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Exploring Other Causes of Villous Atrophy Beyond Celiac Disease
Scott Adams posted an article in Spring 2024 Issue
Celiac.com 02/10/2024 - Villous atrophy, a condition marked by the blunting or flattening of the microscopic structures called villi in the small intestine, is most commonly associated with celiac disease. However, emerging research and clinical observations have unveiled a spectrum of diverse conditions beyond celiac disease that can lead to villous atrophy. This article explores the lesser-known contributors to villous atrophy, shedding light on various health conditions that may present with similar histological changes in the small intestine. While celiac disease remains a prominent cause, understanding these alternative pathways to villous atrophy is crucial for accurate diagnosis, appropriate management, and a comprehensive approach to gastrointestinal health. From autoimmune disorders to infections and drug-induced reactions, exploring the multifaceted nature of villous atrophy enhances our grasp of gastrointestinal pathology and guides clinicians toward more nuanced and personalized patient care. Other Conditions Associated with Villous Atrophy In the following sections, we delve into a comprehensive exploration of diverse health conditions intricately linked to villous atrophy, shedding light on their unique associations and implications for gastrointestinal health. Eosinophilic Enteritis Eosinophilic enteritis is an inflammatory disorder characterized by an increased presence of eosinophils in the gastrointestinal tract. Eosinophils are a type of white blood cell involved in the immune response. In eosinophilic enteritis, these cells infiltrate the walls of the intestines, causing inflammation and damage. This inflammatory process can lead to various symptoms, including abdominal pain, diarrhea, and malabsorption. In some cases, the inflammation may result in villous atrophy, affecting the absorptive capacity of the small intestine. Diagnosis often involves endoscopic procedures with tissue biopsy to evaluate the extent of inflammation and associated damage. Crohn's Disease Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, from the mouth to the anus. In the small intestine, Crohn's disease can cause inflammation and damage to the intestinal lining, leading to complications such as strictures and fistulas. In some cases, individuals with Crohn's disease may experience villous atrophy, particularly in areas of the small intestine affected by inflammation. The severity of villous atrophy can vary among patients with Crohn's disease, and its presence may contribute to malabsorption issues and nutritional deficiencies. Management often involves anti-inflammatory medications, immunosuppressants, and, in severe cases, surgical intervention to address complications. Giardiasis Giardiasis is an intestinal infection caused by the parasite Giardia lamblia. This parasitic infection can lead to symptoms such as diarrhea, abdominal cramps, and bloating. In addition to the acute phase of the infection, chronic giardiasis has been associated with villous atrophy in some cases. The mechanisms by which Giardia lamblia causes villous atrophy are not fully understood, but it is believed to involve both direct damage to the intestinal lining and an immune response triggered by the presence of the parasite. Diagnosis typically involves stool tests to detect the parasite, and treatment includes antiparasitic medications. Common Variable Immunodeficiency (CVID) Common Variable Immunodeficiency (CVID) is a primary immunodeficiency disorder characterized by impaired antibody production, leading to increased susceptibility to infections. Some individuals with CVID may experience gastrointestinal symptoms, including chronic diarrhea and malabsorption. In severe cases, villous atrophy can occur, impacting the absorption of nutrients in the small intestine. The association between CVID and villous atrophy underscores the complex interplay between the immune system and the intestinal mucosa. Management involves immunoglobulin replacement therapy to address the immune deficiency and supportive measures for gastrointestinal symptoms. Autoimmune Enteropathy Autoimmune enteropathy is a rare autoimmune disorder that primarily affects the small intestine. In this condition, the immune system mistakenly attacks the cells of the intestinal lining, leading to severe inflammation and damage. Villous atrophy is a characteristic feature of autoimmune enteropathy, affecting the absorptive surface area of the small intestine. Individuals with autoimmune enteropathy often present with persistent diarrhea, malabsorption, and failure to thrive. Diagnosis requires extensive evaluation, including endoscopic procedures and tissue biopsy. Treatment involves immunosuppressive medications to modulate the autoimmune response and manage symptoms. Human Immunodeficiency Virus (HIV) Advanced Human Immunodeficiency Virus (HIV) infection can result in various gastrointestinal complications, affecting both the upper and lower parts of the digestive tract. HIV-associated enteropathy may involve villous atrophy, contributing to malabsorption and nutritional deficiencies. The mechanisms leading to villous atrophy in HIV infection are multifactorial, involving both direct viral effects and immune-mediated processes. Additionally, opportunistic infections and other HIV-related complications can further impact the gastrointestinal mucosa. Management includes antiretroviral therapy to control HIV replication and supportive measures to address nutritional deficiencies and associated symptoms. Regular monitoring and a multidisciplinary approach are crucial in the care of individuals with HIV-associated gastrointestinal conditions. Dermatitis Herpetiformis (DH) Dermatitis herpetiformis is a chronic skin condition characterized by intensely itchy, blistering skin lesions. While DH primarily manifests as a skin disorder, its connection to celiac disease is well-established. Both conditions share a common trigger: gluten ingestion. DH is considered the skin manifestation of celiac disease, and individuals with DH often have underlying gluten sensitivity. The immune response triggered by gluten in susceptible individuals leads to the formation of IgA antibodies, which deposit in the skin, causing the characteristic skin lesions. While DH predominantly affects the skin, it is crucial to recognize its association with celiac disease, as individuals with DH may also experience villous atrophy in the small intestine. Therefore, a gluten-free diet is not only essential for managing skin symptoms but also for addressing the underlying celiac disease and preventing intestinal damage. Diagnosis involves skin biopsy for characteristic IgA deposits and, in some cases, intestinal biopsy to assess the extent of villous atrophy. Treatment primarily revolves around strict adherence to a gluten-free diet, often complemented by medications to control skin symptoms. Managing DH effectively requires a multidisciplinary approach, involving dermatologists, gastroenterologists, and dietitians to address both the skin manifestations and the underlying celiac disease. Idiopathic Sprue Idiopathic sprue is a term used for cases of sprue (malabsorption syndrome) where the cause is unknown. It may include cases that do not fit the criteria for celiac disease or other known causes of malabsorption. It shares some features with celiac disease, such as malabsorption and damage to the small intestine, but it lacks specific diagnostic markers for celiac disease. Diagnosis may involve excluding other causes of malabsorption, and it may be considered when typical celiac disease markers are absent. Tropical Sprue Tropical sprue is a malabsorption syndrome that occurs in tropical regions, and its exact cause is not fully understood. It is thought to be associated with infections or environmental factors. It presents with symptoms of malabsorption, such as diarrhea, weight loss, and nutritional deficiencies. It is more commonly observed in tropical regions but can occur in non-tropical areas as well. Collagenous Sprue Collagenous sprue is a rare disorder characterized by collagen deposition in the small intestine. The cause is not well-established. It leads to malabsorption and features similar to celiac disease but is distinguished by the characteristic collagen band in the intestinal lining. Diagnosis involves histological examination of small intestinal biopsies. The management of collagenous sprue may involve a combination of treatments, including a gluten-free diet and immunosuppressive medications. Corticosteroids or other immunosuppressants may be prescribed. Peptic Duodenitis Peptic duodenitis, a condition characterized by inflammation of the duodenal lining due to exposure to stomach acid, shares a commonality with celiac disease in its potential to induce villous atrophy. In peptic duodenitis, the inflammatory response triggered by gastric acid can extend into the duodenum, disrupting the delicate balance of the intestinal mucosa. This sustained inflammation may lead to changes in the architecture of the small intestine, including the villi, finger-like projections crucial for nutrient absorption. The damage incurred can result in villous atrophy, akin to the characteristic intestinal changes observed in celiac disease. Helicobacter Pylori Helicobacter pylori, a bacterium known for its association with gastric ulcers and gastritis, has been implicated in gastrointestinal conditions that extend beyond the stomach, including potential involvement in villous atrophy akin to celiac disease. The presence of H. pylori in the duodenum and small intestine has been linked to chronic inflammation and alterations in mucosal architecture. The bacterium's ability to induce immune responses may contribute to the damage of the intestinal villi, compromising their structure and functionality. This shared consequence of villous atrophy highlights the interconnectedness of various gastrointestinal disorders and underscores the need for comprehensive investigations to discern the specific triggers and mechanisms at play. While celiac disease and H. pylori-related duodenal changes differ in their etiology, understanding the potential overlap in their impact on intestinal health is crucial for accurate diagnosis and tailored therapeutic interventions. Small Intestinal Bacterial Overgrowth (SIBO) Small intestinal bacterial overgrowth (SIBO) is recognized for its capacity to disrupt the normal balance of microorganisms in the small intestine, leading to various gastrointestinal manifestations. In some cases, SIBO has been associated with mucosal damage, mirroring the villous atrophy observed in conditions like celiac disease. The overgrowth of bacteria in the small intestine can interfere with nutrient absorption and trigger an inflammatory response, potentially contributing to the erosion of the intestinal villi. While the mechanisms differ from those in celiac disease, the shared outcome of villous atrophy underscores the intricate relationship between dysbiosis and intestinal health. Lymphoma Lymphoma, a form of cancer that originates in the lymphatic system, can exhibit parallels with celiac disease in terms of inducing villous atrophy. In some cases, individuals with longstanding untreated celiac disease may face an elevated risk of developing enteropathy-associated T-cell lymphoma (EATL), a rare but serious complication. EATL is characterized by the infiltration of malignant T lymphocytes into the intestinal mucosa, leading to structural changes reminiscent of villous atrophy. While lymphoma and celiac disease differ fundamentally, the shared manifestation of villous atrophy underscores the intricate interplay between chronic inflammation and the potential oncogenic transformations within the gastrointestinal milieu. Thiamine (Vitamin B1) Deficiency There is some old research that indicates that prolonged low thiamine (vitamin B1) may cause thinning of the microvillus membrane. While these conditions may share some clinical features with celiac disease, the differences in their etiology, histopathology, and diagnostic criteria make them distinct entities. Accurate diagnosis and differentiation often require a thorough clinical evaluation, including serological tests, histopathological examination, and consideration of geographic or idiopathic factors. Consulting with a gastroenterologist or healthcare professional is essential for proper diagnosis and management. Drug-Associated Enteropathy: Medications Associated with Villous Atrophy Understanding the intricate interplay between medications and intestinal well-being is paramount for individuals managing chronic health conditions. While medications play a pivotal role in alleviating symptoms and improving overall health, certain drugs may harbor the potential to influence the delicate environment of the small intestine. This section delves into the impact of various medications on the intestinal villi, focusing on conditions that may lead to villous atrophy. From common pain relievers to immunosuppressive drugs, the discussion aims to shed light on the nuanced relationship between medications and gastrointestinal health. It underscores the importance of informed healthcare decisions, proactive monitoring, and open communication between patients and healthcare providers to mitigate potential complications and ensure optimal intestinal function during the course of medical treatments. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are commonly used to alleviate pain and inflammation, but prolonged and excessive use has been associated with adverse effects on the gastrointestinal (GI) tract. NSAIDs can cause irritation and inflammation in the small intestine, potentially leading to villous atrophy. The mechanism involves the inhibition of cyclooxygenase enzymes, which play a role in maintaining the integrity of the GI mucosa. Individuals relying on NSAIDs for chronic pain management should be cautious and work closely with healthcare providers to monitor and mitigate potential GI complications. Immunosuppressive Drugs Immunosuppressive drugs, such as methotrexate and mycophenolate mofetil, are crucial in managing autoimmune conditions and preventing organ rejection after transplantation. While these medications target the immune system to curb excessive responses, they may also impact the gastrointestinal lining. Long-term use could lead to intestinal complications, including villous atrophy. Healthcare providers prescribing immunosuppressive drugs carefully assess the risk-benefit profile for each patient and monitor closely for potential adverse effects on the GI tract. Chemotherapy Drugs Chemotherapy, a cornerstone in cancer treatment, aims to eradicate rapidly dividing cells, including cancerous ones. However, the impact isn't limited to tumors, and normal, healthy cells may also be affected. The rapidly renewing cells in the small intestine are particularly susceptible, potentially resulting in damage to the villi and compromising the absorptive capacity of the intestines. Individuals undergoing chemotherapy should discuss potential gastrointestinal side effects with their oncologist to address and manage any complications that may arise. Some Antibiotics Certain antibiotics, such as tetracycline and ampicillin, may disrupt the balance of the gut microbiota, leading to gastrointestinal disturbances. While these antibiotics target harmful bacteria, they can also affect beneficial microbes, influencing the overall health of the intestinal lining. The intricate relationship between antibiotics and the gut underscores the importance of judicious antibiotic use and, when necessary, the simultaneous administration of probiotics to support a healthy gut environment. Proton Pump Inhibitors (PPIs) Proton Pump Inhibitors (PPIs), commonly prescribed for acid reflux and gastroesophageal reflux disease (GERD), reduce stomach acid production. Prolonged use of PPIs has been linked to changes in the small intestine, potentially impacting the structure and function of the villi. Individuals relying on PPIs for an extended period should collaborate with healthcare providers to assess the necessity of continued use and explore alternative approaches to manage acid-related conditions. Opioid Pain Medications Opioid pain medications, including morphine and oxycodone, are known for their analgesic properties but are also associated with side effects such as constipation. Chronic use of opioids may lead to intestinal issues, affecting the normal functioning of the small intestine. It is crucial for healthcare providers to carefully manage opioid prescriptions, considering the potential impact on the gastrointestinal tract, and to explore alternative pain management strategies whenever possible. Patients should communicate openly with their healthcare team about any digestive issues experienced during opioid therapy to ensure timely intervention and support. Conclusion In conclusion, the journey through conditions associated with villous atrophy extends far beyond the realms of celiac disease. This exploration has highlighted the intricate interplay of various factors that can impact the health of the small intestine, leading to structural changes in the form of villous atrophy. Recognizing these diverse contributors is pivotal for healthcare professionals navigating the complexities of gastrointestinal disorders. As we deepen our understanding of the nuanced manifestations of villous atrophy, we pave the way for improved diagnostic accuracy and tailored treatment strategies. The heterogeneity of conditions linked to villous atrophy underscores the need for a holistic and individualized approach to patient care, ensuring that the intricacies of each case are addressed with precision and empathy. Through continued research and clinical vigilance, we strive to unravel the mysteries of these conditions and enhance the well-being of individuals facing the challenges of villous atrophy. Further reading on the topic of other causes of villous atrophy: Not All That Flattens Villi Is Celiac Disease: A Review of Enteropathies -
Celiac.com 01/20/2024 - The tissue transglutaminase IgA antibodies (tTG-IgA) test is a crucial diagnostic tool for celiac disease. In individuals with celiac disease, the ingestion of gluten triggers an immune response, leading to the production of antibodies, including tTG-IgA. These antibodies target the tissues of the small intestine, causing damage and inflammation. The tTG-IgA test measures the levels of these specific antibodies in the blood. Elevated tTG-IgA levels are indicative of an active immune response to gluten and suggest the presence of celiac disease. This blood test is an essential component of the diagnostic process, helping healthcare providers identify individuals who may require further evaluation, such as genetic testing and an endoscopic biopsy, to confirm the diagnosis of celiac disease. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) are primarily associated with celiac disease, but they can also be elevated in some other conditions. It's important to note that the presence of elevated antibodies alone doesn't diagnose a specific condition, and further clinical evaluation is needed. Conditions and factors that may lead to elevated tTG-IgA antibodies may include the following: Non-Celiac Gluten Sensitivity (NCGS) Wheat Allergy Inflammatory Bowel Diseases (IBD) Type 1 Diabetes Autoimmune Liver Diseases Rheumatoid Arthritis Thyroid Disorders Genetic Conditions Casein/Cow's Milk Intolerance Non-Celiac Gluten Sensitivity (NCGS) Although it doesn't involve the autoimmune response seen in celiac disease, NCGS can lead to symptoms similar to those of celiac disease and may be associated with elevated tTG-IgA. NCGS is characterized by gluten-related symptoms without the autoimmune response and intestinal damage seen in celiac disease. The exact mechanisms leading to elevated tTG-IgA in NCGS are not fully understood, but it's believed that gluten sensitivity in NCGS may still induce an immune response, even though it differs from the autoimmune process seen in celiac disease. The presence of elevated tTG-IgA in NCGS underscores the complexity of gluten-related disorders and highlights the need for further research to elucidate the underlying immune responses and mechanisms associated with different gluten-related conditions. Wheat Allergy Individuals with a wheat allergy may produce antibodies, including tTG-IgA, as part of the allergic response. Individuals with a wheat allergy may also exhibit increased tTG-IgA levels. Wheat allergy is an immune-mediated response to proteins in wheat, distinct from the autoimmune nature of celiac disease. The presence of elevated tTG-IgA in individuals with a wheat allergy is somewhat perplexing, as tTG is an enzyme involved in the pathology of celiac disease, and its elevation is not commonly associated with allergies. One possible explanation is that the immune response triggered by a wheat allergy might lead to some cross-reactivity or shared epitopes with components involved in celiac disease, causing an increase in tTG-IgA. However, the exact mechanisms behind this phenomenon are not well-elucidated, and more research is needed to understand the connections between wheat allergy and the elevation of tTG-IgA. It emphasizes the intricate interplay between the immune system and various wheat-related disorders, requiring further exploration to unravel the complexities of immune responses in these conditions. Inflammatory Bowel Diseases (IBD) Conditions such as Crohn's disease and ulcerative colitis can cause gastrointestinal inflammation, and elevated tTG-IgA levels have been reported in some individuals with IBD. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) can also be observed in individuals with Inflammatory Bowel Diseases (IBD). IBD, which includes conditions like Crohn's disease and ulcerative colitis, involves chronic inflammation of the gastrointestinal tract. The link between IBD and elevated tTG-IgA is not as straightforward as in celiac disease, and the reasons behind this elevation in some IBD patients remain a subject of research. One hypothesis suggests that the chronic inflammation and alterations in the intestinal mucosa associated with IBD may lead to increased permeability of the gut barrier. This heightened permeability might allow gluten proteins to interact with the immune system in a way that triggers the production of tTG-IgA. The intricate relationship between IBD and tTG-IgA elevation underscores the complex interplay between autoimmune responses and gastrointestinal disorders, requiring further investigation to uncover the underlying mechanisms and clinical implications. Type 1 Diabetes Some individuals with type 1 diabetes may have elevated tTG-IgA antibodies, and there is an increased risk of celiac disease in individuals with diabetes. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) can be found in individuals with Type 1 Diabetes (T1D), establishing a connection between these two autoimmune conditions. Both celiac disease and Type 1 Diabetes involve an autoimmune response, where the body's immune system mistakenly targets its own tissues. In the case of celiac disease, the immune system reacts to gluten, while in Type 1 Diabetes, it attacks the insulin-producing cells in the pancreas. The shared genetic susceptibility to autoimmune disorders could explain the co-occurrence of celiac disease and Type 1 Diabetes. The presence of certain genetic markers might predispose individuals to develop multiple autoimmune conditions. Additionally, environmental factors and common triggers in the immune response pathways could contribute to the simultaneous development of these disorders. Clinicians often monitor individuals with Type 1 Diabetes for celiac disease-related antibodies, including tTG-IgA, to identify and manage celiac disease early, highlighting the importance of understanding these interconnected autoimmune processes for comprehensive patient care. Thyroid Disorders Conditions such as autoimmune thyroiditis (Hashimoto's thyroiditis) and Graves' disease may be associated with elevated tTG-IgA antibodies. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) can be associated with thyroid disorders, particularly autoimmune thyroid conditions such as Hashimoto's thyroiditis. Hashimoto's thyroiditis is an autoimmune disease where the immune system attacks the thyroid gland, leading to inflammation and potential impairment of thyroid function. The link between celiac disease and autoimmune thyroid disorders has been observed, suggesting a shared genetic predisposition for autoimmune conditions. Individuals with celiac disease may have an increased risk of developing autoimmune thyroid disorders, and vice versa. The interconnected nature of autoimmune diseases suggests that the immune system's response to gluten in celiac disease might trigger or exacerbate autoimmune reactions in other organs, including the thyroid. Monitoring thyroid function and related antibodies, such as tTG-IgA, is crucial in individuals with celiac disease to identify and manage potential thyroid complications early. Understanding these complex interactions between autoimmune disorders is essential for comprehensive patient care and effective management of associated health conditions. Autoimmune Liver Diseases Certain autoimmune liver diseases, such as autoimmune hepatitis and primary biliary cirrhosis, may be associated with elevated tTG-IgA antibodies. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) may be detected in individuals with autoimmune liver diseases, particularly autoimmune hepatitis (AIH). Autoimmune hepatitis is a chronic inflammatory condition where the body's immune system erroneously attacks liver cells, leading to liver inflammation and potential damage. The connection between celiac disease and autoimmune liver diseases, although not fully understood, suggests shared autoimmune mechanisms. In some cases, individuals with celiac disease may experience immune system dysregulation that extends beyond the small intestine, leading to autoimmune reactions in other organs such as the liver. The presence of elevated tTG-IgA in individuals with autoimmune liver diseases underscores the complex interplay between various autoimmune conditions. Monitoring liver function and related antibodies is essential for comprehensive healthcare in individuals with celiac disease, as the autoimmune cascade can impact multiple organs. Understanding these connections aids in early detection, proper management, and improved overall outcomes for individuals with autoimmune liver diseases and concurrent celiac disease. Genetic Conditions Some genetic conditions, such as Down syndrome, may be associated with an increased prevalence of celiac disease and elevated tTG-IgA. Elevated tissue transglutaminase IgA antibodies (tTG-IgA) in individuals with genetic conditions such as Down syndrome can be attributed to the increased prevalence of autoimmune disorders in this population. Down syndrome, characterized by the presence of an extra copy of chromosome 21, is associated with a higher susceptibility to autoimmune conditions, including celiac disease. The genetic link between Down syndrome and celiac disease suggests a shared vulnerability to immune dysregulation. Individuals with Down syndrome may exhibit an elevated risk of developing autoimmune disorders due to alterations in immune system function associated with the genetic anomaly. The complex relationship between genetics and autoimmune responses underscores the importance of monitoring individuals with Down syndrome for various health conditions, including celiac disease. Early detection and management of celiac disease in individuals with Down syndrome are crucial for optimizing their overall health and well-being, considering the potential impact of untreated celiac disease on nutrient absorption and long-term health outcomes. Rheumatoid Arthritis Elevated tTG-IgA levels have been reported in some individuals with rheumatoid arthritis. The presence of elevated tissue transglutaminase IgA antibodies (tTG-IgA) in individuals with rheumatoid arthritis (RA) can be linked to the complex interplay between autoimmune disorders. Rheumatoid arthritis is a chronic inflammatory condition primarily affecting the joints, but it is increasingly recognized that individuals with RA may have an elevated risk of coexisting autoimmune diseases, including celiac disease. The shared genetic predisposition and immune dysregulation mechanisms contribute to the observed association between RA and elevated tTG-IgA. In the context of rheumatoid arthritis, the immune system mistakenly attacks the joints, leading to inflammation and joint damage. This dysregulated immune response may extend beyond the joints and manifest as an increased susceptibility to other autoimmune conditions, such as celiac disease. The identification of elevated tTG-IgA in individuals with RA underscores the importance of comprehensive health assessments in autoimmune disorders, as coexisting conditions may impact the overall management and prognosis of these individuals. Regular monitoring and collaboration between healthcare providers specializing in different autoimmune diseases are crucial for a holistic approach to patient care. Casein/Cow's Milk Intolerance Recent studies have shown that elevated tTG-IgA levels have been reported in some individuals with casein/cow's milk intolerance. Conclusion While it's true that elevated tissue transglutaminase IgA antibodies (tTG-IgA) can be associated with various conditions beyond celiac disease, including autoimmune disorders and genetic conditions, the tTG-IgA test remains a valuable tool in the diagnosis of celiac disease. In individuals with celiac disease, there is a specific immune response triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. People with celiac disease often have higher levels of tTG-IgA in their blood due to the immune system's reaction to gluten. When gluten is ingested, individuals with celiac disease produce antibodies, including tTG-IgA, which target and attack the tissues of the small intestine. The elevated tTG-IgA levels are indicative of this immune response and the damage occurring in the intestinal lining. However, it's important to note that the interpretation of tTG-IgA levels should be done in the context of the individual's overall health, medical history, and the possibility of other conditions. A definitive diagnosis of celiac disease typically involves a combination of blood tests, genetic testing (HLA-DQ2 and HLA-DQ8), and, in some cases, an endoscopic biopsy of the small intestine. In summary, while elevated tTG-IgA levels are a common feature in celiac disease, the diagnosis involves a comprehensive assessment, and healthcare providers consider various factors to ensure accurate identification of the condition. It's crucial to interpret antibody test results in the context of the individual's clinical symptoms, medical history, and additional diagnostic tests. If tTG-IgA antibodies are elevated, further evaluation by a healthcare professional, typically including endoscopic procedures and biopsies, is often necessary to confirm or rule out celiac disease.
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Celiac.com 08/21/2020 - So who, exactly, should be screened for celiac disease? The guidelines and parameters for who and when to test for celiac disease change as new data becomes available. Based on recent study data, and recommendations by the three major celiac disease organizations, many doctors advise celiac screening for patients with any of the following twenty-two conditions or diseases: Anemia Unexplained iron, vitamin B12 or folate deficiency. A 2014 study showed that celiac disease is common in people with unexplained anemia. The study team recommends celiac screening for anyone with unexplained iron-deficient anemia, while the The U.K. National Institute for Health and Care Excellence recommend celiac screening for anyone with unexplained vitamin B-12 or folate deficiency. Aphthous stomatitis People with severe or persistent mouth ulcers (canker sores) should get screened for celiac disease. A 2020 study confirms that doctors should consider celiac disease in patients with severe or recurrent aphthous stomatitis. Autism People with autism have celiac disease at rates almost 20 times higher than in those without autism, reported lead investigator Daniel Karb, MD, a second-year resident at University Hospitals Case Medical Center in Cleveland. As such, many doctors now recommend celiac screening for people with autism. Autoimmune Thyroid Disease The The U.K. National Institute for Health and Care Excellence recommends celiac screening for anyone with thyroid disease. Dental Enamel Defects Certain types of dental enamel defects can be strong indicators of celiac disease. A 2018 study shows that non-specific tooth wear and enamel defects can be strong indications of celiac disease. Dermatitis Herpetiformis (DH) People with dermatitis herpetiformis, aka DH, or Duhring’s disease, suffer from a herpes-like rash. About 10% to 15% of people with celiac disease have DH. Anyone with DH should be checked for celiac disease. Most people with DH see major improvements on a gluten-free diet. Failure to Thrive and Persistent Diarrhea in Children The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and The American College of Gastroenterology recommends celiac screening for children with failure to thrive, especially with persistent diarrhea. Unexplained Fatigue Unexplained fatigue. People with persistent unexplained fatigue should consider screening for celiac disease, according to the U.K. National Institute for Health and Care Excellence. GERD Some studies show no link between Gastroesophageal Reflux Disease (GERD) and celiac disease. A 2015 study showed that celiac disease not a big factor in gastro-esophageal reflux disease. But a 2020 study showed that non-celiac gluten sensitivity is common in patients with refractory functional dyspepsia. Many doctors recommend celiac disease screening for patients with GERD. High Transaminase Levels High transaminase levels can be an indication of liver damage, heart damage, and are common in people with celiac disease. Down syndrome A 2020 study shows that people with Down syndrome have celiac disease at up to twenty times the rate of the general population. Celiac disease screening is important for anyone with Down syndrome. IgA Deficiency The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends testing for celiac disease in asymptomatic children who have conditions associated with celiac disease, including selective IgA deficiency. Irritable Bowel Syndrome in Adults Adults with irritable bowel syndrome should be screened for celiac disease, according to the The U.K. National Institute for Health and Care Excellence. Persistent Unexplained Elevated Liver Enzymes The U.K. National Institute for Health and Care Excellence recommends celiac screening for people with persistently elevated liver enzymes with unknown cause. Recurrent Miscarriages The U.K. National Institute for Health and Care Excellence recommends celiac screening for women who experience recurrent miscarriages. Immediate Relatives of Anyone with Celiac Disease First-degree relatives (mother, father, brother, sister, son, daughter) of anyone with celiac disease should get a celiac screen, according to Mayo Clinic. Short Stature A 2020 study shows that biopsy confirmed celiac disease affects about 1 in 14 patients with all‐cause short stature, and 1 in 9 patients with idiopathic short stature. Based on these results, doctors are recommending screening all patients with short stature should be screened for celiac disease. Thyroiditis Thyroiditis is an auto-immune condition associated with celiac disease. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommends celiac disease screening in children who have thyroiditis. Turner syndrome Turner syndrome is associated with celiac disease. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommends celiac disease screening in children who have Turner syndrome. celiac.comhttps://www.celiac.com/celiac-disease/who-should-get-screened-for-celiac-disease-r5201/ Type 1 diabetes More than 20% of people with Type 1 diabetes have celiac disease. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommends celiac disease screening in children who have Type 1 diabetes. Unexplained Infertility Women with infertility face higher rates of celiac disease. Many doctors do not screen for celiac disease in these women. However, for women experiencing unexplained infertility, especially repeatedly, a celiac disease screen is probably a good idea. Unexplained Neuropathy Patients with unexplained neuropathy, or small fiber neuropathy should be screened for celiac disease and gluten-sensitivity, according to researchers. Unexplained Weight Loss According to the U.K. National Institute for Health and Care Excellence, people who suffer from unexplained weight loss should be screened for celiac disease. Consider Celiac Screening for These Common Physical Complaints People with any of the ten most common complaints of celiac patients, or any of the below conditions that are associated with celiac disease, along with any obvious signs of celiac disease, including persistent diarrhea or stomach upset, should consider celiac screening. These include: Anemia Alternating bowel habit Bloating Constipation Cryptogenic hypertransaminasemia Diarrhea Gastroesophageal reflux disease Osteopenia/Osteoporosis Recurrent miscarriages Unexplained Infertility Other Conditions Associated with Celiac Disease The following conditions are not included in the official celiac screening recommendations by the above organizations. However, anyone with any of the following conditions, along with any obvious signs of celiac disease, including persistent diarrhea or stomach upset, should consider celiac screening. These include: Addisons Disease Alopecia Anxiety and Depression Ataxia Attention Deficit Disorder/ADHD Autism Autoimmune Hepatitis / Chronic Active Hepatitis Bird Fanciers Lung Brain White-Matter Lesions Cerebellar Atrophy Chronic Fatigue Syndrome (myalgic encephalomyelitis or ME, PVS, post viral fatigue syndrome or PVFS) Crohns Disease Congenital Heart Disease Cystic Fibrosis Dental-Enamel Hypoplasia Dyspepsia Epilepsy (with or without cerebral calcification) Farmers Lung Fibromyalgia and Celiac Disease Fibrosing Alveolitis Follicular Keratosis Gall Bladder Disease Gastroparesis Head Aches (Migraine) IBD - Irritable Bowel Disease Impotency Infertility Inflammatory Bowel Disease Lung Cavities Multiple Sclerosis and Celiac Disease Myasthenia Gravis Pancreatic Disorders / Exocrine Pancreatic Insufficiency Peripheral Neuropathy Polymyositis Polyneuropathy Primary Biliary Cirrhosis Pulmonary Hemosiderosis Recurrent Pericarditis Sarcoidosis Schizophrenia / Mental Problems and Celiac Disease Scleroderma Short Stature, Delayed Puberty Small-Intestinal Adenocarcinomas Spontaneous Abortion and Fetal Growth Retardation Systemic Lupus Erythematosus Thrombocytosis (Hyposplenism) Thrombocytopenic Purpura (ITP) Thyrotoxicosis Vasculitis Vitamin K Deficiency Celiac Disease Screening Recommendations by Organization The American College of Gastroenterology The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) The U.K. National Institute for Health and Care Excellence
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Celiac.com 04/12/2021 - Celiac disease is an autoimmune disorder of the small bowel, classically associated with diarrhea, abdominal pain, and nutritional deficiencies. Rapid diagnosis of celiac disease is important, since strict adherence to a gluten-free diet can resolve most resolution of clinical and histologic manifestations of the disease. Celiac disease is commonly misdiagnosed, most often as one of these conditions. Numerous diseases and conditions can present with clinical and/or histologic features of celiac disease. In a recent review article, a pair of researchers highlight key clinical and histologic mimickers of celiac disease. Many conditions that mimic celiac disease offer clues to the underlying diagnosis, and many have a targeted therapy. It is important to provide patients with a correct diagnosis, and to avoid an unnecessary gluten-free diet for non-celiac patients. Two researchers recently set out to better understand the conditions that mimic celiac disease. Researchers Amrit K Kamboj, MD and Amy S Oxentenko, MD, are affiliated with the Department of Internal Medicine, Division of Gastroenterology and Hepatology, and the Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, USA. The diagnosis of celiac disease is made when there are compatible clinical features, supportive serologic markers, representative histology from the small bowel, and response to a gluten-free diet. Histologic findings associated with celiac disease include intraepithelial lymphocytosis, crypt hyperplasia, villous atrophy, and a chronic inflammatory cell infiltrate in the lamina propria. The evaluation of a patient with serologically negative enteropathy necessitates a carefully elicited history and detailed review by a pathologist. Medications can mimic celiac disease and should be considered in all patients with a serologically negative enteropathy. Clinical conditions that mimic celiac disease include: Autoimmune and/or inflammatory Conditions Can Mimic Celiac Disease Autoimmune and/or inflammatory conditions such as inflammatory bowel disease (IBD), microscopic colitis, thyroid dysregulation, and adrenal insufficiency may all cause clinical features that mimic celiac disease, or be concurrently present in patient known to have celiac disease. Infectious Diseases Can Mimic Celiac Disease Infectious mimickers include giardiasis and both viral and bacterial gastroenteritis, although most viral and bacterial infections are self-limited and do not cause the chronic symptoms that can be seen with Giardia infection, unless post-infectious IBS ensues. Other chronic parasitic infections may also cause symptoms that mimic celiac disease. Other less common clinical mimickers include tropical sprue, autoimmune enteropathy, drug-induced enteropathy, Whipple’s disease, and others. Irritable bowel syndrome (IBS) Can Mimic Celiac Disease Irritable bowel syndrome (IBS) is the most commonly diagnosed gastrointestinal disorder, and has features that mimic celiac disease.10 Symptoms include abdominal pain along with altered bowel form and/or frequency. IBS is often associated with other disorders including somatic comorbidities. Small Intestinal Bacterial Overgrowth (SIBO) Can Mimic Celiac Disease Small intestinal bacterial overgrowth (SIBO) is known to cause diarrhea, bloating, and weight loss, which may mirror symptoms of classic celiac disease; SIBO may also be a cause of recurrent or refractory symptoms in a patient with known celiac disease. The researchers divide the histological mimickers of celiac disease into early and late. The key difference being that early histologic mimickers are characterized by increased intraepithelial lymphocytes with no villous atrophy, and crypts that are either normal or have minimal hyperplasia. Late histologic mimickers are characterized by increased intraepithelial lymphocytes, partial or total villous atrophy, crypt hyperplasia, and chronic inflammation in the lamina propria. Early histologic mimickers include: Non-steroidal anti-inflammatory drugs Inflammatory bowel disease Small intestine bacterial overgrowth Helicobacter pylori Self-limited gastroenteritis Autoimmune conditions Unexplained Late histologic mimickers include: Medications (olmesartan, ipilimumab, colchicine, mycophenolate mofetil, methotrexate, and azathioprine) Common variable immunodeficiency Giardia Crohn’s disease Autoimmune enteropathy Collagenous sprue Tropical sprue Whipple’s disease Enteropathy-associated T-cell lymphoma CD4+ T-cell lymphoma Unclassified sprue Read the full report in Clin Transl Gastroenterol. 2017 Aug; 8(8): e114.
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Celiac.com 04/15/2021 - Cases of celiac disease are on the rise. Celiac disease is associated with both gastrointestinal (GI) and extra-intestinal manifestations, with psychiatric disorders being among the most common extra-intestinal manifestations. The connection between celiac disease and associated psychiatric disorders has not been well documented or studied. A team of researchers recently set out to provide a greater understanding of the existing evidence and theories surrounding psychiatric manifestations of celiac disease. The research team included Emma Clappison, Marios Hadjivassiliou, and Panagiotis Zis. They are variously affiliated with the Medical School, University of Sheffield, Sheffield S10 2YN, UK; and the Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust and University of Sheffield, Sheffield UK For their study, the team conducted an online literature search using PubMed to locate eligible articles containing data on the rates of both celiac disease and psychiatric disorders. They also conducted meta analyses on odds ratios. In all, the team located 37 eligible articles. They detected a significant increased risk for patients with autistic spectrum disorder, attention deficit hyperactivity disorder, depression, anxiety, and eating disorders amongst the celiac disease population compared to healthy controls. They found no significant differences for bipolar disorder or schizophrenia. The data connects celiac disease to an increased risk of depression, anxiety, eating disorders, as well as ASD and ADHD. They point to the need for more research to investigate specific biological explanations as well as the potentially beneficial effects of a gluten-free diet. Data can be helpful in showing connections, and certainly the connection between celiac disease and psychiatric conditions is worthy of study, but further studies are crucial to understanding the connection in any meaningful way. Read more at MDPI.comNutrients 2020, 12(1), 142;
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Celiac.com 07/08/2020 - There are a number of medical, and genetic, conditions related to celiac disease. Those include a number of autoimmune other conditions. Associated Diseases Disorders Common Among Celiacs Having associated autoimmune or other diseases increases the likelihood of developing celiac disease. Associated diseases include: Addison's disease; Autoimmune thyroid disease; Chronic active hepatitis; Dermatitis herpetiformis; Down syndrome or Turner syndrome; Graves disease; Lupus erythematosus; Microscopic colitis (lymphocytic or collagenous colitis); Myasthenia gravis; Rheumatoid arthritis; Scleroderma; Sjogrens syndrome; Systemic lupus erythematosus; and Type 1 diabetes Certain Risk Factors Associated with Celiac Disease These are the ten risk factors most associated with celiac disease include: Age at First Gluten Consumption; Amount of Gluten Consumed; Antibiotics; Being Female; Courses of antibiotics before 2 years old; Ear Infection; Skim Milk consumption; Viral Infection; and Vitamin D Drop Exposure in Infancy. High Rates of Celiac Disease Among Close Relatives of Celiacs Among celiacs and their relatives, there appears to be a higher incidence of other disorders related to the immune system. Celiac Disease Common with These Disorders Other diseases are related in the sense that large numbers of people who have them also have celiac disease. Those include: Type 1 diabetes mellitus, autoimmune thyroiditis, Down syndrome, Turner syndrome, Williams syndrome, selective IgA deficiency, and first-degree relatives with celiac disease Celiac Screening Recommended for These Conditions Additionally, The U.K. National Institute for Health and Care Excellence recommends considering serologic celiac testing for persons with metabolic bone disorder (reduced bone mineral density or osteomalacia), unexplained neurologic symptoms (particularly peripheral neuropathy or ataxia), unexplained sub-fertility or recurrent miscarriage, persistently elevated liver enzymes with unknown cause, dental enamel defects, Down syndrome, or Turner syndrome. Consider Celiac Screening for Top Physical Complaints The ten most common physical complaints of people who have celiac disease are: Osteopenia/Osteoporosis; Anemia; Cryptogenic hypertransaminasemia; Diarrhea; Bloating; Aphthous stomatitis; Alternating bowel habit; Constipation; Gastroesophageal reflux disease and Recurrent miscarriages. People with any one or more of these symptoms might want to consider the possibility of celiac disease, look for any other celiac-related symptoms, and consult a doctor if they suspect celiac disease. Most Common Misdiagnosis for Celiac Disease Celiac disease is commonly misdiagnosed as one of these conditions: Allergies; Chronic fatigue syndrome; Colitis; Cystic fibrosis; Gallbladder disease; Gastro-esophageal reflux disease (GERD); Inflammatory bowel disease; Irritable bowel syndrome; Lactose intolerance; Parasitic infection; Psychological dysfunction; and Ulcers. These Disorders are Commonly Confused with Celiac Disease These twenty-one diseases commonly suspected or diagnosed before celiac disease is discovered. Gluten-Free Diet Can Help In addition, a gluten-free diet appears to have helped some individuals with autism, chronic fatigue syndrome (myalgic encephalomyelitis or ME, PVS, post viral fatigue syndrome or PVFS), attention deficit disorder (ADD), and ADHD. However, a gluten-free diet is is by no means a cure for any of these conditions. For more information on this topic visit the Related Disorders page.
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Celiac.com 03/12/2020 - Lactose intolerance is one of the most common food intolerances. Many people with celiac disease also have lactose intolerance, especially at the time they are first diagnosed. Lactose intolerance happens when the gut fails to produce enough lactase, and enzyme that breaks down the lactose sugar in milk. Lactose intolerance can be inherited, but it can also happen as people get older and their bodies produce less lactase. Studies consistently shows that only about one in three people worldwide can digest lactose beyond seven or eight years of age. Celiacs who eat gluten can become lactose intolerant after the villi and microvilli in their small intestine become damaged, and can no longer intercept and break down lactose molecules. However, most people recover on a gluten-free diet. Once the damaged villi and microvilli to grow back, and the gut heals, the sensitivity to lactose often disappears. This can take time. In most people, full gut healing takes between six months and a year. In some cases the villi and microvilli damage can take up to two years to heal fully. In any case, once the gut heals, lactose intolerance issues should disappear. Also, most people who are lactose intolerant can eat goat and sheep products, such as milk, yogurt and cheeses, such as feta and pecorino Romano, without any problems. Many people with lactose intolerance can also consume raw, unpasteurized dairy without symptoms. Links to Goat, Sheep, and Raw Cow Milk Products Goat Milk Products Sheep Milk Products Raw Cow Milk Products
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Celiac.com 06/08/2010 - Paul Seelig of Durham, owner of Great Specialty Products; a bread company that claimed to manufacture gluten-free bread which actually contained gluten and made many people sick, is now facing additional indictments for false murder implications. Selling, 48, is facing nine felony fraud charges for selling gluten contaminated bread which he claimed was gluten-free. People began complaining about Seelig's bread products after getting sick from them, which led state state officials to close Seelig's business in January, and arrest Seelig on criminal charges in February. In March, State School Board member Kathy Taft was raped and left for dead. She later died, and almost two months after that Jason K. Williford was charged with Kathy Taft's rape and murder. Prosecutors said that Seelig volunteered information about Taft's killer to barter for reducing or dismissing his felony charges. Seelig implicated a former co-worker who was entirely innocent, and had no connection to Taft's murder. On Monday, Seelig was expected to plead guilty to his felony charges and accept a plea deal, but he refused. Instead, Wake Superior Court Judge Donald Stephens arraigned Seelig on felony charges, is seeking additional indictments against Seelig for false murder accusations, and at the prosecutors request raised Seelig's bond to 750,000. Sources: NewsObserver.com News-Record.com
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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
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Celiac.com 12/19/2016 - Research conducted with high-resolution peripheral quantitative computed tomography (HRpQCT) has documented substantial bone micro-architecture in premenopausal women with newly diagnosed celiac disease. A team of researchers recently set out to assess changes in bone micro-architecture after 1 year on a gluten-free diet in a cohort of pre-menopausal women. The research team included MB Zanchetta, V Longobardi, F Costa, G Longarini, RM Mazure, ML Moreno, H Vázquez, F Silveira, S Niveloni, E Smecuol, Temprano M de la Paz, F Massari, E Sugai, A González, EC Mauriño, C Bogado, JR Zanchetta, and JC Bai. They are variously affiliated with the Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina; the Sección Intestino Delgado, Departamento de Medicina at the Hospital de Gastroenterología "Dr. C. Bonorino Udaondo” in Buenos Aires, Argentina; and with the Cátedra de Gastroenterología Facultad de Medicina and the Cátedra de Osteología y Metabolismo Mineral at the Universidad del Salvador in Buenos Aires, Argentina. Their team prospectively enrolled 31 consecutive females upon celiac diagnosis, and reassessed 26 of them after 1 year of gluten-free diet. All patients received HRpQCT scans of distal radius and tibia, areal BMD by DXA, and bone-specific parameters and celiac serology both times. The team then compared 1-year results against data from a control group of healthy pre-menopausal women of similar age and BMI in order to assess whether the micro-architectural parameters of treated celiac patients matched values expected for their age. Compared with baseline, the trabecular compartment in the distal radius and tibia showed marked improvement of trabecular density, trabecular/bone volume fraction [bV/TV] [p < 0.0001], and trabecular thickness [p = 0.0004]. Trabecular number remained stable in both regions. Cortical density increased only in the tibia (p = 0.0004). Cortical thickness decreased significantly in both sites (radius: p = 0.03; tibia: p = 0.05). DXA increased in all regions (lumbar spine [LS], p = 0.01; femoral neck [FN], p = 0.009; ultradistal [uD] radius, p = 0.001). Most parameters continued to be significantly lower than those of healthy controls. This prospective HRpQCT study showed that most trabecular parameters altered at celiac disease diagnosis improved significantly with a gluten-free diet, along with calcium and vitamin D supplementation. However, there were still significant differences with a control group of women of similar age and BMI. The team plans a prospective follow-up, in which they expect to be able to assess whether bone micro-architecture matches levels expected for a given patient's age. Source: J Bone Miner Res. 2016 Jul 22. doi: 10.1002/jbmr.2922.
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Celiac.com 03/24/2010 - Celiac disease is a permanent intolerance to gluten ingestion, which is predisposed in individuals with human leukocyte antigen (HLA ) and DQ2 or DQ8 haplotype. Celiac is an autoimmune disease and there has been mounting evidence indicating a substantial connection between celiac and other autoimmune disorders such as, autoimmune thyroiditis and diabetes mellitus type 1. Additionally, recent evidence has surfaced correlating a relationship between celiac and inflammatory bowel disease (IBD). An Italian study was designed to research a gene commonly associated with celiac disease known as MYO IXB, which was recently found to be mutated in IBD patients as well. Additionally, the chromosome 4q27 region is also associated with celiac disease and other autoimmune diseases, and predisposes patients to ulcerative colitis, indicating a common genetic code for these diseases. Although, other IBD risk factors were not found to be candidate genes for celiac disease. Italian patients with IBD were tested for celiac disease and their results were lower than expected, and lower than compared with the general population. celiac disease was found to be more prevalent in patients with ulcerative colitis than in those with Crohn's disease. Ulcerative colitis is typically isolated to the colon and is not present in the small intestine. However, there have been reports of diffuse duodenitis in ulcerative colitis patients which is sometimes mistaken for celiac disease. The gastroduodenal association with Crohn's disease varies from 30% to 80% of patients. Celiac disease and inflammatory bowel are not related, they are merely two diseases that sometimes cross the same path. While the prevalence of celiac disease in Italian IBD patients was typically low indicating no close relationship between celiac disease and inflammatory bowl disease, the mutual relationship of these diseases lies in the fact that patients with both conditions frequently share a history of iron-deficient anemia. It is thus important for patients that are unresponsive to treatments for IBD and are prone to incessant anemia, to also test for celiac disease. Source: Science Direct
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Scand J Gastroenterol 1999 Sep;34(9):909-14 AW Morrow Gastroenterology and Liver Centre, Dept of Histopathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. SPECIAL NOTE: European Codex Alimentarius quality wheat starch was used in this study. (Celiac.com 06/25/2000) BACKGROUND: It is expected that in patients with coeliac disease the small bowel mucosal mucosa will return to normal if they adhere to a gluten-free diet (GFD). However, in many this is not the case. This study aims to determine whether this persistent villous atrophy (VA) could be due to continued ingestion of the trace amounts of gluten in gluten-free foods, as defined by the WHO/FAO Codex Alimentarius. METHODS: Duodenal biopsy specimens from 89 adults with long-standing coeliac disease were examined, and the findings correlated with their form of gluten-free diet. RESULTS: In 51 subjects the duodenal specimen was normal, whereas in 38 there was villous atrophy (partial, 28; subtotal, 8; total, 2). There was no relationship between the presence or absence of VA and ingestion of either a GFD as defined by the Codex Alimentarius (Codex-GFD; 39 patients) or a GFD that contained no detectable gluten (NDG diet: 50 patients). Intraepithelial lymphocyte counts were higher, and lactase levels lower, in subjects with an abnormal biopsy specimen than in those in whom it was normal. However, within each of these biopsy groups there was no difference in these variables between patients on a Codex-GFD and those on an NDG-GFD. IgA antigliadin antibody was detected in 4 of 29 patients on a Codex-GFD and in 3 of 13 on a NDG-GFD (NS). CONCLUSION: The persistent mucosal abnormalities seen in patients with coeliac disease on a GFD are not due to the ingestion of trace amounts of gluten. The consequences of these abnormalities have yet to be determined.
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Children, Gluten Sensitivity and Other Food Related Issues
Paul Smith posted an article in Additional Concerns
Celiac.com 11/03/2009 - Many infants, toddlers and young children are either born with or develop a variety of protein allergies with symptoms including anaphylaxis, intolerance or sensitivity to milk, egg, shellfish, crustacean, peanuts, nuts, sesame seeds, soy and gluten. These symptoms can manifest themselves in a variety of ways including coeliac (celiac) disease (gut damage), eczema, shock, migraines, headaches, crankiness, aggression, depression, listlessness, chronic fatigue, irritable bowel, wind, flatulence, diarrhea, bloating, fluid retention, poor growth patterns, feeling vaguely and sometimes seriously unwell: a general failure to thrive.Unfortunately, we do not understand all the reasons. There are nutritional, neurological and hormonal implications, which often go unconsidered, to many of the foods we eat. In some instances, with babies, the problems are transmitted via the mother’s breast milk and there are many instances of babies, for example plainly uncomfortable at being entirely covered in a painful rash due to their reactions to gluten and other foods in their mother’s diets. Such problems are more common where there is a history of asthma, colic, gluten sensitivity and other immune system issues in the family. In other instances, the problems may be caused by too early an introduction of solid foods and food types and in some cases by simple over exposure to particular food categories. These issues require awareness and careful observation on the part of the mother to try and relate/identify the problem foods to the problems in the child. In some instances, these problems may also overlap with lactose intolerance, fructose malabsorption and other fermentable sugar issues. There can also be cumulative issues with preservatives and the histamines in chocolate/cocoa and orange juice. Histamines and gluten, either singly or in combination, can both contribute to headache, migraine and behavioral problems. I recall one young mother, the wife of a colleague, who found that her normally happy and contented baby son reacted negatively to the coffee, cabbage, curry, chocolate, pasta and occasional alcohol in her diet – all foods his mother enjoyed, particularly the chocolate - by becoming red in the face, grizzly, plainly uncomfortable and often with diarrhea. Fortunately, she was perceptive enough to relate these incidents to her diet and chose to abstain from consuming the offending foods for the duration of the breast-feeding period. We had spent some time discussing and theorizing about the underlying reasons.With the coffee we suspected the caffeine. With the cabbage we suspected the nitrogenous (high protein) fertilizers used in growing the vegetable and the sugar content. With the pasta we suspected the gluten and possibly the fructose content of the garlic and perhaps the garlic as an irritant. The curry and chili plainly had an irritant effect and we suspected the histamines in the chocolate. Michael, now in his late teens, eats all these foods sparingly but is pleased to avoid them where possible. He thrives on plain, simple meals with careful food combinations. Although not a celiac he is not fond of bread, biscuits and cakes etc and appears to instinctively avoid them. He likes his fruit and, particularly, his vegetables. He prefers to avoid spicy foods, deep fried foods, meat pies and the like where he struggles to digest the combination of meat and pastry: of protein and carbohydrate. He also prefers to avoid consuming orange juice in combination with toast and breakfast cereals: the combination of acid and carbohydrate. He deliberately avoids cucumber, garlic, onion, soft drinks, coffee and alcohol due to sugar fermentation and acidity issues. An intelligent, fun loving and well adjusted young man who towers over both his parents and enjoys robust good health, he has learned, with his mother’s support, to select and develop a diet which suits him and upon which he obviously thrives. He is living proof of the adage “that one man’s meat is another man’s poison”: that a single diet does not suit everyone. A lesson many people have yet to learn. Recently, via my blogs and Youtube videos I have made “friends” with three young men in their early twenties: one of Hispanic background from California and two from Melbourne. All are coeliacs (celiacs) with diabetes and thyroid complications overlapping with their gluten induced gut damage. All I suspect the result of long term poor food choices exacerbated by having to fend for themselves in early adulthood without the parental support, awareness and perception enjoyed by Michael. Interestingly, one of these young men from Melbourne has come to the conclusion that, unless he urgently does something to help himself, he will seriously compromise both his longevity and quality of life if he continues going down the path he has pursued to date. He has come back several times for reassurance, to seek further information and to express his determination to reach 80 years of age in good health. He is slowly, painfully and somewhat belatedly trying to go down the path pursued by Michael and his mother since Michael was a baby: that of finding the diet that suits his individual nutritional and health needs. He is making solid progress with the occasional setback like a recent bout of Ataxia (poor co-ordination, a classic symptom of gluten sensitivity, in addition to his severe gut damage) resulting from the eating of potato chips deep fried in gluten contaminated oil: an all too frequent occurrence. In some instances the child may outgrow the problem but in many others the problems or tendencies may be lifelong, for example, in the case of coeliac disease and many forms of gluten sensitivity and as in the case of Michael, recounted above, where many of the food sensitivities of early childhood remain into adulthood. In some other health problems, the degree of exposure to a particular food or food additive may be the issue. A small amount is OK but too much may lead to eczema, mucus, arthritis or headache problems etc. The consumption of such a food needs to be managed carefully. It is my belief that it is often better to eat a small amount of as many foods as possible – to build some tolerance to them - rather than to go down the road of the total exclusion of every offending food. Often, this approach is not only socially desirable but sometimes a necessity where there is limited opportunity to organize the food. In these circumstances, it is important for the dietary challenged individual to be selective and to know and understand their dietary limits and the consequences of exceeding those limits. I am a firm believer in the old adage of moderation and diversity in the diet and of gentle shifts in dietary regimes if making any changes. It is possible, for example, and often desirable to reduce the intake of sugar, salt, coffee, milk etc., in the diet and these changes are all best done gradually over a few weeks to enable the body, digestive system and the taste buds to acclimatise to the new regime. The same applies to the introduction of a new food. A gradual introduction of any new food is often more beneficial and pleasant than a sudden change in diet as this allows the body to adjust without adverse and off-putting reactions. -
Bile Acid Malabsorption Related to Chronic Diarrhea
Scott Adams posted an article in Diagnosis, Testing & Treatment
Eur J Gastroenterol Hepatol 2000;12:541-547. (Celiac.com 07/09/2000) Researchers in Sweden released a report that shows a high number of patients with chronic diarrhea also have bile acid malabsorption. Further, steatorrhea is also common, but appears to be independent of bile acid malabsorption. Their study evaluated 94 patients with chronic diarrhea for loss of bile acids using both 75-SeHCAT and a fecal fat excretion tests. The patients also completed a symptom questionnaire before during a 7 day period before taking the 75-SeHCAT test. Dr. Kjell-Arne Ung and his colleagues from Sahlgrenska University Hospital, in Goteborg reported their finding in the the May issue of the European Journal of Gastroenterology and Hepatology. They found that mild steatorrhea was present in 50% of patients with non-organic bile acid malabsorption, and in 38% of patients with functional diarrhea. Further, low 75-SeHCAT levels alone is not an indicator or risk for steatorrhea, although some patients with severe organic disease had a concomitant malabsorption of fat and of bile acids. Dr. Ungs study also shows that severe steatorrhea was common in patients with celiac disease, even in patients with high 75-SeHCAT values. When compared with patients who had functional diarrhea, those with bile acid malabsorption had significantly more frequent and looser stools, however, abdominal pain, distension and flatulence was equal between those with bile acid malabsorption and normal bile acid absorption. In conclusion Dr. Ung and colleagues state: The high prevalence of bile acid malabsorption and the absence of specific symptoms, with the exception of frequent and liquid stools, indicates that the 75-SeHCAT test should be performed early in the investigation of patients with chronic diarrhea. -
Author: Auricchio S; De Ritis G; De Vincenzi M; Silano V. Source: J Pediatr Gastroenterol Nutr, 1985 Dec, 4:6, 923-30. This paper is a critical appraisal of current theories on the mechanisms of toxicity of wheat and other cereals in celiac disease and some related enteropathies. The peptidase deficiency, primary immune defect, and gluten-lectin theories on celiac disease are examined and critically discussed on the basis of the relevant data available in 88 references. Special attention has been paid in this review to the nature of the cereal components triggering the appearance of toxic symptoms and signs in celiac disease as well as to underlying action mechanisms. The gluten-lectin theory is the one best able to explain celiac disease. It also explains some secondary intolerance that may occur in temporarily predisposed individuals as a consequence to viral hepatitis and intestinal infections, as well as the occurrence of intestinal lesions in healthy subjects that are administered very high amounts of gluten.
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