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I have read several postings from members who have gone off gluten before
diagnosis, and are now facing the dilemma of how to get diagnosed, not
wanting to resume a diet containing gluten.  (It is important NOT to go
off gluten before diagnosis, but we have learned of many people through
our support group who were not given this information, or did not choose
to follow this advice.)  Could rectal gluten challenge be an answer for
them?

Michael Marsh, M.D., in speaking to the last annual GIG conference
(Videotape available from GIG), presented Rectal Gluten Challenge as a
preferable method of diagnosis for CD.  He stated that Rectal Gluten
Challenge is "relatively fast...  easier to analyze...can be given to any
age group...  is useful in diagnosing latent gluten sensitivity, and can
be used if the patient has been on a recent gluten-free diet."

He stated that an ordinary syringe is used, containing gluten in the
tube.  Gluten is discharged into the proximal rectum.  The patient is
dismissed and returns four hours later, for a rectal biopsy.  If there is
gluten sensitivity, there will be an increase of T-cells in the rectal
mucosa..  A before and after count of T-cells is done, and it is
determined by this count if there is gluten sensitivity.  According to
Dr.  Marsh, in a blind study, all those with intestinal biopsy proven CD
were ID'd correctly with gluten sensitivity, and all the disease controls
were identified correctly, as not showing gluten sensitivity.

This information was taken from the videotape mentioned above.

Now the question is:  Is diagnosis by rectal challenge accepted as valid
anywhere in the United States?.  Is anyone doing it?  Is there anything
in the literature to support Dr.  Marsh's study?  Is diagnosis by rectal
challenge reliable for those who are gluten-free?

This sounds, to a non-medical person like me, like a safer, more
comfortable, surer means of diagnosis for everyone, but I'd like more
information.

Sue Goldstein
Westchester County, NY Celiac Support Group