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Hi everyone

In light of the LA Times article quoted by Megan I think it is important to stress that many of the so called “self diagnosers” mentioned in the article may have either celiac disease but do not fit current diagnostic criteria or gluten sensitivity unrelated to celiac disease. Abstracts dealing with both of these scenarios were presented at Digestive Disease Week.

To recap the first study the abstract states that damage to the small intestine in celiac disease develops gradually. However patients may suffer symptoms prior to this damage becoming apparent on a biopsy. These patients under current diagnostic criteria would not be given a diagnosis of celiac disease.

Study investigators looked at 71 adults with positive antiendomysial antibodies. Of these adults 48 had villous atrophy suggestive of celiac disease. The remaining 23 had increased intraepitheal lymphocytes but no villous atrophy. These 23 participants were randomized to follow either a gluten-free or gluten-containing diet. At the end of 12 months they were all retested.

In the group following a gluten-free diet symptoms were alleviated antibodies disappeared or decreased and mucosal inflammation diminished.

In the group following a gluten-containing diet villous architecture deteriorated and symptoms and antibodies remained the same.

Quoting from the abstract “Patients with endomysial antibodies may have clear gluten-dependent symptoms before small bowel mucosal villous atrophy develops. A gluten-free diet may alleviate the symptoms and mucosal inflammation. Also, the antibodies may disappear or titers decrease.”

The authors go on to conclude that current diagnostic criteria for celiac disease are no longer valid and should be revisited.

The other abstract that caught my eye had to do with differences between celiac disease and gluten sensitivity. Study authors include Allesio Fasano from the Center for Celiac Research in Maryland. The abstract states that gluten sensitivity is considered a non-allergic, non-autoimmune condition. In other words gluten sensitivity is neither a wheat allergy nor celiac disease. While intestinal permeability appears to play a role in celiac disease it does not in gluten sensitivity. These findings suggest to the study investigators that two different pathogenic mechanisms are responsible for the two conditions. In other words gluten sensitivity is not simply a milder form of celiac disease but a separate condition all together.

The authors conclude that “gluten sensitivity appears to be a new chapter in the book of food intolerance to be investigated further.”

In an upcoming diet.com blog I interview Dr. Fasano about non-celiac gluten sensitivity.

Tricia


Tricia Thompson, MS, RD
The Gluten-Free Dietitian
Author: The Gluten-Free Nutrition Guide
Co-author: The Complete Idiot's Guide to Gluten-Free Eating
Manchester, Massachusetts
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