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   Conditions:

      Alternative Medicine
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    Procedures:

      Colonoscopy
      Endoscopy
      Liver Biopsy
 

  Ask Dr. Aron

Jul 07


How accurate are the blood tests for celiac disease?
The commonly used antibody tests (IgA anti-gliadin and anti-tissue trans glutaminase) can diagnose about 85-90% of those with celiac disease. A total IgA (immunoglobulin A) level must be done, because 10% of celiacs are deficient in this immunoglobulin, and these antibodies may be falsely low in this setting.

On occasion, even those with biopsy-proven disease may test negative, so it is recommended that genetic testing for HLA-DQ2 and HLA-DQ8 genes be done.

Either one or both are positive in 95-98% of celiacs, but are also present in about 25-30% of the population at large, so an intestinal biopsy remains the gold standard for diagnosis.

Health and happiness,
Dr. Aron
, JUNE 25, 2007
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How long does it take to see symptoms from a gluten-contaminated food?

I have been gluten-free since Sept., 2004, although a biopsy came back negative at that time. I have experienced a night and day difference on the diet, and as a result, my partner and I work very hard to keep my diet extremely clean. However, I have noted that there are some things that I consider GF based on the listed ingredients and what the manufacturer tells me, that I get gastrointestinal symptoms from. Can you tell me if there is a way to narrow down what the culprit might be by how long it takes for me to have symptoms? In other words, if I go to a restaurant, and I eat something that has cross contamination from say a grill or utensils that are used in the kitchen, I know that within the hour. But there are times when I don’t exhibit any symptoms for 4 or 5 hours. I am wondering if this is because the ingredient I am responding to is such a trace ingredient, that I don’t feel it till the food is broken down to a certain level, way beyond the superficial. Is that a possibility, or am I way off base here?

We know that small fragments or peptides of glutens are directly injurious to the gut. These are independent from the celiac mechanism. It probably depends on the dose and variety of peptides that arrive in your gut. You’ll drive yourself crazy trying to figure it out, but it is likely that you will not undergo serious damage from this occasional exposure.

Health and happiness,
Dr. Aron
, JUNE 15, 2007

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What is the link between celiac disease and cancer?

There is an increased risk of developing lymphoma of the digestive tract and the bloodstream in those who have celiac disease and go undiagnosed and do not eat a gluten-free diet, or in those who have celiac disease, and who do not stay on the diet.

If the initial biopsy used to make the diagnosis was a Marsh III or worse (Marsh I means no architectural change to the villi; Marsh IV means complete destruction of the villi), then the risk is greater than the rest of the population that does not have celiac disease.

There is a very slightly increased risk in developing other solid tumors of the gut, such as colon cancer or esophageal cancer, if one does not adhere to the gluten-free diet.

If, at the time of diagnosis, the biopsy is Marsh III or worse, you should also get imaging of the rest of the small intestine. The best way for this is still the barium swallow small bowel follow-through test.


Health and happiness,
Dr. Aron
, JUNE 1, 2007    

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