Celiac Disease Diagnosis

stomachacheBefore launching into this week's blog on celiac disease, Rick and I would like to invite you to view our YouTube. And now, on to the topic at hand:

Lots of people complain of gastrointestinal symptoms. In point of fact, this week's meta-analysis on diagnosing celiac disease in JAMA states that between 35 and 40 individuals out of every 1000 who visit their primary care doctor do so because of abdominal discomfort, bloating, diarrhea, or other chronic symptoms, and these can adversely impact quality of life.

Among the plethora of conditions that can cause chronic abdominal distress is celiac disease, with an estimated prevalence (medspeak for how many people have this in the population at large) of 0.5%-1.0%. That's a lot of people. And what exactly is celiac disease?

Celiac disease can be defined as a sensitivity to gluten, a protein found in wheat, barley and rye, that largely affects the small bowel or intestine. This sensitivity gives rise to nonspecific symptoms such as diarrhea and bloating, but can have long term consequences, including fertility problems, osteoporosis, and cancer. The best news about celiac disease is it can be managed very well by avoiding foods that contain gluten. Few conditions respond so well to such simple intervention.

Since both cause and cure are well known, diagnosing celiac disease properly is pivotal. This analysis makes the case that abdominal symptoms alone are not sufficient to diagnose the condition, and that two blood tests, used sequentially, may be the way to start. IgA antitissue transglutaminase antibodies and IgA antiendomysial antibodies are two types of antibodies found circulating in the blood in the majority of folks with celiac disease, and both tests are widely available. Those who test positive for the first can then be tested for the second, but as Rick points out in the podcast, the definitive test is a biopsy of the lining of the small bowel. I would be sorely tempted if I tested positive for both tests, however, to try eliminating gluten from my diet and see what happened rather than undergo biopsy.

Other topics this week include the benefits of early follow up in avoiding rehospitalization in people with congestive heart failure in JAMA, a new type of stent for the heart in NEJM, and the risk of Alzheimer's disease in spouses who provide care for their affected spouse in the Journal of the American Geriatrics Society. Until next week, y'all live well. And please watch the YouTube!

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April 25, 2012 at 4:36 pm
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October 24, 2012 at 8:18 pm

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heart problems May 31, 2013 at 1:10 am

I’m not that much of a internet reader to be honest but
your blogs really nice, keep it up! I'll go ahead and bookmark your website to come back down the road. Many thanks

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Heather Worthington January 8, 2013 at 9:12 am

Coeliac's present with such a vast range of symptoms much more that those around abdominal symptoms that it really is hard to know what the problem is. However the easy availability of the blood tests (not as definitive as the biopsy accepted) that it if someone is having problems and the suspect Coeliac's they such get tested by their doctor or buy a test for themselves.

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Leo Voisey August 9, 2012 at 11:30 pm

Chronic cerebrospinal venous insufficiency (CCSVI), or the pathological restriction of venous vessel discharge from the CNS has been proposed by Zamboni, et al, as having a correlative relationship to Multiple Sclerosis. From a clinical perspective, it has been demonstrated that the narrowed jugular veins in an MS patient, once widened, do affect the presenting symptoms of MS and the overall health of the patient. It has also been noted that these same veins once treated, restenose after a time in the majority of cases. Why the veins restenose is speculative. One insight, developed through practical observation, suggests that there are gaps in the therapy protocol as it is currently practiced. In general, CCSVI therapy has focused on directly treating the venous system and the stenosed veins. Several other factors that would naturally affect vein recovery have received much less consideration. As to treatment for CCSVI, it should be noted that no meaningful aftercare protocol based on evidence has been considered by the main proponents of the ‘liberation’ therapy (neck venoplasty). In fact, in all of the clinics or hospitals examined for this study, patients weren’t required to stay in the clinical setting any longer than a few hours post-procedure in most cases. Even though it has been observed to be therapeutically useful by some of the main early practitioners of the ‘liberation’ therapy, follow-up, supportive care for recovering patients post-operatively has not seriously been considered to be part of the treatment protocol. To date, follow-up care has primarily centered on when vein re-imaging should be done post-venoplasty. The fact is, by that time, most patients have restenosed (or partially restenosed) and the follow-up Doppler testing is simply detecting restenosis and retrograde flow in veins that are very much deteriorated due to scarring left by the initial procedure. This article discusses a variable approach as to a combination of safe and effective interventional therapies that have been observed to result in enduring venous drainage of the CNS to offset the destructive effects of inflammation and neurodegeneration, and to regenerate disease damaged tissue.
As stated, it has been observed that a number of presenting symptoms of MS almost completely vanish as soon as the jugulars are widened and the flows equalize in most MS patients. Where a small number of MS patients have received no immediate benefit from the ‘liberation’ procedure, flows in subject samples have been shown not to have equalized post-procedure in these patients and therefore even a very small retrograde blood flow back to the CNS can offset the therapeutic benefits. Furthermore once the obstructed veins are further examined for hemodynamic obstruction and widened at the point of occlusion in those patients to allow full drainage, the presenting symptoms of MS retreat. This noted observation along with the large number of MS patients who have CCSVI establish a clear association of vein disease with MS, although it is clearly not the disease ‘trigger’.For more information please visit http://www.ccsviclinic.ca/?p=978

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Michael Hooks June 7, 2011 at 3:25 pm

Are there other symptoms other than the ones you described, such as tingling in the legs from
thehips to the ankles in both legs, also do the joints ache and hurt knees and ankles?
Thank you,
Michael

Reply

Elizabeth Tracey June 11, 2011 at 8:47 am

We are not aware of these additional symptoms but your primary care doc can probably help.

Reply

wheelchairs February 9, 2011 at 4:05 am

I really appreciate your post and you explain each and every point very well.Thanks for sharing this information.And I’ll love to read your next post too.

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