Celiac Disease, also known as gluten intolerance, is a genetic disorder that affects at least 1 in 1331 Americans. Symptoms of Celiac Disease can range from classic features, such as diarrhea, weight loss, and malnutrition, to latent symptoms such as isolated nutrient deficiencies but no gastrointestinal symptoms.
Celiac Disease mostly affects people of European (especially Northern European) descent, but recent studies show that it also affects Hispanic, Black and Asian populations as well. Those affected suffer damage to the villi (shortening and villous flattening) in the lamina propria and crypt regions of their intestines when they eat specific food-grain antigens (toxic amino acid sequences) that are found in wheat, rye, and barley. Oats have traditionally been considered to be toxic to celiacs, but recent scientific studies have shown otherwise. This research is ongoing, however, and it may be too early to draw solid conclusions.
Celiac Disease mostly affects people of European (especially Northern European) descent, but recent studies show that it also affects Hispanic, Black and Asian populations as well. Those affected suffer damage to the villi (shortening and villous flattening) in the lamina propria and crypt regions of their intestines when they eat specific food-grain antigens (toxic amino acid sequences) that are found in wheat, rye, and barley. Oats have traditionally been considered to be toxic to celiacs, but recent scientific studies have shown otherwise. This research is ongoing, however, and it may be too early to draw solid conclusions.
Because of the broad range of symptoms of Celiac Disease, it can be difficult to diagnose. The symptoms can range from mild weakness, bone pain, and aphthous stomatitis to chronic diarrhea, abdominal bloating, and progressive weight loss. Many people have Celiac Disease and don't know it. To determine the disease, there are two types of celiac tests to be taken. First, a set of blood tests and if inconclusive, then a biopsy should be performed.
When a person with Celiac Disease continues to eat gluten, studies have shown that he or she will increase their chances of gastrointestinal cancer by a factor of 40 to 100 times that of the normal population. Further, gastrointestinal carcinoma or lymphoma develops in up to 15 percent of patients with untreated or refractory Celiac Disease. It is therefore imperative that the disease is quickly and properly diagnosed so it can be treated as soon as possible.
The Top 5 Misdiagnoses For Celiac Disease:
When a person with Celiac Disease continues to eat gluten, studies have shown that he or she will increase their chances of gastrointestinal cancer by a factor of 40 to 100 times that of the normal population. Further, gastrointestinal carcinoma or lymphoma develops in up to 15 percent of patients with untreated or refractory Celiac Disease. It is therefore imperative that the disease is quickly and properly diagnosed so it can be treated as soon as possible.
The Top 5 Misdiagnoses For Celiac Disease:
- Anemia
- IBS
- Psychological stress, nerves, imagination
- Diarrhea
- IBD
Based on the figure mentioned above, we can extrapolate the total number of people in the United States with Celiac Disease: 2.18 million (based on the total population: 290,356,0285). It is very important that doctors understand just how many people have this disease so that routine testing for it is done to bring the diagnosis rate in line with the diseases epidemiology.
Taking the celiac test is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis.
Taking the celiac test is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis.
The only acceptable treatment for Celiac Disease is strict adherence to a 100% gluten-free diet for life. An adherence to a gluten-free diet can prevent almost all complications caused by Celiac Disease. A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods.
How To Prepare For the Celiac Test:
Before undergoing any celiac test (blood test or biopsy), it is important to continue to eat a regular gluten-containing diet. If you stop eating gluten and then take the celiac test, the results may be falsely negative, that is, the celiac test results might say you do not have Celiac Disease, even though you really do. Therefore, if you have started a gluten-free diet before being tested for Celiac Disease, you might need to start eating gluten again before taking the celiac tests.
Taking The Celiac Blood Test:
The first step in the diagnosis of Celiac Disease is usually a set of blood tests to measure levels of certain auto antibodies. Unlike antibodies, which attack foreign substances in the body, auto antibodies attack the body’s own tissues. The autoantibodies that doctors usually measure during the celiac blood test are called immunoglobulin A (IgA), anti-tissue transglutaminase (tTGA), and IgA anti-endomysium antibodies (AEA).
If the auto antibody levels turn out to be high, the patient probably has Celiac Disease. Unfortunately, however, if the levels are not elevated, it is not safe to conclude that the patient does not have celiac disease. A biopsy should then be performed.
Biopsy for Celiac Disease Diagnosis:
If the celiac blood test or symptoms suggest celiac disease, the next step is a small bowel biopsy during an endoscopy. (“Small bowel” is another term for “small intestine.”) Small bowel biopsies are usually done to confirm the diagnosis, even when the initial blood celiac test is positive. If the patient has positive blood tests and biopsy-proven dermatitis herpetiformis, however, a small bowel biopsy is not required.
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| Microscope views of tissue taken from the small intestine by biopsy. At left are normal villi (finger like projections ex- tending from the surface). At right, is tissue from a celiac patient, the villi have flattened and disappeared. |
Ordinarily, the lining of the small intestine (the mucosa) is covered with hairlike projections called villi. In patients with untreated Celiac Disease, the inflammation that develops in response to gluten causes the villi to shrink and flatten. This effect can be seen when tissue samples taken from the small intestine by biopsy are examined under a microscope, as shown here.
While the patient is asleep, the doctor passes a long, narrow tube called an endoscope through the patient’s mouth and stomach, into the small intestine. The doctor can then pass instruments through the endoscope to remove tissue samples and also take photographs. Later, a pathologist will study the tissue samples to check for the classic signs of shrinkage and flattening of the villi.
How Accurate Are The Celiac Blood Tests?
The current diagnostic tests for Celiac Disease are very accurate, particularly when tTG and anti-endomysial antibodies are elevated. The isolated presence of anti-gliadin antibodies does not necessarily imply that the subject is affected by Celiac Disease, with the exception of children under the age 2 in which tTG and EMA may not be present.
Confirmation of a Celiac Disease Diagnosis: Improvement on the Gluten-Free Diet
The final piece that confirms the diagnosis of Celiac Disease (after the positive biopsy result), is improvement of health with the gluten-free diet.
Once conformation of Celiac Disease is established, you'll need to adhere to a strict gluten-free diet. For more on gluten-free diets, visit gluten-free-pasta.blogspot.com.
When Should You Have Follow-Up Celiac Blood Tests?
According to the University of Chicago Celiac Disease Center, new celiacs should receive follow-up blood tests twice in the first year after their diagnosis: The first time between 3 to 6 months after their diagnosis, and then again after a full year of being gluten free. After that, blood tests should be done once a year.
When Should You Have Follow-Up Celiac Blood Tests?
According to the University of Chicago Celiac Disease Center, new celiacs should receive follow-up blood tests twice in the first year after their diagnosis: The first time between 3 to 6 months after their diagnosis, and then again after a full year of being gluten free. After that, blood tests should be done once a year.
Celiac Disease
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