Celiac Disease Biopsy Explained: Part I Villous Atrophy

 Flattening of the normal finger like projections called villi accompanied by signs of inflammation is taken to indicate damage or injury from the storage protein gluten in wheat and similar proteins in barley and rye.
 Before 1960 gluten withdrawal followed by improvement and subsequent worsening upon rechallenge was the diagnostic criteria.
 This was used to suction up tissue into the capsule before guillotining off some tissue once the capsule was confirmed to be in the small intestine by x-ray.
Celiac disease biopsy: What does the pathologist look for under the microscope?
The small intestine normally has finger like projections called villi that give it a large surface area or contact area for absorption.
  Lining the outside surface of each villous are intestinal cells or enterocytes that secrete mucus and absorb fluids, nutrients, minerals like iron, and vitamins like B12.
  At the base of the villi are crypts or circular like collections of intestinal cells.
 However, intestinal injury can result in blunting, shortening (partial villous atrophy) or complete loss of the villi and flattening (villous atrophy) of the intestinal surface.
 The result is lack of absorption of nutrients and water resulting in weight loss, malnutrition, and diarrhea.
 However, an increased number of IEL's (intra-epitheliel lymphocytes) in the setting of a positive specific blood test for celiac, symptoms and especially if supported by presence of DQ2 and/or DQ8 gene pattern, is highly suggestive of celiac disease.
 Also, some people with milder forms of celiac have no blood tests abnormal but have classic biopsy findings of celiac and are termed seronegative (blood test negative) celiacs.
 However, recent studies have shown that the biopsy can be normal in some people with celiac.
  However, more importantly is the recent recognition that normal appearing biopsies may not be normal.
 Special stains, that include immune labeling of lymphocytes, have also confirmed increased numbers of certain types of specific lymphocytes in the villi of intestinal biopsies of people confirmed to have celiac.
Celiac diasease biopsy: What are other possible causes of biopsy changes that mimic celiac disease?
Cow's milk protein sensitive enteropathy (CMSE), viral or bacterial infections, medications (especially aspirin like arthritis medications e.
 ibuprofen etc), autoimmune enteropathy, Helicobacter pylori infection (the stomach ulcer bacteria), AIDs, common variable immunodeficiency, and lymphoma of the intestine are all possible causes of small intestine changes that may mimic celiac.
 The likelihood is further increased if you carry one or both of the two major genes associated with celiac disease, DQ2 and/or DQ8.


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Gluten Free Diet - So What Is Celiac Disease

Grains are good for you, right?NOT if you have a gluten sensitivity!
In the US alone.  "Now the research indicates that celiac disease is as common in the United States as it is in Europe and is also found in Africa, Middle East, Asia, New Zealand, and Australia.
ifoundhealth.
 Over the past 50 years, there has been large growth in the number of autoimmune suferrers, and even a fast increase in the number of autoimmune disorders.
 Recent reports say that the list of disorders has grown to over 80 known autoimmune disorders.
What exactly is Celiac Disease?
is a digestive disease that causes damage to the small intestine and inhibits the absorption of nutrients.
 It is a real hassle.
 When your own cells fail to recognize neighbor cells as "self", this is not normal.
 This is not good!
Celiac Disease Culprit?
Research says that the actual cause is still unknown.
 These genes (HLA class II antigens) are involved in the regulation of the body's immune response to the gluten protein fractions.
 With Celiac disease, there is a certain protein known as "gluten" that has been shown to be the trigger.
 When the gluten is broken down inside the intestine, gluten peptides that bind to HLA-DQ8 or HLA-DQ2 trigger an inflammatory T cell response.
 Although celiac disease was first described as early as 50 AD by Aretaeus, it wasn't until 1950, that Dickey identified grains, wheat in particular, as the toxic factor.
 What is so bad about that? Well, without these villi hairs in the intestine, you cannot absorb nutrients from your diet.
Classical  celiac disease includes those symptoms commonly associated with the      disease in the past, diarrhea, bloating, abdominal pain, and weight loss.
 Silent      celiac disease includes those individuals who are asymptomatic yet have      both positive serology and biopsy.
Glyconutrients and Celiac Disease
According to the medical industry, there is no treatment to control or manage this disorder, aside from just staying completely away from all gluten proteins.
" (Lee, Anne)
But recently, there have been a number of people who have reported great results from glyconutrients products.
This is how I heard about this.
  Foods, cheap vitamins, medications, and even things such as postal stamp adhesive, can have gluten in them.
 In the Columbia University "Celiac Disease Center", they have even studied the social and emotional impact that the strict gluten-free diet can have on people.
 If this seems like too much of a hassle for you, and you would like to know how glyconutritionals can help you, then feel free to contact me to learn more about the research and studies behind glyconutrition.
 Some companies use a wheat type of binder, to bind the product together, or as an extender, or in order to assist the cells in assimilating (absorbing) the glyconutrients, but you will want to use a product that is a gluten free glyconutritional, in order to be completely safe.


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Diagnosing Celiac Disease and Gluten Sensitivity

 It is an autoimmune disease of intestinal damage due to gluten in people who are genetically predisposed.
Several blood tests exist for Celiac disease.
 Some are more sensitive, meaning they will be positive in milder forms of the disease but are not specific, meaning a positive test may not indicate Celiac disease.
The most specific tests are tests for Celiac disease endomysial antibodies (EMA) and

tissue transglutaminase antibody (tTG) tests.
 When either EMA or tTG are positive  Celiac disease is very likely and usually the intestine biopsy is positive.
 Seronegative Celiac, meaning the blood tests are negative but the biopsy is positive, may occur in up to 20% of Celiacs.
  Newer assays for AGA antibodies for gluten that has undergone a chemical change

called deamidation appear to be more specific for Celiac disease (Gliadin II,

Inova) than the older gliadin tests.
The most distressing problem for people with lesser forms of gluten intolerance who have blood tests and/or biopsies that are normal or borderline yet respond to a gluten free diet is either not being taken seriously or knowing for sure if they are sensitive to gluten.
  Such stool testing has been performed in research labs and published in a few studies but are only recently available through the commercial lab, Enterolab.
 Dr.
  However, his unpublished data and the clinical experience of some of us who have used his test have

indicated the tests are very sensitive for signs of gluten sensitivity.
  In the presence of symptoms, that reverse on a gluten-free diet,

abnormal stool antibody levels can be found in most people before blood tests or biopsies become

abnormal.


However, recent studies have demonstrated that some people with gluten sensitivity, especially relatives of Celiacs

with little or no symptoms, have changes from gluten injury to the intestine that can not be seen with normal microscope examination.
 The special stains are known as immunohistochemistry stains.
 When these lymphocytes are increased it is known as intraepithelial lymphocytosis or increased IELs and it is the earliest sign

of gluten induced injury or irritation.
  When people who have these changes are

offered the option of a gluten-free diet they usually responded favorably.


What these studies suggest is that a "normal small intestine biopsy" may exclude

Celiac disease as defined by strict criteria but it is not a gold standard for detecting gluten sensitivity.


Another source of confusion is in the genetics of Celiac and gluten sensitivity.
 Some use the absence of these two patterns

as a way of excluding the possibility of Celiac disease and the need for testing or

gluten-free diet.
 Moreover, recent studies indicate other DQ

patterns may be associated with gluten sensitivity though unlikely to

predispose to classic Celiac disease.
 Fine, based on his

experience with stool antibody test results.


According to his unpublished data, all the DQ types except DQ4 are associated with

a risk of intolerance to gluten.


Enterolab's stool testing for gliadin antibodies and tissue

transglutaminase antibodies, though not widely accepted, have gained favor in the lay

public's opinion as an option for determining sensitivity to gluten either despite negative blood tests and/or biopsies or in place of the more invasive tests.
 Though the reports in the lay community

are overwhelmingly positive they have not been subjected to peer review in

the medical community pending Dr.


However, doctors open to

the broader problem of gluten

sensitivity are reporting these tests helpful in many patients suspected of gluten

intolerance.
  The national Celiac organizations are uncertain about how to

comment on their application without published research though a recent article

in the British Medical Journal did show stool tests highly specific for Celiac.


Fine has publicly commented that his unpublished data demonstrates those with

abnormal stool tests indicating gluten sensitivity

overwhelmingly respond favorably to a gluten free diet with improvement of

symptoms and general quality of life.
 This becomes especially difficult for those who do not meet strict criteria for Celiac disease yet may have abnormal tests and/or symptoms that respond to a gluten-free diet.
 Consensus in the medical community on definitions and more research in this area is greatly needed.
 Doctors either unfamiliar with the limitations of the tests as documented by Celiac research or who insist on the

strict criteria for Celiac being the only indication for recommending a gluten free

diet unfortunately may confuse or frustrate gluten sensitive individuals.
 Many have their diagnosis missed, challenged, dismissed, or are misinformed.
 In the meantime, Celiac disease and gluten sensitivity continue to be undiagnosed or misdiagnosed.
thefooddoc.


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A Celiac Disease Diet - The Only Way to Fight Celiac Disease

 Their bodies cannot tolerate gluten and never will. Understand this about celiac disease treatment: what is food to one is poison to another.  Food products that contain gluten are made from wheat, rye, and barley and traces of them.
Other than this, celiac food consists of much of what everyone else eats.  Many foods are naturally gluten-free. Celiac food includes:
fresh meat, chicken, fish
 eggs
 cheese
 milk, cream, butter
 all fresh fruit, salads, vegetables
 potatoes
 rice and maize
 nuts and seeds
 jam
 marmalade
 honey
 some brands of chocolate
 some brands of ice cream
 sugar
 sunflower oil and olive oil

Please note the emphasis on the word fresh.
 Processed foods like pre-prepared meals, cereal, frozen french fried potatoes, snacks, and sauces such as mayonnaise, mustard,and soy sauce often contain gluten.
 The celiac suffer needs to learn how to carefully read the labels on processed foods because glutenous traces are often found in them.
It is best to get professional advice from a dietician or nutrition specialist to compile a list of all foods and products that must be avoided.
 Fortunately, there are products today which are gluten free.
 The big exception is beer.
 There may be a gluten free beer on the market now.
 Although straight Bourbon is made from corn and wheat, rye or barley, the gluten in these grains is removed by the process of distillation.
 And, the labels on liqueurs and pre-mixed drinks should be examined carefully for glutenous ingredients.
A celiac disease diet need not be boring
Some people may think that cooking food for people on a celiac disease diet is boring and routine.
 People on a celiac disease diet still eat many of the foods they ate before they were diagnosed, but they replace some ingredients with gluten content with ingredients that are gluten free.
 Today it is easier, since there are manufacturers who sell gluten free bread, pasta and other food.
Lastly, there are celiac disease support groups in every state in the USA.
A boring celiac disease diet is down to a boring and perhaps lazy cook.


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