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The U.S. is considering lowering the threshold for diagnosis of celiac disease:

"[W]hat is required is a new definition of a gold standard for the diagnosis of CD" [p.4]
http://www.ahrq.gov/clinic/epcsums/celiacsum.htm 
(This is the site for the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services.)
They are admitting that the strict cut-off requiring villous atrophy for a diagnosis lacks sensitivity [p.3] (sensitivity means finding all that may have the disease).

They are wondering whether some degree of villous atrophy is even necessary for a diagnosis of CD? [p.3]   

They are suggesting pathology measures "such as quantification of gamma delta positive intraepithelial lymphocytes (gd+ IELs)" to allow for the use of lower grade cut-offs, while maintaining reasonable specificity" (correct identification of celiac disease). [p.3]

And they state ultimately a trial is required using "multiple diagnostic tests in an attempt to capture as many CD patients in a clinically relevant population as possible, along with a time dimension such as a response to a gluten-free diet or gluten challenge." [p.4] 


And they are studying whether "celiac disease patients without symptoms or villous atrophy have the same risk of complications as those with villous atrophy."  [p.2]

Jo Anne

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