PubMed - 2006

jccgf · 10-04-2006, 05:15 PM

Celiac disease presenting with chilblains in an adolescent girl.
PMID: 17014640 Sep-Oct 2006

Quote:

Chilblains, or pernio, are cutaneous lesions that may accompany systemic illnesses including states of malnutrition and autoimmune diseases. We report an adolescent girl in whom chilblains were the chief presenting sign of celiac disease. A gluten-free diet led to weight gain and resolution of the chilblains. We speculate that in this patient, weight loss due to celiac disease contributed to the development of chilblains.
PMID: 17014640

What are chilblains?
http://www.mayoclinic.com/health/chilblains/AN00952
http://www.dermnet.org.nz/reactions/chilblains.html

jccgf · 10-04-2006, 05:20 PM

Should Stored Serum of Patients Previously Tested for Celiac Disease Serology be Retested for Transglutaminase Antibodies?
PMID: 17016136 Oct 2006

Quote:

INTRODUCTION: Tissue transglutaminase (tTG) antibodies are currently recognized as a highly sensitive indicator of celiac disease (CD). Although a high concordance rate between tTG antibodies and anti-endomysial antibodies (EMA) has been reported up to a third of known CD patients are positive for only one of these antibodies. AIM: To determine whether in laboratories in which serum samples previously examined for CD serology markers had not been discarded, these samples should be tested for tTG antibodies. METHODS: Fifty-eight stored (frozen at -70) serum samples of patients previously found to be EMA-negative but positive for one or more of the non-EMA markers: antigliadin antibodies (AGA)-IgA, AGA-IgG, antireticulin antibodies, were tested for anti-tTG antibodies (IMMCO Diagnostics). In patients found to be tTG positive, medical charts were reviewed and patients or their physicians contacted. RESULTS: Twelve of fifty-eight (20.7%) samples were found to be anti-tTG positive. These included: group A: 3/3 samples previously positive for AGA-IgA, AGA-IgG, and antireticulin antibodies. Group B: 3/16 samples positive for AGA-IgA and AGA-IgG. Group C: 3/4 samples positive for AGA-IgA and group D: 3/35 samples positive for AGA-IgG. Of the 12 positive patients, 1 was a 2-year-old boy, 5 were lost to follow up, and 7 underwent an intestinal biopsy. In 3 of these 7 patients, the biopsy was compatible with CD; 2 of these 3 patients were from group A and 1 from group B. CONCLUSIONS: In laboratories where stored serum samples are available, EMA-negative samples previously found to be positive for at least 2 other CD markers should be retested for tTG antibodies.
PMID: 17016136

valeriemates · 10-06-2006, 10:18 AM

Quote:

Originally Posted by jccglutenfree

CONCLUSIONS: In laboratories where stored serum samples are available, EMA-negative samples previously found to be positive for at least 2 other CD markers should be retested for tTG antibodies.

Wow, that one is fascinating. And, come to think of it, that would apply to my four-year-old. Her first celiac test was an EMA (negative) and one of the antigliadin tests (off-the-scale positive), which made the doctor say that she didn't have celiac disease. A year and a half later, when I finally pestered her doctor into sending her to a gastroenterologist, she had transglutaminase IgA and IgG tests (and antigliadin IgA and IgG tests) that were strongly positive. I wonder what would have happened if I hadn't pestered her doctor into sending her to a GI. Would the lab have eventually dug up her old blood samples and run transglutaminase testing on it the way this article says to? Man, that would be a weird phone call to receive. "Hi, remember that negative blood test on your daughter from several years ago? Well, guess what -- it wasn't so negative after all, and she may have this disease....."

-Valerie

jccgf · 10-06-2006, 10:52 AM

Yep, blood tests are good but not perfect.

I used to hear in a perfect world that anti-endomysial and anti-tTG should be consistent, but they aren't always. Which is why a thorough doctor will run them all. I know in our case, only the anti-tTG was run, yet I believe it can go both ways (negative anti-tTG and positive anti-endomysial)

It is also why it makes me a little crazy that some of our major celiac centers (like a very windy one) suggest all is needed is a single anti-tTG test.

Recommendations for testing come down to picking what is considered the BEST TEST OVERALL to contain cost, but it is a shame that it comes down certain people falling through the cracks because no test is 100% accurate.

Cara

jccgf · 10-06-2006, 10:59 AM

Valerie,

Well, your daughter's case highlights TWO things. One is that more sensitivity is gained by running the entire panel of tests, and two is that negative testing one year can turn positive a year later. I'm glad you did pester your doctor!

Cara

valeriemates · 10-06-2006, 12:13 PM

Quote:

Originally Posted by jccglutenfree

I used to hear in a perfect world that anti-endomysial and anti-tTG should be consistent, but they aren't always.

The thing that bothers me about the endomysial test is that it's done by labs all over the place, but it's only accurate if it's interpreted by a highly trained special technician -- which most labs don't have. So most EMA test results are about as valid as flipping a coin. What in the world is the point of even *doing* a test that is known to be that inaccurate? Sigh....

Quote:

Originally Posted by jccglutenfree

...negative testing one year can turn positive a year later. I'm glad you did pester your doctor!

I am glad too. But I believe that my daughter had active celiac disease when they did the first test, too, and the test was only negative because the EMA is a very inaccurate test.

-Valerie

jccgf · 10-06-2006, 12:37 PM

Quote:

Originally Posted by valeriemates

The thing that bothers me about the endomysial test is that it's done by labs all over the place, but it's only accurate if it's interpreted by a highly trained special technician -- which most labs don't have. So most EMA test results are about as valid as flipping a coin. What in the world is the point of even *doing* a test that is known to be that inaccurate? Sigh....

I am glad too. But I believe that my daughter had active celiac disease when they did the first test, too, and the test was only negative because the EMA is a very inaccurate test.

-Valerie

I think you are probably right, and I'm sorry your daughter was one who fell through the diagnostic crack

. I guess that is part of our mission... to help people understand that the diagnostic testing is not perfect and there is room for plenty of error in both false negative blood work and false negative biopsy.

Cara

jccgf · 10-24-2006, 04:37 PM

Gluten-Free Diet Impact on Leptin Levels in Asymptomatic Coeliac Adolescents: One Year of Follow-Up. PMID: 17057405 Oct 2006

Quote:

Coeliac disease, daily more frequently diagnosed in our population, involves many organs also in oligosymptomatic patients and with an adequate nutritional regime. Possible endocrine implications include failure to thrive, pubertal delay and reproduction diseases due to deregulation of GH, FSH and LH secretion. Leptin, an adipose tissue hormone, can be decreased as well and its deficiency could be related to growth and puberty anomalies. We studied 14 asymptomatic coeliac patients in peripubertal age (7.5-13.8 years) and tested their leptin levels in order to correlate them with endocrine and anthropometric data. Before the diet was started leptinaemia (M+/-DS) was: 4.94 +/- 5.53 ng/ml. In 10/14 patients (71%) leptinaemia was </=2 DS for gender and age. In all the patients, after a period of 6-12 months of gluten-free diet, Leptin levels appreciably raised to 10.8 +/- 7.9 ng/ml, with a significant correlation to the time of the diet. Leptinaemia was actually lower in patients with a severe mucosal atrophy, and in these patients it increased more significantly after the diet was started. The removal of gluten itself may reduce immunological hit to adipose tissue and the 'malnutrition' of adipocytes: leptin can hence increase despite no significant increase of body mass index occurs. This study could partially explain the correlation between body mass index, Coeliac disease and the deregulation of puberty and fertility, mainly in patients who started the diet late. It could also explain the reversibility of this alteration if the cause is removed. Copyright (c) 2007 S. Karger AG, Basel.
PMID: 17057405

jccgf · 10-25-2006, 05:55 PM

Quote:

Objective. Coeliac disease (CD) is a common disease with a strong heredity. About 10-20% of 1st-degree relatives of probands develop CD. Relatives should be screened for CD, because if not treated, CD exposes patients to numerous complications. The heterogeneity of symptoms and the lifetime-spanning risk of CD render the timing of CD antibody and/or gastroscopy screenings difficult. As CD susceptibility has been shown to be strongly associated with the HLA alleles DQA1*0501 and DQB1*0201 (together encoding the DQ2 heterodimer) and DRB1*04 (associated with the DQ8 heterodimer), our aim was to investigate whether HLA genotyping might be useful in the identification of 1st-degree relatives of CD patients who do not need further screening for CD.Material and methods. The study comprised 54 Finnish CD families including 54 CD probands and 382 living 1st-degree relatives. All subjects who were willing to participate were screened for CD (duodenal and skin biopsies; endomysial, reticulin and gliadin antibodies). The DQA1*0501, DQB1*0201 and DRB1*04 allele frequencies of CD patients and the 1st-degree relatives were determined.Results. Altogether 17.6% (5.9% of the parents, 15.7% of the siblings, 25.8% of the offspring) of the investigated 1st-degree relatives (n=245) did not carry any of the alleles studied. All of the CD patients (n=136) with the exception of one (0.7%) carried at least one of the alleles investigated.Conclusions. By using the HLA genotyping a considerable proportion of 1st-degree relatives of CD probands could be excluded from further screening for CD.

HLA genotyping is useful in the evaluation of the risk for coeliac disease in the 1st-degree relatives of patients with coeliac disease.
PMID: 17060123 Nov 2006

Quote:

Background Coeliac disease is strongly associated with human leukocyte antigen (HLA)-DQ2 or DQ8 genotypes. The diagnosis is based on demonstrating crypt-hyperplastic villous atrophy, endomysial or transglutaminase antibodies and correlation of disease activity with gluten intake. Aim To evaluate the clinical utility of HLA-DQ typing, when coeliac disease diagnosis had previously been established solely by histology. Methods HLA-DQ alleles, endomysial and transglutaminase antibodies were investigated and histology slides reviewed in 70 patients diagnosed 2-25 years earlier by small-intestinal biopsy but without measuring endomysial or transglutaminase antibodies. Patients without DQ2 or DQ8 or without unequivocal villous atrophy were followed-up on free diet by using serology and biopsies. Results All 40 endomysial/transglutaminase antibodies positive patients carried DQ2 or DQ8, and 39 of them had severe villous atrophy. Only 56% of patients without endomysial or transglutaminase antibodies positivity had DQ2 or DQ8 (P < 0.001). Seropositivity and relapse developed in 4 of 11 DQ2 positive but in none of 15 DQ2 and DQ8 negative patients on long-term gluten exposure. Conclusions Coeliac disease diagnosis based solely on histology is not always reliable. HLA-DQ typing is important in identifying DQ2 and DQ8 negative subjects who need revision of their diagnosis, but it does not have additive diagnostic value if endomysial positivity is already known.

Diagnostic significance of HLA-DQ typing in patients with previous coeliac disease diagnosis based on histology alone. PMID: 17059521 Nov 2006

jccgf · 10-25-2006, 06:01 PM

Quote:

Objective. Although in both adults and children with coeliac disease (CD) it is now recommended that oats be added to their gluten-free diet, there is still some controversy concerning the possible harmful effects of oats in some individuals. In this study concentrations of nitric oxide metabolites were repeatedly measured in the urine of children under investigation for CD, when on a gluten-free diet with or without oats. Material and methods. The study included 116 children, randomized to a standard gluten-free diet (GFD-std) or a gluten-free diet supplemented with wheat-free oat products (GFD-oats), over a one-year period. Small-bowel biopsy was performed at the beginning and end of the study. Morning urine samples were collected from 87 children and urinary nitrite/nitrate concentrations were monitored at 0, 3, 6, 9 and 12 months. Results. All patients were in clinical remission after the study period. There was a rapid decline in urinary nitrite/nitrate concentrations in both groups as early as after 3 months. No differences were seen between the study groups at any of the checkpoints. However, at the end of the study, the nitrite/nitrate values of 9 children in the GFD-oats group and 8 children in the GFD-std group had not normalized. Conclusions. Children with CD on a gluten-free diet with oats display a similar reduction in urinary nitrite/nitrate as those on a traditional gluten-free diet. Some children, however, still demonstrate high nitrite/nitrate excretion after one year on either diet, indicating that long-term follow-up studies of children on an oats-containing diet are needed.

Urinary nitric oxide during one year of gluten-free diet with or without oats in children with coeliac disease.
PMID: 17060120 Nov 2006

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