remains a mystery. A team of researchers recently set out to shed some light on that mystery. The research team included Maria Pia Sperandeo, Antonella Tosco, Valentina Izzo, Francesca Tucci, Riccardo Troncone, Renata Auricchio, Jihane Romanos, Gosia Trynka, Salvatore Auricchio, Bana Jabri, and Luigi Greco. They are variously affiliated with the European Laboratory for Food Induced Disease, and the Department of Pediatrics at the University of Naples Federico II in Naples, Italy, the Department of Genetics at the University Medical Centre at the University of Groningen, Groningen in The Netherlands, and with the Department of Medicine, the Department of Pathology and the Department of Pediatrics at University of Chicago. To more fully explore the genetic features of potential celiac disease individuals, the team enrolled 127 patients with potential celiac disease, positive anti-tissue transglutaminase and no mucosal lesions. Ultimately, about 30% of those followed for four years developed celiac disease. The team then genotyped each of the subjects for 13 polymorphisms of the 'candidate genes’ and compared the results to control subjects, and to patients with known celiac disease. They used 60 biopsy specimens to more fully evaluate gene expression. They found that people with potential celiac disease have less HLA-related risk compared to those with celiac disease (χ2 = 48.42; p value = 1×10−8). Those with potential celiac disease also share most of the polymorphisms of the celiacs, but the frequency of c-REL* G allele was suggestive for a difference compared to celiac (χ2 = 5.42; p value = 0.02). There was one marker of the KIAA1109/IL-2/IL-21 region that differentiated those with potential celiac disease from those with clinical celiac disease (rs4374642: χ2 = 7.17, p value = 0.01). In people with potential celiac disease, the expression of IL-21 was completely suppressed, whereas, in those with celiac disease (p value = 0.02) and in control subjects (p value = 0.02), IL-2, KIAA1109 and c-REL expression were over-expressed. The study reveals that people with potential celiac disease show different genetic features expression markers than those with celiac disease. The study also shows potential celiac disease to be a useful biological model of the pathways leading to the small intestinal mucosal damage in genetically predisposed individuals. Source: PLoS ONE 6(7): e21281. doi:10.1371/journal.pone.0021281