<<Disclaimer: Verify this information before applying it to your situation.>> Dear listmates, I am one of those Celiacs - hard to diagnose but whom has had severe symptoms with three gluten challenges directed by my Gastroenterologist. Attending the diagnosis meeting with my Gastroenterologist was my husband who is a PhD immunologist. The doctor was excited that they could speak each others lingo and I could understand some of it since he is aware we've been doing a lot of medical research. However, I did need translation. As you may know, I was negative on the anti-endomysial, anti-gliadin, and transglutaminase blood tests as well as negative for "blunted villi" or any grade of villous atrophy on all 10 of 12 biopsies taken from the second part of my duodenum in an endoscopy performed in December 2001. In the Given capsule endoscopy (experimental pill w/ tiny camera) performed a month later, he discovered that the abnormalities (nodular mucosa, scalloping of the duodenal folds, flattening of the valvulae conniventes, etc.) had disappeared after I went on a gluten-free diet. He agreed with me that such abnormalities suggested the presence of villous atrophy and Celiac disease but they are not definitive for Celiac disease. However, my Gastroenterologist (a Univ. of California doctor with approx. 25 years experience) says that he will give me a diagnosis of "most likely gluten-sensitive enteropathy" as the cause of my malabsorption symptoms (weight loss, diarrhea, joint pain, fatigue and weakness, abdominal pain) which was further supported by fecal fat stool tests. He based his conclusive diagnosis on my symptomatic improvement on a gluten-free diet of almost eight weeks. He had also excluded all other causes he was testing for (i.e., giardia, parasites, occult blood, Chrohn's, etc.). He said the reason why I'm getting negative results is because I probably have "patchy" mucosal damage. FYI, I have two medical research papers corroborating that the blood tests can miss up to 20-25% of the cases with subtotal villous atrophy (less blunted villi) or even nonflat mucosa (or normal villous architecture), but have an increase in the no. of intraepithelial lymphocytes (IELs are the cells attacking your villi). The pathologists didn't count my IELs either. Also, my doctor said, "As you know, celiac disease has been traditionally diagnosed by jejunal biopsy. He then proposed that if I wanted the absolute diagnosis, he could have me take a fourth gluten challenge and he would specially order an enteroscope to take a bunch of biopsies of my jejunum. He added that the shortcoming of the December endoscopy was that he could only take biopsies of my duodenum since the endoscope was too large to reach the jejunum. I explained that I am satisfied with the diagnosis because my body couldn't hold up to another gluten challenge and after the 3rd gluten challenge, I was having heart problems and have since been diagnosed with "mitral valve regurgitation". No more Russian roulette for me. Other conclusions made by my Gastroenterologist based on the Given capsule results and December endoscopies were Gastritis (stomach inflammation) which looks like red stripes on the stomach lining and he noticed I have a problem which involves "slow stomach emptying". He said that the implication of slow stomach emptying is a future risk of Type 1 Diabetes Mellitus. As you listmates may know, the New England Journal of Medicine (Vol. 346, No. 3, 1/17/2002) cites Type 1 diabetes as a DEFINITE association to Celiac Disease. Diabetes Mellitus is a group of disorders with one common manifestation; Hyperglycemia. You can see an expanded picture of how Celiac Disease can play a role in creating other complications or manifestations. My Gastroenterologist explained that slow gastric (stomach) emptying results in the food sitting there in the stomach and fermenting which is a process by where the bacteria in the stomach are eating your nutrients, producing acids, alcohols, and gases, while leaving less nutrients available for me to absorb. I asked him why I am having trouble digesting fats and not gaining weight quickly; He said that I am still malabsorbing and he thinks that the slow gastric emptying plays a role in both those problems. No wonder the Gastritis is taking longer to resolve because it being irritated by the fermentation of the food. He advised that I eat small meals frequently and foods that are absolutely neutral Ph, non-acidic and non-alkaline with low fat such as broths for more easy absorption as well and to increase stomach transit time: (the following list is written by my husband) Moderate acids: acetic acid (vinegar, sour taste), peppers (hot spicy taste such as chilis and black and jalapeno) Weak acids: ascorbic acid (vitC) Alkaline: bitter taste foods (bell pepper, brussel sprouts, bittermelon) My doctor commented that everything in your gut has to run perfectly in order to absorb fats and fats slow the stomach transit time. To make me feel better, he said that he's tried the gluten-free baked stuff and thought it tasted pretty good. I told him that I mill my own flours and bake my own bread and it doesn't always taste as good as wheat but I'm glad that I can still have bread and am thankful for that. All those Celiacs still recovering with stomach or other residual problems - let's make a run to the wellness finish line! Also, I'm interested in hearing from anyone diagnosed with Diabetes, Hyperglycemia, or slow gastric emptying, and residual stomach ailments. What is working for you and how were you diagnosed? I've been reading that Diabetes has been found in people with latent Celiac Disease. P.S. Those trying to get a diagnosis, ask if IELs will be counted and if the jejunum can be biopsied in addition to the duodenum. Regards, Laura