Diagnosing celiac disease in those who don’t eat gluten, the challenge – WWN

Self-diagnose a gluten intolerance a frequent (bad) habit in our country, where it is estimated that approximately 12 percent of the population has eliminated gluten from their diet without having had a diagnosis of celiac disease from your doctor. In these cases, finding out if you really have celiac disease can become difficult, but a new marker However, it could help distinguish patients who are truly gluten intolerant from those who are not.

Correct diagnosis

The diagnosis of celiac disease is in fact possible with blood tests to be performed while on free feeding, because being on a gluten-free diet could distort the results. They must be dosed anti-transglutaminase antibodies (anti-tTG) of the IgA class together with Total IgA: 2-5 percent of celiacs have an IgA deficiency, so it is important to evaluate them in relation to their total dosage. In those who test positive for this marker, a test is carried out esophagogastroduodenoscopy with duodenal sampling, which is then observed under the microscope: in celiacs the intestinal villi necessary for the absorption of nutrients are flattened, atrophic and there is an infiltration of lymphocytes in the mucosa indicative of intense inflammation. Also in this case, a diet already purified from gluten complicates the evaluation of the test. For diagnostic confirmation, villous biopsy essential in adults; in children with classic symptoms and high levels of auto-antibodies, the diagnosis can be made without an endoscopic examination, which is invasive and more difficult in children.

A marker to understand

To still be able to reach the diagnosis in cases in which gluten intake has been suspended, a group of Spanish researchers has identified a genetic marker, UBE2L3whose expression measured in the blood appears to be indicative of celiac disease regardless of gluten consumption. The authors have patented the test, but it is not yet available in the clinic: for this reason it is important that in case of suspicion of celiac disease, an adequate diagnostic procedure is followed, indicated by the doctor. Even once the diagnosis has been made, however, It is important to continue monitoring patients for the possible appearance of associated autoimmune diseases (such as type 1 diabetes, thyroiditis, psoriasis, more frequent in celiacs) and metabolic alterations, but also to diagnose as early as possible any complications, including intestinal lymphoma or adenocarcinoma of the small intestine, which are extremely rare but must be recognized promptly. After diagnosis they must also be periodically evaluated bone mass and thyroid function.