Research - The way Celiac Disease is diagnosed is not monolithic

Celiac Disease (CD) is notoriously difficult to diagnose, even in the best case scenario.  Today's featured scientific article is about a man whose only sign of CD was inflammation called "polyserositis" affecting, heart, lungs and brain.  It's unclear why they did an endoscopy in that case, but they did, and it revealed the CD.  Technically, other things can cause jejunal lining destruction.  So I'm a bit doubtful about the last few sentences.  They say the man's outcome  was that he had partial recovery from CD because it was hard for him to avoid all gluten (that's probably true, I've heard the same in other research from Tunisia).  But there is more to that story, I'm sure.

 In any case, it helps to know that the way CD is diagnosed is not monolithic.  

[Celiac disease in adult patients revealed by polyserositis: about a case].


Celiac disease (CD) is an autoimmune disease affecting multiple organs. It often presents as gastrointestinal manifestations associated with malabsorption. However, serosa involvement uncommonly reveals this enteropathy, making the diagnosis difficult. We here report the case of JA, aged 63 years, admitted to hospital to detect the cause of malabsorption syndrome associated with polyserositis signs including pleurisy, pericarditis, ascites and hydrocephalus. The diagnosis of CD was based on endoscopic signs without serology tests. Patient's evolution was partially favorable, due to lack of compliance with a gluten-free diet. Our study reports the first case of CD revealed by polyserositis. CD should be suspected in patients with malabsorption syndrome, in the absence of evocative signs.
There's more.  In other countries besides the USA, anemia may be used as a marker for Celiac Disease, or other autoantibodies may be sought.  There seems to be a surprisingly strict definition of Celiac disease according to the gold standard of anti-tTG and endoscopy in the US.  However, there are many ways to describe the effect of gluten on people who are sensitive to it.  Here's a discussion from 2001 about the various means we have for detecting the illness.  Anti-reticulum was one  of the first observations before transglutaminase became the star. 

It may turn out that this new "Non-Celiac Gluten Sensitivity (NCGS)" is really just the beginning of the end of the limited definition of Celiac disease.  It may turn out to be a spectrum of responses to the presence of gluten in the diet.  And if genetic databases are to be believed, there are many more Celiac linked genes than just two.  Already we have discussions online about treatment resistant or refractory Celiac disease, and in that article specifically, the most effective treatment seems to be Remicade(R), a drug that is used in many autoimmune diseases and lowers TNF-alpha.  This should tell us that we don't have a complete picture of Celiac Disease, let alone NCGS.

It's important to use the most reliable medical means possible to detect Celiac disease and treat it.  However, we should keep in mind that it's not a monolithic process that works for everyone.

Disclaimer: I am not a doctor or a scientist.  I'm a blogger.  If you have health questions, you should consider all sources of information, including your doctor, and you shouldn't change things unless you have good reasons to do so and have discussed them with a trained medical professional.  In my experience, the best doctors will react with interest when you bring them information like freshly published studies.  But I should warn you that some MD's may react with scorn.  My health outcomes have been much better since my doctor and I have been researching my condition, but your results may not match mine.


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