Tuesday, April 17, 2012

Celiac Disease Diagnosed without a Biopsy

There has been much discussion about the validity of the intestinal biopsy as a necessary measure when diagnosing celiac disease. A recent report regarding nomenclature stated that one could still assume celiac disease with a positive blood test and a negative biopsy if the patient clearly improved on a gluten-free diet and worsened when gluten was reintroduced.

A recent study out of Italy tried to find a correlation between blood and biopsy testing such that some people could be spared the unnecessary cost and invasive biopsy procedure. They analyzed a large group of close to one thousand patients and found out that the more positive the blood test was (they used the classic tTG test) the more it correlated with a positive intestinal biopsy.

How positive? They concluded that if the result of the tTG test was 5-fold higher than the upper limits of normal, it correlated 100% with a positive biopsy. In other words if the normal limit went from 0 – 10 and a person’s result was 50, they could receive a clear-cut diagnosis of celiac disease, without the need of a biopsy to ‘confirm’ it. Of the group of 945 patients they analyzed, this resulted in a full 1/3 of them falling into this category. Over 300 patients would be spared the need of a biopsy, according to this study.

This portends significant ramifications. Not only for the healthcare costs involved, but avoiding an invasive test with potential side effects, is always a good thing. These researchers felt strongly that this particular group of people who fell within high tTG scores, be excused from an unneeded biopsy. They summarized their findings, which conflict with traditional diagnosis, with the following statement “diagnostic criteria of celiac disease in adults need revision.”

Do understand that we are only talking about classic celiac disease with its textbook small intestine damage. This would not be valid for the types of celiac disease that don’t create such damage nor for gluten sensitivity. The reason is that the tTG test measures intestinal damage. Non-classic celiac disease and gluten sensitivity don’t typically show such damage, at least not to a significant extent.

The takeaway is this: if someone is being tested for celiac disease and receives a positive test result back and it is very high – 5x the normal limit – they now have data to support that a follow-up biopsy is unnecessary and they can show their doctor this study.

Change comes slowly to most professions and the medical profession is no different. So don’t be surprised if your medical doctor or gastroenterologist has not heard this data. But I find that patients are much better educated and savvy about their health. I know that some doctors really dislike that but personally I love it. Your body IS after all, yours. If you educate yourself about it you have every right to share that knowledge with your doctor. If they resent it, you should likely find a new one.

I hope this was helpful. Please share it with anyone considering an intestinal biopsy, who falls within the above criteria. If your health is not at the level you desire and you want to receive a free health analysis, please give me a call at 408-733-0400.

Our destinationclinic treats patients from across the country and internationally. You don’t need to live locally to receive help.

To your good health,

Dr Vikki Petersen, DC, CCN
Co-author of “The Gluten Effect”
Author of the eBook: “Gluten Intolerance – What you don’t know may be killing you!”

Reference:
Zanini B, et al.” High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease”. Digestive & Liver Disease. 2012 Apr; 44(4):280-5. Epub 2011 Nov 25.

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