Latest news with #celiacdisease
Yahoo
05-07-2025
- Health
- Yahoo
Could You Have 'Silent Celiac' And Not Know It?
You're likely somewhat familiar with celiac disease, a serious autoimmune disorder that causes certain people to experience small intestine damage when they consume gluten. Those afflicted often experience gastrointestinal symptoms like stomach pain, bloating, constipation, gas and diarrhea. But not everyone does. In fact, you can have 'silent celiac' and have no idea. Below, GI specialists explain what silent celiac is, how it's diagnosed and treated and what to look out for. ''Silent' celiac disease is when someone has celiac disease, a reaction to the gluten protein, but they do not manifest symptoms from the disease,' said Dr. Rabia De Latour, a gastroenterologist and assistant professor of medicine at NYU Grossman School of Medicine. 'They can have the physical manifestations of the disease like small bowel inflammation but without the GI symptoms like diarrhea and abdominal pain.' As such, the form of celiac often called 'silent' celiac can also be referred to as 'asymptomatic' celiac. 'This is a rare form of celiac, as usually patients develop GI symptoms from the malabsorption, which is secondary to the intestinal damage caused by the celiac disease,' said Dr. Kevin Cronley, a gastroenterologist with Gastro Health in Cincinnati. Although the idea of silent celiac presumes you have no symptoms of the disease, some people might simply not realize they're experiencing mild symptoms. 'For probably a portion of those patients who think they have no symptoms, they discover that they did have symptoms and feel much better once they go on a gluten-free diet,' said Dr. David Kastenberg, chief of the division of gastroenterology and hepatology at Jefferson Health in the Greater Philadelphia area. 'They weren't aware that they had symptoms because they thought things like headaches, joint aches, chronic sinus problems or muscle aches were just part of their normal everyday life rather than celiac.' Because this manifestation of celiac disease does not involve clear symptoms, many people go undiagnosed. 'Silent celiac disease is underdiagnosed, and physicians should have a low threshold to test for it if there are any laboratory abnormalities suggestive of celiac, family history of celiac disease, or other conditions which celiac can be associated with,' Cronley said. As he noted, further inspection of lab abnormalities are typically the way people with the disease wind up with a diagnosis. 'Someone might have silent GI symptoms but may have abnormal lab findings or nonspecific generalized symptoms like fatigue and headaches,' De Latour noted. 'Going to your doctor for regular checkups with appropriate blood work can pick up the lab work signs of celiac before your symptoms might. Someone might have blood work findings suggesting they are not absorbing certain nutrients well from their food due to the gut inflammation.' If a patient's bloodwork shows iron deficiency or elevated liver function, for instance, doctors may then check for celiac by doing a blood test for certain antibodies, like tissue transglutaminase antibody. They can also do an upper endoscopy to look at the GI tract and take a sample of tissue from the small intestine. 'Silent celiac might be 'unsilenced' if someone is getting an upper endoscopy for something separate like acid reflux and the findings suggest celiac, leading them to go on and do blood tests,' Kastenberg said. 'People also need to take notice when someone is at a higher risk for having celiac, like having a first-degree relative with celiac or concomitant medical problem like autoimmune thyroid disease.' He noted that conditions like type 1 diabetes, Down syndrome and certain skin rashes are also associated with increased risk of celiac disease. The good news is there's a clear and effective treatment for celiac disease, silent or otherwise. The bad news is it calls for a big lifestyle change. 'The treatment for celiac disease is a gluten-free diet,' Cronley said. 'Gluten is a protein that is found in wheat that the body will confuse with the lining of the patient's intestines, causing damage to the intestines. This intestinal injury can result in symptoms of malabsorption, vitamin deficiencies, and can increase the risk of cancer of the small intestine.' To remove this harmful protein from the equation and reduce the inflammation, patients must completely cut gluten out of their diets. 'For sicker patients, there are more intense therapies, but this is less common,' De Latour noted. Fortunately, there's now more awareness and understanding around gluten-free eating than in the past. 'Gluten-free diets are popular right now because in general, people feel better on a gluten-free diet by eating less processed foods,' Cronley said. 'If you think you may have celiac, seek an evaluation by a physician who can properly evaluate you for the disease.' Once you get the celiac diagnosis, it's important to make those dietary changes, even if you don't feel symptoms after eating gluten. 'Silent celiac is really celiac disease, so it's serious,' Kastenberg said. 'It's hard for people to accept that when they feel perfectly fine. If you feel terrible when you have gluten, you get that feedback that you shouldn't eat that thing. But if you aren't so sensitive and can eat gluten all the time without feeling it, you aren't getting that feedback that it's a problem for you.' But you need to recognize that silent celiac should be taken just as seriously. Ignoring it can lead to long-term issues. 'Even if you feel well, your small intestine is not well,' Kastenberg emphasized. 'It's not functioning properly, and there are lots of potential consequences like an increased risk for osteoporosis, nutritional deficiencies, malignancies and even reproductive and pregnancy-related issues like low birth weight or spontaneous abortion. If you have celiac, it's important to tell your family members to get screened as well. Catching it early makes a big difference.' If You're A Healthy Eater, Is It Possible You Get TOO Much Fiber? The Worst Foods To Eat Before Flying Why Are People Eating Oranges In The Shower On TikTok?
Bloomberg
04-07-2025
- Health
- Bloomberg
The Daunting Cost of Eating With Celiac Disorder
Hi, it's Freya in London, where my gluten-free grocery bill is skyrocketing. But more on that in a moment ... I was diagnosed with celiac disease eight years ago — an autoimmune disorder where the body attacks its own gut lining if you eat gluten. Changing my diet was more than a health adjustment, it was also a financial one, and the price I've been paying to eat gluten-free has been adding up ever since.
Medscape
17-06-2025
- Health
- Medscape
Celiac Blood Test Eliminates Need for Eating Gluten
Think your patient may have celiac disease? The harsh reality is that current diagnostic tests require patients to consume gluten for an accurate diagnosis, which poses challenges for individuals already avoiding gluten. A more tolerable approach appears to be on the horizon. Researchers in Australia have developed a blood test that can identify celiac disease with high sensitivity and specificity, even without consuming gluten. 'This is a simple and accurate test that can provide a diagnosis within a very short time frame, without the need for patients to continue eating gluten and feeling sick, or to wait months for a gastroscopy,' Olivia Moscatelli, PhD candidate, Tye-Din Lab, Walter and Eliza Hall Institute and University of Melbourne, Parkville, Australia, told Medscape Medical News . The study was published online on June 9 in Gastroenterology . Most Cases Go Undiagnosed Celiac disease is an autoimmune disorder triggered by gluten found in wheat, rye, and barley. The only available treatment is a strict, life-long gluten-free diet. The global prevalence of celiac disease is estimated at around 1%-2%, with 50%-80% of cases either undiagnosed or diagnosed late. That's because the current reliable diagnosis of celiac disease requires the intake of gluten, which may deter people from seeking a diagnosis. In earlier work, the researchers, working with Robert Anderson, MBChB, BMedSc, PhD, now with Novoviah Pharmaceuticals, made the unexpected discovery that interleukin-2 (IL-2) spiked in the blood of people with celiac disease shortly after they ate gluten. But would this signal be present when no gluten had been consumed? The team developed and tested a simple whole blood assay measuring IL-2 release (WBAIL- 2) for detecting gluten-specific T cells to aid in diagnosing celiac disease. They collected blood samples from 181 volunteers — 75 with treated celiac disease on a gluten-free diet, 13 with active untreated celiac disease, 32 with nonceliac gluten sensitivity and 61 healthy controls. The blood samples were mixed with gluten in a test tube for a day to see if the IL-2 signal appeared. The WBAIL-2 assay demonstrated high accuracy for celiac disease, even in patients following a strict gluten-free diet. For patients with HLA-DQ2.5+ genetics, sensitivity was 90% and specificity was 95%, with lower sensitivity (56%) for patients with HLA-DQ8+ celiac disease. The WBAIL-2 assay correlated strongly with the frequency of tetramer-positive gluten-specific CD4+ T cells used to diagnose celiac disease and monitor treatment effectiveness, and with serum IL-2 levels after gluten challenge. The strength of the IL-2 signal correlated with the severity of a patient's symptoms, 'allowing us to predict how severely a person with celiac disease might react to gluten, without them actually having to eat it,' Moscatelli said in a news release. 'Current diagnostic practice involves a blood-based serology test followed by a confirmatory gastroscopy if positive. Both tests require the patient to eat gluten daily for 6-12 weeks prior for accurate results. We envision the new blood test (IL-2 whole blood assay) will replace the invasive gastroscopy as the confirmatory test following positive serology,' Moscatelli told Medscape Medical News . 'In people already following a gluten-free diet, we propose they would have this new blood test done on two separate occasions and two positive results would be required for a celiac diagnosis. This would allow a large number of people who previously have been unable to go through the current diagnostic process to receive a diagnosis,' Moscatelli said. Practice Changing Potential Blood-based test that can accurately detect celiac disease without the need for a gluten challenge would be 'welcome and practice changing,' said Christopher Cao, director, Celiac Disease Program, Division of Gastroenterology, Mount Sinai Health System, New York City. 'A typical 'gluten challenge' involves eating the equivalent of 1-2 slices of bread daily for the course of 6 weeks, and this may be incredibly difficult for patients who have already been on a gluten-free diet prior to an official celiac disease diagnosis. Inability to perform a gluten challenge limits the ability to make an accurate celiac disease diagnosis,' Cao told Medscape Medical News. 'This study shows that gluten-stimulated interleukin release 2 assays may correlate with the presence of pathogenic gluten-specific CD4+ T cell response in celiac disease,' Cao noted. He cautioned that 'further large cohort, multicenter prospective studies are needed to assess generalizability and may be helpful in evaluating the accuracy of WBAIL-2 in non-HLA DQ2.5 genotypes.' Other considerations prior to implementation may include reproducibility across different laboratories and overall cost effectiveness, Cao said. 'Ultimately in clinic, the role of WBAIL-2 will need to be better defined within the algorithm of celiac disease testing,' he added. The Path Ahead The researchers plan to test the performance of the IL-2 whole blood assay in a pediatric cohort, as well as in other countries to demonstrate the reproducibility of the test. In these studies, the test will likely be performed alongside the current diagnostic tests (serology and gastroscopy), Moscatelli told Medscape Medical News . 'There are some validation studies starting in other countries already as many celiac clinicians globally are interested in bringing this test to their clinical practice. I believe the plan is to have this as an approved diagnostic test for celiac disease worldwide,' she said. Novoviah Pharmaceuticals is managing the commercialization of the test, and the plan is to get it into clinical practice in the next 2 years, Moscatelli said.
Medical News Today
14-06-2025
- Health
- Medical News Today
Celiac disease: Is an easier way to diagnose it on the horizon?
Could a blood test diagnose celiac disease without the need to trigger symptoms? Image credit: Alvaro Lavin/Stocksy. Celiac disease has to do with an abnormal immune response of the body to gluten. Experts are interested in the best ways to test for celiac disease. A recent study discovered that a blood test called WBAIL-2 could aid in diagnosing celiac disease and even contribute to biopsy-free diagnosis. Celiac disease occurs when someone's immune system responds abnormally to gluten. Efforts to improve celiac disease diagnosis are ongoing. A study recently published in Gastroenterology evaluated the effectiveness of using a blood test that measures the cytokine interleukin-2 to diagnose celiac disease. The study's results indicated that the test to be highly effective for celiac disease diagnosis, even for people following a gluten-free diet. The test could offer another option to help with celiac disease diagnosis — importantly, one that would not require triggering symptoms to confirm the disease. The authors of the current study note that there is often a delay or lack of diagnosis when it comes to celiac disease. Diagnosis usually involves people having to eat gluten and get biopsies of the small intestine. Celiac disease also has to do with the response of a group of immune cells, CD4+ gluten-specific T-cells. For this study, researchers wanted to determine if the use of a blood test that measures interleukin-2 — a protein produced by some T-cells — release could help to accurately diagnose celiac disease. This research involved a total of 181 adult participants between 18 and 75 years old. Of these participants, 88 had celiac disease, and others were controls. Among controls, 32 participants had a non-celiac gluten sensitivity and were on a gluten-free diet. The rest were healthy controls who did not have gluten sensitivity. All participants provided blood samples, and researchers collected data on medications and medical history. A subset of participants, including healthy controls, participants with non-celiac gluten sensitivity, and treated celiac disease, went on a gluten-free diet for four weeks or more and then consumed gluten for 'a single-dose open-label gluten challenge.' Some participants with treated celiac disease also did an oral gluten challenge that lasted 3 days. If participants underwent the oral gluten challenge, they used diaries to keep track of their symptoms. Researchers utilized a blood test called a WBAIL-2 assay, which measures the release of interleukin-2 in vitro after adding gluten peptides. In general, the test was able to effectively confirm celiac disease, with higher concentrations and fold change of interleukin-2 in participants who had celiac disease. However, the results were less sensitive for participants with a certain, less common genotype. Analysis results also found that the WBAIL-2 assay correlated with age and the number of years participants had been following a gluten-free diet. Next, researchers tested participants' serum levels of interleukin-2 after they did an oral gluten challenge. The levels of interleukin-2 were higher for participants with celiac disease following the oral gluten challenge. Researchers also found these levels 'positively correlated with the WBAIL-2 results.' So, if the levels of interleukin-2 were elevated on one test, they were also elevated on the other. They also tested how the WBAIL-2 results related to the presence of gluten-specific T cells, which were higher among participants with celiac disease. They did find that the presence of these cells, as well as activated versions of these cells, correlated with the WBAIL-2 test. The researchers further found that gluten-specific T cells, activated versions of these cells, and WBAIL-2 increased after participants underwent a gluten challenge. However, one participant had lower gluten-specific CD4+ T cells and a lower WBAIL-2 test on day six. Researchers also looked at treated celiac disease participants and how the tests related to their symptoms after gluten exposure. When it came to gluten-specific T-cells, their frequency was higher in participants who experienced vomiting. The measurement of serum interleukin-2 following the gluten tolerance test was also elevated, as was the WBAIL-2 level. The WBAIL-2 level was also increased greatly for one participant who did not experience vomiting but did report severe tiredness. Further analysis also suggested that activated gluten-specific CD4+ T cells are the cells that lead to gluten-induced production of interleukin-2. The results suggest that the WBAIL-2 assay can help with celiac disease diagnosis, even when people are already following a gluten-free diet. There are some limitations to this study. For one thing, it was performed out of one area, most participants were female, and there were strict inclusion criteria, so it has a limited generalizability. It also had small sample sizes for some subgroups, which means more research may be particularly necessary in these subgroups. Since researchers did not test children or people taking immunosuppressants, more research is needed to see how well this testing method would work in these populations. Researchers also acknowledge an untested 'reproducibility across laboratories.' More research is thus needed before the WBAIL-2 assay can really be used in the clinical setting. Further, the authors did not examine the cost-effectiveness of the WBAIL-2 test and how well this would stack up against current ways of diagnosing celiac disease. Then, the test was not as accurate for some participants with a specific genotype, which means it might not work for everyone. However, the number of participants with this genotype was very small in this study, and it is possible that the level of interleukin-2 response of some participants with this genotype was just not able to be detected by the test. Overall, more research is required regarding this subtype of individuals and the use of this test. Ian Storch, DO, an osteopathic physician specializing in gastroenterology and internal medicine, and an American Osteopathic Association member, who was not involved in this study, spoke to Medical News Today about its findings. 'One limitation of this study is the poor performance in the DQ8 genetic arm, which makes up 10% of celiac patients. This will decrease the sensitivity and specificity for the control group or require HLA typing before the assay is run.' Researchers acknowledge that the serum analysis of interleukin-2 following a gluten challenge does not always line up with the results of the WBAIL-2 assay, which could have to do with the assays' differences. Shilpa Mehra Dang, MD, double board-certified in gastroenterology and internal medicine with Medical Offices of Manhattan and contributor to LabFinder, who was similarly not involved in this research, noted that 'we need to look at bigger samples to really see its clinical usefulness.' In addition to larger studies, research can also focus on more details regarding gluten-specific T cells. Celiac disease is a challenging condition to manage, and accurate diagnosis is important. Researchers suggest that examining WBAIL-2 and serum interleukin-2 after gluten consumption could allow people with celiac disease to not have to get biopsies done to confirm celiac diagnosis. The authors of this study also suggest that the WBAIL-2 assay could also become a first test among people following a gluten-free diet and help with symptom severity prediction. Storch said: 'I do not think that based on the data presented, removal of histology to confirm the diagnosis can be suggested.' Jeffrey D. Davis, DO, CMD, an osteopathic physician specializing in Family Medicine and Preventive Health and an American Osteopathic Association board member, who was not involved in the study, noted the following to MNT : 'I see potential for a commercially available rapid, simple, cost-effective laboratory test for physicians to use to assist in the accurate diagnosis of celiac disease. This study shows that especially in adults already on a gluten-free diet using this lab test versus currently available tests would improve our diagnostic capabilities for Celiac Disease. However, it would most likely be just another tool in our tool box to aid in the diagnosis along with other current diagnostic methods.'
Medscape
28-05-2025
- Health
- Medscape
Bone Metabolism in Celiac Disease
When most people think of celiac disease (CD), they understandably associate it with digestive system problems such as bloating, diarrhea, and abdominal pain. The chronic autoimmune disorder, characterized by an abnormal immune response to gluten — a protein found in wheat, barley, and rye— leads to damage of the small intestine when people with the disorder consume gluten. This intestinal damage causes uncomfortable digestive symptoms associated with the disease, but it also affects a very different system: the skeletal system. This is because CD impairs absorption of essential nutrients, including calcium and vitamin D — two nutrients crucial for maintaining bone health. As a result, individuals with CD are at an increased risk for developing metabolic bone diseases, such as osteomalacia, low bone density, and osteoporosis. Thus, prompt diagnosis of the condition, which affects approximately 1%-2% of the global population, is crucial in order to prevent these bone consequences. This also highlights the need for bone screening in those found to have the disease. Importantly, a significant number of patients with CD may present without the classic gastrointestinal symptoms, instead exhibiting extraintestinal manifestations, including bone loss. An impact on bone health has been reported in individuals with CD across a range of ages, including children. Postmenopausal women with the condition are at heightened risk due to associated estrogen deficiency, which further compromises bone density. Older adults with CD are also more vulnerable as bone mass naturally declines with age and is further exacerbated by malabsorption-related deficiencies. Regional studies indicate that the prevalence of CD-associated osteoporosis is particularly high in Europe and North America. A Danish study reported that the risk of major osteoporotic fractures is increased by 37% and of any fractures by 27% in patients with CD. The pathophysiology of bone disease in CD is multifactorial. The intestinal damage caused by the condition results in the malabsorption of vitamin D, which plays an essential role in calcium and phosphate homeostasis and in promoting optimal conditions for bone mineralization. Vitamin D deficiency is common in untreated CD and drives bone loss and can cause osteomalacia — a condition characterized by softening of bones. In children with CD, severe vitamin D deficiency with reduction in phosphate levels can cause rickets. Further, impaired calcium absorption and hypocalcemia triggers secondary hyperparathyroidism— a compensatory increase in parathyroid hormone (PTH) secretion aimed at restoring serum calcium levels. PTH stimulates osteoclast activity, leading to increased bone resorption and, ultimately, a deterioration in bone microarchitecture. Thus, bone impairment may occur even when serum calcium levels appear normal. Systemic inflammation also plays a critical role. Pro-inflammatory cytokines such as TNF-alpha and IL-1 and -6 are elevated in CD and are known to directly stimulate osteoclastogenesis. These cytokines promote bone resorption and interfere with bone formation, further skewing the balance toward bone loss. Hormonal disturbances may contribute to bone disease in CD. Women with CD may experience menstrual irregularities, such as amenorrhea or early menopause, resulting in decreased estrogen levels, a hormone critical for bone preservation. In men, a condition of reversible androgen resistance may occur, reducing the anabolic effects of testosterone on bone. Together, these hormonal imbalances can significantly impair bone density. In light of these risks, it is important to promptly screen patients for CD when they have symptoms suggestive of this condition, or in some patients with vitamin D deficiency who do not respond to usual vitamin D replacement doses, or in situations where a diagnosis of low bone density is made for unrelated reasons, to prevent to prevent long-term complications, including bone disease. The preferred initial screening test in patients suspected to have CD and consuming a gluten-containing diet is the tissue transglutaminase IgA antibodies (tTG-IgA) test accompanied by total serum IgA (to rule out IgA deficiency). If IgA concentrations are low, an IgG based test is indicated. A positive serologic test should be followed by endoscopic duodenal biopsy, which can confirm the diagnosis through findings such as increased intraepithelial lymphocytes, crypt hyperplasia, and villous atrophy. However, the biopsy may not be necessary if the tTG-IgA antibody titer is 10 or more times the upper limit of normal. Human leukocyte antigen testing is sometimes necessary in patients with suspected CD. Importantly, diagnostic procedures must be conducted while the patient is still consuming gluten, as high antibody titers and endoscopic findings resolve on a gluten-free diet. The European Society for the Study of Celiac Disease recommends that, upon diagnosis, individuals aged 30-35 or older with CD undergo bone mass density (BMD) testing using dual-energy x-ray absorptiometry (DXA), particularly if there is evidence of malabsorption, if the diagnosis is delayed, or if there are other concerning risk factors for low bone density. DXA scans should be repeated every 5 years if the initial scan was normal, or every 2-3 years if the initial scan revealed low bone density or for ongoing risk factors for low bone density. The American College of Gastroenterology also recommends DXA screening for low bone density in CD. Children with CD, similarly, should be screened with a DXA scan when there are risk factors for low bone density. Calcium, vitamin D, alkaline phosphatase and PTH levels should be checked at diagnosis and monitored annually (or more frequently in the case of children) until they return to normal. The cornerstone of treatment for CD is strict, lifelong adherence to a gluten-free diet (GFD). Eliminating gluten from the diet allows the intestinal mucosa to heal, leading to improved nutrient absorption and a reduction in systemic inflammation. Numerous studies have demonstrated that adherence to a GFD can significantly improve BMD, with notable changes observed within the first year of dietary compliance. The American Gastroenterological Association emphasizes the critical role of the GFD in both gastrointestinal recovery and the prevention of complications like osteoporosis. In addition to the GFD, patients with CD should receive calcium and vitamin D supplementation to address deficiencies and support bone health. The Canadian Family Physician guidelines recommend routine supplementation and monitoring to ensure optimal levels. Regular BMD assessments are advised as previously discussed to detect early signs of bone loss and monitor the effectiveness of interventions. Physical activity, particularly weight-bearing exercises, is encouraged as it helps to stimulate bone formation and enhance skeletal strength. Patients should be encouraged to participate in weight-bearing (bone loading) exercises, resistance training, limit alcohol intake, and avoid cigarette smoking. In severe cases of osteoporosis, antiresorptive medications such as bisphosphonates may be considered. However, evidence supporting their use specifically in CD patients is limited, and such treatments should be tailored to individual needs. Bone disease is a common and potentially serious complication of CD, often arising from a combination of malabsorption, inflammation, and hormonal imbalances. Early detection and comprehensive management — including implementation of a gluten-free diet, nutritional supplementation, and optimal physical activity, along with routine BMD screening — are vital to preserving bone health and preventing long-term complications in individuals with CD.
