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    Tuesday, July 06, 2004

    When Food Fights Back: A panel of gastroenterology experts has told the NIH that celiac disease goes unrecognized and untreated in this country:

    Celiac disease isn't nearly as rare as once thought: Roughly 3 million Americans may have the severe digestive disorder, most undiagnosed and thus suffering unnecessarily, an expert panel told the National Institutes of Health.

    On average, patients suffer symptoms for 11 years before they're diagnosed, because the disease, triggered by the gluten protein found in certain grains, is so little understood even by physicians, the panel found.

    Simple new blood tests can help diagnose celiac more easily today than just a few years ago, but only if doctors know to order them -- and many patients complain of symptoms very different than those long taught in medical school.

    Actually, we've known for some time that celiac disease is hard to diagnose, and thus underdiagnosed:

    To determine the prevalence of celiac disease in the United States, 2,000 healthy blood donors were screened for IgA and IgG antigliadin antibodies. Those with elevated levels were tested for antiendomysial antibodies. The prevalence of elevated antiendomysial antibody levels in healthy blood donors in the United States was found to be 1:250. This rate is similar to the prevalence in Europe, where subsequent small intestine biopsies have confirmed celiac disease in all patients testing positive for antiendomysial antibody (positive predictive value: 99 percent). The authors of the U.S. study conclude that data suggest that celiac disease may be greatly underdiagnosed and is relatively common in this country.

    The antibodies mentioned, of which IgA is the most sensitive screening test for the disease, are antibodies to proteins found in wheat, rye, and barley. In celiac disease (also known as celiac sprue), the presence of these grain proteins in the gut activates the immune system in the lining of the gut. Unfortunately, the immune system then not only attacks the grain proteins, it also attacks the gut itself. It's like a contact dermatitis of the intestines. The resulting inflammation is the source of the symptoms - gas, bloating, diarrhea, and malabsorption. But, like contact dermatitis of the skin, there are varying degrees of severity of inflammation, so not everyone has the symptoms or intensity of symptoms.

    Treatment doesn't require medication, just a gluten-free diet, which is actually somewhat difficult to follow. Treatment doesn't necessarily prolong life (except in severe cases accompanied by malabsorption), but it does make one feel better.

    So why don't we diagnose it more often? The tests aren't too expensive, around $135 for a series of antibody tests. We probably could do a better job of diagnosing it in symptomatic patients, especially those who have been given the diagnosis of irritable bowel syndrome. However, screening the general population probably isn't warranted. If the disease is so mild that it doesn't cause symptoms, then it really doesn't need treatment.

    posted by Sydney on 7/06/2004 06:08:00 AM 0 comments


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