<<Disclaimer: Verify this information before applying it to your situation.>>

For those struggling for a formal diagnosis or with the confusion they or
their loved ones may or may not have celiac disease, research studies (see
references at bottom) have documented that not everyone has to demonstrate
the classic celiac lesion where the villi, the intestinal projections
involved in absorption, are atrophied or blunted.  If a person demonstrates
in even a mild lesion or demonstrated immune response as gluten-dependent
(where there is only an increase in a type of white blood cells called
lymphocytes or other inflammatory indicators) and they respond favorably to
a gluten-free diet both in terms of their symptoms and biopsy findings, such
findings can justify a gluten-free diet in the absence of absolute proof of
a classic lesion.  However, some doctors still gluten challenge their
patients to obtain this type of proof.

Studies have found that some gluten-sensitive patients with normal biopsies
have a case of latent or potential celiac disease.  Some of these patients
are antibody positive despite normal biopsies.  These patients have the
potential and some eventually develop the classic celiac lesion in what is
called latent celiac disease.  Studies show that some gluten-sensitive
patients without blood antibody positivity have just mild evidence of
intestinal damage, but not the diagnostic lesion, and are known as silent
(no symptoms with high risk factors, i.e., diabetics or first degree
relatives of celiacs)  or subclinical (extraintestinal symptoms alone )
celiacs.  More often than not, blood antibody tests do not detect these
kinds of patients.

Yes, there are alternative diagnostics than even the current blood antibody
tests and evaluation of patient biopsies but they are not used in clinical
practice.  Some of these diagnostic tests were utilized in the research
studies where other clinical diagnostic tests failed to detect patients with
gluten-sensitivity in what some of the studies described as other forms of
celiac disease.

I hope one day that even better diagnostics with the focus on early
detection are utilized whereby gluten challenges no longer contribute to the
further suffering of patients, either symptomatically or more insidiously in
people without symptoms.

References:

Tursi A, and Brandimarte G. 2003. The symptomatic and histologic response to
a gluten-free diet in patients with borderline enteropathy. J Clin
Gastroenterol 36:13-17.
Tursi A, et al 2001. Low prevalence of antigliadin and anti-endomysium
antibodies in subclinical/silent celiac disease. Am J Gastroenterol
96:1507-10.
Tursi A, et al. 2003. Prevalence of antitissue tranglutaminase antibodies in
different degrees of intestinal damage in celiac disease. J Clin
Gastroenterol 36:219-21.
Wahab P, et al. 2001. Gluten challenge in borderline gluten-sensitive
enteropathy. Am JGastroenterol 96:1464-69.
Picarelli A, et al 1996. Gluten-sensitive disease with mild enteropathy.
Gastroenterol 111:608-16.
Holmes G, 2001. Potential and latent coeliac disease. Eur J Gastroenterol
Hepatol 13:1057-60.
The histologic diagnosis of celiac disease in "nonflat" intestinal mucosa.
Am J Clin Pathol 116:7-9.

Laura Yick






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