NFCA Scientific/Medical Advisory Council Member Alessio Fasano, M.D. and Carlo Catassi, M.D. of the Center for Celiac Research publish comprehensive review of celiac disease in the New England Journal of Medicine.
The below content is a portion of a press release from the University of Maryland Center for Celiac Research surrounding the journal article published in the New England Journal of Medicine by NFCA Scientific/Medical Advisory Council Member Alessio Fasano, M.D. and Calo Catassi, M.D.
Baltimore, Md., Dec. 20, 2012—Celiac disease and other disorders related to consuming gluten affect a substantial number of Americans. During the last decade, increased awareness of these conditions have led to higher rates of diagnosis along with a growing number of gluten-free products on grocery shelves and gluten-free offerings in restaurants.
“The world of gluten-free products has really exploded,” says Alessio Fasano, M.D., director of the University of Maryland Center for Celiac Research. “Celebrities and self-proclaimed experts are giving a lot of attention to the gluten-free diet. Along with the spotlight on gluten, confusion has also grown about who can safely consume gluten and who cannot,” says Dr. Fasano.
He is one of two leading international experts who offer their latest insights on how to make sense of the changing landscape of celiac disease and matters related to gluten in the Dec. 20 issue of the New England Journal of Medicine in a review article titled “Celiac Disease.”
Ten years after publication of their seminal article that established the rate of celiac disease at 1 in 133 Americans, Dr. Fasano and Carlo Catassi, M.D., co-director of the Center for Celiac Research, present a comprehensive review of the condition. The article includes the latest epidemiological findings, guidance on diagnosis and treatment, and a discussion on gluten sensitivity, what Dr. Fasano calls “the new kid on the block of gluten-related disorders.”
Once considered a pediatric gastrointestinal disorder affecting mainly Caucasian children, celiac disease is on the rise worldwide, note Dr. Fasano and Dr. Catassi, an expert on the epidemiology of the disease. “We are now seeing cases in China,” says Catassi, “and in many developing countries the ‘Westernization’ of the diet means the rate of celiac disease is also growing.”
The autoimmune disorder is now known to affect people of all ages and races, with an estimated worldwide prevalence of .06 to 1 percent, according to the authors. Individuals with celiac disease present a wide variety of gastrointestinal and other clinical symptoms including chronic diarrhea, weight loss, chronic fatigue, anemia, rash, and loss of coordination.
In some individuals, celiac disease can be “silent,” with no symptoms, gastrointestinal or otherwise, and can result in ongoing intestinal damage due to malabsorption of nutrients. Only a small proportion of individuals who have celiac disease have been diagnosed, according to Drs. Fasano and Catassi.
Blood tests, with the IgA anti-tTG antibody as the preferred test, are used for the initial diagnosis. In cases of IgA deficiency, which is increased in people with celiac disease, screening for IgG anti-tTG or IgG DGP antibodies is recommended. For serological tests to be accurate, an individual must be consuming gluten before being tested for celiac disease, otherwise the antibodies may not show up in the results.
Dr. Fasano notes that many patients who test negative for celiac disease report symptoms of “gluten sensitivity,” and, after ruling out other conditions, they respond well to the gluten-free diet. Although the authors focus mainly on celiac disease in this review, they mention gluten sensitivity as an “area of uncertainty.” “This is a condition that we’ve just identified,” says Dr. Fasano. “We know it’s different in its immune response from celiac disease, but we have a lot more to learn about gluten sensitivity.”
In some patients with celiac disease, loss of gluten tolerance appears reversible, according to a Finnish study cited by the authors. According to Dr. Fasano, there are anecdotal cases of adults with documented celiac disease in childhood who later maintained negative blood tests and normal intestinal structure after reintroduction of gluten.
However, in some cases the condition can remain dormant and return after decades of normal intestinal structure and negative serology, notes Dr. Fasano, who advises close monitoring of such patients. “Many of these cases relapse over time,” he says.
About the Center for Celiac Research
Founded at the University of Maryland School of Medicine in Baltimore in 1996, the CFCR is a world leader in the treatment, diagnosis, research and education of celiac disease, gluten sensitivity, and other gluten-related disorders. Its mission is to promote the awareness of celiac disease and gluten-related disorders to provide better care, better quality of life, and more adequate support for people around the world. The CFCR is relocating to Boston in January 2013 to become part of Massachusetts General Hospital for Children. Visit www.celiaccenter.org and www.massgeneral.org for more information.