<<Disclaimer: Verify this information before applying it to your situation.>>
========================= Medical Information
Much medical information is of no interest to celiacs, but articles are a
simple way to explain an issue to a medical professional. These extracts
are handy references to show your physician, in his technical language,
what research has been documented throughout the world. When you
encounter a similar problem or if you have a physician willing to learn
from a patient, share these articles for the benefit of all concerned.
A. A Lupus Registry and Repository has been established for obtaining
information from families with two or more diagnosed family members with
Lupus. The study may identify the genes that determine a high
susceptibility. If you are interested contact: Ms Ida Adams, Oklahoma
Medical research Foundation, Oklahoma City, OK, (800) 522-0211 E7479. (5)
B. Autoimmunity Disease in the US effects 20 % of the population
according to AARDA. Of these, the majority are women. (6)
C. Fibroyalgia and Hypothyroidism is reported by one clinician to be
one of the many faces of hypothyroidism. the clinical features of
vitiligo, water retention, hypothermia, weight gain, cold sensitivity,
dry skin, muscle weakness, arthritis, hypertension, slow heart rate, and
constipation are common to both.
. . . Briefly with regard to treatment, patients need to be started on
thyroid hormone, T4. (7)
D. Study on the prevelance of CD in the US
ENDOMYSIUM ANTIBODIES IN BLOOD DONORS PREDICTS A HIGH PREVALENCE
OF CELIAC DISEASE IN THE USA. T. Not, K. Horvath, I.D. Hill, A.
Fasano, A. Hammed, G. Magaz. Division of Pediatric Gastroenterology
& Nutrition, University of Baltimore School of Medicine, *The
Bowman Gray School of Medicine, Winston-Salem, University of
Messina, Italy.
Several epidemiological studies in Europe using antigliadin (AGA)
and endomysium antibodies (EmA) for initial screening report the
prevalence of celiac disease (CD) to be about 1:300 of the
population. EmA is most reliable for screening with greater than
99% positive predictive value in subsequent biopsy proven cases.
There are no comparable scientific data for the USA yet and CD is
considered rare in this country. Lack of awareness could result in
significant underdiagnosis of CD in the USA.
Aim: To determine the prevalence of positive serological tests for
CD in healthy blood donors in USA.
Methods: Sera from 2000 healthy blood donors were screened for IgG
and IgA
AGA using ELISA test. All those with elevated AGA levels (IgA >18
units or IgG >25 units) and those with high normal levels (IgA 10-
18 units or IgG 15-25 units) were tested for EmA by indirect
immunofluorescence using both monkey esophagus (ME) and human
umbilical cord (HUC).
Results: The mean age of blood donors was 39 yrs with 52% being
men, 87% being Caucasian, 11.5% African American and 1.5% Asian. 95
(4.75%) of subjects had elevated AGA levels (IgG and/or IgA). A
total of 44 (2.2%) had an elevated IgA AGA. Of these, 7 were also
positive for EmA. No patient with only raised levels of IgG AGA was
positive for EmA. Of the subjects with high normal AGA levels, one
(IgA 12 units, IgG 1.8 units) was positive for EmA. Among the total
of 8 subjects with elevated EmA levels, seven were Caucasian and
one was African American. There was a 100% correlation between ME
and HUC for positively (8 samples) and negativity (288 samples).
Conclusions: The prevalence of elevated EmA levels in healthy blood
donors in USA is 1:250 (8/2000). This is similar to that reported
from countries in Europe where subsequent small intestinal biopsies
have confirmed CD in all those with EmA positively. Based on a
positive predictive value of >99% for CD in patients with elevated
EmA levels, it is likely that the 8 blood donors identified in this
study have CD. These data suggest that CD is not rare in the USA
and may be greatly underdiagnosed. There is need for a large scale
epidemiological study to determine the precise prevalence of the
disease in the USA. (8)
E. Clinicopathological Exercise of a 74-year-old woman admitted to the
hospital because of diarrhea with recurrent dehydration and severe weight
loss. This interesting discussion of the diagnosis process on pages 383
- 389 of the August 11, 94 issue of the New England Journal of Medicine
shows the diagnosis process for CD. This discussion is informative on
the process that physicians must go through in eliminating other
disorders. (9)
F. Celiac and Teens is an area of considerable differences on the diet
between teens and their parents. The majority of physicians state that
CD is a lifelong disease with the only treatment being the GF diet. But
this is hard to use on a teenager who inadvertently cheats and then
realizes that he or she do not have any symptoms.
G. The Spring 96 issue of the Canadian Celiac Association newsletter had
an excellent discussion of this subject derived from a Montreal
conference in June 1995 titled First Ste-Justine Hospital International
Symposium on Pediatric Gastroenterology and Nutrition.
The key points from the article were:
To have celiac disease and follow the GF diet is to be healthy
despite having a permanent disease.
A celiac cannot assume to be in full remission after eating gluten
for a few months or years without a biopsy. This biopsy should be
repeated every 2 to 3 years for follow-up.
Most celiac children who appear to be in remission because they
have no symptoms are still sensitive to gluten as shown by the flat
mucosa
For some unexplained reason, some will take years on a gluten
containing diet for the flat mucosa to appear. (10)
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