A Call for Earlier Diagnosis of Celiac Disease

Sunday, December 09, 2007 by: Teri Lee Gruss
Tags: celiac disease, health news, Natural News

(NewsTarget) Alessio Fasano, M.D. is professor of pediatrics, medicine and physiology at the University of Maryland School of Medicine and director of its Center for Celiac Research. He is famous, at least in celiac research circles for asking, back in 1996, "Where have all the American celiacs gone?"

Dr. Fasano's early celiac screening research led him to observe that physicians in the US gave "limited attention to the disease" which might explain why the prevalence of celiac disease was comparatively so much higher in Europe. At the time, almost 11 years ago, most US physicians considered celiac disease a rare disorder and rarely diagnosed it.

Thanks to Dr. Fasano's research, we now understand that as many as 1 in 133 people in the US have celiac disease and the number is thought to be much higher in people with celiac relatives and in those that have the gene type(s) for celiac disease.

From 2002 to 2004 Dr. Fasano was involved in a large, multiple center prevalence study involving 25 centers across the US. Results of the study findings have recently been published in the American Journal of Gastroenterology.

The purpose of this study was to assess the number of undiagnosed cases of celiac disease due to a lack of awareness and inadequate training among primary care physicians.

"All individuals with symptoms or conditions known to be associated with CD were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies, and those with elevated anti-tTG were subsequently tested for IgA antiendomysial antibodies (EMA). All subjects who were positive for EMA were advised to undergo an intestinal biopsy and HLA typing."

Researchers found that when doctors tested all of their patients with symptoms associated with celiac disease "the diagnostic rate increases 32- to 43-fold" and concluded that "an active case-finding strategy in the primary care setting is an effective means to improve the diagnostic rate of CD in North America".

In an interview for the University of Maryland School of Medicine News Dr. Fasano said that "The projected number of people in the United States with celiac disease could be as high as three million, yet only a small fraction of these cases has been correctly diagnosed and treated".

Celiac disease is a genetic disorder that can affect people of all ages when they eat foods that contain gluten. A protein fraction of gluten called gliadin causes an immune reaction that destroys tissue in the lining of the small intestines called villi.

This destruction is called villous atrophy and it leads to multiple and serious health problems including the malabsorption of nutrients from food. Rather than being a passive or inert tube, the small intestine is loaded with cells and tissue that are responsible for the majority of nutrient absorption in humans.

If a person develops malabsorption, malnutrition and multiple nutrient deficiencies occur, followed by a long list of degenerative diseases linked to nutrient deficiencies.

According to the University of Maryland Center for Celiac Research, untreated Celiac disease can be life threatening and is associated with "osteoporosis, tooth enamel defects, central and peripheral nervous system disease, pancreatic disease, internal hemorrhaging, organ disorders (gall bladder, liver, and spleen), gynecological disorders and is linked to an increased risk of certain types of cancer, especially intestinal lymphoma".

Dermatitis herpetiformis is an indication of celiac disease and researchers around the world are beginning to associate untreated celiac disease to  neurological and psychological disorders including depression and even schizophrenia.

Celiac disease is getting more media coverage in the US than ever before. How can our primary care physicians overlook its symptoms in so many people?

In addition to the University of Maryland, the Mayo Clinic, Columbia University and the University of Chicago have celiac research centers directed by world class celiac specialists.

In the US there are at least six national celiac education and support organizations including:

• Celiac Disease Foundation
• Gluten Intolerance Group
• National Foundation for Celiac Awareness
• American Celiac Disease Alliance
• Celiac Sprue Association
• Children's Digestive Health and Nutrition Foundation

The internet, health food store and grocery store shelves have a growing selection of gluten free foods, there are magazines devoted to this one disorder and online support groups are flourishing. 

Based on the findings of his recent prevalence research, Dr. Fasano "strongly recommends" that primary care doctors screen all patients that have symptoms and disorders associated with celiac disease.

The University of Maryland Celiac Research Center lists the following symptoms associated with risk for celiac disease:

A partial listing of gastrointestinal symptoms (from the National Library of Medicine)

• Abdominal pain
• Abdominal distention, bloating, gas, indigestion
• Constipation
• Decreased appetite (may also be increased or unchanged)
• Diarrhea, chronic or occasional
• Lactose intolerance (common upon diagnosis; usually resolves following treatment)
• Nausea and vomiting
• Stools that float, are foul smelling, bloody, or "fatty"
• Weight loss, unexplained (although people can be overweight or of normal weight upon diagnosis)

 A partial listing of non-intestinal symptoms (from the National Library of Medicine)

• Anemia (low blood count)
• Bone and joint pain
• Bone disease (osteoporosis, kyphoscholiosis, fracture)
• Breathlessness (due to anemia)
• Bruising easily
• Dental enamel defects and discoloration
• Depression
• Fatigue
• Growth delay in children
• Hair loss
• Hypoglycemia (low blood sugar)
• Irritability and behavioral changes
• Malnutrition
• Mouth ulcers
• Muscle cramps
• Nosebleed
• Seizures
• Short stature, unexplained
• Skin disorders (dermatitis herpetiformis)
• Swelling, general or abdominal
• Vitamin or mineral deficiency, single or multiple nutrient (for example, iron, folate, vitamin K)

Additionally, children with Type I diabetes as well as those with signs of failure to grow are at higher risk for of celiac disease.

To read more about Celiac disease:

http://medschool.umaryland.edu/celiac/question.asp

Is Gluten From Grains Making You Sick?  (http://www.newstarget.com/022122.html)
Monday, October 15, 2007 by: Leslee Dru Browning

American Journal of Gastroenterology. Volume 102 Issue 7 Page 1454 Date July 2007

About the author

Teri Lee Gruss, MS Human Nutrition