<<Disclaimer: Verify this information before applying it to your situation.>>
 
     I read with interest the Celiac ActionLine Fact sheet on Diagnosis of
celiac disease.  This described three biopsies: the first for diagnosis, the
second after a GF diet is followed, and the third in response to gluten
challenge.  The third is I know controversial because of subjecting oneself or a
loved one to something that is believed to be harmful.
      However the details of the third biopsy interested me because it there is
a new form of it and it may provide an alternative diagnosis for those already
on a gluten free diet but who are self diagnosed.
      The third biopsy new variation involved "a rectal dose of gluten rather
than an oral dose.  The rectal biopsy, far easier to obtain than a jejunal
biopsy, is then examined for the diagnosis.  The test was assessed in 11
patients thought to have celiac disease and 21 patients with other types of
bowel disorder.  Six hours after rectal challenge with gluten digest, a rectal
biopsy was obtained and examined for an increase in the number of lymphocytes
within the epithelia tissue.  An increase of 10 percent or more was taken as
indicative of celiac disease.  Among patients tested, the procedure produced one
false positive and one false negative. The results demonstrated that the rectal
challenge is effective: it is also more rapid that the traditional oral test. In
addition, the test is preferred by some patiets, who may refuse an oral test
that must be followed by a jejunal biopsy."
      It sounds like this test could be given to those on a gluten free diet who
have not had biopsies 1 and 2.  What are the thoughts from the professional
community?  How generally available might such a test be?
     I have also read about some work by Fais, S. et al, Gut 22, 472-475, where
cultured cells of patients with suspected celiac disease but are on a gluten
free diet are tested with gluten digests and enterocytes in these cells became
differentially expressed in the crypt cells of those with celiac but not others.
This sounds more difficult (more like research than an available test). This
might be an alternative for diagnosis.
     Sorry for so many posts all together, but this has interested me for a
while.
                              Martha Teeter