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      Frequently Asked Questions About Celiac Disease   04/24/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What is Celiac Disease and the Gluten-Free Diet? What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes

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Found 10 results

  1. Celiac.com 08/10/2012 - A diagnosis of Celiac disease is measured mainly by an adverse response to gluten, yet there is very little in the way of data regarding gluten challenge in adults on a gluten-free diet. A research team recently studied the kinetics of histological, serological, and symptomatic responses to gluten challenge in adults with celiac disease. The research team included D. Leffler, D. Schuppan, K. Pallav, R. Najarian, J.D. Goldsmith, J. Hansen, T. Kabbani T, M. Dennis, and C.P. Kelly. They are affiliated with Beth Israel Deaconess Medical Center in Boston, Massachusetts. For their study, the team wanted to address a lack of data regarding the kinetics of responses to gluten, which causes assessment issues in clinical practice and research when gluten-challenge is performed. For their study, the researchers recruited twenty adults with biopsy-proven coeliac disease. For each participant, the team conducted two run-in visits followed by a 14-day gluten-challenge at a randomly assigned dose of 3 or 7.5 g of gluten/day. Patients visited study team doctors at 3, 7, 14 and 28 days after the start of their gluten challenge. The researchers performed duodenal biopsy during the run-in and at days 3 and 14 of gluten challenge. The team used two pathologists to measure villous height to crypt depth ratio (Vh:celiac disease) and intraepithelial lymphocyte (IEL) count/100 enterocytes. Upon each visit, the team also assessed antibodies to tissue transglutaminase and deamidated gliadin peptides, lactulose to mannitol ratio (LAMA) and any physical symptoms. Compared to the initial data, results after 14 days showed substantially lower Vh:celiac disease (2.2-1.1, p Interestingly, gastrointestinal symptoms increased significantly after three days, but had returned to baseline by day 28. There were no differences between the higher and lower gluten doses. The team concludes by noting that a 14-day gluten challenge at or above 3 g of gluten/day triggers cellular, tissue, and blood changes in most adults with celiac disease. These findings will help researchers create more accurate clinical trials, and show that many individuals will meet celiac diagnostic criteria after a basic 2-week gluten challenge. Source: Gut. 2012 May 22.
  2. Celiac.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
  3. Celiac.com 03/26/2010 - Mass screening studies among the general population for celiac disease show a prevalence of approximately 0.5-1.0% in adults and in children. Yet, despite the growing numbers of newly diagnosed celiac disease patients, most cases still remain undiagnosed and therefore, untreated. In part, the masses of misdiagnosed or undiagnosed celiac disease patients are a result of the variety of disguises celiac disease can have. Celiac disease can manifest into a multitude of symptoms including, but by no means exclusive to, malabsorption syndrome, diarrhea, anemia, infertility and osteoporosis. It has been demonstrated that there is a clear advantage to early testing for celiac disease. Early testing can aide in avoiding the irreversible damages that come from diagnosis later in life, such as stunted growth and organ damage. It is also faster for children to heal from intestinal lesions caused from undiagnosed celiac disease, when diagnosed early on. New evidence shows that 10 years after being diagnosed with celiac disease, 66% of the children diagnosed exhibited improvement in their health and overall quality of life; indicating that mass screening at an early age is critical. This study was based on a previous study performed by mass screening for celiac disease by a group of scientists in the Netherlands between 1997 and 1998, who studied 6,127 asymptomatic children between the ages of two and four. Using endomysial antibodies (IgA EmA) testing, the children were screened for celiac disease. 57 seropositive children were then given biopsies. The scientists compared different testing methods for celiac disease, evaluated their serological persistence over time, and determined optimum cut-off points for the testing. Using serological samples obtained at biopsy, EmA and tTGA was assessed for each subject studied. Human leukocyte antigen (HLA)-typing was obtained from 55 children; 26 of those had normal biopsies and were genetically predisposed for celiac disease and 29 of the children had small-bowel alterations known to be distinctive traits for celiac disease. Of the 26 children with normal biopsies, 4% of them tested positively for HLA-DQ8, and the other 96% tested positive for HLS-DQ2. Of the 29 children diagnosed with celiac disease, all of them tested positive for HLA-DQ2. However, a proportionately large number of children who tested EmA-positive and were diagnosed with celiac disease, had normal biopsies and were thus regarded as false positives. The results of this test confirmed that celiac disease antibody levels may fluctuate in children who are genetically predisposed for celiac disease. While the reason for the transient antibodies is still not known, it has been suggested that children who are seropositive but have normal small-intestine biopsies, potentially have celiac disease, and are susceptible to developing gluten sensitive enteropathy as they get older. Future testing is needed to establish results for this hypothesis. However, children with histological alterations in their small-intestine biopsy indicative of celiac disease, had considerably higher antibodies for EmA than those without celiac disease. The tTGA levels were significantly higher and occurred with more frequency in children with celiac disease than in children without celiac disease. EmA persisted in all celiac disease children, but only in 50% of the non-celiac disease children. tTGA was evident in 83% of celiac disease children, and 15% in non-celiac disease children. Additionally, increasing the cut-off points provided a reduction of false positives, but resulted in lowering test sensitivity. While optimization of standard cut-off points reduced unnecessary biopsies by 50%-96%, it also reduced test sensitivity. In conclusion, celiac disease antibodies are proven to be transient in children genetically predisposed to celiac. It is therefore crucial for medical providers to reduce the number of unnecessary biopsies. As this study has demonstrated, to reduce the number of unnecessary biopsies by 85%, serological mass screening methods may be improved by repeating EmA and/or tTGA in children who test seropositive after 6 months, and before continuing to biopsy. Source: http://www.ncbi.nlm.nih.gov/pubmed/20047580
  4. Celiac.com 03/11/2010 - Many people are confused about which tests provide the most accurate results for a celiac disease diagnosis. In a recent study by a team at the Department of Gastroenternology and Internal Medicine, St. Orsola-Malpigihi Hospital, University of Bologna, Bologna, Italy, researchers evaluated current testing methods, and made some conclusions about celiac testing that may shed light on the subject for those of us overwhelmed by current conflicting information. Duodenal biopsy is considered to be the universal 'gold standard' for celiac diagnosis. However, in recent years the importance of serological testing has been been emphasized as a reliable marker for antibodies as well. The tTG antibodies of IgA class are currently recognized to be the most effective test for celiac screening, resulting in up to 95% accuracy. Although, a new serological test, DGP, is now being investigated as a more reliable alternative to tTG. A study was devised to compare the effectiveness of DGP antibodies with that of tTG antibodies, and used a meta-analysis of eleven studies that were published between 1998 and 2008. The study analyzed the results of 937 patients with untreated celiac, and 1,328 control subjects. The analysis of the eleven studies showed that IgA tTG antibodies revealed a higher likelihood ratio (LR) than IgA DGP antibodies, and IgA tTG antibodies exhibited a lower LR than IgA DGP antibodies. The data between the two antibody tests validates that IgA tTG continues to display the most accurate diagnostic tests for a positive celiac diagnosis, as well as for excluding a negative celiac diagnosis. However IgG DGP antibody tests were shown to be more effective at identifying 'false negatives' and had more success in determining celiac in patients that had IgA deficiency, and in children under two years old. The results of these tests clearly demonstrate that IgA DGP does not offer any advantages to the IgA tTG antibodies, and is actually less accurate and more expensive. However, IgG DGP antibodies present an invaluable tool in screening for celiac disease in cases where IgA tTG tests fail. Eventually, a new antibody screening will hopefully be designed which combines IgA tTG and IgG DGP, and reduces the number of tests currently used in celiac screening. However, intestinal biopsy is always required to confirm the presence of celiac disease no matter what serological tests are involved. Source: http://www.ncbi.nlm.nih.gov/pubmed/20136587
  5. The following abstract was submitted to celiac.com directly by William Dickey, Ph.D., a leading celiac disease researcher and gastroenterologist who practices at Altnagelvin Hospital, Londonderry, Northern Ireland. Dig Liver Dis. 2005 Sep 29; Dickey W, McMillan SA. Department of Gastroenterology, Altnagelvin Hospital, Londonderry BT47 6SB, Northern Ireland, UK. Celiac.com 10/11/2005 - BACKGROUND.: Serological testing, using IgA class endomysial and tissue transglutaminase antibodies has high sensitivity and specificity for celiac disease and allows case finding by clinicians other than gastroenterologists. We reviewed new celiac patients seen over a 9-year period to determine how the availability of serology, particularly to primary care physicians, has changed rates and sources of diagnosis. METHODS.: Files of patients attending a specialist celiac clinic who were diagnosed from 1996 through 2004 were reviewed. Patients with villous atrophy consistent with gluten sensitive enteropathy (Marsh III) on duodenal biopsy were selected. Data analyzed included clinical characteristics, endomysial and tissue transglutaminase antibodies status and source of request for serology. RESULTS.: Over the study period 347 new celiac patients, comprising adults and children aged 10 years and over, were identified, of whom 163 (47%) were identified by serological testing in primary care, 152 (44%) at the hospital gastroenterology department and 32 (9%) by other physicians in secondary care. Over three consecutive 3-year periods, the percentage of patients identified in primary care rose from 28% through 47% to 60%, with a rise in total numbers diagnosed from 93 through 118 to 136. There was no change in patient clinical characteristics over the study period. Though tissue transglutaminase antibodies were less sensitive than endomysial antibodies, combined testing obtained a sensitivity of over 90%. Patients identified in primary care were significantly younger and more likely to present with diarrhea as a primary symptom. CONCLUSION.: Currently over half of our celiac patients are identified by serological testing in primary care, which has resulted in an overall rise in diagnosis rates. Primary care practitioners have an important role in the diagnosis of celiac disease, particularly of patients who present with non-gastrointestinal symptoms. The contribution of specialists other than gastroenterologists in secondary care is disappointing and may improve with directed education.
  6. Dig Dis Sci. 2004 Apr;49(4):546-50 Celiac.com 08/27/2004 – Dr. Peter Green and colleagues at the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, conducted a study designed to determine the sensitivity of the various serological tests used to diagnose celiac disease. To do this they looked at 115 adults with biopsy-proven celiac disease who fulfilled strict criteria which included serological testing at the time of their diagnosis, and a positive response to a gluten-free diet. Out of those studied, 71% had total villous atrophy, and 29% had partial villous atrophy. Serological results indicated that only 77% of those with total and 33% of those with partial villous atrophy actually tested positive for celiac disease, and it did not matter whether the patients presented with classical or silent symptoms. All patients who were positive for anti-tissue transglutaminase had total villous atrophy. The researchers conclude: Seronegative celiac disease occurs. Endomysial antibody positivity correlates with more severe villous atrophy and not mode of presentation of celiac disease. Serologic tests, in clinical practice, lack the sensitivity reported in the literature.
  7. V. Kumar,* M. Jarzabek-Chorzelska, J. Sulej, Krystyna Karnewska,** T. Farrell,* and S. Jablonska *IMMCO Diagnostics, Inc., Buffalo, New York 14228; Departments of Microbiology and Dermatology, State University of New York at Buffalo, Buffalo, New York 14214; and Department of Dermatology, Warsaw School of Medicine, Warsaw, Poland; ** Department of Gastroenterology and Pediatrics, Selesian School of Medicine, Warsaw, Poland Clinical Diagnostic Immunology 9:1295-1300, 2002. Celiac.com 12/31/2002 - Background: Immunoglobulin A (IgA) deficiency is 10-15 times more common in patients with Celiac Disease (celiac disease) than in normal subjects. Serological tests have become the preferred methods of detecting both symptomatic and asymptomatic patients with celiac disease. However, commercially available serological methods are limited in that they detect only the IgA isotype of antibodies (with the exception of IgG gliadin assays); hence, IgA deficient celiac disease patients may yield false negative serology. Methods: Fifteen celiac disease and ten non-celiac disease IgA deficient pediatric cases were examined for IgA and IgG antibodies to endomysium, gliadin and tissue transglutaminase. Results: Twenty five specimens with IgA deficiency were examined. Fifteen were celiac disease cases and ten were non-celiac disease cases. All fifteen IgA deficient celiac disease cases were positive for endomysium antibodies of the IgG isotype and for IgG gliadin antibodies. All but one of the IgA deficient celiac disease cases were also positive for IgG tissue transglutaminase antibodies. None of the non-celiac disease IgA deficient cases were positive for any of the antibody markers. All the specimens examined were also negative for IgA specific antibodies to endomysium, gliadin, and tissue transglutaminase. Conclusions: IgG specific antibody tests for endomysium, gliadin and tissue transglutaminase are useful for the identification of IgA deficient celiac disease patients. IgG antibody tests along with tests routinely being used in clinical laboratories can reliably detect all active celiac disease patients. In addition, the levels of these celiac disease-specific IgG antibodies could be used to monitor patient dietary compliance.
  8. Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: There is no simple answer to this question as the susceptibility of the patient to developing celiac disease is dependent upon several factors. One factor is the amount of gluten intake. Another is the genetic makeup of the individual. However, we feel that several weeks of gluten intake, especially in doses of 2 gm gluten/day, should result in positive serology in patients with celiac disease. Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: The result of serological tests depends on the diet. Generally, three to six months of a gluten-free diet may result in normal antibody levels in a new patient. A strict gluten-free diet for more than three months may result in inconclusive serological tests in patients, who have started a diet without any diagnostic test. In this case a gluten challenge should be introduced for a proper diagnosis. Each patient has different sensitivity to gluten for reasons that are unclear. The period of gluten challenge and the amount of gluten necessary to provoke serological immune response are individually different. A 0.3 g/kg body weight/day of single gluten challenge causes immunological changes (cellular immunity) in the intestine (J Pediatr Gastroenterol Nutr 1989; 9:176-180) in patients on a gluten-free diet, however, the serological response is much slower. Our recommendation is to ingest at least 0.3 g/kg/day of gluten for two months prior to the serological tests. However, if somebody experiences symptoms during the gluten challenge we recommend to perform serological tests earlier. The protein content of wheat flour is between 7-15% and approximately 90% of the protein content is gluten. That means a slice of bread may have 2-3 g of gluten.
  9. Vijay Kumar, MD, Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics I enjoyed reading J. Murrays comments related to the diagnosis of celiac disease and agree that taking multiple biopsies is still the gold standard of diagnosing celiac disease. However, I am sure he will agree that there are limitations in the histopathological methods of diagnosing celiac disease. As we know, histological features occur in continuum, with flat lesions at one end of the spectrum and a mucosa with normal villous and crypt architecture but abnormally high density or count of villous intraepithelial lymphocytes at the other, which may be reported normal. In addition, patients with silent, atypical or occult celiac disease may exhibit normal or mild villous atrophy and histopathology may not be diagnostic. The best example would be patients with dermatitis herpetiformis (DH). As we know, all DH patients have gluten sensitive enteropathy, but only 60-70% of DH patients exhibit characteristic histopathology diagnostic of gluten sensitive enteropathy. In this regard, there has been a constant effort to put forth a simple serological method that is a specific and sensitive indicator of gluten sensitive enteropathy. There are basically three antibody markers (ARA, AGA and EMA) that could be used for diagnosing celiac disease and DH. Our studies indicate and corroborate with the others that the AGA test is a sensitive but not very specific marker of celiac disease. On the other hand, ARA is very specific but not sensitive. We described in 1984 the endomysial antibody test and we felt very comfortable reporting that this EMA test has >99% specificity and sensitivity for gluten sensitive enteropathy. We reported cases of DH who were biopsy negative but EMA positive in which the histopathological changes consistent with celiac disease could be induced on an increased gluten intake indicating thereby the sensitivity of EMA tests. The following table is a summary of our studies on the utility of various serological methods of diagnosing celiac disease. Comparison of Sensitivity, Specificity, Positive and Negative Predictive Value of AGA, ARA, and EMA in Active Celiac Disease: % of Sensitivity % of Specificity Predictive Value % Pos Predictive Value % Neg EMA (Endomysium) 97% 98% 97% 98% ARA (Reticulin) 65% 100% 100% 72% IgG AGA 88% 92% 88% 92% IgA AGA 52% 94% 87% 74% I shall be glad to discuss the utility of serological methods in diagnosing celiac disease with anyone interested.
  10. Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: The three serological tests that are used for diagnosing celiac disease are: Anti-endomysial antibody (EMA) Anti-reticulin antibody (ARA) Anti-gliadin antibody (AGA) Each of these three tests provide a certain degree of reliability for diagnosing celiac disease. Of these, endomysial antibody is the most specific test. The following table is taken from our studies (Lerner, Kumar, Iancu, Immunological diagnosis of childhood coeliac disease: comparison between antigliadin, antireticulin and antiendomysial antibodies). % of Sensitivity % of Specificity Predictive Value % Pos Predictive Value % Neg EMA 97% 98% 97% 98% ARA 65% 100% 100% 72% IgG AGA 88% 92% 88% 92% IgA AGA 52% 94% 87% 74% The following definitions related to sensitivity, specificity, positive and negative predictive values may help: Sensitivity is the probability of a positive test result in a patient with disease. Specificity is the probability of negative test result in a patient without disease. Positive predictive value is the probability of disease in a patient with positive test result. Negative predictive value is the probability of no disease in a patient with negative test result. Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: The summary below shows the results of the main serological tests based on several publications including 388 patients with celiac disease, and 771 healthy subjects. SENSITIVITY- the proportion of subjects with the disease who have a positive test. It indicates how good a test is at identifying the diseased: Percentage of - IgA AGA Percentage of - IgG AGA Percentage of - IgA EMA Average 78% 79% 97% Range 46-100% 57-94% 89-100% SPECIFICITY- the proportion of subjects without the disease who have a negative test. It indicates how good a test is at identifying the non-diseased: Percentage of - IgA AGA Percentage of - IgG AGA Percentage of - IgA EMA Average 92% 84% 98.5% Range 84-100% 52-98% 97-100% POSITIVE PREDICTIVE VALUE- the probability that a person with positive results actually has the disease: Percentage of - IgA AGA Percentage of - IgG AGA Percentage of - IgA EMA Average 72% 57% 92% Range 45-100% 42-76% 91-94% NEGATIVE PREDICTIVE VALUE- the probability that a person with negative results does not have the disease: Percentage of - IgA AGA Percentage of - IgG AGA Percentage of - IgA EMA Average 94% 94% 100% Range 89-100% 83-99% 100% References: McMillan SA, Haughton DJ, Biggart JD, Edgar JD, Porter KG, McNeill TA. Predictive value for coeliac disease of antibodies to gliadin, endomysium, and jejunum in patients attending for jejunal biopsy. Brit Med J 1991;303:1163-1165 Ferreira M, Lloyd Davies S, Butler M, Scott D, Clark M, Kumar P. Endomysial antibody: is it the best screening test for coeliac disease? Gut 1992;33:1633-1637. Khoshoo V, Bhan MK, Puri S, Jain R, Jayashree S, Bhatnagar S, Kumar R, Stintzing G. Serum antigliadin antibody profile in childhood protracted diarrhea due to coeliac disease and other causes in a developing country. Scand J Gastroenterol 1989;24:1212-1216. Chan KN, Phillips AD, Mirakian R, Walker-Smith JA. Endomysial antibody screening in children. J Pediatr Gastroenterol Nutr 1994;18:316-320. Bode S, Weile B, Krasilnikoff PA, Gdmand-Hyer E. The diagnostic value of the gliadin antibody testing celiac disease in children: a prospective study. J Pediatr Gastroenterol Nutr 1993;17:260-264. Calabuig M, Torregosa R, Polo P, Tom s C, Alvarez V, Garcia-Vila A, Brines J, Vilar P, Farr C, Varea V. Serological markers and celiac disease: a new diagnostic approach ? J Pediatr Gastroenterol Nutr 1990;10:435-442.