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Testing for Celiac Disease
It's clear that Celiac Disease can be very challenging to diagnose. Stomach pain, diarrhea and bloating, some of the more common symptoms of Celiac, can also mean anything from gallbladder disease to Irritable Bowel Syndrome (IBS). There is good research, for instance, that shows those diagnosed with IBS are four times as likely to actually have Celiac Disease. Given that this condition is under diagnosed it's important to know exactly what testing is effective.
Is Any Amount of Gluten Safe for Those with Celiac Disease?
Celiac Disease is essentially an autoimmune disorder that is triggered by eating foods containing gluten, which is in wheat, rye, and barley products. While there are blood tests to detect the disease, the true confirmation of the diagnosis requires doing a biopsy of several sites in the small bowel. If the villi in the small bowel show damage, the diagnosis is confirmed.
Non-celiac gluten sensitivity: does it exist?
There's been a fair amount of coverage in the health news on recent research into non-celiac gluten sensitivity (NCGS). A study that appeared to confirm the existence of NCGS was refuted by a later study, performed by the same team. Their conclusion was that despite their earlier research, they could find no evidence that non-celiac gluten sensitivity exists.
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Some research has suggested that Celiac Disease may contribute to reproductive problems in women, including infertility, miscarriages and problems with the baby's growth. One study, for example, found that women with Celiac Disease became fertile earlier in their lives and entered menopause sooner than those women without Celiac Disease, while also having fewer children and more miscarriages. Another study compared 150 fertile women versus 150 infertile women and found that 4 of the infertile women had sub-clinical Celiac Disease, while none of the fertile women had it. Still, evidence linking Celiac Disease to infertility is tenuous at best.
Researchers in Italy tried to improve on previous studies by recruiting 200 women who were actively being treated with assisted reproduction techniques, either In-Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) (Hum Rep 2006;21(2):376-379). These women were paired with a control group of 200 women with no complaint of reproductive problems who had already had one child.
The women who were being treated for infertility went through standard tests to ascertain the cause of their infertility and they were all given the standard blood tests for indications of Celiac Disease. Current estimates are that between 0.5% and 1% of all persons have Celiac Disease. In this case, however, 2.5% of the women (5 of them) being treated for infertility also showed blood markers indicating Celiac Disease. To confirm the diagnosis, four of the five underwent intestinal biopsy, with positive results. (The fifth woman admitted that she was already on a gluten-free diet for her Celiac Disease.) Only two of the diagnosed women had any sort of symptoms, which were "mild and undefined abdominal discomfort," and not the more serious symptoms which are sometimes seen in those with Celiac Disease, such as diarrhea, nausea or vomiting.
Interestingly, two of the women diagnosed with Celiac Disease were infertile due to tubal factors, while three were infertile due to their husband's infertility. None of the women in the infertile group were diagnosed with "unexplained" infertility.
While it's true that over twice as many of the women in the infertility group were diagnosed with Celiac Disease than those in the control group, this is a small study and the numbers are still considered statistically insignificant - some areas of Italy have as many as 1 person in 70 diagnosed with Celiac Disease. By no means should infertility alone be considered a reason to test for Celiac Disease, although it should be kept in mind as part of making sure that both prospective parents are as healthy as possible.
First posted: March 17, 2010