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1999 CSA Conference Report
--------------------------
by Janet Armil and Carolyn and Tom Sullivan
The 22nd Annual CSA Conference was held in Atlanta, Georgia, on
October 1-3, 1999. In general, it was a slower-paced gathering in an
atmosphere of pleasant civility and helpfulness. As can be said for
any gathering or conference, things happen. Yes, speakers were absent
or late because of traffic accidents or other impediments; and yes,
breakfast was not prepared or served where it should have been. But
at no time were the staff anything but smiling, polite to a fault, and
pitching in from all over to help make the conference a success.
In addition, Saturday's lunch included a mini-travelogue through the
far east with Mr. Jeffrey Alford from Toronto, Canada. Mr. Alford
is the author of The World of Rice and Flat Breads. He and his wife,
Naomi Dagurd, also co-authored two cookbooks that could belong in any
celiac's kitchen library--Flat Breads and Flavors: A Bakers Atlas,
William Morrow & Co., New York, 1995; and Seductions of Rice, C.
Artisan, New York, 1998.
Combine beautiful weather with excellent food, serve both in copious
quantities, and you have, all in all, a busy and enjoyable week-end.
Reflections from a Newcomer, Janet Armil, celiac and TCCSSG member
---------------------------
I've been to many professional conferences as a teacher and
psychologist, but this is the first time I've attended a conference
for personal reasons. Those reasons weren't even lofty; I went for
the food and the getaway, and if I learned something, it would be a
bonus. (Hey, what can I say? I needed a vacation.). Not only did
the conference meet my expectations for food and escape, I really did
learn something, and I had a good time. The good time came from
communing with hundreds of other gluten-free people (I felt so
normal!) and hearing from a myriad of professionals who are dedicated
to the diagnosis and understanding of celiac disease. I felt happy
and hopeful.
What follows are highlights from several of the talks.
Update on Current Diagnostic Dilemmas: Celiac Disease, Matthew S. Z.
------------------------------------------------------ Bachinski,
M.D., Gastroenterologist, Department of Medicine, Section of
Gastroenterology, Medical College of Georgia, Augusta, GA
The following individuals should ALWAYS be screened for CD because
they are considered AT RISK for the disease:
* First degree relatives of celiac patients (8-10% will have CD
also). These include parents, children, and siblings.
* Anyone with autoimmune endocrinopathy.
* Anyone with IgA deficiency.
* Anyone with IDDM (Type 1 diabetes). (Many diabetics have chronic
diarrhea often labeled as "diabetic diarrhea". Diagnosis of CD
and adherence to a GF diet decreases the risk of cancer and helps
manage the patient's diabetes).
* Anyone with CTD (Connective Tissue Disease).
* Anyone with Down's Syndrome.
The following individuals should consider screening for CD as a
possible diagnosis for their condition:
* Anyone of short stature (8-10% will have CD).
* Anyone with infertility problems. (in 2.7% of the cases, one of
the couple has CD.)
* Anyone with intractable seizures.
* Anyone with unexplained anemia (as shown by fecal occult blood).
* Anyone with abnormal liver tests.
* Anyone with osteoporosis and/or alopecia (baldness).
* Anyone with a lymphoma (an untreated CD patient has a 20-120 fold
increased risk).
The gold standard for CD diagnosis is the small bowel biopsy. The
sensitivity of any screening test is the percentage of times it is
positive in the presence of CD when compared to the gold standard.
The specificity of a screening test is the percentage of times a
positive (abnormal) result is predictive of the disease (in other
words, what percentage are "true" positives). In response to a
question, Dr. Bachinski stated that screening is not the gold
standard because of the missed positives (i.e., false negatives). The
lab screens the blood for anti-endomysial antibodies (EMA) and anti-
gliadin antibodies (IgA and IgG). The newer tissue transglutaminase
test (tTg) is a more reproducible screening test with a sensitivity of
98% and a specificity of 95%. It is now limited to special order
availability but Dr. Bachinski thinks it will become the new standard
for CD screening. [Ed. note: These tests are of use ONLY when the
patient is still consuming gluten. Going on a GF diet first makes the
tests essenti ally meaningless.] Dr. Bachinski stated further that
if anyone is referred to his clinic because of suspected CD, even if
the blood tests are all negative, he considers that a biopsy is still
required.
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