Research Advances May Help Prevent And Improve Diagnosis Of Celiac Disease

ScienceDaily (May 21, 2008) — For those suffering from celiac disease, there may be good news on the horizon. New research presented at Digestive Disease Week® 2008 (DDW®) will discuss the latest advancements in the diagnosis and prevention of celiac sprue.

"At this time, the only effective treatment for celiac disease is a lifelong gluten-free diet, a lifestyle that is difficult for many patients to manage," said Peter H. Green, MD, Columbia University Medical School. "Unfortunately, many people are unaware that they have celiac disease, and if left untreated, it can be life threatening. The studies presented today will hopefully lead to improved diagnosis, prevention, treatment and quality of life for this disease."

Celiac disease is an autoimmune disorder in the small intestine triggered by the consumption of a common protein called gluten - found in bread, pasta and many other common foods. Though the disease is genetic, it often goes undiagnosed. It is estimated that one in every 100 Americans may be affected by celiac disease.

A new therapy may protect patients with celiac disease from exposure to gluten, according to findings from the first double-blind study ever conducted on celiac disease.

Celiac sprue is a digestive disease that damages the small intestine and disrupts the absorption of nutrients from food. People who have this disease are unable to tolerate gluten, which is found in wheat, rye and barley. Gluten is found mainly in foods but may also be found in common products such as medicines and vitamins. Symptoms of gluten toxicity include diarrhea, weight loss, abdominal pain, anemia and oral ulcerations.

While most people with celiac disease do well on a gluten-free diet, the level of gluten avoidance needed to maintain disease remission represents a significant burden. Further, inadvertent gluten exposure is the leading cause of persistent symptoms in adults with celiac disease. For these reasons, investigators set out to evaluate the safety and efficacy of AT-1001, a medication that may prevent gluten from crossing the intestinal mucosa by reversing barrier dysfunction. The primary outcome was to examine the effect of treatment on intestinal permeability. This involves examining how well the intestine functions by measuring differential absorption of a combination of sugars.

Eighty-six patients with celiac disease were treated with AT-1001 as part of three different groups: gluten-challenged but received placebo AT-1001; no gluten as well as either active or placebo AT-1001; gluten and one of four doses of active AT-1001.

After the first seven days of treatment, patients in all groups improved their intestinal permeability, which was an unexpected outcome, possibly reflecting patients' stricter adherence to a gluten-free diet. At the end of the 21-day study period, participants receiving active AT-1001 were found to have decreased intestinal permeability and less symptoms of gluten toxicity compared to the group receiving gluten and placebo AT-1001.

Still, Daniel Leffler, MD, clinical research director at the Celiac Disease Center at Beth Israel Deaconess Medical Center in Boston, said that while the subjects did improve, the primary study outcome was not met. But he added that the findings are promising enough that investigators are currently conducting a larger trial over a longer time period.

"Even allowing for the fact that people in clinical trials may practice healthier habits, the fact that all of the groups showed improvement in the first week of the study is significant and helps us to plan better celiac studies," said Dr. Leffler. "This work offers great promise for patients who, in the near future, may have a treatment that improves upon dietary restriction alone."

Criteria For Diagnosing Celiac Disease May Be Too Stringent and in Need of Revision

Current diagnostic criteria for celiac disease include small intestinal mucosal membrane villus atrophy and inflammation. But according to new research, these criteria may be too stringent, leaving patients with the disease undiagnosed and untreated.

Researchers studied 145 patients suspected of having celiac disease to determine if the current diagnostic criteria are too narrow. Seventy-one of the patients were found to be endomysial antibody positive, and of those only 48 met the criteria under the current definition of celiac disease. The remaining 23 patients were divided randomly into two groups. One group was placed on a gluten-free diet and the other continued a regular diet that included gluten.

Patients were biopsied again after one year following their respective diets. Investigators found that the patients on the gluten-free diet were asymptomatic, and that their endomysial antibodies disappeared as did their small intestinal mucosal inflammation. However, the patients on a regular diet continued to experience symptoms. These patients continued to be endomysial antibody positive, and showed further deterioration of the small bowel membrane, mucosal inflammation and gluten-induced lesions in the bowel.

According to Markku Maki, MD, professor of pediatrics at the University of Tampere, Celiac Disease Study Group, Tampere, Finland, patients on the gluten-free diet elected to continue the diet after the yearlong study, and the patients on the regular diet elected to eliminate gluten from their diet and over time became symptom free, endomysial antibody-free and experienced healing of the mucosal membrane.

Researchers believe that over time, patients who are endomysial antibody positive may develop the gut injury that makes up the current criteria for diagnosing celiac disease. "By redefining the criteria for celiac disease, we can treat patients before they begin to experience the most severe symptoms and signs of the disease," said Dr. Maki.

Treatment options for celiac disease have not changed in decades. They remain limited to asking patients to adhere to a life-long gluten-free diet, which is difficult to maintain and can adversely effect quality of life. Humans cannot fully digest gluten; instead, the gluten in food is only partially broken down. In celiacs these remaining gluten fragments are toxic to the intestine, causing intestinal inflammation and damage that can result in the various symptoms of the disease (malabsorption, diarrhea, weight loss and anemia). Many patients however are only mildly affected and may have few if any symptoms

With the hope of broadening treatment options for those with celiac disease, researchers sought to determine if certain natural enzymes given to celiac patients could help fully break down gluten fragments, making the gluten they ingest non-toxic. They tested the combination of two enzymes derived from micro-organisms -- prolyl-endopeptidase (PEP) and barley (EP-B2) -- to see if gluten that is treated with these enzymes, when given to celiac patients, would avoid the usual toxic effects of gluten.

Investigators performed a double blind cross-over study of 20 celiac patients who had biopsy-proven disease and had recovered from the disease on a gluten free diet. Each patient was randomized to ingest either five grams of gluten or five grams of gluten pre-treated with the enzyme treatment, daily for two weeks. Then, after participating in a wash-out period of six weeks following the conclusion of the two week treatment, patients then switched to consume the alternative gluten preparation. Each patient's gluten processing was tested via fecal fat analysis. Patients were also asked to report and record the symptoms they experienced during each phase of the trial.

Researchers found that half of the patients increased their fecal fat excretion in response to the ingestion of untreated gluten. In contrast the enzyme pre-treated gluten did not increase the fecal fat output in these patients, supporting the possibility that a combination of the two enzymes could be a potential future treatment that would allow celiac patients to eat a normal diet.

"Our evidence supports the concept that these enzymes can break down gluten and by so doing "detoxify" it said Peter Watson, MD FRCP, Belfast Hospitals Trust, Belfast, United Kingdom. "A treatment of this kind would finally allow those with celiac disease to enjoy social occasions and not worry when they are in situations where they cannot control the preparation of food."

The study was limited by the fact that not all patients are sensitive to five grams of gluten per day; however the researchers only wanted to ask patients to ingest amounts that would show measurable results. Higher levels of gluten would likely cause patients in the trial to suffer from more severe symptoms.

Adapted from materials provided by American Gastroenterological Association, via EurekAlert!, a service of AAAS.

Celiac disease is related to vitamin D deficiency and a misregulated auto-immune response. Calcium, Vitamin D, and a gluten free diet have been produced significant beneficial results.

a dystonia group states that a gluten free diet is best for those with dystonia.....it also helps those with arthritis....so finding something to counter act gluten is a miracle...because trying to eliminate bread, cereal, pasta and all flour products is an immense undertaking...

I was diagnosed a few months ago. It is not a bad thing.
For me, it has been a Godsend.
I feel tons better. I’ve lost weight (some Celiacs are overweight, which makes diagnosis more difficult because doctors look for it in the underweight, typically.
I eat foods I would have likely never tried.
All of the symptoms I previously had are gone, after years of sometimes severe pain.
Good luck and good health to your brother. And consider the possibility that others in your family may have it. There is possibly an increased chance that they do.

"because trying to eliminate bread, cereal, pasta and all flour products is an immense undertaking..."

While it is very true that avoiding the products that you listed is maybe not easy in today's supermarkets, some people think it might just be a good idea to try to avoid those products that come from agriculture that didn't exist before 10,000 years ago. It's called a Paleolithic Diet, and it prefers mainly meat, fish, vegetables, fruit, roots and nuts, and eliminates grains, legumes, dairy products, salt and refined sugar.

I confess that I do not use this diet myself, yet, but it does seem to make some sense nutritionally. It's basically saying that humans evolved for hundreds of thousands of years on this diet, and this is what we should be eating, not the stuff that we learned to grow "recently". Sounds right to me.

"because trying to eliminate bread, cereal, pasta and all flour products is an immense undertaking..."

Sorry about the double post. I would like to state also that the website “Sciencedaily.com” is one of the best sources of medical and nutritional info that I have seen, plus many other areas of science. (They like global warming).

Mu husband suffered from Celiac Sprue the last four years of his life. It is much easier to eliminate gluten, wheat and other grains than you ming think.

There is a ton of products available, and almost all packaged foods are clearly marked.

When diagnosed, he was at the point of death, and like the article said about a week into treatment was a new person.

I watched his diet like a hawk, but then he died from a short bout with cancer.

Yes, the famous double-blind study. The researchers attempt to slip gluten in on the celiac patients to see if they notice.

30 minutes into the test the patients detect that they've been deceived.

So, no, it's not a double-blind study ~ at least not in its purest form!

You simply cannot give these guys gluten AND a placebo! They'll know.

BTW, they've now got the number of allele variations up to 8 ~ count'em ~ EIGHT!!!.

There's only one that gives you the kind of response you need to make a definitive statement using only blood samples.

Thanks or this.

I have a friend who has started eating gluten-free. Her tests for celiac disease were borderline, so the doc said she most likely didn’t have it. She started the diet anyway and is a million times better. Nearly all her allergies have disappeared, her health is better overall, even her skin looks amazing. Needless to say, she ignores what the doc says and believes she has it.

It's really not that bad. My kids and I have it. We do have to really limit eating out, but it wasn't as difficult to adjust as I though it would be.

Last night we had meatloaf made with instant mashed potatoes in the recipe instead of bread crumbs. Tonight we're having steak, potatoes and salad with strawberries and homemade whipped cream.

More and more stores are starting to stock GF products. (I *love* eating spaghetti again!) We can easily find GF cornbread, cake mix and cookie mix now.

Life is good, but not as low carb as it should be.

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