Jump to content
This site uses cookies. Continued use is acceptance of our Terms of Use and Privacy Policy. More Info... ×
  • Welcome to Celiac.com!

    You have found your celiac tribe! Join us and ask questions in our forum, share your story, and connect with others.




  • Celiac.com Sponsor (A1):



    Celiac.com Sponsor (A1-M):


  • Get Celiac.com Updates:
    Support Our Content
    eNewsletter
    Donate
  • Record is Archived

    This article is now archived and is closed to further replies.

    Scott Adams
    Scott Adams

    Excerpts from 'Celiac Disease. Going Against the Grains' by M. Pietzak, C. Catassi, S. Drago, F. Fornaroli, A. Fasano. Nutrition in Clinical Practice: 12/01; 16: 335-344 (prepared by Laura Yick)

    Reviewed and edited by a celiac disease expert.

    Celiac.com 09/01/2002 - Patients with celiac disease are 20 times more likely than the general population to have epilepsy and often have associated cerebral and cerebellar calcifications imaged by CT and MRI. Depression, dementia, and schizophrenia are all also common in persons with untreated celiac disease. Cerebellar degeneration with resulting ataxia (gluten-associated ataxia) is a known entity in Europe, and the National Institutes of Health (NIH) is currently recruiting subjects with ataxia to examine them for gluten sensitivity and celiac disease. Focal white matter lesions in the brain recently have been reported to occur in children with celiac disease and are thought to be either ischemic in origin as a result of vasculitis or caused by inflammatory demyelination. Parents of children with celiac disease have reported behavioral changes such as irritability, separation anxiety, emotional withdrawal, and autistic-like behaviors that all seemed to improve on a GFD. Although not scientifically validated, the GFD is now also being advocated for children with autism by several groups. Whether or not children with autism are at a higher risk for celiac disease or celiac children have a higher incidence of autism remains to be proven. However, children with Down syndrome, who often have autistic-like behaviors, are at higher risk for celiac disease. It has been hypothesized that gluten may be broken down into small peptides that may cross the blood-brain barrier and interact with morphine receptors, leading to alterations in conduct and perceptions of reality.

    Celiac.com Sponsor (A12):
    The serologic tests can be divided into 4 different types of antibodies: antigliadin (AGA), antireticulin, antiendomysium (AEA), and antitissue transglutaminase (tTG). Each antibody varies widely in its sensitivity, specificity, and positive and negative predictive values (Table 2).

    Table 2 (from Pietzak et al, 2001, compiled data from multiple studies)

    Test Sensitivity Specificity PPV NPD
    AGA IgG 57-100 42-98 20-95 41-88
    AGA IgA 53-100 65-100 28-100 65-100
    AEA IgA* 75-98 96-100 98-100 80-95
    Guinea pig tTG† 90.2 95
    Human tTG† 98.5 98

    * Patients older than 2 years of age.
    † IgG +IgA antibodies.

    The AEA IgA immunofluorecent antibody is an excellent screening test for celiac disease, with both a high sensitivity and specificity. This antibody was discovered in the early 1980s and rapidly gained use as part of a screening celiac panel by commercial laboratories in combination with AGA IgG and AGA IgA. Its major drawbacks are that it may be falsely negative in children under the age of 2 years, in patients with IgA deficiency, and in the hands of an inexperienced laboratory. Also, the substrate for this antibody was initially monkey esophagus, making it expensive and unsuitable for screening large numbers of people. Recently, the human umbilical cord has been used as an alternative to monkey esophagus. However, the subjective nature of the AEA assay may lead to false-negative values and unacceptable variability between laboratories.

    Because tTG had been first described as the autoantigen of celiac disease in 1997, it has been used to develop innovative diagnostic tools. The tTG IgA ELISA test is highly sensitive and specific, using either the commercially available guinea pig tTG or human recombinant tTG. The tTG assay correlates well with AEA-IgA and biopsy. However, it represents an improvement over the AEA assay because it is inexpensive and rapid (30 minutes), is not a subjective test, and can be performed on a single drop of blood using a dot-blot technique. Therefore, this test is ideally suited for mass screenings and in the future could be performed in the general practitioners office, much like the now routine finger-stick hematocrit.

    For the reasons outlined above, the IgA class human anti-tTg antibody, coupled with the determination of total serum IgA, currently seems to be the most cost-effective way to screen for celiac disease. AEA should be used as a confirmatory, pre-biopsy test, whereas AGA determinations should be restricted to the diagnostic work-up of younger children and patients with IgA deficiency, using the guidelines in Table 3.

    Table 3
    Probability of celiac disease based on three antibodies in combination

    AEA IgA
    AGA IgA
    AGA IgG
    Interpretation
    +
    +
    +
    Celiac disease 99% probable
    +
    -
    +
    probable
    +
    +
    -
    Celiac disease probable
    +
    -
    -
    Celiac disease probable
    -
    +
    +
    Celiac disease less likely*
    -
    -
    +
    Celiac disease less likely*
    -
    +
    -
    Celiac disease less likely
    -
    -
    -
    Celiac disease very unlikely+

    * If patient is IgA sufficient: AGA IgG > 100 warrants work-up of enteropathy.
    + If patient is on a gluten-containing diet.
    Celiac disease: AEA, antiendomysium antibodies: AGA, antigliadin antibodies.



    User Feedback

    Recommended Comments

    There are no comments to display.



    Guest
    This is now closed for further comments

  • Get Celiac.com Updates:
    Support Celiac.com:
    Donate
  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


  • Celiac.com Sponsor (A17):
    Celiac.com Sponsor (A17):





    Celiac.com Sponsors (A17-M):




  • Related Articles

    Scott Adams
    BMJ 2004;328:438-439 (21 February) Celiac.com 02/27/2004 – The following report is interesting, but I believe that serological studies done on those with schizophrenia would be a far better way to conduct such a study. Also, the use of such a small control group cannot accurately predict the actual incidence of schizophrenia in those with celiac disease. –Scott Adams
    According to a Danish study published in the British Medical Journal, people with celiac disease may have an increased risk of developing schizophrenia. Previous studies have also suggested an association between these two disorders. The study identified 7,997 people over age 15 who were admitted to a Danish psychiatric unit for the first time between 1981 and 1998 and were diagnosed with schizophrenia. The res...


    Scott Adams
    American Journal of Psychiatry 163:521-528, March 2006
    Celiac.com 03/14/2006 – Danish researchers have found yet another link between celiac disease and schizophrenia. In a large epidemiologic study the researchers looked at 7,704 Danish people who were diagnosed with schizophrenia between 1981 and 1998, including their parents, and matched them to comparison control subjects. The data linkage required that the autoimmune disease be diagnosed before the diagnosis of schizophrenia. The researchers found that patients with a history of an autoimmune disease had a 45% increased risk for schizophrenia, and nine autoimmune disorders were indicators of a higher prevalence for schizophrenia when compared to the controls. The researchers conclude: “Schizophrenia is associated with a l...


    Jefferson Adams
    Celiac.com 07/13/2009 - Doctors are recommending that kids with mental and behavioral disorders, and with low cholesterol be tested for celiac disease.
    This, after findings from a recent study suggest that low plasma cholesterol levels might have a role in the development and pathogenesis of certain behavioral disorders such as schizophrenia, depression, and obsessional neurosis in people with celiac disease.
    It is well documented that children with celiac disease face higher rates of certain behavioral disorders such as schizophrenia, depression, and obsessional neurosis. Still, not much is known about the development and pathogenesis of celiac-related mental and behavioral disorders.
    A team of researchers made up of Italians Luca Mascitelli, M.D., Francesca Pezzetta, M.D.,...


    Jefferson Adams
    Celiac Disease in Patients with Chronic Psychiatric Disorders
    Celiac.com 05/04/2012 - Some studies have shown that people with untreated celiac disease can have higher rates of psychiatric disorders, but little study has been made to determine whether people with psychiatric disorders have higher rates of celiac disease.
    To answer that question, a team of researchers recently studied celiac disease in patients with chronic psychiatric disorders. The research team included Manouchehr Khoshbaten, Mohammad Rostami Nejad, Nasrin Sharifi, Ali Fakhari, Mahdyar Golamnejad, Sayed Hassan Hashemi, Pekka Collin, and Kamran Rostami
    The team set out to assess rates of celiac disease in Iranian patients suffering from chronic depression or schizophrenia.
    For their study, they screened 200 Iranian inpatient men with in chronic phase of depressive disorders...


  • Recent Activity

    1. - knitty kitty replied to Louise Broughton's topic in Post Diagnosis, Recovery & Treatment of Celiac Disease
      4

      Louise

    2. - knitty kitty replied to Blue Roan's topic in Related Issues & Disorders
      1

      Lymph nodes in neck + thyroid issues

    3. - cristiana replied to MeghanEileenReilly's topic in Post Diagnosis, Recovery & Treatment of Celiac Disease
      47

      Severe Itching And No Rash

    4. - knitty kitty replied to MeghanEileenReilly's topic in Post Diagnosis, Recovery & Treatment of Celiac Disease
      47

      Severe Itching And No Rash

    5. - SoBannaz replied to MeghanEileenReilly's topic in Post Diagnosis, Recovery & Treatment of Celiac Disease
      47

      Severe Itching And No Rash


  • Celiac.com Sponsor (A19):



  • Member Statistics

    • Total Members
      125,663
    • Most Online (within 30 mins)
      7,748

    Hannah Bosak
    Newest Member
    Hannah Bosak
    Joined

  • Celiac.com Sponsor (A20):


  • Forum Statistics

    • Total Topics
      120.8k
    • Total Posts
      1m

  • Celiac.com Sponsor (A22):





  • Celiac.com Sponsor (A21):



  • Popular Now

    • Louise Broughton
      4
    • sh00148
      19
    • pasqualeb
      9
    • Jean Shifrin
      14
  • Popular Articles

    • Scott Adams
    • Scott Adams
    • Scott Adams
    • Scott Adams
    • Scott Adams
  • Upcoming Events

×
×
  • Create New...