Spectrum of gluten-sensitive enteropathy in first-degree rel

[mle_ii]

Though I realize this isn't Lymphocytic Colitis, it does point to yeat another study showing gluten sensitive enteropathy without serlogic markers for celiac.

Spectrum of gluten-sensitive enteropathy in first-degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.
http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

[tex]

Mike.

Interesting report. The last line says:

The high number of symptomatic patients with lymphocytic enteritis (Marsh I) supports the need for a strategy based on human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy in relatives of patients with coeliac disease and modifies the current concept that villous atrophy is required to prescribe a gluten-free diet.

That pretty well blows the outdated celiac diagnostic criteria out of the water, as far as addressing gluten sensitivity in the general population is concerned. Clearly, the current diagnostic standards are obsolete.

Obviously, there are also a huge number of undiagnosed gluten-sensitive individuals in the general population who can't even be linked with a family member who is a diagnosed celiac, simply because the medical industry has such a poor track record of diagnosing celiac disease in the first place. IOW, just because someone is capable of a positive result on the classic celiac tests, does not mean that the individual in consideration will actually be diagnosed as celiac, (the average length of time for a correct diagnosis in the U. S. is still listed as over 11 years). That's really pathetic.

Tex

[mle_ii]

Yes, and given other recent studies one might not even have GI related symptoms yet have problems with gluten sensitivity. I'm thinking connective tissue and brain tissue problems.

[mle_ii]

Strange I thought I posted this study as well:

Endomysial antibody-negative coeliac disease: clinical characteristics and intestinal autoantibody deposits.
http://www.ncbi.nlm.nih.gov/entrez/quer ... s=16571636

BACKGROUND: Some patients with untreated coeliac disease are negative for serum endomysial autoantibodies (EmA) targeted against transglutaminase 2 (TG2). AIMS: To evaluate the clinical and histological features of EmA-negative coeliac disease, and to examine whether EmA-equivalent autoantibodies against TG2 can be seen in the small-bowel mucosa when absent in serum. PATIENTS: Serum EmA was studied in 177 biopsy-proved specimens from adult patients with coeliac disease. 20 patients with intestinal diseases served as non-coeliac controls; three had autoimmune enteropathy with villous atrophy. METHODS: Clinical manifestations, small-bowel mucosal morphology, intraepithelial inflammation and TG2-specific extracellular immunoglobulin A (IgA) deposits were investigated in both serum EmA-negative and EmA-positive patients. RESULTS: 22 patients with IgA-competent coeliac disease were negative for serum EmA. Three of these had small-bowel lymphoma. Patients with EmA-negative coeliac disease were older, had abdominal symptoms more often, and the density of gammadelta+ intraepithelial lymphocytes in their intestinal mucosa was lower than in EmA-positive patients; otherwise the histology was similar. All serum EmA-negative patients with coeliac disease, but none of the disease controls, had gluten-dependent mucosal IgA deposits alongside TG2 in the small-bowel mucosal specimens. In vivo deposited IgA was shown to be TG2-specific by its ability to bind recombinant TG2. CONCLUSIONS: Negative serum EmA might be associated with advanced coeliac disease. TG2-targeted autoantibodies were deposited in the small-bowel mucosa even when absent in serum. This finding can be used in the diagnosis of seronegative coeliac disease when the histology is equivocal. It may also be helpful in the differential diagnosis between autoimmune enteropathy and coeliac disease.

Here's another take on this study supporting Dr Fine's findings:
http://www.celiac.com/st_prod.html?p_prodid=1412