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               The Widening Spectrum of Celiac Disease
               ---------------------------------------
                      by Joseph Murray, MD, PhD
                       summarized by Jim Lyles
 
Dr. Joseph Murray, one of the leading US physicians in the diagnosis
of celiac disease (CD) and dermatitis herpetiformis (DH), spoke at our
October meeting.  Dr. Murray originally came from Ireland and got his
medical degree and a doctorate from the National University of Ireland
in Galway.  His residency was at the University of Dublin and he
completed his fellowship in gastroenterology at the University of Iowa
College of Medicine, where he has been since 1988.  What follows are
some highlights of Dr. Murray's talk.
 
Dr. Murray started off by endearing himself to the audience:  He
spoke of TCCSSG in glowing terms and compared our group favorably with
other active support organizations, both local and national.  Because
our newsletter appears on the internet, he wanted us to know that we
are helping not only our local members but also people thousands of
miles away.
 
 
The Standard Definition of CD
-----------------------------
 
Dr. Murray gave us the "standard" definition of CD:  "CD is a
permanent intolerance to gluten that results in damage to the
intestine and is reversible with avoidance of dietary gluten."  There
are some important parts in this definition:
 
  *  "permanent":  The effects of CD may change from time to time.
     You may be sicker at one phase of your life than at another.  For
     example, you may be sicker at age two, may seem to get better
     during the teenage years, may be sick again in your 20's (but
     with different symptoms), and then present with bone problems
     when you are in your 50's.  So there may be different phases, but
     it is a PERMANENT intolerance.  You do NOT outgrow it; you do not
     go through phases where you don't have it anymore.  (That used to
     be what was thought and TAUGHT in medical schools.)
 
  *  "damage to the intestine":  There is definitely intestinal
     damage; without it you cannot define CD.  For some people the
     damage is severe, for others it is not so severe.  It is the
     cases which are not so severe that can be difficult to diagnose.
     If the damage is mild then the person interpreting the biopsy
     might not even think of CD as being a possible cause of the
     damage.
 
  *  "reversible":  The damage should be reversible.  Dr. Murray says
     there are about 5% of people with what he believes is CD in whom
     at one point in their lives the damage becomes irreversible.  In
     these cases there is intestinal damage that does not completely
     recover.  It may partially heal, but not completely.  One can
     infer that they have the same condition as celiacs that do
     recover, based on their history.  There may be something
     different about that group of patients in their immune systems
     that makes them different, but that is an area that is still
     being actively researched.