Article --> Celiac Disease May Be Underrecognized in America

Discussion in 'Fibromyalgia Main Forum' started by MemoryLane, May 29, 2003.

  1. MemoryLane

    MemoryLane Member

    <center>Celiac Disease May Be Underrecognized in America</center>

    from Clinician Reviews ®
    Posted 05/16/2003

    Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003;163:286-292.

    Contrary to common belief, celiac disease (CD) may not be limited mainly to the European population, according to research published in the Archives of Internal Medicine. The results of this study, the largest of its kind, suggest that incidence of CD in the United States is comparable to that in Europe. Because many Americans are of European ancestry, blood testing for the CD-specific antibody is important for patients who are at risk, the study authors advise. CD is a heritable malabsorption syndrome precipitated by the ingestion of gluten-containing grains, such as wheat, barley, oat and rye.

    Fasano and colleagues obtained blood samples from 13,145 clinic outpatients in 32 states. Subjects were identified as being at risk (ie, presenting with diarrhea, abdominal pain, or constipation, or having relatives with CD; n = 9,019) or not at risk (blood donors, school children, and those presenting for routine checkups; n = 4,126) for CD. Serologic tests for anti-endomysial antibodies (anti-EMA), intestinal biopsy (for those with positive anti-EMA findings), and comparative genetic testing were all part of the statistical analysis.

    The researchers found that 2.7% of all subjects had anti-EMA findings consistent with CD, with the prevalence similar across age-groups and racial groups. Of these, 41% were asymptomatic.

    Among symptomatic subjects, one in 68 adults and one in 25 children were anti-EMA positive. "However, only 35% of newly diagnosed patients with CD had chronic diarrhea," the authors noted. Most others had extraintestinal symptoms. For not-at-risk adults and children, the prevalence of CD was 1:105 and 1:320, respectively.

    Diagnosis of CD in the United States may be overlooked if clinicians believe that incidence is low, the authors surmise. They cite results from another study of CD patients that showed an average gap of 11 years between onset of symptoms and diagnosis.

    More Americans may have celiac disease than is commonly thought.

    Clinician Reviews 13(3):28, 2003. © 2003 Clinicians Group, LLC

  2. kellbear

    kellbear New Member

  3. Shirl

    Shirl New Member

    This is a bit over my head, but I am sure the others who are big into research will be interested, so am giving you a 'bump' as your post went to the second page.

    This board has been very fast moving today!

    Shalom, Shirl
  4. Applyn59

    Applyn59 New Member

    I once posted on an arthritis board with all my
    symptoms and someone wrote to me and said
    I could have celiac disease. I often wonder
    I I have something worse than IBS. I just have so
    many problems it is hard to know where to
    begin and if they are just IBS or something else.
    When I am feeling better (I am surprised I didn't
    say IF), I want to make an appt with a gastro guy
    to rule out Chrohns,etc. So many diseases seem
    to be interrelated to FMS and also PCOS and since
    I have both, maybe I have twice the chance of them.
    Who knows.
    Thanks for the article.
  5. klutzo

    klutzo New Member

    I had always eaten grains, so did not realize that I was not normal ,until I started eating low carb and gave up grains about 7 months ago. Within 2 wks. my bloated stomach collapsed just like a cake when you slam the oven door. About 90% of my IBS-D was gone. The one time I ate grains since then I bloated up again. How unpleasant! And to think I used to take feeling that way for granted.
    I think some of us may have a milder grain problem than the traditional celiac dx, but a problem nevertheless. It is worth a trial to see if you are helped, although it's even better if you give up all starches, including starcy veggies, not just the grains.
  6. MemoryLane

    MemoryLane Member

    From the website of Jewish Hospital in Louisville, KY:

    Celiac disease

    Alternative Names
    celiac sprue, nontropical sprue, sprue, gluten-sensitive enteropathy, gluten intolerance

    Celiac disease is a malabsorption syndrome. The intestine is not able to absorb vital dietary nutrients from foods containing gliadin, an alcohol-soluble portion of gluten.

    <bold>What is going on in the body?
    Nutritional considerations are important for persons with celiac disease. People with celiac disease are sensitive to cereal protein found in wheat and other grains. But they are more sensitive to the protein in wheat than the protein in other cereals such as rye, oats, and barley. The protein causes a reaction in the person's small intestine that prevents absorption of essential nutrients from the diet. The defect in absorption leads to the symptoms of the disease and malnutrition.</bold>

    What are the signs and symptoms of the disease?
    The symptoms of celiac disease are:
    diarrhea and foul smelling stools
    weight loss
    abdominal bloating
    difficulty in concentrating

    What are the causes and risks of the disease?
    Celiac disease is suspected to be a genetic disorder. But exactly how the genetic changes cause the sensitivity to gluten is not known.

    Celiac disease, for example, is common among people from northwest Europe. The frequency among the British is 1 in 1,000 to 1 in 2,000. The frequency among the Irish is as high as 1 in 600. Relatives of people with celiac disease are at higher risk than others in the same population.

    What can be done to prevent the disease?
    There is no way to prevent celiac disease. Genetic testing may be useful in some cases.

    How is the disease diagnosed?
    Celiac disease may be diagnosed by observing the symptoms after an infant begins eating cereals. More often, however, it is diagnosed during the second year of life. The age and onset of celiac disease can vary, though. A blood test may show impaired levels of carbohydrate absorption.

    Stool may be examined for excessive amounts of fat as this is a common sign of celiac disease. A healthcare provider may also order a barium enema x-ray study of the small bowel to check for increased intestinal secretion and clumping of the barium in the bowel. When celiac disease is suspected, a biopsy of the small intestine may be done. The biopsy shows an abnormal inner surface of the small intestine.

    What are the long-term effects of the disease?
    The long-term effects of celiac disease include:
    anemia, which is a reduction in the number of red blood cells circulating in the blood
    delayed growth
    bone loss. Bone loss can cause osteomalacia in adults, with bone pain and tenderness. Bone loss in children is seen as rickets, with bowlegs, a protruding stomach and a pigeon breast in children.
    defects of the nervous system
    inflammation of the skin
    malignant lymphoma

    What are the risks to others?
    Celiac disease is not contagious. It is an inherited disease, but the way it is inherited is not clear. Genetic counseling is useful for those at risk of passing it to their children. The risk for identical twins may be as high as 70%. The risk for other brothers and sisters is 10%. The risk for children of parents with celiac disease is 5-10%.

    What are the treatments for the disease?
    Many of the effects of celiac disease can be minimized with a special diet. People with celiac disease learn to avoid the proteins in cereal. The proteins in wheat, rye, barley, and oats cause the symptoms of the disease. A healthcare provider may recommend a gluten-restricted and gliadin-free diet. Gluten is found in wheat, rye, barley, oats, corn and rice. Gliadin, the substance that seems to cause the symptoms in celiac disease is not found in corn or rice. People with the disease cannot tolerate wheat, rye, barley and oats or any products made with these grains. They can eat corn and rice because these grains do not contain gliadin. Some people may be able to tolerate oats, but this should not be tested until initial recovery has occurred. Some people do not respond to dietary limitations, and may need steroid therapy.

    What are the side effects of the treatments?
    Use of steroids may cause memory loss, bone loss, weight gain, congestive heart disease, or high blood pressure.

    What happens after treatment for the disease?
    Dietary restriction or drug therapy will be needed throughout the person's life.

    How is the disease monitored?
    Celiac disease is monitored by simple observation of symptoms.

    Author: Ronald J. Jorgenson, DDS, PhD, FACMG
    Date Written: 05/23/00
  7. MemoryLane

    MemoryLane Member

    Then I stopped eating the breads, wheat, etc. I can't even eat oatmeal, though I love it and it is supposed to be a lower risk than the others. In fact, the only grain I can eat is rice, which fortunately I like.

    Anyway, I have never been tested for Celiac and even though I have the heritage...the proof was in the pudding...bread pudding that is!