Progress in treatment and screening for celiac disease

Would you believe that 30-50% of celiacs do not always adhere to the gluten-free diet? How about that 20% of adult celiac patients’ biopsies do not normalize after diagnosis? According to researchers presenting at Digestive Disease Week 2008, an annual conference in San Diego for physicians and researchers, there is a “need for something beyond a gluten-free diet” in the treatment of celiac disease.

Treatment of celiac disease

In a talk led by Peter Green (leader in celiac disease research and author of the book Celiac Disease: A Hidden Epidemic, which I highly recommend), 2 research groups presented their progress in developing a treatment for celiac disease — Alvine Pharmaceuticals and Alba Therapeutics. Their approaches are different and their outcomes and uses remain undetermined, but both are trying to find a treatment for celiac disease, other than the gluten-free diet. You can hear both presentations in the video clip below.

Screening for celiac disease

Also discussed at the conference: could the criteria for the diagnosis of celiac disease be too strict?

The “gold standard” diagnosis for celiac disease is a positive blood test, followed by a small intestinal biopsy via endoscopy. If the patient has villous atrophy, meaning that the villi of the intestine is damaged to a certain degree, then the person has the official diagnosis of celiac disease.

Dr. Markku Maki from Finland presented his findings about whether this criteria for diagnosis is good enough. His study included 23 people who had elevated antibodies but had normal or only slightly inflamed intestinal lining. They therefore did not meet the criteria for celiac disease. The researchers put one half of this group on a gluten-free diet and the other half continued to eat gluten. They followed both groups for one year — their symptoms, antibodies, and endoscopy. After one year, the gluten-eaters’ symptoms worsened and their small bowels had deteriorated. The gluten-free people’s antibodies disappeared and their bowels became better than before. The gluten-eaters all wanted to go on the gluten-free diet and a year later everyone in that group improved also.

Dr. Maki’s conclusion is that “we have disease before we have gluten-induced small intestinal mucosal lesion.” In other words, perhaps our gold standard needs to be reevaluated, because according to this study, many people already have the disease before it shows up on a biopsy.

You can hear it all for yourself in this video from the conference.