Do you know about - Diagnosing Celiac Disease and Gluten Sensitivity
Gluten Free Diets! Again, for I know. Ready to share new things that are useful. You and your friends.Celiac disease, also known as gluten sensitive enteropathy is very common but frequently missed. It is an autoimmune disease of intestinal damage due to gluten in people who are genetically predisposed. First-rate Celiac disease is diagnosed by abnormal blood tests and an abnormal
appearing intestine on biopsy and symptoms that conclude with a gluten free diet.
How is Diagnosing Celiac Disease and Gluten Sensitivity
Several blood tests exist for Celiac disease. They have varying degrees of accuracy. Some are more sensitive, meaning they will be certain in milder forms of the disease but are not specific, meaning a certain test may not indicate Celiac disease. Others are felt to be very specific, meaning that when they are positive, it is practically certain you have the disease.
The most definite tests are tests for Celiac disease endomysial antibodies (Ema) and
tissue transglutaminase antibody (tTg) tests. These two tests are IgA based tests and can be negative if you are deficient in the immunoglobin IgA, which occurs in 10-20% of people with Celiac. When either Ema or tTg are certain Celiac disease is very likely and usually the intestine biopsy is positive. recent studies indicate that the tTg may only be certain in 40% of true Celiacs when mild degrees of intestine damage are gift on biopsy. Seronegative Celiac, meaning the blood tests are negative but the biopsy is positive, may occur in up to 20% of Celiacs.
Antibodies for gliadin (Aga), the toxic fraction of gluten are carefully very sensitive but not definite for Celiac disease. Newer assays for Aga antibodies for gluten that has undergone a chemical convert
called deamidation appear to be more definite for Celiac disease (Gliadin Ii,
Inova) than the older gliadin tests. They also may be as or more strict than Ema and tTg
antibody tests but are not yet widely available.
The most distressing qoute for people with lesser forms of gluten intolerance who have blood tests and/or biopsies that are normal or borderline yet acknowledge to a gluten free diet is either not being taken seriously or knowing for sure if they are sensitive to gluten. For these individuals stool
antibody testing for antigliadin and tTg have been helpful. Such stool testing has been performed in investigate labs and published in a few studies but are only recently ready straight through the industrial lab, Enterolab. Founded by a previous Baylor investigate gastroenterologist, Dr Ken Fine, the tests are ready to people online without a doctors order but are not commonly covered by insurance. Dr. Fine, who patented the test, has yet to issue the results of his findings in a peer reviewed journal so his tests are not widely accepted. However, his unpublished data and the clinical perceive of some of us who have used his test have
indicated the tests are very sensitive for signs of gluten sensitivity. He reports that they are 100% sensitive for Celiac disease and highly sensitive
for gluten sensitivity of lesser degrees. In the nearnessy of symptoms, that reverse on a gluten-free diet,
abnormal stool antibody levels can be found in most people before blood tests or biopsies come to be
abnormal.
Small intestine biopsies during upper gastrointestinal endoscopy
are carefully the "gold standard" for the diagnosis of Celiac disease.
However, recent studies have demonstrated that some people with gluten sensitivity, especially relatives of Celiacs
with little or no symptoms, have changes from gluten injury to the intestine that can not be seen with normal microscope examination. They can only be seen with special stains not routinely done or with a investigate electron microscope. The special stains are known as immunohistochemistry stains. They stain specialized white
blood cells called lymphocytes in the intestinal lining tips or villi. When these lymphocytes are increased it is known as intraepithelial lymphocytosis or increased Iels and it is the earliest sign
of gluten induced injury or irritation. Electron microscopy also reveals very early ultrastructural changes in some individuals when blood tests and approved biopsy exam are normal. When people who have these changes are
offered the choice of a gluten-free diet they usually responded favorably. In contrast, those who continue to eat gluten often later industrialized First-rate Celiac disease.
What these studies advise is that a "normal small intestine biopsy" may exclude
Celiac disease as defined by strict criteria but it is not a gold approved for detecting gluten sensitivity. This fact is appreciated by many individuals who have acknowledge to a gluten-free diet they start
based on their symptoms, house history, suggestive blood test or stool antibody
test(s).
Another source of confusion is in the genetics of Celiac and gluten sensitivity.
Testing for definite blood type patterns on white blood cells known as Hla
Dq2 and Dq8 is increasingly being employed to conclude if a man carries either of the two gene
pattern gift in 95-98% of Celiacs and predisposing them to the amelioration of Celiac disease. Some use the absence of these two patterns
as a way of excluding the possibility of Celiac disease and the need for testing or
gluten-free diet. However, there are rare reports of documented Celiac disease in people who are Dq2 and
Dq8 negative. Moreover, recent studies indicate other Dq
patterns may be related with gluten sensitivity though unlikely to
predispose to First-rate Celiac disease.
Testing for all the Dq patterns is advocated by Dr. Fine, based on his
experience with stool antibody test results. He reports that other Dq types are
associated with elevated levels of gliadin and tTg in the stool and symptoms that acknowledge to a gluten-free diet.
According to his unpublished data, all the Dq types except Dq4 are related with
a risk of intolerance to gluten. Therefore, testing for all the Dq types allows a man to
determine if they carry one of the two high risk gene types for Celiac disease or
any of the other "minor Dq" genes Fine has found related with gluten sensitivity.
Enterolab's stool testing for gliadin antibodies and tissue
transglutaminase antibodies, though not widely accepted, have gained favor in the lay
public's plan as an choice for determining sensitivity to gluten either despite negative blood tests and/or biopsies or in place of the more invasive tests. Most doctors still advise the approved blood tests and small
bowel biopsy for confirmation of Celiac. Though the reports in the lay society
are overwhelmingly certain they have not been subjected to peer quote in
the healing society pending Dr. Fine publishing his data or other researchers reproducing his results.
However, doctors open to
the broader qoute of gluten
sensitivity are reporting these tests helpful in many patients suspected of gluten
intolerance. Especially when man has symptoms consistent with gluten sensitivity but has negative or inconclusive blood tests and/or biopsies these tests may be very helpful though some are not certain
how to clarify the tests. The national Celiac organizations are uncertain about how to
comment on their application without published investigate though a recent narrative
in the British healing Journal did show stool tests highly definite for Celiac. Dr.
Fine has publicly commented that his unpublished data demonstrates those with
abnormal stool tests indicating gluten sensitivity
overwhelmingly acknowledge conveniently to a gluten free diet with improvement of
symptoms and normal quality of life.
Another qoute is that there are not universally agreed upon definitions for gluten sensitivity or intolerance. This becomes especially difficult for those who do not meet strict criteria for Celiac disease yet may have abnormal tests and/or symptoms that acknowledge to a gluten-free diet. Those individuals come to be confused when they try to find data but do not have a formal diagnosis of Celiac disease. Consensus in the healing society on definitions and more investigate in this area is greatly needed.
The few doctors who appreciate the spectrum of gluten
intolerance or sensitivity are outnumbered by the healing majority that continue to
insist on strict criteria for diagnosis for Celiac disease before recommending a
gluten-free diet. Doctors either unfamiliar with the limitations of the tests as documented by Celiac investigate or who insist on the
strict criteria for Celiac being the only indication for recommending a gluten free
diet unfortunately may confuse or frustrate gluten sensitive individuals. Some of these people then seek answers on the internet or from alternative practitioners. Many have their diagnosis missed, challenged, dismissed, or are misinformed. As a succeed they fail to benefit from the health
benefits of a gluten-free diet because they are advised that it is not required based on normal blood tests and/or normal biopsies. In the meantime, Celiac disease and gluten sensitivity continue to be undiagnosed or misdiagnosed. For more data visit http://www.thefooddoc.com.
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