Diagnosing Celiac Disease is Far from Straightforward

Perhaps because celiac disease presents clinically in such a variety of ways, diagnosing it often takes an inordinately long time. A serological test positive for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and symptoms, and that patients should be spared it; others claim that the onset of celiac disease can predate the occurrence of villous atrophy, yielding a falsely negative misinterpretation of biopsy results.

To lend some clarity, a group of researchers in Romania analyzed the significance of genetic tests. It has been estimated that 98% of people with celiac disease have the DQ2 and DQ8 HLA haplotypes. But because these alleles are found in as many as 40% of the general population, they are considered more a prerequisite for developing celiac than a true positive indicator. However, they have high negative predictive value: their absence has traditionally been used to rule out a diagnosis of celiac.

Celiac Disease & Kids by Danna Korn

Welcome to CeliacKids.com by Danna Korn, founder of R.O.C.K. - Raising Our Celiac Kids, a support group for kids and their parents, and author of "Kids with Celiac Disease: A Family Guide to Raising Happy, Healthy Gluten-Free Children."

This is the premiere Web site for families and friends of gluten-free kids. The gluten-free lifestyle can be a challenge for anyone, and the information in other areas of Celiac.com will prove to be invaluable. Raising kids on a gluten-free diet presents unique challenges, and this site is filled with valuable information or resources to help you deal with some of those challenges and situations, including:

• Finding "fun" gluten-free treats for kids
• Menu ideas for school lunches, quick dinners, and sports snacks
• Helping the kids to take responsibility for reading labels, cooking and planning/preparing food
• How to prepare for unexpected birthday parties and food-oriented activities at school, church, and elsewhere
• Halloween, Easter, and other special days - how do we include our kids safely?
• Educating day-care providers and teachers - without burdening them
• Dealing with grandparents, babysitters, and "helpful" friends who offer gluten-containing foods to our kids
• But I don't want my kid to feel different!
• Ensuring our kids won't cheat, and what to do WHEN they do
• Sending kids away to camp, friends' houses, and other times when we're not around to help
• The psychological impact of growing up with celiac disease (peer pressure, teenage years, and more)
• Safe and forbidden ingredients and additives
• Latest news and important updates
• A must-read survival guide for parents, friends, teachers, and caretakers: Kids with Celiac Disease: A Family Guide to Raising Happy, Healthy Gluten-Free Children

Celiac Disease Screening

For someone along with a relatives heritage of celiac disease or of problems similar to thyroid disorder, Anemia of unidentified cause, sort I diabetes or other immune ailments or Downs syndrome, medical doctors may perhaps advise regimen screening. In any other case, clients are commonly screened on the situation by situation foundation in line with individual indications.

Individuals with celiac illness have abnormally significant levels of involved antibodies, including a single or maybe more for the following: anti-gliadin, anti-endomysium and anti-tissue transglutaminase, and harm to the villi (shortening and villous flattening) inside lamina propria and crypt regions of their intestines whenever they try to eat targeted food-grain antigens (toxic amino acid sequences) which might be found in wheat, rye, and barley.

Using HLA-DQ2-gliadin Tetramer Test to Assess Possible Celiac Disease

In an effort to improve diagnosis of celiac disease in patients already on a gluten-free diet, a team of researchers recently evaluated HLA-DQ2-gliadin tetramers for detection of gluten-specific T cells in peripheral blood and histological changes in the duodenum after a short gluten challenge as a diagnostic tool.

The study team included Margit Brottveit MD, Melinda Ráki MD, PhD, Elin Bergseng MScPharm, PhD, Lars-Egil Fallang MSc, PhD, Bjørg Simonsen BLS, Astrid Løvik MSc, Stig Larsen MSc, PhD, Else Marit Løberg MD, PhD, Frode L Jahnsen MD, PhD, Ludvig M Sollid MD, PhD, and Knut EA Lundin MD, PhD.

They are associated variously with the Department of Gastroenterology, the Department of Medicine, and the Department of pathology at Oslo University Hospital in Ullevål, Norway, the Centre for Immune Regulation at the Institute of Immunology at the University of Oslo and Oslo University Hospital, the Department of Pathology at Oslo University Hospital in Rikshospitalet, Norway, and the Norwegian School of Veterinary Medicine, Oslo, Norway.

Adherence to Biopsy Guidelines Increases Celiac Disease Diagnosis

A duodenal biopsy during endoscopy is the gold standard for diagnosing celiac disease. Because the histopathological features suggesting celiac disease , specifically villous atrophy, can vary in severity throughout the length of the small intestines, the American Gastroenterological Association Institute recommended in 2006 that at least 4 specimens be taken for examination. Yet the degree of adherence to this recommendation has not been assessed, and neither has its impact on diagnoses. A recent study by Benjamin Lebwohl at the Columbia University Celiac Disease Center concludes that most physicians are not following the guidelines, but they should be; doing so doubles the diagnosis of celiac disease.

Dr. Lebwohl and colleagues collated the specimens sent to Caris Life Sciences, a specialized GI pathology laboratory that receives samples from endoscopy centers in forty-three states plus the District of Columbia and Puerto Rico. They looked at 132, 352 patients who had endoscopies for various indications between January 1, 2006 and December 31, 2009. From these endoscopies, only 35% followed the recommendation of submitting at least four specimens. There was a slight increase once the guidelines were proposed, in 2006; but by the end of 2009 adherence to the guidelines was still a low 37%. Interestingly, the number of specimens submitted could be directly correlated with the probability of a positive diagnosis of celiac disease.

Gluten-Free Recipes

Gluten-Free Recipes by Category. Please submit your favorite gluten free recipe here by registering as an author on our site. Your recipes will appear here and help thousands of other people with celiac disease.

Note: You can buy many types of prepared gluten-free foods and the ingredients used in these recipes at Gluten-Free Mall

• Gluten-Free Bread Recipes
• Gluten-Free Dessert Recipes: Pastries, Cakes, Cookies, etc.
• Gluten-Free Flour Mixes
• Gluten-Free Kids Recipes
• Gluten-Free Muffin Recipes
• Gluten-Free Pancake Recipes
• Gluten-Free Recipes: American & International Foods

Celiac Disease Symptoms

How do symptoms of celiac disease differ with age of onset? continued...

Adults with celiac disease may have symptoms of diarrhea, steatorrhea, weight loss and flatulence; however, many adults do not have diarrhea or steatorrhea. They have either no symptoms or only vague abdominal discomfort such as bloating, abdominal distension and excess gas. They also may have only one, or only a few signs of malnutrition such as iron deficiency anemia, abnormal bleeding, or bone fractures. Some patients with celiac disease and gastrointestinal symptoms are mistakenly diagnosed with irritable bowel syndrome. For more information, please see the Irritable Bowel Syndrome article.

There have been changes during the past 20 years in the way in which celiac disease is diagnosed. The average age at which celiac disease is diagnosed has increased, probably because of the increased awareness that the disease can first cause symptoms or signs in adults. Whereas diarrhea was the initial symptom in 80% of patients, it now is the initial symptom in only 40%. A small proportion of patients-about 15%--are now diagnosed with blood antibody tests because they have a close relative with celiac disease and they are being screened to see if they also have the disease.

Celiac Disease Symptoms

2. Signs and symptoms of malnutrition and vitamin or mineral deficiencies

Symptoms of malnutrition and vitamin or mineral deficiencies include: weight loss, fluid retention, anemia, osteoporosis, bruising easily, peripheral neuropathy (nerve damage), infertility, and muscle weakness.

• Weight loss and fluid retention: Weight loss is the direct result of inadequate absorption of carbohydrates, proteins and fat. However, weight loss may not always occur because patients with celiac disease often have enormous appetites that compensate for the reduced absorption of nutrients. Moreover, weight loss can be masked by fluid retention. Fluid retention occurs in advanced malnutrition because the reduced absorption of protein results in low protein levels in the blood. High protein levels in the blood are necessary to keep fluid from leaking out of blood vessels and into the body's tissues. When blood protein levels fall as in celiac disease, fluid leaks into many tissues (edema) but particularly the ankles and feet, which swell due to the edema.
• Anemia: Lack of absorption of vitamin B12 and iron can lead to anemia.
• Osteoporosis: Lack of absorption of vitamin D and calcium can lead to osteoporosis and bone fractures.
• Easy bruising: Lack of absorption of vitamin K can lead to diminished ability of blood to clot and hence to easy bruising or excessive bleeding.

Celiac Disease Symptoms

What are the signs and symptoms of celiac disease?

Depending on the degree of malabsorption, the signs and symptoms of celiac disease vary among individuals, ranging from no symptoms, few or mild signs and symptoms, to many or severe signs and symptoms. There are two categories of signs and symptoms: 1) signs and symptoms due to malabsorption, and 2) signs and symptoms due to malnutrition including vitamin and mineral deficiencies.

1. Signs and symptoms of malabsorption

The three major categories of dietary nutrients are carbohydrates, proteins, and fat. Absorption of all of these nutrients can be reduced in celiac disease; however, fat is the most commonly and severely affected nutrient. Most of the gastrointestinal symptoms and signs of celiac disease are due to the inadequate absorption of fat (fat malabsorption). Gastrointestinal symptoms of fat malabsorption include diarrhea, malodorous flatulence (foul-smelling gas), abdominal bloating, and increased amounts of fat in the stool (steatorrhea). The unabsorbed fat is broken down by intestinal bacteria into fatty acids, and these fatty acids promote secretion of water into the intestine, resulting in diarrhea. Fatty stools typically are large in volume, malodorous (foul smelling), greasy, light tan or light grey in color, and tend to float in the toilet bowl. Oil droplets (undigested fat) also may be seen floating on top of the water.