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An article from the European Journal of Gastroenterology & Hepatology 2001,
13: 1119-1121 entitled  "Coeliac disease: the cause of various associated
disorders? (James et al) cites that most of the associated disorders are
thought to have an autoimmune basis.  A table in the article lists primary
Sjogren's syndrome at having a prevalence of 15% with a 95% confidence
interval (5-31).  The table lists this disorder among 11 others (see below)
for which the article cites in its introduction, "the advent of the
endomysial antibody test has allowed the true association between coeliac
disease and at least 12 other disorders to be established.  There is
evidence suggesting that coeliac disease is a cause of these disorders; a
mechanism for this is proposed."  The article cites that "the associated
disorders could be caused by the deposition of immune complexes produced by
the damaged small bowel mucosa.  We are aware of no further supporting
evidence for the involvement of immune complexes, and attention in coeliac
disease has firmly shifted to T-cell mediated immune responses."
"That tTG is the auto antigen recognized by EMA (endomysial antibody)
explains why EMA is more sensitive and specific than antigliadin
antibodies." "...Once above a certain threshold level , the tTG would be
targeted by sensitized T cells, resulting in local damage and leading
theoretically to type 1 diabetes mellitus, Grave's disease and Sjogren's
syndrome, respectively.  The lymphocytic infiltration of the diseased organs
in these conditions is certainly consistent with this mechanism.
Furthermore, a study from Italy showed a strong association between the
development of various autoimmune diseases in coeliac disease and the
duration of exposure to gluten, suggesting that events in the small
intestine are directly related to disease in the other organs.  The
continued recruitment of specifically sensitized T cells to tTG predisposes
to a prompt and significant response to tTG elsewhere in the body.  It has
been demonstrated that T cells specific for these neoepitopes can escape
thymic education, and become active and aggressive when these epitopes are
presented at high concentrations."
"... this cannot be the only underlying cause for the associated disorders
listed, since most patients with these disorders do not have coeliac
disease.  The influence of other HLA class II genes (or genes closely
associated with them), other genetic factors and environmental factors may
all contribute."
The review article's table lists the %prevalence of celiac d. in other
disorders using a 95% confidence interval:
Dermatitis Herpetiformis               81  (67-91)
Epilepsy with cerebral calcifications  77  (59-90)
Hyposplenism                           50  (25-75)
Bird fancier's lung                    31  (11-59)
Unexplained ataxia                     16  (5-36)
Primary Sjogren's syndrome             15  (5-31)
Primary biliary cirrhosis               7  (2-17)
Type 1 diabetes                         5  (2-11)
Autoimmune thyroid disease              6  (2-13)
Cryptogenic hypertransaminasaemia     1.5  (0.5-4)
Recurrent aphthous ulcers             3.8  (1-9)
Autoimmune hepatitis                  2.8  (0.9-6)

More reasons why we should maintain a GF diet and why duration of exposure
should be minimized by prompt diagnosis.  Because of my gluten challenges, I
had to ingest gluten at high amounts in a short span of time which led to a
new struggle I've been having with Gastroparesis, slow stomach emptying,
which my Gastroenterologist has explained now puts me at risk for Diabetes.
Laura




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