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What is Celiac Disease?
Celiac disease occurs in individuals with a genetic predisposition for making antibodies to gluten. When gluten protein – found in wheat, barley and rye – is ingested, autoimmune antibodies not only attack the gluten, they also damage the lining of the small intestine. Symptoms may include digestive pain, constipation, diarrhea and fatigue. The resulting malabsortion of nutrients can lead to slowed growth and development in children and anemia, osteoporosis and fertility issues in adults. Untreated celiacs are also at an increased risk of developing digestive cancers and other autoimmune diseases. The only treatment is a strict gluten-free diet for life. The world-wide incidence of Celiac disease is estimated at 1 in 100. Of the number of people with Celiac disease in Canada, less than 5% will be properly diagnosed in their lifetimes despite the existence of a simple, prescreening blood test.
What is Non-Celiac Gluten Sensitivity?
Individuals with Non-Celiac Gluten Sensitivity (NCGS) experience digestive symptoms that are similar to those experienced by individuals with Celiac disease. Like celiacs, their symptoms improve when gluten is eliminated from their diet. Unlike celiacs, their bodies do not create antibodies to gluten, nor do they exhibit the damage to the small intestine that is the hallmark of Celiac disease. People with NCGS are at no greater risk of developing additional autoimmune conditions or digestive cancers. At the moment, there are no tests that can prove whether one has NCGS. A diagnosis of NCGS can be made when tests for Celiac disease are negative. It is estimated NCGS affects 6-10% of the population.
Is there a test for Celiac disease?
Yes! There are two pre-screening blood tests that can determine whether your body makes the antibodies that are associated with Celiac disease:
- tTg: IgA anti-transglutaminase antibody test
- Total Serum IgA
While these blood tests are very sensitive, they are not 100% accurate. If the tTg test is positive or the IgA test shows a deficiency, a duodenal biopsy is required to make a diagnosis. Collected under mild sedation, evidence of damage to the lining of the small intestine is definitive proof of Celiac disease.
*Blood tests and intestinal biopsies are diagnostic services that are provided at no charge to residents of British Columbia. See Medical Services Plan.
Ask to be tested if you have unexplained iron deficiency, osteoporosis, brittle type 1 DM, a family history of Celiac disease, have experienced 3 months of frequent diarrhea, weight loss, dairy intolerance or exceptional gas and bloating.
Can I view my test results online?
Yes! My e-health offers a fast and secure method for patients to receive their results electronically. As soon as results are released from the performing lab, they’re available online in my ehealth. A variety of secure technologies and procedures to help protect your information from unauthorized access, use or disclosure. My ehealth is a free service available to residents of British Columbia registered with the Medical Services Plan and is available in 4 languages.
Why can’t I just go gluten free?
Knowing whether or not you have a chronic autoimmune disorder is important to your future health and the health of your family. There may be a price for choosing not to know.
• Screening for Celiac disease is free in British Columbia
• Blood samples can be collected at your local out patient laboratory
• A diagnosis will tell you how strict your diet needs to be
• In conjunction with a lifelong commitment to the diet, health complications may be reduced
• Your doctor can better monitor your health for other autoimmune disorders
• Celiac disease is genetic. A diagnosis confirms for your family that they may also be at risk
• Familial screening provides an early diagnosis for those with latent (asymptomatic) Celiac disease
• A diagnosis offers eligibility for future therapies that require a definitive diagnosis
• You may qualify for a Medical Expense Tax Credit
• If Celiac disease is ruled out, your doctor can proceed to test you for other disease(s)
• You can save money on gluten-free food if celiac disease is ruled out!
Can I be diagnosed if I’ve already gone gluten free?
It is essential that prescreening blood tests and the biopsy be performed while a person is consuming gluten in order to measure the antibodies associated with the disease and observe associated damage to the small intestine. Test results may appear falsely negative if gluten has already been removed from the diet.
Adults should consume 10 grams of gluten (4 slices of bread or equivalent) for at least 1 month prior to testing. Children should consume 5 grams of gluten (2 slices of bread or equivalent).
It may take 2-3 months on a gluten challenge to turn the tTg and biopsy positive. Because it can be very uncomfortable to reintroduce gluten to one’s diet – the gluten challenge is truly a challenge – consult your medical care provider about being prescreened for CD BEFORE choosing to go gluten free.
What Is Dermatitis Herpetiformis?
Dermatitis Herpetiformis (DH) is an inherited autoimmune disease of the skin marked by groups of watery, itchy blisters. Like Celiac disease, ingesting gluten triggers an immune system response that deposits inflammatory lgA antibodies under the top layer of skin.
The lgA deposits result in eruptions similar to the beginning of a pimple. This painfully itchy rash may progress to red, raised patches of skin that develop into small, watery blisters. The itching and burning of the eruptions are severe and the urge to scratch them is intense. Eruptions commonly occur on pressure points – around the elbows, the front of the knees, the buttocks, back, shoulders, face, and scalp and typically occur on both sides of the body. Sixty percent of those diagnosed are men and the most common ages at diagnosis are between 15 and 40 years old.
A small biopsy of unaffected skin, next to an eruption that reveals the presence of IgA deposits confirms a diagnosis of DH. A strict gluten-free diet for life is the only treatment, but the diet should only be started once a diagnosis has been made. The medication Dapsone may be prescribed to ease symptoms until the gluten-free diet reduces the severity and frequency of eruptions.