Thursday, May 31, 2012

Why Was My Biopsy Negative, When I Know Gluten Makes Me Sick? AGA Guidelines Increases Celiac Diagnosis By Two!

Diagnosing celiac disease can be very difficult. One of the difficulties lies in the significant failure rate of small bowel biopsy ( the gold standard for diagnosing celiac disease). To improve this accuracy, of the American Gastroenterological Association Institute recommended in 2006 that at least 4 specimens be taken for examination. A recent study by Benjamin Lebwohl at the Columbia University Celiac Disease Center concludes that most physicians are not following the guidelines, but they should be.

Why? Because his team was able to show, by doing four or more specimens doubles the diagnosis of celiac disease. Hmmmmmm!

If you are going for a small bowel biopsy, ask if your doctor takes four specimens or more routinely. If you have had a biopsy, and a negative diagnosis maybe you should get a copy of your pathology report and see how many specimens were taken.

Here Diana Gitig Ph.D reports:
Dr. Lebwohl and colleagues collated the specimens sent to Caris Life Sciences, a specialized GI pathology laboratory that receives samples from endoscopy centers in forty-three states plus the District of Columbia and Puerto Rico. They looked at 132, 352 patients who had endoscopies for various indications between January 1, 2006 and December 31, 2009. From these endoscopies, only 35% followed the recommendation of submitting at least four specimens. There was a slight increase once the guidelines were proposed, in 2006; but by the end of 2009 adherence to the guidelines was still a low 37%. Interestingly, the number of specimens submitted could be directly correlated with the probability of a positive diagnosis of celiac disease.

Adherence varied by indication, with the highest rates (43.9%) among patients undergoing endoscopies for diarrhea and the lowest rates (30.0%) among those having endoscopies because of heartburn. Among patients having endoscopies for malabsorption or suspected celiac disease adherence was only 38.5%. Adherence to the guidelines also decreased with the age of the patient. The researchers did not have access to socioeconomic or racial data regarding the patients, so could not determine if that factored into adhering to the guidelines.

The proportion of patients diagnosed with celiac doubled when at least four biopsy specimens were submitted. This increase varied by indication; it was most apparent in those undergoing endoscopy because of malabsorption and suspected celiac disease, but was present for the other indications as well. This study validates those recommendations; hopefully the slight increase in adherence since they have been proposed will continue to grow.

Read Diana Gitig Ph.D.'s report at 06/15/2011

Tuesday, May 22, 2012

Mucous Producing Cells Provide Intestinal Immunity

Goblet cells that line the intestine and secrete mucous are emerging as part of a tag team to protect us from harmful bacteria, viruses and large undigested food particles that can trigger food allergies. And they allow for vitamins and other nutrients to pass to the circulatory system.

A recent report from a research team at Washington University School of medicine in St. Louis shows that goblet cells work with dendritic cells.

Dr. Miller says the results are important because they help scientists understand that intestinal immune responses may depend as much on the ability of goblet cells to transport antigens to dendritic cells as much as on what the dendritic cells then do with those antigens. 

Vitamin A and D are important in maintaining healthy mucosal lining, and it is imperative to have ones vitamin A and D blood levels done to make sure the blood level is above 120 (Canadian) and 48 (USA) . You can only tell if you have absorbed the vitamin D that you have taken (or the effects of sun tanning) with a blood level. There are many ways that the absorption of vitamin D and A can go wrong.

The more we know about the workings of our intestinal system the more we can understand how to stop abnormal reactions to normal, not disease producing proteins that may be found in the bowel, like gluten or casein. 

Jefferson Adams writes more about this in Goblet Cells Emerge asUnexpected Player in Intestinal Immunity 05/16/2012 - Goblet cells that line the intestine and secrete mucous are emerging as a possible target for treating inflammatory bowel disease, celiac disease and food allergies. With every meal, immune cells in the intestine stand guard against harmful bacteria but permit vitamins and nutrients to pass. The small intestine is protected from harmful pathogens by a layer of mucus secreted from goblet cells.

A research team at Washington University School of Medicine in St. Louis has identified the cells that protect the intestine against food antigens, or proteins so that the immune system does not begin an attack…… …….. and observed antigens as they were passed by goblet cells to dendritic cells.

Dendritic cells play a key role in the immune system. But until now, scientists thought that intestinal goblet cells were only responsible for secreting mucus.

Miller and Newberry also studied healthy human intestinal tissue from patients undergoing weight-loss surgery. Those results showed that goblet cells perform the same function in people as in mice. This indicates that the cells may be solid drug targets for treating inflammatory bowel disease and other intestinal problems.