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Here are 2 newly listed articles. It appears that serological CD testing
is not very useful in evaluating recovery from intestinal damage after
starting a GF-diet. The second article gives a good overview of CD.
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J Clin Gastroenterol. 2003 Nov-Dec;37(5):387-91
Lack of usefulness of anti-transglutaminase antibodies in assessing
histologic recovery after gluten-free diet in celiac disease.
Tursi A, Brandimarte G, Giorgetti GM.
SUMMARY: Gluten-free diet (GFD) plays a key role in the treatment of celiac
disease (CD), but it is difficult to evaluate the effect of GFD on the
improvement of villous architecture using sensitive, non-invasive tests.
Aim of this study is to evaluate anti-transglutaminase (tTG) antibodies in
the follow-up of CD to detect histologic recovery. We studied 42
consecutive patients with CD. In all the patients anti-tTG antibodies
(evaluated by the enzyme linked immunosorbent assay method) and EGDscopy
with multiple bioptic samples before GFD and then 6, 12, and 18 months
after GFD were evaluated. For comparison, a sorbitol H2-breath test (H2-BT)
and anti-endomysium (EMA) antibodies test were carried out concomitantly.
Anti-tTG results were positive in 36 of 42 patients before GFD (80.95%),
while they were positive in 11 of 34 (32.35%), 1 of 17 (5.88%), and 0 of 6
(0%) of patients with a persistence in histologic lesions 6, 12, and 18
months of GFD respectively, without any correlation with persistence of
histologic lesions (P = NS). Also EMA failed to show correlation with
improvement of histologic lesions. They were positive in 31 of 42 patients
before GFD (73.80%), while they were positive in 18 of 34 (52.94%), 3 of 17
(17.64%), and 0 of 6 (0%) cases 6, 12, and 18 months of GFD respectively (P
= NS). Regarding sorbitol H2-BT, it was positive in 40 of 42 (95.24%)
patients before GFD, while it was positive in 31 of 34 (91.17%), 13 of 17
(76.47%), and 4 of 6 (50%) of patients with a persistence in histologic
lesions 6, 12, and then 18 months after GFD starting (see Fig. 2, infra).
So, anti-tTG and EMA were ineffective in assessing the histologic recovery
at each follow-up visit (P = NS), while sorbitol H2-BT seems more effective
than anti-tTG and EMA in this field (P < 0.0001 sorbitol H2-BT versus anti-
tTG and versus EMA at 18 months after gluten withdrawal). Thirty-eight of
42 (90.47%) patients adhered to a strict GFD. Four patients were found to
have occasional dietary transgression, and in all we noted a progressive
decreasing of anti-tTG after 6 months of GFD and negative anti-tTG after 12
months of GFD, but sorbitol H2-BT persisted being positive during the
entire follow-up. Intestinal damage persisted during the follow-up, despite
anti-tTG and EMA negativity, and worsened in the presence of dietary
lapses. Anti-tTG does not seem effective to assess histologic recovery in
the follow-up of celiac patients after they have started GFD due to its
poor correlation with histologic damage.
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article free by registering at the following website:
http://gastro.theclinics.com/
Gastroenterol Clin North Am. 2003 Sep;32(3):931-47
Advances in celiac disease.
Shamir R.
Division of Pediatric Gastroenterology and Nutrition, Meyer Children's
Hospital of Haifa, Bruce Rappaport Faculty of Medicine, Technion-Israel
Institute of Technology, Rambam Medical Center, POB 9602, Haifa 31096,
Israel. [log in to unmask]
In recent years, it has become evident that CD is much more common than
previously appreciated, with a prevalence of 0.5% to 1% in Western,
Arabian, and Indian populations. The disease may be present without
symptoms (silent CD) or may present with extraintestinal manifestations
only. Increasing awareness of the many faces of CD will increase diagnosis
rate. CD patients have a cure for their disease, named the gluten-free
diet, but this curative measure is very hard to adhere to. With the new
insights into the pathogenesis of CD, clinicians enter an era where new
treatment modalities for CD may turn into reality.
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