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From:
Marilyn McCool <[log in to unmask]>
Date:
Sun, 15 Sep 1996 09:44:08 -0400
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<<Disclaimer: Verify this information before applying it to your situation.>>

>My question is this.  If you take a ratio of 1:250 for celiacs to
>non-celiacs in the United States, and if you use the figures for
>specificity and sensitivity from the tables in the digests cited above, I
>don't understand how the predictive value for testing positive on all
>three serological blood tests is so high.

I am not a medical doctor but have read a lot about celiac disease.  My
understanding of the EmA testing is that  for those individuals who test
positive to it, an immune process is occurring that is causing attack on
smooth muscle and that ingestion of gluten in those susceptible individuals
has been identified as what is involved in initiating this attack.

A false positive test is claimed when subsequent biopsy reveals that there
is no intestinal enteropathy.  This "gold standard" of diagnosis does not
take into account that the biopsy may have missed the damaged tissue (i.e.
that the biopsy could have been false negative) or that this patient runs a
very high risk of developing intestinal enteropathy at a later date.  It
does also not take into account that this positive reading may be a signal
of attack on smooth muscle  in some other tissue or organ of the body.

There are some European countries where intestinal biopsy is not longer
considered the gold standard of diagnosis.  It's possible  that our
definition and criteria for the diagnosis of celiac disease needs to be
overhauled also.

BTW, welcome to the list Melissa.  I'm sure you and your daughter will enjoy
it.

Marilyn

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