Archive for the ‘Celiac disease’ Category

 


PA Legislature proclaims April ‘Celiac Disease Awareness Month.’

Ambler, PA, April 03, 2009 --(PR.com)-- Legislation passed by the Pennsylvania House of Representatives General Assembly recognizes April 2009 as the state’s official ‘Celiac Disease Awareness Month’. With the passing of House Resolution 153 (HR 153), Pennsylvania takes the lead in raising awareness for celiac disease as the most common and most undiagnosed autoimmune disorder in the United States.

HR 153 was ratified unanimously, 196-0, on March 31st, 2009 with the assistance of its prime sponsor, state representative Craig A. Dally (R).

Geoffrey M. Roche, advocacy chairman for the National Foundation for Celiac Awareness (NFCA) and resident of Bethlehem, PA, collaborated extensively with representative Dally on the creation and development of HR153, and lobbied for its passage in the State House of Representatives.

"I would like to thank my State Representative, Craig Dally, and the entire State House for recognizing the impact this disease has on many Pennsylvanians and for assisting the National Foundation for Celiac Awareness in creating awareness that will ensure individuals with celiac get diagnosed, and correctly manage the disease." says Roche. “I understand first hand the impact this disease has on one's life and the need for education and awareness across our entire nation.”

The entire resolution in its entirety can be read on the National Foundation for Celiac Awareness website, www.celiaccentral.org.

Roche’s role in the successful sanctioning of HR153 and his passionate efforts on behalf of NFCA, stem from his personal experience with celiac disease, having been diagnosed with the autoimmune disorder just 11 months ago.

NFCA founder and president Alice Bast describes HR153 as, "‘The first step in reforming the US health care system in relation to autoimmune diseases, preventive care and chronic disease management.”

NFCA and Roche aim to pass similar resolutions in every state nationwide, providing assistance and resources for citizens working on legislative efforts for the purpose of spreading awareness of celiac disease, a disease which current estimates suggest affect 1 in every 133 Americans. Only 120,000 of individuals with the autoimmune digestive disorder, roughly 1 in every 4700, have been diagnosed.

“Early assessment of celiac is crucial in preventing the onset of complications such as other autoimmune disorders, serious illnesses, and some cancers for individuals with this disease.” says Bast.

Those interested in enacting legislation in their states should contact the NFCA at info@celiaccentral.org, by phone (215) 325-1306 ext.101, or visit the ‘Get Involved’ section on the NFCA website, www.celiaccentral.org for information.

Celiac disease is an autoimmune digestive disease that damages the small intestine and interferes with absorption of nutrients from food. It is triggered by consumption of the protein called gluten, which is found in wheat, barley and rye. Left untreated, people with celiac disease can develop further complications such as other autoimmune diseases, osteoporosis, thyroid disease, and some cancers. An estimated three million Americans have celiac disease, but only about 1 in every 4700 with the disease receives an accurate diagnosis. Currently, the only treatment is a lifelong gluten-free diet.

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NFCA is a 501(c)(3) non-profit organization dedicated to raising awareness and funding for celiac disease that will advance research, education and screening amongst medical professionals, children and adults. Visit www.celiaccentral.org or call 215-325-1306 for further information.

Contact Information National Foundation for Celiac Awareness Whitney Ehret 215-325-1306 whitney@celiaccentral.org www.celiaccentral.org


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recognizing_celiac_disease_cover_lg1 The University of Chicago Celiac Disease Center has chosen Recognizing Celiac Disease as the supplemental reading material for medical professionals who complete its Preceptorship Program.

Dr. Stefano Guandalini, medical director of the center, recommends the book for both patients and healthcare providers. “The book is useful for prospective patients to determine whether their complaints are consistent with celiac disease. It is also an excellent patient resource for self management, especially in identifying ongoing and future health problems related to celiac disease and bringing them to the attention of their physician for proper treatment. “Recognizing Celiac Disease” is a useful reference that will serve as a helpful tool for health care providers and anyone diagnosed with the disease.”

The University of Chicago Celiac Disease Center's Preceptorship Program is an on-site intensive 2-day training course for medical professionals. Candidates study under the direction of the Center's celiac disease experts. The course includes formal instruction, as well as hands-on training. This is the nation's only such program. More information about the University of Chicago Celiac Disease Center and the Preceptorship Program can be found at www.celiacdisease.net.

“Recognizing Celiac Disease” is the definitive guide to understanding, diagnosing and managing celiac disease. It is a reader-friendly, celiac disease reference manual written for both medical professionals and the general public.

For more information visit, www.recognizingceliacdisease.com.

 

restless leg syndrome treatment

RLS from low iron in celiac disease responds to a gluten-free diet

Low iron levels have been associated with increased severity of restless leg syndrome. The following medical case report discusses four patients with low iron and restless leg syndrome who were tested positive for celiac disease and placed on a gluten free diet. All four had improvement on the gluten free diet.

"Celiac disease as a Possible Cause for Low Serum Ferritin in Patients with Restless Legs Syndrome."

Manchanda S, Davies CR, Picchietti D.

University of Illinois at Urbana-Champaign, College of Medicine, 506 S. Mathews Avenue, Suite 190, Urbana, IL 61801, USA.

OBJECTIVE: To describe celiac disease as a possible cause for low serum ferritin in patients with restless legs syndrome (RLS). BACKGROUND: Low iron stores have been found to be a risk factor for RLS with serum ferritin levels less than 45-50ng/mL associated with increased severity of RLS. It has become routine clinical practice to test serum ferritin in the initial assessment of RLS. Celiac disease is a common genetic disorder that can cause iron deficiency.

METHODS: Consecutive case series of four patients with RLS and serum ferritin below 25ng/mL, who had positive screening tests for celiac disease. RESULTS: We report four patients who had serum ferritin <12ng/mL and positive screening tests for celiac disease. All had celiac disease confirmed by duodenal biopsy and response to a gluten-free diet. RLS symptoms improved in all four, with two able to discontinue RLS medication and two responding without medication.

CONCLUSIONS: In patients with RLS and low serum ferritin who do not have an obvious cause for iron deficiency, we suggest looking for celiac disease by simple, inexpensive serologic testing. Diagnosis and treatment of celiac disease is likely to improve the outcome for RLS, as well as identify individuals who are at risk for the significant long-term complications of celiac disease.

Source: Sleep Med. 2009 Jan 10. [Epub ahead of print] url: http://www.ncbi.nlm.nih.gov/pubmed/19138881

John Libonati

New IBS Guidelines Include Screening for Celiac Disease

December 20th, 2008 by John Libonati

New guidelines for the treatment of IBS published by the American College of Gastroenterology include screening for celiac disease...

New IBS Guidelines Offer Treatment Ideas

American College of Gastroenterology Updates Recommendations for Irritable Bowel Syndrome By Bill Hendrick

WebMD Health NewsReviewed by Louise Chang, MDDec. 19, 2008 -- New guidelines have been issued by the nation's gastroenterologists that are aimed at easing the abdominal pain, diarrhea, and other symptoms of irritable bowel syndrome (IBS), which afflicts millions of Americans.

The guidelines, issued by the American College of Gastroenterology, also offer hope to patients who've struggled with the condition and found satisfactory treatments lacking.

IBS is diagnosed in people whose symptoms include abdominal pain, bloating, gas, diarrhea, and constipation, or a combination of these symptoms. Though sometimes confused with inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, IBS is a separate condition.

IBS care uses up more than $20 billion a year in direct and indirect expenditures, according to William Chey, MD, professor of medicine and director of the Gastrointestinal Physiology Laboratory at the University of Michigan Health System. He developed the guidelines in conjunction with Philip Schoenfeld, MD.

"The last time the American College of Gastroenterology published guidelines for the management of IBS was in 2002, and the College recognized that in the span of five to six years there has been a remarkable explosion in knowledge that's become available that's helped us to understand the cause and management of IBS," Chey says in a news release.

Tests and Treatments for IBS According to the new guidelines:

Patients with symptoms typical for IBS -- and without alarm features like rectal bleeding, low blood count due to iron deficiency, weight loss, or a family history of colon cancer, IBD, or celiac disease -- do not need extensive testing before being diagnosed.

IBS patients with diarrhea, or a combination of constipation and diarrhea, should be screened with blood tests for celiac disease, a disorder in which patients can't tolerate the gluten protein found in wheat or other grains.

When IBS patients have alarm features or are over 50 years old, they should have further tests (such as colonoscopy) to rule out other bowel disease such as IBD and colon cancer. IBS patients and their doctors should consider treatments involving antidepressants, which have been shown to offer relief.

The drug Amitiza helps with women who have IBS with constipation; the non-absorbable antibiotic rifaximin can ease IBS and bloating as a short-term treatment. And Lotronex, a drug that affects serotonin receptors, can be considered for patients with severe IBS with diarrhea.

Certain anti-spasm treatments may offer short-term help with abdominal pain from IBS. These include hyoscine, cimetropium, and peppermint oil.

A probiotic called Bifidobacteria may help some IBS patients.

According to the guidelines, women are twice as likely as men to suffer from IBS, which often begins in young adulthood. Gastroenterologists have found that dietary changes have proved helpful, including the addition of dietary fiber supplements such as psyllium.

Chey says IBS can be managed in most patients with counseling, dietary and lifestyle interventions, and use of both over-the-counter and prescription medications.

The guidelines suggest many treatments might be tried, though the authors concede no single magical answer has yet been found to eliminate symptoms in IBS patients. But the guidelines offer hope for people with IBS that their doctors can try a number of methods to reduce discomfort, and that some of the steps that can be taken seem to work.

ARTICLE SOURCE: http://www.webmd.com:80/ibs/news/20081219/new-ibs-guidelines-offer-treatment-ideas

John Libonati

Shared Genes in Type 1 Diabetes and Celiac Disease

December 16th, 2008 by John Libonati

A 2008 study provides more evidence that there is a link between celiac disease and gluten. This article in Scientific American reviews the study.

Diabetes and celiac disease: A Genetic Connection Patients with type 1 diabetes have been known to be more prone to another autoimmune disorder, celiac disease, in which gluten in wheat, rye and barley triggers an immune response that damages the small intestine or gut. Now there’s evidence that the two diseases have a genetic link: they share at least seven chromosome regions.

The discovery, published in this week's New England Journal of Medicine, indicates that both diseases may be triggered by similar genetic and environmental mechanisms, such as certain foods, that cause patients' immune systems to become overactive and destroy healthy instead of infected tissue. Previous research has found that celiac disease is five to 10 times more common in people with type 1 diabetes than in the general population, an editorial accompanying the study notes.

"These findings suggest common mechanisms causing both celiac and type 1 diabetes – we did not expect to see this very high degree of shared genetic risk factors," said study co-author David van Heel, a gastrointestinal geneticist at Barts and the London School of Medicine and Dentistry.

Van Heel and his colleagues studied genetic material or DNA from about 20,000 people, half of them healthy, nearly half with type 1 diabetes, and 2,000 with celiac disease. The overlapping genetic variants occurred on regions of chromosomes (parts of cells that carry genetic code) that are believed to regulate the gut’s immune system, the BBC notes.

Type 1 diabetes occurs when a person’s immune system mistakenly attacks healthy beta cells in the pancreas that produce the hormone insulin, which is needed to convert glucose into energy. In celiac disease, a similar attack occurs on the small intestine when sufferers eat gluten-rich grains, causing inflammation in the gut that can lead to bloating, abdominal pain, nausea, constipation, diarrhea, fatigue, anemia, headaches, weight loss and failure to thrive in children. Whereas diabetes 1 patients must inject insulin daily to make up for their deficiency, people with celiac disease can avoid damage and symptoms by sticking to a gluten-free diet.

"The finding raises the question of whether eating cereal and other gluten products might trigger type 1 diabetes by altering the function of the gut and its interaction with the pancreas, the authors write. But Robert Goldstein, chief scientific officer of the Juvenile Diabetes Research Foundation, which helped fund the study, says it would be premature to assume from this study that gluten is also a diabetes trigger.

“I fear the newspaper headlines in the popular press will read like, ‘Eating wheat will cause type 1 diabetes,’” Goldstein tells us. “The presence or absence of these associations has to be linked to some biological consequence” for a person's health.

Article Source: http://www.sciam.com/blog/60-second-science/post.cfm?id=diabetes-and-celiac-disease-a-genet-2008-12-11

*UK Study Source: Shared and Distinct Genetic Variants in Type 1 Diabetes and Celiac Disease, New England Journal of Medicine. http://content.nejm.org/cgi/content/full/NEJMoa0807917

by John Libonati

Here are six important facts about celiac disease in the United States:

1. Doctors do not understand celiac disease. 97% of celiacs are not diagnosed. Diagnosis takes over 10 years on average and follow up treatment is poor.

2. Doctors do not understand nutrition. Medical schools do not teach it, so doctors generally do not look for nutrient deficiencies unless you are emaciated.

3. Most of the 300 health problems stemming from celiac disease are due to nutrient deficiencies.

4. Comparing symptoms with one another does not work in celiac disease because symptoms change over time and everyone absorbs or malabsorbs nutrients differently. You may absorb everything but vitamin B12. Another person will not absorb calcium or vitamin D. Even siblings sometimes have totally different symptoms.

5. Symptoms from nutrient deficiencies show up before intestinal damage occurs, but also after starting the gluten-free diet depending on the degree of damage and quality of diet.

6. Most celiacs do not realize how sick they really are. They think, "This is me. I've always been this way." They end up spending thousands of dollars on lotions, salves, medications and surgeries when the root of their problem has been a missing nutrient or nutrients all along.

You need to understand gluten and how celiac disease affects your body if you want to be healthy.

You must be able to identify health problems and the nutritional deficiencies that cause them so you can add the missing nutrients to your diet and inform your doctor to help him treat you.

You need the book, Recognizing Celiac Disease.

Recognizing Celiac Disease teaches you everything about gluten, celiac disease, the health problems it causes and what you need to fix them.

Thousands of celiacs around the world are using Recognizing Celiac Disease…because it works.

"Having been dx with CD for one year, I reached saturation - almost overload point a few months ago. Then I read the summary of "Recognizing Celiac Disease" and felt it might encompass everything I had referenced across numerous articles and books - and more. I love being able to look in the index and go to detailed information in my struggle to ensure my nutritional requirements and deficiencies are being met and addressed." - Reta McCallum, TX

Read how this one of a kind book is helping others at www.recognizingceliacdisease.com.

Order your copy of Recognizing Celiac Disease today. Review it and bring it with you to your next doctor visit. This way you can work with your doctor to make sure you get the best treatment possible.

Visit www.recognizingceliacdisease.com for more information and to see what others are saying.

 

PRESS RELEASE
Milestone Marks the First Time a European Patient with Active Celiac Disease has Enrolled in a Clinical Trial for an Investigational Medication from Alba Therapeutics
Last update: 8:22 p.m. EST Nov. 11, 2008
BALTIMORE, Nov 11, 2008 /PRNewswire via COMTEX/ --

Alba Therapeutics Corporation announced today that for the first time, a European patient with active celiac disease has been enrolled in its clinical trial to investigate a treatment for the disease. Alba has enrolled and randomized the newly diagnosed patient from Spain in an eight-week Phase IIb trial with oral larazotide acetate, a tight junction regulator, for the treatment of patients with active celiac disease (CD). The global multi-center, randomized, double-blind, placebo-controlled study will evaluate the clinical and histological efficacy, safety and tolerability of larazotide acetate in 106 active CD subjects adhering to a gluten-free diet, while assessing improvement in the clinical signs and symptoms of celiac disease.

"These are decisive times for our desire to one day be able to offer our celiac patients a treatment that allows them to live more normal lives," said Dr. Gemma Castillejo, MD, a pediatric gastroenterologist and principal investigator in the study. Dr. Castillejo, a leading European celiac expert from the Sant Joan de Reus University Hospital in Reus, Spain added, "I believe this clinical trial has the potential to be a turning point in the search for treatments for celiac disease."
"This is a major milestone for the celiac community in Europe," stated Francisco Leon, MD, PhD, Vice President, Clinical Development and Medical Affairs of Alba. "This is Alba's sixth human trial with larazotide acetate, and we are excited to be advancing our investigational program for larazotide acetate in this important region of the world."
About Celiac Disease
Celiac disease is an inherited autoimmune disorder where gluten has been identified as the environmental trigger of the disease. Gluten is an ingested protein found in wheat, barley and rye. Gluten is broken down into gliadin which can pass through the intestinal epithelial barrier during times of increased intestinal permeability. The ingestion of gluten causes an immune response which triggers an inflammatory reaction in the small intestine. This then causes damage to the villi in the small intestine and can lead to total villous atrophy in celiac disease. This results in varying symptoms such as fatigue, skin rash, anemia, fertility issues, joint pain, weight loss, pale sores inside the mouth, tooth discoloration or loss of enamel, depression, chronic diarrhea or constipation, gas and abdominal pain. The immunology and nutritional abnormalities in celiac disease can potentially result in long- term complications such as osteoporosis, refractory sprue, small intestinal cancer, and lymphoma.
Celiac disease is a growing public health concern, affecting approximately 3 million people in the United States and over 6.5 million people worldwide. The only current management of celiac disease is complete elimination of gluten from the diet, which can be very difficult to implement in practice. Additionally, the response to the gluten-free diet is poor in up to 30% of patients, and dietary nonadherence is the chief cause of persistent or recurrent symptoms.(1)
(1) Green, P, and Cellier, C, Review Article,
 Medical Progress, Celiac Disease, N ENGL J MED
 2007;357:1731-43
About "Larazotide Acetate"
Larazotide acetate is an experimental medicine and a tight junction regulator that acts locally by inhibiting the opening of tight junctions in epithelial cells lining the small intestine. In celiac disease, gluten crosses the epithelial barrier and stimulates the immune system, leading to cytokine release, gut inflammation, and opening of tight junctions. This leads to increased paracellular permeability, increased entry of gluten and the establishment of an intestinal permeability-inflammation loop. Larazotide acetate inhibits tight junction opening triggered by both gluten and inflammatory cytokines, thus reducing uptake of gluten. Larazotide acetate disrupts the intestinal permeability-inflammation loop, and reduces symptoms associated with celiac disease. Larazotide acetate is orally formulated, has been granted "Fast Track" designation by the U.S. Food and Drug Administration for the treatment of celiac disease, and is also being evaluated for the treatment of Crohn's Disease.

For more information about Alba's clinical trials, please visit the www.clinicaltrials.gov web site and search for Alba Therapeutics.

About Alba
Alba Therapeutics Corporation is a privately held, clinical-stage biopharmaceutical company focused on the discovery, development, and commercialization of therapies to treat autoimmune and inflammatory diseases and is located in Baltimore, Maryland. Alba's technology platform is based upon a key pathway that regulates the assembly and disassembly of tight junctions in cell barriers throughout the body. As a result of its unique technology platform, Alba is a leader in mucosal biology and has developed a pipeline of innovative therapeutic candidates that has the potential to modify the course of disease and significantly improve upon existing treatments for a wide range of diseases such as celiac disease, Crohn's disease, and Asthma/COPD or acute lung injury.
    Media: Mariesa Kemble
    Sam Brown Communications
    608-850-4745
    kemblem@aol.com 

    Corporate: Wendy Perrow, MBA
    Alba Therapeutics Corporation
    410-878-9850
    info@albatherapeutics.com
    http://www.albatherapeutics.com
----------------------
Author Information: John Libonati, Philadelphia, PA
Publisher, Glutenfreeworks.com.
Editor & Publisher, Recognizing Celiac Disease.
John can be reached by e-mail here.
John Libonati

Dentists Can Help to Recognize Celiac Disease

July 21st, 2008 by John Libonati

gluten free dentist
Photo © ADAM

Dentistry Blog

By Tammy Davenport, About.com Guide to Dentistry since 2005

Celiac disease causes the body's immune system to damage and attack the small intestine upon consumption of proteins in barley, rye, wheat and possibly oats. Since there are no specific blood tests to determine if someone has Celiac disease, doctors use blood tests to look for certain autoantibodies and biopsy the small intestine to look for traits of Celiac disease.Nancy Lapid, our Guide to Celiac Disease, points out that certain dental conditions are more common in people with this disease, which puts dentists in a good position to help notice when a patient might have Celiac disease.

Some examples of dental related problems in a patient with Celiac disease are tooth enamel defects, canker sores and delayed eruption in the teeth.

Source: http://dentistry.about.com/b/2008/05/14/dentists-can-help-to-recognize-celiac-disease.htm

The news release below is timely because anti-gliadin antibody blood tests are losing ground while the reality of gluten sensitivity looms far larger than is now appreciated by many doctors!  These blood tests are absolutely necessary to investigate health problems caused by gluten itself, yet they are being dismissed by doctors who look only to diagnosing celiac disease.

Positive anti-gliadin antibody tests show undigested gluten peptides in the bloodstream.  This abnormal finding tells the story that gluten has passed through the tight barrier defenses of the small intestinal lining into the body where it can wreak havoc, with or without celiac disease.  Gluten is a food protein in wheat, barley, rye and oats.

In screening for celiac disease, an inherited immune response to gluten entering the small intestinal lining, doctors rely on the celiac specific antibody tests, anti-endomysium and anti-tissue transglutaminase.  However, the investigation to find these auto-antibodies must not exclude the anti-gliadin antibodies. 

Doctors Slow To Recognise Gluten Harm.” Dr. Rodney Ford, Leading New Zealand Paediatrician And Allergist Challenges Medical Stalwarts With Revolutionary Gluten Thinking

There is more to gluten problems than just coeliac disease. Gluten sensitivity is ten times more prevalent than celiac disease in New Zealand and mostly undiagnosed. This is the message that Christchurch-based paediatrician, allergist and author, Doctor Rodney Ford wants to get across to the public and the ever conservative medical fraternity.

The practice of medicine is restricted to the knowledge, experience, attitudes and politics of the society it functions in. Medicine is an inexact but evolving science, thus current standard medical practices are often disproved. The validity of medical opinion, long held to be the gold standard of diagnosis and treatment, are constantly challenged. This is a healthy dynamic, one that enables the pursuit of excellence and the evolution of better forms of practice, resulting in better outcomes for patients. Why, then asks Dr Ford, is there such resistance to his new Gluten Syndrome hypothesis recently published in a book and supported by years of clinical experience and research.

In the absence of coeliac disease, his latest research shows that the simple gluten test (IgG-gliadin antibody) is a sensitive indicator to detect those people who get sick eating gluten but who have tested negative to Celiac Disease. However, this test is rarely ordered by general practitioners or specialists. He says “This is because of an illogical rejection of gluten sensitivity as a valid diagnosis. Ignoring gluten flies in the face of all of the evidence and is also alienating doctors from their patients.”

Picture this, if you will: a six year old girl, Elizabeth, small for her age, a distended stomach, gas and suffering from gastric reflux. Her teachers reported a lack of attention at school and early learning problems. Elizabeth had been thoroughly investigated by the medical profession: blood tests, bowel biopsies, colonoscopy, endoscopy. Celiac Disease had been ruled out, various medications had been tried and doctors had started to question her mother’s parenting skills. Elizabeth’s parents had gone beyond frustration and fear for their child, they were at the point of desperation.

This is a common story in Dr Ford’s practice. It is also one of the many success stories he has to share. After seeing Dr Ford, a positive IgG-gliadin antibody test and being put on a gluten free diet, Elizabeth improved within a few days. Within weeks she made a remarkable recovery and was in essence cured. Gluten was no longer a choice for her and accidental intake still causes her a reoccurrence of symptoms. Adhering to a gluten free diet has enabled Elizabeth to grow into the healthy, happy and successful young woman that she is today.

Common stories such as this, along with the increasing research and evidence of gluten based harm, should be enough to spur the medical profession into action in an effort to save the current generation of children from the long term health, social and financial consequences of what is an easily diagnosed and treatable condition.

The shocking truth is that this terrible scourge of gluten is being ignored by most medical practitioners. Even worse, the blood tests that can diagnose it are being abandoned by many medical laboratories. For instance, Medlab Diagnostics in Auckland no longer offers gliadin antibody tests.

The medical professions reluctance to act on the gluten problem is costing New Zealand billions of dollars each year with long term and far reaching consequences. From a dollars and cents point of view it makes no economic sense. From a patient care point of view it is bordering on negligence.

Source: Scoop Independent News, New Zealand, Thursday, 19 June 2008, 9:49 am You can find this news release at http://www.scoop.co.nz/stories/GE0806/S00059.htm

Cleo Libonati, RN, BSN

Making the Connection – in Celiac Disease

May 19th, 2008 by Cleo Libonati, RN, BSN

Advance For Nurses Magazine Vol. 9 •Issue 11 • Page 21

Making the Connection Underdiagnosed in the U.S., celiac disease can be identified and treated if the condition is understood

By Cleo Libonati, RN, BSN

Celiac disease is a common food sensitivity that can be the underlying source of hundreds of health problems mistakenly attributed to other causes. This insidious disorder has the potential to disfigure, disable and destroy lives at any age. Yet, of the 3 million affected Americans, only 3 percent are diagnosed and treated.1 Prevalence rates are higher in certain populations, such as blood relatives of a person with celiac disease and those with autoimmune disorders.

Unfortunately, people in the U.S. with this condition actively seeking help for their symptoms can go a lifetime without diagnosis and proper treatment. Typically, worldwide diagnosis is faster. Genetic Susceptibility & Gluten

Celiac disease is also called celiac sprue, nontropical sprue, gluten-sensitive enteropathy or simply celiac by the public.

This immune-mediated disorder stems from an inherited lifelong intolerance to the gluten protein found in wheat, barley, rye and oats. When ingested, gluten resists the breakdown action of normal digestive enzymes into harmless amino acids. Undigested peptides precipitate hyperpermeability of the small intestinal lining (so-called "leaky gut") to breach the intestinal barrier defense system. In this way, gluten unnaturally gains entrance to the lamina propria.

Within the lamina propria, gluten peptides encounter the enzyme transglutaminase and the local immune system. Transglutaminase deamidates, or breaks off, the rich glutamine residues in gluten. This deamidation creates the toxic molecular compounds, or epitopes, the immune system identifies as foreign.

These epitopes trigger autoimmune antibodies in genetically susceptible individuals. Ensuing inflammation swells affected portions of the small intestinal lining and damages its delicate structures, interfering with its function to finish digestion and absorb nutrients.

While gluten itself is the environmental cause for antibody development, some stressors that can trigger active disease include gluten overload, pregnancy, viral gastrointestinal infection, surgery and severe stress. Recognizing Celiac Disease

Despite dramatic advancements in knowledge and testing procedures, recognition of this multifaceted disorder is lacking.1Celiac disease often is undiagnosed due to ignorance of the following:

Pathophysiology — The traditional description of celiac disease as an intestinal disorder with malabsorption as the primary defect is a shadow of the real condition.

Prevalence — In contrast to the historic belief celiac disease affected just one in 5,000 individuals, antibody testing demonstrated prevalence of one in 100.

Diagnostic tests — Healthcare providers are unfamiliar with new and improved testing methods.

Manifestations — Many patients do not have diarrhea and wasting symptoms of classic celiac disease. Extraintestinal symptoms predominate in people with atypical symptoms. How It's Diagnosed

Diagnosis of celiac disease is made by a positive serologic antibody study and confirmed by histological findings of small-bowel biopsy specimens obtained by endoscopy and improved clinical response following a gluten-free diet.

The single most important step in diagnosing celiac disease is to recognize its myriad clinical features. No single test can definitively diagnose or exclude celiac disease in every individual; there also is a continuum of laboratory and histopathologic results.1

Positive anti-endomysium antibodies and positive anti-tissue transglutaminase antibodies show celiac disease. Positive antigliadin antibodies demonstrate sensitivity to gliadin itself, the gluten in wheat.

Not all patients have positive antibodies at presentation. When symptoms are present but test results are negative, further testing is warranted, including selective immunoglobin A deficiency. In the event the patient started a gluten-free diet prior to testing, suggest a gluten challenge of 3 months or longer in the expectation of antibody development.

Positive small intestinal biopsy shows the degree of villous atrophy, yet this is not foolproof either. The gastroenterologist must be skilled in taking accurate specimens from multiple sites, and the pathologist must be skilled in examining them properly. In addition, damage may be submicroscopic, returning a level not yet detectable by histological examination.

Additional studies include sonogram and genetic testing. Sonogram shows edema and abnormal appearance of the bowel wall. This is especially helpful for children or those who cannot undergo an endoscopy.

More than 97 percent of people with celiac disease share the same genetic human leukocyte antigen (HLA) haplotype markers, HLA-DQ2 and HLA-DQ8. While HLA genotyping is not specific for celiac disease, it has a very high negative predictive value. If the markers are not present, genetic testing essentially rules out the disease.

Annual follow-up testing is warranted for patients with negative test results who continue to show symptoms. Recognizing Symptoms

There are no typical symptoms of celiac disease, although the most common clinical presentation is unexplained iron-deficiency anemia with or without gastrointestinal symptoms.

Celiac disease, by way of malnutrition, immunity or the direct toxic effect of gluten on cellular structures, has the potential to produce a broad range of symptoms, associated disorders and complications that may affect any organ or body system. Manifestations vary and may appear at any age.

Nutrient deficits are responsible for many seemingly unrelated conditions, such as depression, inability to concentrate, anxiety, insomnia, defective tooth enamel, coagulopathies, hypertension, obesity, anorexia and excessive thirst.

Associated autoimmune disorders may affect any body tissue, including type I diabetes mellitus, hypothyroidism and Grave's disease, to name a few. Further, severe complications include various cancers such as B-cell non-Hodgkin lymphoma, cryptic intestinal T cell lymphoma and enteropathy-associated T cell lymphoma.

Chronic diarrhea in childhood should provoke screening. Pediatric presentation for celiac disease could involve hypotonia, failure to thrive, growth retardation, short stature, convulsions, poor bone and tooth development, thymic atrophy and delayed puberty. Treatment

Treatment is a gluten-free diet. Excluding gluten usually results in rapid healing of the small intestinal mucosa, resolution or improvement of nutritional deficiencies, and disappearance of many manifestations of celiac disease.

The gluten-free diet is challenging due to the plethora of gluten-containing foods in the standard American diet. To succeed, patients need detailed diet instruction, including how to read food labels and identify hidden sources of gluten, such as in medications and supplements. Refer patients to a qualified dietitian if possible; otherwise, nurses can teach appropriate information.

Inform patients about community help such as celiac support groups, which offer practical advice on how to shop and cook, and where to dine. Many support groups hold their meetings at local hospitals. Prognosis

Clinical outcome depends on duration of exposure to gluten. The longer gluten is consumed, the more the body is damaged, and the greater the likelihood of health disorders and complications developing.

Intestinal permeability improves within 2 months of starting a gluten-free diet. Despite a good clinical response, abnormal endoscopic and histologic appearances persist in the majority of patients.2Patients who receive adequate education about celiac disease and treatment with the gluten-free diet are better able to prevent intestinal damage and improve their health by dietary self-management. Clearly, nursing intervention that uncovers hidden celiac disease, provides nutritional education and promotes regular follow-up will considerably improve prognosis. n References for this article can be accessed at www.advanceweb.com/nurses. Click on Education, then References. Cleo Libonati is author of Recognizing Celiac Disease, and co-founder, president and CEO of Gluten Free Works Inc., Ambler, PA. This article copyrighted to Advance For Nurses and can be accessed online at their website at http://nursing.advanceweb.com/Editorial/Search/AViewer.aspx?AN=NW_08may12_n4p21.html&AD=05-12-2008