Talk:Coeliac disease

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Contents 1 Greetings 2 Religious controversy section 3 Add a research section? 4 Beer 5 External link 6 Thanks 7 Eucharist 8 re:"thanks" GF pizza 9 Gramineae 10 Terminology problems 11 say what? 12 Coeliac disease 13 status of millets 14 coughing? 15 Requested move 15.1 Vote 15.2 Discussion 16 A section on genetics? 17 false positive IgG 18 the good news 19 History 20 Expansion and sourcing: a list of useful sources 21 Disease associations and complications 22 "cures"/ vaccinations / therapies 23 Referencing and junking 24 Rye and barley too 25 AGA 26 Jokers 27 Lipids 28 Quality of life 29 Some suggestions 29.1 Intro 29.2 Medical manual of style 30 External peer review 31 Marsh classification 32 Anti-gliadin antibody 33 Celiac and esophageal webs 34 Images 35 Sentence correct? 36 External review 37 FAC? 38 Oats 39 JCI article 40 Wegman's Disease? 41 1728 42 Constipation 43 Epidemiology 44 Why UK-centric coeliac and not celiac? 45 Dramatic increase in diagnosis, and possibly incidence, now omitted, as indicated 46 Breastfeeding under "triggers" 47 Large forehead sign 48 Update for pathologists 49 Persistent villous atrophy 50 History 51 DM1 52 Things not being mentioned at the moment 53 Mortality 54 Newer Testing procedures

[edit] Greetings

I am a gastroenteorlogist with an interest in this disease.

I am going to be proposing and executing some major edits. The science on this has advanced quite a bit. This is a disease of major interest, and has an element of patient activism due to the disease being underdiagnosed up until recently (still a problem) For folks that have interests in suggesting topics to include, please post in the discussions.

Stephen Holland, M.D.
Kd4ttc

I agree with you, Stephen (kd4ttc)! There a lot of disease articles that need major rewrites... Hfwd 00:47, 7 Dec 2004 (UTC)

Almost two years later... JFW | T@lk 16:31, 3 September 2006 (UTC)

[edit] Religious controversy section

I think the religious controversy section is a bit over the top and imbalances the article. Dokane 16:48, 6 Oct 2004 (UTC)

Well done. JFW | T@lk 10:43, 10 Oct 2004 (UTC)

I don't think it is over the top. It is a relevant issue for Catholics with Celiac Disease. If you want a reference, here is one from the New York Times. http://www.nytimes.com/2004/10/04/nyregion/04communion.html?ex=1136696400&en=cc6d3a625138c57b&ei=5070

As for the issue with passover, I think some information needs to be added to that. It is a part of the passover seder that everone must eat a special piece of matzah (the afekomen (sp?)) before the seder can conclude. This would appear to be an issue for Celiacs, however it is not. There is a law (or eithical code, or something like that) in the Jewish religion (I can't remember the name of it, which is why I didn't edit the article myself) that says that Health must always be considered before traditions and customs. I am familiar with this as a Jewish Diabetic, since I do not fast on Yom Kippur, and I have applied this to not eating matzah on passover.

I'm hoping that someone who knows the name of this law can edit the article accordingly.

AJackson 20:13, 6 January 2006 (UTC)

The section of Communion should be moved to Communion and the section on Passover moved there. Kd4ttc 21:22, 8 January 2006 (UTC)

[edit] Add a research section?

From what I have read there is research going on about a possible medication that can allow celiacs to eat regular food. Maybe a section on research and medication should be added? There is an article covering one possible medication at the following address:

http://www.nature.com/ncpgasthep/journal/v2/n3/full/ncpgasthep0111.html Madman332 13 Jan 2006 (UTC)

If anything I would add that it will be a bad idea. Immunology works at very low antigen concentrations. However, that would look like original research. I don't mind my saying it since I do GI. If you want to mention the article go ahead and I'll follow up with something. Steve Kd4ttc 18:18, 13 January 2006 (UTC)

[edit] Beer

I'm a 'coeliac' myself, and of necessity an autodidact on the matter. For some time I squandered vast amounts of time trying to educate beer-drinking celiacs about their gullibility when it came to hearsay 'information' about certain beers -- Uncle Fred said Guinness was gluten-free, for example, and his word was taken at face value. I finally gave up: they wanted to believe, and they persisted in their belief.

This is not the same as the wafer issue, but in both cases, desires and beliefs drive actions.
Roger Scrafford

Some coeliacs are cross-sensitive to secaleins and hordeins, which may occur in beer. If these people are not getting malabsorption symptoms they may be fine, but a surveillance biopsy may reveal the harsh truth :-( JFW | T@lk 13:50, 2 Dec 2004 (UTC)

[edit] External link

On 15 Jan I created a link to http://www.msnbc.msn.com/id/5762478/, as it provides an example of the controversy surrounding this disease and the Catholic church. The addition was immediately deleted, but there was no reason given. Is a link of this nature inappropriate? Was the link too NPOV? If so, I'll try to find a better example, but I truly believe that linking to a story that details both sides helps readers gain contextual understanding. 67.171.64.84 18:51, 15 Mar 2005 (UTC)

Perhaps you should put it back as a footnote. If it is inserted as an external link, it would clutter the article. JFW | T@lk 06:38, 16 Mar 2005 (UTC)

[edit] Thanks

I just wanted to thank all the people who have worked hard on this article, as i am also suffering from the disease. i just recently discovered this issue (1 month or so ago) and it is hard to deal with. i really want some pizza, but i cant. thanks again, Gazeofsorrow 06:06, 21 Apr 2005 (UTC)

My Views

I have had Coceliac desease since I was 7 (I am now 14) I find that I enjoy my diet but none of my mates understand and they can't see its caused emotional pain. I have never really tried to cheat on my det but in food lessons I often get upset but I have learnt to deal with it. My diet defines who I am.

[edit] Eucharist

I've made some edits to the Catholic Church section (not least changing the section name) to be broader and more NPOV. JHCC (talk) 6 July 2005 18:01 (UTC)

(Further comment) Part of my edit was to remove the note that some bishops had asked to use rice wafers. If anyone has a reference for this, I'd be happy to re-include it. Also (the AP article notwithstanding), it should be fairly clear that celiac sufferers are not denied communion on the grounds that rice wafers cannot be used in the Eucharist; the fullness of the sacrament is, according to Catholic doctrine, still present in the consecrated wine alone. (A further theological point: the little girl in the AP article was not denied communion; her First Communion was ruled invalid after the fact because, although the form was correct, the matter was not.) There's a difference between being denied communion ("You can't take communion at all) and having that communion ruled invalid (what you did wasn't really the Eucharist). JHCC (talk) 6 July 2005 20:35 (UTC)

There is no mention of the Catholic Church allowing celiac sufferers to take wine to complete the sacrement. Thus, for the most part it is not much of an issue wrt this religion. Most priests, if they are aware of the situation, will happily oblige and allow an individual to take wine instead of Eucharist.

[edit] re:"thanks" GF pizza

I have celiac, too (diagnosed ca. 5 years ago), and although at first I was quite depressed about it and often yearned for my favorite food (same as you - pizza), I eventually found that celiac was actually a blessing. It forced me to try different foods and ultimately enriched my diet. Now I cook all kinds of different foods - Indian, Korean, Chinese, etc., and I've grown to accept and actually be proud of my condition. It may seem paradoxical, but strangely, celiac actually gives us more options.

P.S. Regarding pizza, there are a number of good gluten-free pizza mixes. The best one is by The Gluten-Free Pantry (www.glutenfree.com) and it is called the "Country French Bread and Pizza Mix". Even non-celiacs I know like it. --149.159.2.14 19:18, 10 August 2005 (UTC)

[edit] Gramineae

At first I want to express that I find this article on coeliac disease pretty good. Thanks for the work altogether!

I added the hint to Gramineae in the therapy section. That's a conclusion from self-described case studies i received and experiments not only by myself but by some other people too who didn't recover from a gluten-free diet alone. One toxicologist and one physician were among the people. Partial blood analysises and allergy tests were included. The problem with coeliac disease is (in some cases) probably not only a problem of defective gluten digestion and according T-cell mediated immune response but related to prolamines of the Gramineae family of plants in general. Allergic responses to Gramineae challenging support this opinion in some cases of suspected (but neither definitely proven nor ruled out by biopsy and antibody testing) coeliac disease.

For those having trouble even with gluten-free beer: Beer contains hops. And hops also is a member of the Gramineae family...

For those possibly affected by the disease and searching for literatur on the lesser well-known symptoms of c.d. I give here some references for further reading. (Unfortunately Wikipedia articles do not have a special section for literature what bothers me for years now.) In chronological order:

• Morris, J.S.; Adjukiewicz, A.B. & Read, A.E. Coeliac infertility: an indication for dietary gluten restriction? Lancet, 1970, 1, 213-
• Green, J.R.; Goble, H.L.; Edwards, C.R. & Dawson, A.M. Reversible insensitivity to androgens in men with untreated gluten enteropathy. Lancet, 1977, 1, 280-2
• Vanderschueren-Lodeweyckx, M.; Eggermont, E.; Cornette, C.; Malvaux, P.; Eeckels, R. & Beckers, C. [TSH-response to TRH in active coeliac disease in infants (author's transl)] Ann Endocrinol (Paris), 1978, 39, 149-50
• Prader, A. [Normal growth and disorders of growth in children and adolescents (author's transl)] Klin Wochenschr, 1981, 59, 977-84
• Farthing, M.J.; Edwards, C.R.; Rees, L.H. & Dawson, A.M. Male gonadal function in coeliac disease: 1. Sexual dysfunction, infertility, and semen quality. Gut, 1982, 23, 608-14
• Farthing, M.J.; Mattei, A.M.; Edwards, C.R. & Dawson, A.M. Relationship between plasma testosterone and dihydrotestosterone concentrations and male facial hair growth. Br J Dermatol, 1982, 107, 559-64
• Farthing, M.J.; Rees, L.H. & Dawson, A.M. Male gonadal function in coeliac disease: III. Pituitary regulation. Clin Endocrinol (Oxf), 1983, 19, 661-71
• Farthing, M.J.; Rees, L.H.; Edwards, C.R. & Dawson, A.M. Male gonadal function in coeliac disease: 2. Sex hormones. Gut, 1983, 24, 127-35
• Magazzu, G.; Luca, F.d.; Benvenga, S. & Trimarchi, F. [Transient biological hypothyroidism in an infant carrier of celiac disease] Pediatrie, 1983, 38, 249-52
• Várkonyi, A. & Falkay, G. [Hyperprolactinemia in children with celiac disease] Monatsschr Kinderheilkd, 1984, 132, 547-9
• Korepanov, A.M. & Ivanov, G.I. [Several endocrine aspects of duodenal stasis in the process of therapeutic gymnastics] Ter Arkh, 1987, 59, 65-8
• Ventura, A.; Florean, P.; Trevisan, M.; Not, T.; Perticarari, S.; Quadrifoglio, F.; Torre, G. & Cauci, S. [Anti-alpha-gliadin antibodies. Sensitivity, specificity and correlation with blood xylose test in the 3 diagnostic stages of celiac disease in children] Pediatr Med Chir, 1987, 9, 653-60
• Zadik, Z. & Kowarski, A. Incidence of neurosecretory dysfunction among children aged 6-14 years in Rehovot, Israel. Acta Paediatr Scand Suppl, 1989, 349, 77-80; discussion 81-3
• Sher, K.S.; Jayanthi, V.; Probert, C.S.; Stewart, C.R. & Mayberry, J.F. Infertility, obstetric and gynaecological problems in coeliac sprue. Dig Dis, 1994, 12, 186-90
• Hoggan, R. Considering wheat, rye, and barley proteins as aids to carcinogens. Med Hypotheses, 1997, 49, 285-8
• Reifen, R.; Buskila, D.; Maislos, M.; Press, J. & Lerner, A. Serum prolactin in coeliac disease: a marker for disease activity. Arch Dis Child, 1997, 77, 155-7
• Várkonyi, A.; Boda, M.; Endreffy, E.; Németh, I. & Timár, E. Coeliac disease: always something to discover. Scand J Gastroenterol Suppl, 1998, 228, 122-9
• Collin, P.; Hakanen, M.; Salmi, J.; Mäki, M. & Kaukinen, K. Autoimmune hypopituitarism in patients with coeliac disease: symptoms confusingly similar. Scand J Gastroenterol, 2001, 36, 558-60
• James, W.H. Hormones and offspring sex ratios associated with celiac disease. Am J Gastroenterol, 2001, 96, 2266-7
• Johnson, T.N.; Tanner, M.S.; Taylor, C.J. & Tucker, G.T. Enterocytic CYP3A4 in a paediatric population: developmental changes and the effect of coeliac disease and cystic fibrosis. Br J Clin Pharmacol, 2001, 51, 451-60
• Blanco Quirós, A.; Arranz Sanz, E.; Garrote Adrados, J.A.; Oyágüez Ugidos, P.; Calvo Romero, C. & Alonso Franch, M. [The tumor necrosis factor system and leptin in coeliac disease] An Esp Pediatr, 2001, 55, 198-204
• Dunger, D.; Ahmed, L. & Ong, K. Growth and body composition in type 1 diabetes mellitus. Horm Res, 2002, 58 Suppl 1, 66-71
• Porpora, M.G.; Picarelli, A.; Porta, R.P.; Tola, M.D.; D'Elia, C. & Cosmi, E.V. Celiac disease as a cause of chronic pelvic pain, dysmenorrhea, and deep dyspareunia Obstetrics & Gynecology, 2002, 99, 937-939
• Bernstein, C.N. & Leslie, W.D. The pathophysiology of bone disease in gastrointestinal disease. Eur J Gastroenterol Hepatol, 2003, 15, 857-64
• Green, P.H.R. & Jabri, B. Coeliac disease. Lancet, 2003, 362, 383-91
• Jansson, U.H.G.; Kristiansson, B.; Albertsson-Wikland, K. & Bjarnason, R. Short-term gluten challenge in children with coeliac disease does not impair spontaneous growth hormone secretion. J Pediatr Endocrinol Metab, 2003, 16, 771-8
• Bozzola, M.; Giovenale, D.; Bozzola, E.; Meazza, C.; Martinetti, M.; Tinelli, C. & Corazza, G.R. Growth hormone deficiency and coeliac disease: an unusual association? Clin Endocrinol (Oxf), 2005, 62, 372-
• Capristo, E.; Farnetti, S.; Mingrone, G.; Certo, M.; Greco, A.V.; Addolorato, G. & Gasbarrini, G. Reduced plasma ghrelin concentration in celiac disease after gluten-free diet treatment. Scand J Gastroenterol, 2005, 40, 430-6
• Karagiannis, A. & Harsoulis, F. Gonadal dysfunction in systemic diseases. Eur J Endocrinol, 2005, 152, 501-13
• Peters, J.H.; McKay, B.M.; Simasko, S.M. & Ritter, R.C. Leptin-induced satiation mediated by abdominal vagal afferents. Am J Physiol Regul Integr Comp Physiol, 2005, 288, R879-84
• Pynnönen, P.A.; Isometsä, E.T.; Verkasalo, M.A.; Kähkönen, S.A.; Sipilä, I.; Savilahti, E. & Aalberg, V.A. Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study. BMC Psychiatry, 2005, 5, 14

They are mostly related to disturbances of the endocrine system because that is what was common in the group of people mentioned above (diabetes, grave's disease, deranged hormone levels, pituitary dysfunction and so forth) and which all profited from a prolamine-reduced (free if necessary) diet. Gluten-free alone didn't it.

Best regards. 212.202.0.156 10:58, 13 August 2005 (UTC)

Actually, the best pizza is either Chebe (mix) or Foods by George (frozen). Celiac for a long time...

[edit] Terminology problems

This article states:

Maize (corn), sorghum, and rice are considered safe for a patient to consume. They contain types of gluten that do not trigger the disease.

This contradicts the gluten article, which states:

No gluten is contained in rice (even glutinous rice), wild rice, maize (corn), millets, buckwheat, quinoa, or amaranth.

Please discuss on Talk:Gluten.

--Dforest 17:13, 5 October 2005 (UTC)

Well, the scientists argue... By my experience, maize is not safe for all. Most people (with c.d.) have no problems with maize, but some do have problems.

212.202.198.60

Gluten, when talking about Celiac, refers to the protein that's in wheat, rye, and barley, since those are the ones that affect people with Celiac. Corn intolterance can happen with Celiacs, but it is separate (Celiacs have a high chance of having other food allergies/intolerances).

Gluten is a generic term to cover the proteins found in grains (including wheat, barley, rice and maize) however the glutens found in rice and corn do not cause coeliac disease. When people refer to gluten intolerance they are refering to intolerance of gliadin, and the glutens found in barley (?hordeins) and rye.

• I saw that and made a mental note to talk about the gluten issue as a grain protein terminology issue. I think wikipedia readers would be interested in the issue. Isn't gluten actually the alcohol insoluble protein fraction, or is that the gliadin portion? Kd4ttc 22:01, 22 November 2006 (UTC)

[edit] say what?

Said of Passover: "The festival can be very limiting, as matzo meal (fine-ground matzo) is used as a replacement for flour in many products to avoid other stringencies of the festival."

This is worded strangely. I'm not sure what it means. Does it mean those with coeliac must observe the festival in only a limited way? What is the allusion to "other stringencies" that are avoided by replacing flour, and what impact does this have on those who deal with celiac disease? --Shuageo 02:15, 1 January 2006 (UTC)

It means that only gluten-free matzos can be consumed. JFW | T@lk 03:41, 1 January 2006 (UTC)

"Other stringencies of the festival" refers to the regulations surrounding unleavened bread. Any time that you work with unbaked flour or unbaked dough, you run the risk of airborne yeast contaminating and leavening it. This is how some sourdough is formed; some bakeries do not have to add yeast to their dough at all, as there is already enough yeast in the air from years of bread making. In order to be kosher for Passover, matzo dough cannot sit long enough to absorb airborn yeast; it must be baked right away. Strict practice requires bakery workers to scrub every trace of the last batch of dough from their hands before proceeding with the next, for the same reason.

Once baked, however, matzo is essentially impervious to airborne yeast, so matzo meal can be used as a flour substitute in many products (matzo ball soup, for example) without violating the regulation against leavened bread. For coeliac sufferers, this means (to expand on JFW' comment) that only such products made with gluten-free matzo meal can be consumed. JHCC (talk) 19:34, 17 January 2006 (UTC)

[edit] Coeliac disease

The disease is universally known as celiac disease, not coeliac disease. I recommend using "celiac" throughout the document, and putting "coeliac" in the "also known as _______ disease" sentence.

Yeah, the World Health Organization calls it Celiac. Pretty much everyone except the British call it Celiac.

Would the fact that British people seem to be far more likely to have coeliac disease have any bearing on this? And the usual rule about, if there is a conflict of regional spellings in an article that isn't about a specific region, going with the style of the first author? Just wondering. 57.66.51.165 16:59, 28 February 2006 (UTC)

It's been amusing me on the spelling. I didn't know the WHO called it Celiac. I've been deferring to the Brits on this just cause there a bunch of very good docs from the island here on Wikipedia. But with the WHO calling it celiac, well, that is a pretty reasonable example of a legitimate authority on things medical. Kd4ttc 02:30, 1 March 2006 (UTC)

The World Health Organization says "Celiac," as does Encyclopedia Britannica and 9 out of the 10 external links from this article. 696,000 articles were on Google for "Coeliac disease," but 3,280,000 for "Celiac disease" Only people in the UK spell it "Coeliac." I recall hearing that the rate of diagnosis in the UK is slightly higher than it is elsewhere, but that doesn't necessarily mean much. I think it should be changed to "Celiac disease," but I don't know how to do it (in other words, how to move the page and change all references in the page without pissing people off). Help? Jesuschex 15:30, 5 March 2006 (UTC)

I'd say do a move request. But in general, Wikipedia does not automatically follow US spelling, even if there may be Google support. This is a traditional issue. JFW | T@lk 00:07, 7 March 2006 (UTC)

In the archived discussion, academics seem to prefer coeliac disease. But celiac disease is not an academic disease, it is a condition that affects millions. So goodbuy to cumbersome coeliac, welcome simple celiac. Also note that English is an international language; the rate of diagnosis in UK vs. US should have no significance! Plus: it is the tendency of language to go from complicated forms towards the simple. Alestalo 20:37, 29 August 2006 (UTC)

I agree with the above points, but.... This in my opinion is where the American and other European interpritations of the English languages differ. The W.H.O use The American spellings and Terminology. This is simply because the US is much bigger and seems to carry more weight when opinions are formed!

UK English is derived from Latin so we have the spelling "Coeliac" or silent "O" if you type the word in the UK search engines you get the "Did you Mean" link at the top of the page!

Bill G BA(Hons) Dr. Mus PGCE BSc(Hons)Psych —The preceding unsigned comment was added by Billgunn1980 (talk • contribs) 2006-09-23T12:14:25.

Counter to some North American perceptions, the UK is not the only place using the form coeliac disease - try Australia and New Zealand, for a couple of examples. Really, there are more important aspects to this article than simply how North Americans want to change the language. From the manual of style, There are many more productive and enjoyable ways to participate than worrying and fighting about which version of English to use on any particular page. Webaware 04:06, 23 September 2006 (UTC)

[edit] status of millets

dear all, what is the status of millets for celiac patients? i noticed that the article doesn't mention this, but there is a brief reference to it on this page. best, Mumun 14:44, 22 February 2006 (UTC)

It is gluten free. Kd4ttc 23:13, 22 February 2006 (UTC)

[edit] coughing?

From the article:

Rarely, coeliacs may experience symptoms similar to those of sinus infections and/or the formation of thick, choking plugs or ropes of mucus that require considerable effort to expel.

I suspect I might have wheat allergy or coeliac disease - is there a difference between the two? I have an appointment with an allergist at the end of the month. It never dawned on me that the reocurring cough I have might be caused by gluten. When I get a cold, I often cough up clear phlegm for a few weeks after.

But my searches through other coeliac (or celiac) pages have turned up zilch about coughing and phlegm, despite it being mentioned here. Is this a controversial issue? Is there a source for this so-called more rare symptom, given that the main coeliac websites make no mention of it?

Thanks. Nikolaus maack 18:53, 7 March 2006 (UTC)

Further to the above: there's a discussion about renaming at Wikipedia talk:Naming conventions#Coeliac disease - changing our spelling could save lives. (NB: if you can't find it, it may have been acrchived.)--A bit iffy 08:26, 14 March 2007 (UTC)

[edit] A section on genetics?

As this is partly a genetic disease, a section should be added on what racial / ethnic groups are predisposed to this disorder and what the affected percentages of those groups are. —The preceding unsigned comment was added by Flask (talk • contribs) .

I think it's in the epidemiology section: Coeliac disease#Epidemiology -- Samir धर्म 05:12, 17 May 2006 (UTC)

[edit] false positive IgG

Anti-gliadin antibodies (AGA), IgG and IgA. These tests are often useful when testing young symptomatic children, but they are found in fewer coeliacs than Anti-tTG, and their presence does not automatically indicate coeliac disease because they are found in some other disorders.

Can we get a reference to one of these other disorders? Btyner 00:05, 24 May 2006 (UTC)

[edit] the good news

I keep trying to end this article with good news - about the increase in the availability of specialist bread, beer, pasta... However, a user that is stalking me and reversing my edits keeps removing what I do. Although I will keep trying to make the point, I suspect that this bullying will continue. I know that this user only became interested in coeliacs when I started work on it, so sorry that I have brought this illness upon users interested in this page. A statement about this bullying is on my User Page. However, I hope other users with coeliacs will recognise that this bully is not interested in us coeliacs having a social life, in giving us a positive note in a largely negative matter, and is more preoccupied in beating me up. If his negative, unsympathetic edits continue, perhaps other users might share with him our right to be positive rather than crawl away and die. Alternatively, perhaps, other users will want to work on this area, as anything I do seems to attract this guy's nastiness. wikwobble

How about you discuss the material in question here rather than elaborate on your disagreements with one user? JFW | T@lk</small> 23:38, 14 June 2006 (UTC)

• Here's the paragraph:

However, while large scale commercial beers are out of the question for coeliacs (regardless of the sometimes misleading advice on their websites) and a very large amount of the foods available in the supermarket are effectively a poison, the good news is that life is getting easier for coeliacs, and although the choice of a beer may seem peripheral to a life-changing illness, it is important to note that coeliac disease is compatible with a fun and fulfilling life.

• This isn't an encyclopedic paragraph. In fact, the entire "lifelong diet" section sounds more like a health columnist or a cheer-em-up pamphlet in the doctor's office. I notice the exact same first paragraph is in Dermatitis herpetiformis. Wikipedia does not tell people what to think, so It is important for coeliacs to understand that one does not "get over" coeliac disease doesn't work here; it's giving advice. And the entire "Social impact" section is OR. --jpgordon∇∆∇∆ 00:04, 15 June 2006 (UTC)

Thank you for a really positive edit. you do not know how frustrating it has been to offer material to have it repeatedly reversed without discussion. I take your point, but surely there is place for one part of an article (that may be someone's first point of call when they are diagnosed) that their life is not over. Whether they find out after a fall and realising they will struggle to ever have strong bones, or whether they find out at the same time that they find they have cancer. Is there not valid material in a statement that one can still be useful, and still lead a useful life, and that they may socialise normally as well, even if it is against the odds? wikwobble

• Well, if you can provide a verifiable reliable source making such a point, it could be used. But on your own it's not a neutral point of view; it's your opinion that life isn't so bad for a coeliac sufferer. If you live on pizza, pasta, and sandwiches, and suddenly discover you have this problem with gluten, life suddenly sucks very very badly (trust me on this) -- and it's not for Wikipedia to cheer people up. (Though they should be cheered up by the fact that their bellyaches are going to simply disappear, and most likely very quickly.) Now, if you could give us something like "Children often react badly to diagnoses of coeliac disease; nutritional psychiatrist Blahde Blahdly stresses that children should be encouraged in their normal social lives", then it would be going in the right direction. --jpgordon∇∆∇∆ 00:31, 15 June 2006 (UTC)

Thank you again. I understand what you are suggesting, and will try to find something that can be referenced. However, I think it is in the nature of this condition that those connected to it are preocupied with "cures" or, more likley, "vaccination". After that, the next role is persuasion that the diet must be stuck to. I understand this, and it is important. But you must have seen that social isolation is also a symptom - difficult to eat out, go on holiday, drink at the pub.... But I do see your point and I will do my best to find something in the very few articles on coeliacs and their social lives ! wikwobble By the way, since I turned out only to have osteoperosis as a symptom, my bellyaches remain just as bad and since the gut is back to normal clearly I am doubly damned. Curses! a life restricted and still not feeling any better ! Isn't it right to have some good news?

Hello again. I have since worked the material and found supporting references. I hope that combined with my above comments, you will agree a positive note at the end of the article is both supportable and valuable. Trust me ! I do not feel that life with coeliacs is FUN FUN FUN! Actually I find it quite difficult, limited and depressing. However, anything I can do to help my own rehabilitation to normality (or as close as is reasonable) and at the same time provide information for others that may give them hope is of worth. That does not (in itself) make it valid for Wikipedia, I see that. But I hope in the light of all the other depressing stuff, this material actually provides balance without which the article skews towards misery ! wikwobble

Naturally this relates also to DH, so please comment before I past this material to that article.

Wikwobble, please make an effort so make your contributions sound like they would appear in an encyclopedia. Saying that certain products are "effectively poison" is unnecessary hyperbole, given that the article already states in more reserved terms that they would aggrevate coeliac disease. There is no need to make the article sound better than real life; it may be your personal opinion that coeliac does not stop people from enjoying life, but many other patients may not perceive it this way.

I have reduced your paragraph to the important facts: there are gluten-free beers and their presence reflects positively on the joie de vivre of coeliac patients. I don't think the paragraph needs to say any more than that.

Please also read "Raul's razor" on WP:RAUL and see what you think. JFW | T@lk 22:24, 15 June 2006 (UTC)

Thank you for that. I think there is validity in your points here, and I should have been less emotional. However, I think the truth lies somewhere between these positions. It is hard to be "neutral" in the case of medical conditions. How can we balance the bad points about cancer with the "good" points? Shouldn't the reader reasonably assume the writer is anti-cancer? That being said, I repeat that your points are sound and I shall mull. Again I make the point that most work on coeliacs ignores the social impact, and yet this is perhaps the most obvious symptom! I shall try to get some source material on this aspect, as it is a significant area, but I accept and appreciate the opinions raised by Jfdwolff and jpgordon which are positive and helpful. wikwobble

[edit] History

A userful timeline, which may help us find relevant references for historical background[1]. JFW | T@lk 23:38, 14 June 2006 (UTC)

[edit] Expansion and sourcing: a list of useful sources

I'm colllecting useful sources in preparation for a major expansion. Having given a succesful talk about this condition last Friday I think this article is a bit of an embarrassment.

• Historical:
  • Aretaeus of Cappadocia, translated by Francis Adams and printed for the Sydenham Society in 1856
  • Biographical and Bibliographical data on Samuel Gee, Whonamedit entry.
  • Dicke WK. Coeliakie. PhD thesis. The Netherlands: University of Utrecht, 1950.
• Clinical:
  • PMID 15269095 - risk of malignancy
  • PMID 12771245 - coeliac neuropathy
• Immunology:
  • Epitope: PMID 10700238
• Genetics:
  • PMID 12011149 (genome-wide screen)
• Epidemiology and genetics:
  • DOI:10.1177/0272989X06289012 screening
• Recent reviews:
  • PMID 16766754 - Gut very broad review
  • Use of serology (systematic review)

I'm not proposing to refer to each of these articles, but these are resources that I think may be useful. JFW | T@lk 22:31, 19 June 2006 (UTC)

Enzyme therapy, something to watch (when the human trials become available): JAMA. JFW | T@lk 06:53, 26 July 2006 (UTC)

[edit] Disease associations and complications

A big part of what's missing. Autoimmune disease associations (collagenous colitis, PBC, T1DM, etc.) and complications (jejunoileitis, SB Ca, lymphoma, esophageal/pharyngeal Ca) need to be mentioned and referenced -- Samir धर्म 09:47, 21 June 2006 (UTC)

Do you have a good single source that parses all these associations nicely into a citable list? JFW | T@lk 16:31, 3 September 2006 (UTC)

[edit] "cures"/ vaccinations / therapies

It seems to me that there is now a whole range of possibilities that could be included I could attempt to summarise them, and I am willing to, but perhaps someone more close to research in the field should be summarising the various ways to progress the possible therapies, rather than my garbled efforts, followed by a more educated revision? wikwobble

[edit] Referencing and junking

Many section are referenced to what constitutes (in my view) a set of unreliable sources. The websites linked to may be popular and such, but many don't state on which studies they base their statements. If there are studies available, these certainly deserve priority over secondary sources.

I have expanded the historical section. Should we mention how Anderson purified gluten and how the small bowel biopsy was developed (both by women, incidentally, in the male chauvinistic 1950s). JFW | T@lk 11:22, 24 August 2006 (UTC)

Yes! I'm unaware of the history of the small bowel biopsy -- Samir धर्म 11:26, 24 August 2006 (UTC)

Included. Some background reading is here. JFW | T@lk 22:51, 26 August 2006 (UTC)

It's remarkable that almost all early-days research into coeliac disease took place in Europe. Does the condition exist accross the Atlantic? :-) JFW | T@lk 02:00, 27 August 2006 (UTC)

We have a similar disease called celiac disease :) The ligature fell off the Mayflower. -- Samir धर्म 06:11, 28 August 2006 (UTC)

Heh. JFW | T@lk 21:44, 28 August 2006 (UTC)

I suspect it has a lot to do with major crops. In Europe, wheat is by far the major grain crop, and grain derivatives (modified starches, dextrose, maltodextrin, etc.) are largely derived from wheat there (and in Australia and New Zealand). The USA has maize as probably its major grain crop, and such derivatives therefor come from maize instead. Just a theory... Webaware 07:10, 28 August 2006 (UTC)

So American's ain't eatin' no bread, man? JFW | T@lk 21:44, 28 August 2006 (UTC)

Hey, nice tone! Must make you feel more important. My point was simply that, as North America has so much maize, there is more money around for research relating to it than to other foods. Not to mention, the revolving door employment scenario between USDA and major food producers in the USA, which helps shape the regulatory environment there. Webaware 02:55, 3 September 2006 (UTC)

The corn theory is an interesting one. There's not much published on it, but it has certainly come up at a couple of conferences. Also, I think JFW was just making a joke. About cornbread. :) -- Samir धर्म 09:32, 3 September 2006 (UTC)

[edit] Rye and barley too

An important correction needs to made in the second introductory paragraph, as mentioning only wheat is insufficient and misleading. E.g: "Coeliac disease is caused by an abnormal reaction to gluten, a protein found in wheat, rye, and barley." (If we want to be specific, the harmful proteins in wheat are called gliadin, in rye secalin, and in barley, hordein.)

Also "The role of other grains" needs modification accordingly. It has not been "may occur" for a long while. Alestalo 21:58, 29 August 2006 (UTC)

And while you made these changes you removed gliadin from the intro in favour of gluten (which is correct, but gliadin is the peptide we worry about). Gliadin is not present in barley and rye, and I don't think we should delve so deeply into the finer points of secalin/hordein in the intro. After all, wheat is by far the most common source of flour in the Western world. JFW | T@lk 00:59, 3 September 2006 (UTC)

However, barley is by far the most common source of malt, often used to flavour foods that might otherwise be "gluten free" - e.g. cornflakes. I'm not too comfortable with your marginalisation of barley and rye in the disease. When I have time, I'll read some of your citations, to see what they have to say. ITMT, thanks for your excellent contributions - the article has greatly benefited from your work. Webaware 02:50, 3 September 2006 (UTC)

I've reintroduced the mention of both grains (but not the putative proteins) in the intro. Thanks for the compliment. I'm working hard on getting this one featured in a few weeks. Would you be able to supply papers that you would like to have included (e.g. on quality of life in patients on a GFD).

For some reason Wikipedia has been spammed heavily by someone who is addicted to gluten-free beer. Do you agree that we should not have whole paragraphs (plus the same photo with the bearded fellow) in every related article? JFW | T@lk 10:26, 3 September 2006 (UTC)

Looks good, and it would be wonderful to see this article get such coverage. I'd be reticent to add anything now without proper citations, and most of what I can point to is anecdotal patient stuff, e.g. related problems with casein, trace (<20ppm) levels of gliadin in glucose, etc. - I'd need to search for academic citations, and I don't have the time. I've noticed some of the GF beer spam, but haven't seen the bearded fellow. More problematic has been the recent spate of McReverts, but these simply demonstrate the need to back up statements with credible references.

The article probably doesn't need to spend as much time as it does on aspects of the gluten-free diet. For example, is there really any need to mention GF beer at all here, when there is a separate article on both the diet and the beer? I've been reticent to rip it out, however, as I did not build this article and haven't the time to fix up the others appropriately either (the GF beer article is a mess!). If I was to contribute much more to the topic, it would probably be on these articles (and the gluten-free, casein-free diet article which needs a cleanup/out - less autism-specific for a start).

Really, my only concern with what you were doing was the apparent marginalisation of non-wheat grains, which you have addressed. Keep up the good work, and go get that Featured Article status! Webaware 11:47, 3 September 2006 (UTC)

Like you said, a lot of things can be spun off to gluten-free diet. I'll be removing the beer spam from this article in due course. I wasn't aware of the glucose thing, and have little direct knowledge of the casein business. Let me know. JFW | T@lk 15:02, 3 September 2006 (UTC)

Thanks for the corrections. Though I still wonder why you say "such as barley and rye" - there are no others that one needs to worry about. Anyway, mentioning rye and barley really is mandatory: after you have been diagnosed, you start looking for alternatives, and it does not matter that wheat is the most common source of flour. You need to know that you cannot have the next common ones either! (Next common in many countries.) Alestalo 16:27, 12 October 2006 (UTC)

[edit] AGA

The AGA has also issued a guideline (2001, reviewed unchanged 2004), although it seems to have been written by Brits (see here and PMID 11313324). JFW | T@lk 01:52, 3 September 2006 (UTC)

This should be the best reference for the bulk of the clinical part of the article. The 2004 technical review is excellent -- Samir धर्म 01:57, 3 September 2006 (UTC)

I've relied on the UK guideline, incidentally written by the same professor at King's College. JFW | T@lk 02:01, 3 September 2006 (UTC)

[edit] Jokers

PMID 15080306 - a series of coeliakoid biopsies that were not, in fact, due to coeliac. We should include a differential diagnosis for the "typical" biopsy appearance. Whipple's, anyone? JFW | T@lk 02:01, 3 September 2006 (UTC)

Classic exam question: Tropical sprue, Giardia, Radiation, Crohn's, NSAID enteropathy, lymphoma, abetalipoproteinemia, eosiniphilic enteritis, ZE, HIV, bacterial overgrowth, amyloid, hypogammaglobulemia. R0xx0r -- Samir धर्म 02:11, 3 September 2006 (UTC)

Didn't know you took the British exams? I'm due PACES myself in a month or two. JFW | T@lk 09:02, 3 September 2006 (UTC)

Wish I did, but I just forgot the "of Canada". September 20-21, or as I like to call it, doomsday. PACES looks challenging, unlike Canadian exams. Back to celiac disease, I just made small bowel bacterial overgrowth syndrome; have a peek -- Samir धर्म 09:36, 3 September 2006 (UTC)

[edit] Lipids

The Cambridge study suggested a benign cardiovascular risk profile due to the malabsorption, but this paper in Am J Med seems to suggest that while TC and LDL go up, LDL:HDL goes down. JFW | T@lk 08:22, 3 September 2006 (UTC)

Malabsorption is usually associated with a low HDL, which we also know is an independent lipid RF for CAD. My understanding was the low HDL in celiac was of unclear significance, and I'm also not too sure what the significance of an increased HDL post treatment is. -- Samir धर्म 10:30, 3 September 2006 (UTC)

[edit] Quality of life

I've only found patchy research on the quality of life, social stigma and actual mortality figures. These are essential in making the article complete.

I'm thinking of ditching a lot of information presently redundant with gluten-free diet. I'm also planning to drastically shorten the "religious implications" section. Perhaps it can be forked.

There's of course plenty to do, but with some heavy editing behind me I was wondering if we shouldn't send this baby for peer review at some point. Samir, whaddaya think? JFW | T@lk 14:59, 3 September 2006 (UTC)

All done now. A good QOL/psychological comorbidity study was found and duly cited. I'll be requesting an unofficial peer review from WP:CLINMED before officially sending it for WP:PR. JFW | T@lk 16:31, 3 September 2006 (UTC)

It looks very very good. I'll add a few additional pearls over the next bit -- Samir धर्म 17:03, 3 September 2006 (UTC)

[edit] Some suggestions

Here's a dump of some suggestions I've made after reading this. Apologies if these are covered and I've missed it:

1. Name – Could you explain the origins of the terms Coeliac and Sprue. It does mention who coined it but that doesn't really explain it. See [2].
2. British and Italian epidemiology – have you got references for this.
3. The history section is quite terse.
4. There is nothing about "banana babies" – only a brief mention of a banana diet. This was (I believe) quite a widespread treatment prior to the 50s.
5. There is a wide range of symptoms and, it would appear, severity. Can this be explained at all?
6. Prevention – there is a brief mention of delaying exposure to gluten in the Pathophysiology section. However, perhaps this deserves its own section, even if all you can say is that at present, there is very little one can do?
7. There is quite a fad of giving up wheat for various reasons. Where does this come from? Would a person without coeliac disease benefit – is there something about handling gluten that we all find difficult?
8. Can you give figures for what percentage of people are undiagnosed and what percentage are diagnosed but choose not to follow a strict diet?
9. The phrase: "Diagnostic workup" – this isn't a medical textbook.
10. Why is "The role of other grains" inside "Signs and symptoms"?

Colin°^Talk 22:19, 3 September 2006 (UTC)

I've numbered your comments, so I can respond to them easier... Hope you don't mind.

1. We should cover the name in the intro, but the page you've linked to is not well referenced. I'm still looking for an authoritative source.
2. Will look for the British and Italian epidemiology. Not mentioned specificially by van Heel & West.
3. The section presently covers practically all landmarks in the discovery of coeliac disease. Are there things you'd like me to include?
4. Well, I mentioned the banana diet but wasn't aware of the cultural impact of that phenomenon. In the absence of a good etiology this diet was probably quite popular.
   • I googled for various combinations of "banana bab[y/ies]" c[o]eliac and never got more than 70 hits. I don't think the term as such deserves inclusion. Still, more emphasis ought to be placed on the popularity of this diet before Dicke.
5. I have not seen good explanations why some get worse coeliac disease than others. It is also unknown why of the 20-30% with DQ2 only 1:20 develop coeliac disease. Van Heel and West suggest the spectrum of the disease may actually be changing.
6. Only one preventative measure is known (timing of gluten exposure) and even that is not specifically recommended by anyone in absence of stronger evidence. I agree prevention is relevant, but the section would be underpopulated.
7. I have no idea why bread is evil. Sounds like an urban legend built on high-impact cases of coeliac in susceptible communities.
8. It follows from the "epidemiology" section that 1:10 cases of CD are actually diagnosed. The rest is at marginally higher risk for some complications. I have no statistics on how many people are noncompliant with their diet, and I think that is a very temporal/local thing one cannot really generalise on.
9. I don't understand your dislike for "diagnostic workup". It covers quite precisely what the paragraph states: tests generally performed in suspected or confirmed cases of coeliac disease.
10. I placed that paragraph there because symptoms are detected in the context of ingestion of these grains. If you can think of a better place, feel free to move it.

Your elaborate comments are much welcomed. Cheers. JFW | T@lk 23:26, 3 September 2006 (UTC)

2. I've found some supporting papers for the epidemiology section and I've included details of the US study that shows increased prevalence in certain groups. Ref 26 (currently) indicates that assumptions regarding the European focus may be wrong. Some recent studies may suggest it is vastly underreported in the Third World and also unfortunately much harder to treat.

3.I can't comment on whether you've missed something key, but it is all rather rapidly mentioned and lacks detail. From a brief search, there appears to be some history regarding whether there were two diseases (children and adults).

4. Any "banana babies" are now well over 50. It is likely this term was used in the popular press rather than medical books/papers. The Internet doesn't archive old newspapers, so it isn't surprising that Google found little. Here's a newspaper article that I managed to get from Google's cache: [3]

I know someone who was a "banana baby" and it is mentioned on forums in the US so the term seems to have been used on both sides of the Atlantic. Perhaps someone else can comment on whether they have heard this term, or regard it as worth mentioning.

6. A general reader may wish, for example, to learn how to prevent their child getting this disease. Currently, the info is buried in the Pathophysiology section, which is a word the general reader may not even understand. So there's not much that can be said with any certainty, but even that is "information" in a sense.

8. I see now where you get the figures. The huge range highlights the big difference in diagnosis rates from country to country. I think this area is worth expanding on and being explicit (rather than expecting the reader to do maths with percentages).

9. The word "workup" doesn't appear in any British English dictionary I could find. Some online US dictionaries indicate that it is medical jargon: "A thorough medical examination for diagnostic purposes". You've already mentioned the specific blood tests and endoscopy - this sub-section could be better titled "Additional tests" since it doesn't cover the whole "workup". So, in its current usage here, IMO the term is opaque and misleading.

10. Hmm. The section doesn't actually mention any symptoms. I think there is a case for a "Grains" section. This could include a discussion on the importance of certain grains in different population's diet and the changes from one grain to another (principally moving towards wheat) that are happening globally. There are references for this in some of the articles I've looked at. Writing such a section would require more work than I'm able/prepared to do at present.

Cheers, Colin°^Talk 13:45, 4 September 2006 (UTC)

3. In adults it was initially called idiopathic steatorrhoea. I'm not sure at what point they were attributed to the same problem.

4. I await further comment on the banana baby thing.

6. So we should duplicate information for this purpose?

8. The diagnosis rates are not that dissimilar, apart from the obvious Saharawi outliers (which Van Heel and West link to a possible protective effect, e.g. less bowel infections).

9. I'll replace that.

10. To make a level 2 section on "grains" breaks with the general WP:CLINMED outline for medical articles. It can be moved to "pathophysiology". I'm not sure if there is any merit into diverging into diets - it doesn't occur in populations with low prevalence of DQ2/DQ8. JFW | T@lk 16:41, 4 September 2006 (UTC)

FWIW, I've got about 3 or 4 patients who refer to themselves as "banana babies". I think its still in parlance, at least in Canada -- Samir धर्म 10:08, 8 September 2006 (UTC)

[edit] Intro

I've added a sentence to the intro, covering the approximate prevalence in Caucasian populations. I think that briefly establishing how common or rare a disease is, is an important point to get accross in the intro. It is all part of getting the reader's attention. I took this data from the conclusion in the vanHeelWest paper that forms the core reference for the article. I think their use of the word "Caucasian" gives a good indication of the population affected, which appears to include the Middle-East and India, as well as folk of European descent. If you know better, please change. Colin°^Talk 12:02, 5 September 2006 (UTC)

[edit] Medical manual of style

I've reviewed the WP:MEDMOS against this article. There are some (optional) sections that could be considered here. Here are just some suggestions for thought – there is no need to defend their current exclusion.

• Causes (or Etiology). The very technical aspects of the genetic changes and consequent reactions to gluten are covered in the Pathophysiology section. It is a complex subject and I have no problem with the expert-level language used here. It is, of course, quite opaque to the general reader. This topic is covered very briefly in plain-English in the (long) intro. Should that text get expanded, then this might be the section to create for it.
• Prognosis. The lifelong aspect of the disease is briefly stated in the intro. Can any more be said? The references mention some research on the long-term implications of undiagnosed coeliac disease.
• Prevention/Screening. I mentioned prevention earlier. Screening is currently covered as a subsection of Diagnosis.
• Social Impact. Currently there is "Social and religious issues", which is dominated by religious issues. Non-religious social aspects include the ease of implementing the GFD (e.g. no products in Third World countries, prescriptions), teenage non-compliance, getting medical insurance to pay for tests, etc. Perhaps the religious issues could be demoted to a sub-heading and probably abbreviated.
• External links. I thought these went at the end?

One purpose of having these sections is that the reader will come with the big questions: "What caused it", "What will happen to me/them", "How can I prevent it" – and currently they have to work hard to locate and understand their detailed answers. Creating a short section may be a trigger that encourages another editor to add more and ultimately produce a satisfying paragraph or so.

Other resources I've found:

• A non-copyright NIH article on celiac disease that could be a source of plain-English text, if appropriate.
• NIH Consensus Development Conference on Celiac Disease 2004

Colin°^Talk 12:58, 5 September 2006 (UTC)

[edit] External peer review

I've been brave and sent an email to Prof Paul Ciclitira, a gastroenterology professor at KCL in London who has an interest in coeliac disease and has written both the BSG guidelines and the AGA technical review (2001). He has asked one of his registrars to review the article. I'll post any comments over here. JFW | T@lk 16:41, 4 September 2006 (UTC)

Great idea- even better peer review. alteripse 22:11, 4 September 2006 (UTC)

[edit] Marsh classification

Can anyone find a free image of the Marsh classification? It would be an exceptional addition to the article's basic science content. -- Samir धर्म 10:05, 8 September 2006 (UTC)

Not seen much at all on various websites I've seen. Perhaps your local pathologist would be able to assist? JFW | T@lk 19:30, 12 September 2006 (UTC)

I asked WikipedianProlific, whose first draft looked very promising. -- Samir धर्म 07:52, 13 September 2006 (UTC)

[edit] Anti-gliadin antibody

Does anyone test this anymore? I haven't since I was a resident. The operating characteristics are abysmal. Is it still used in pediatrics? -- Samir धर्म 10:31, 8 September 2006 (UTC)

My hospital uses anti-endomysial. In my previous hospital I gave a talk about coeliac (which is the basis for my work on this article). At one point the cardiologist asked: "Do they still use ground-up monkey oesophaguses for that?" Turns out that anti-reticulin antibodies are indeed determined on tissue blocks from monkey oesophagus. Thankfully they're out of fashion (even more than anti-gliadin). JFW | T@lk 19:30, 12 September 2006 (UTC)

Not only monkey oesophagus, but human intestine and human umbilical cord are also used for that purpose. --WS 20:15, 12 September 2006 (UTC)

And tTG is sometimes purified from cavia livers (but also available as recombinant human tTG) :-). --WS 20:18, 12 September 2006 (UTC)

anti-endomysial antibodies are still useful in scientific work as the recent study of EMA-negative patients has revealed the presence or absense of different anti-tTG types can be used to subclassify tTG, see reference #24. As far as AGA is concerned, the disease appears to be mediated by DQ2/8 gliadin restricted T-cells, so that the importance of anti-gliadin is ambiguous. Other than this the page does not elucidate the fact that alpha and to a much lessor degree gamma gliadin are triggering agents, omega gliadins are involved in allergies that may be independent of CD, and glutinen is a factor in DQ8 restricted disease. Omega is a factor in Baker's allegy is and exercise induced anaphalaxis, some better wording of gliadin should be made. prd(10-2-2006)

You mean guinea pig? Don't mention the fact that early reagents for the prothrombin time were made from puréed human brain. Heh. JFW | T@lk 15:52, 21 September 2006 (UTC)

[edit] Celiac and esophageal webs

Classic teaching from textbooks (Sleisenger and Yamada both) is that celiac is associated with webs (both symptomatic and found incidentally) but I can't seem to find a reference in the literature. It's a (very) minor point, but thoughts? -- Samir धर्म 23:45, 13 September 2006 (UTC)

Never heard of it. Could it be spurious? JFW | T@lk 15:52, 21 September 2006 (UTC)

[edit] Images

The article looks fabulous as it is but just a couple more pretty pictures would make this perfect:

• We've got the Marsh classification image cooking
• Dermatitis herpetiformis would be a very neat image (as would IF of the IgA deposits -- that would be the money). I don't have a picture of one.
• I can try to find more small bowel endoscopy pictures but I don't think I have many (any?). I had a beautiful ulcerative jejunitis picture but haven't been able to find it for the past week
• The TTG picture? -- Samir धर्म 00:50, 14 September 2006 (UTC)
  • Didn't User:WikipedianProlific do a great job on Marsh's classification! -- Samir धर्म 11:52, 16 September 2006 (UTC)

I made a TTG picture for the tissue transglutaminase page. Will include it. JFW | T@lk 15:52, 21 September 2006 (UTC)

[edit] Sentence correct?

"While a role for carbohydrates had been suspected, the link with wheat was not made until 1950 by the Dutch paediatrician Dr Willem Dicke.[38]"

This is from the middle of the history section.

Yes, it is. There were several theories prior to Dicke's observation, but most of those involved nutritional carbohydrate content. JFW | T@lk 15:52, 21 September 2006 (UTC)

[edit] External review

As I stated above, I asked Prof Paul Ciclitira (Rayne Unit, London) for a proofreading. He delegated this to Dr Simon McLaughlin, one of his research registrars[4], who kindly went through the whole page and emailed me with the following comments (reproduced here with permission):

I have finally read through your coeliac article. I think this is very good. My only comments would be:

1. I don't like the term DMARDs used outside the context of rheumatology! It is best to use the term 'immunomodulator' or 'steriod sparing agent' for both Azathioprine and methotrexate. We have never used infliximab in non-responsive coeliac, this condition is rare and we have a paper which we are soon to submit looking at the Ix and Mx of over 100 cases referred to Prof C, most of these had an alternate diagnosis! The remainder have been treated with prednisolone and Azathioprine and this is the standard of care. To my knowledge infliximab has only been used in 1 or 2 case reports and I think should probably be classified as an experimental treatment, certainly this is not included in our current BSG guidelines (which are soon to be published).
2. re epidemiology I have copied the following text from the latest (unpublished) guidelines:

   Epidemiological studies in the UK have indicated the prevalence of coeliac disease to be between 0.5-1.0%. There are figures of the same order of magnitude in Caucasian populations worldwide including the USA, South America (2) and Australia. Coeliac disease appears to be uncommon in non-Caucasians but the prevalence is less well defined. There may be geographical sparing in regions that have a rice-based diet.

   From these studies, there is a clear gap between the estimated prevalence of coeliac disease in the general population and the number of people who have actually been diagnosed. This suggests that there is a large excess of undiagnosed individuals, possibly as many as 5-10 cases for each existing patient (3). In the US, with an expected prevalence of about 1%, the number of registered cases amounts to only about 1 in 1000 of the population (4).

3. I think the italian and English epidemiology figures are probably a bit out of date.

I hope this is helpful. Simon McLaughlin, Research fellow and Gastroenterology SpR

I will have another look at the epidemiology section, and was wondering what Samir's views were on the infliximab section. JFW | T@lk 15:52, 21 September 2006 (UTC)

Agreed that anti-TNF therapy for celiac is still investigational: PMID 15879720 PMID 11875014. -- Samir धर्म 00:24, 25 September 2006 (UTC)

The term DMARD is also rarely used in gastroenterology. I prefer immunomodulator myself -- Samir धर्म 00:26, 25 September 2006 (UTC)

[edit] FAC?

Time for another go? -- Samir धर्म 22:43, 25 October 2006 (UTC)

It's nearly ready, and a lot better than the previous FAC nomination, but there are still a few citations needed. --apers0n 07:21, 3 November 2006 (UTC)

No rush. I've seen perfectly good articles fail FA over trivialties. JFW | T@lk 16:12, 7 November 2006 (UTC)

Why not nominate it for GA status? Surely it will achieve that. Wikipediarules2221 00:34, 24 February 2007 (UTC)

[edit] Oats

PMID 17068278 suggests that oats, while clinically not much different, may still have the same long-term risks as other grains. Should be mentioned, uh? JFW | T@lk 16:12, 7 November 2006 (UTC)

(1) Celiacs who eat oats tend to have worse histology than those who do not. (2) We don't know the relevance of that entirely. It may confer higher long term risks -- Samir धर्म 01:15, 8 November 2006 (UTC)

December 22, 2006 I just started googling this disease - mom recently diagnosed and I have dermatitis herpetiformis. My question, which I've never (in previous researches) found an answer. Can someone that has dermatitis herpetiformis have it turn into coeliac disease? I currently don't eat gluten free, but I try to stay away from whole grain/wheat products. Most of the time I don't have any break outs/rashes whatever they are called, but I do have flare ups occassionally. But if I could be at risk for getting coeliac, then I may consider going gluten free. But it is such a drastic diet, I don't want to have to do that if I have what I have and that will be all I'll ever get. Any opinions about this? Thank you, Jennifer

Hi Jennifer, people who have dermatitis herpetiformis and a family history of celiac disease should probably have testing done for celiac disease -- Samir धर्म 23:47, 22 December 2006 (UTC)

[edit] JCI article

This month's JCI contains a large number of gastro-related reviews. Kaganoff has reviewed the immunopathology of coeliac. I will read the article over the weekend and incorporate any interesting material into the article. JFW | T@lk 23:33, 11 January 2007 (UTC)

[edit] Wegman's Disease?

Hello. I recently found out that a person who I was aware of (though had never actually gained an acquaintance with or spoke to) was diagnosed with what they called "Wegman's Disease", and briefly described it as an "autoimmune disease". I have since attempted to find out something regarding this disease, but to no avail. I did, however, see a few mentions of "Celiac disease" while googling it, and found it uncanny that Celiac (or Coeliac) disease is also an autoimmune disease. The symptoms described on this article could be applied to the individual I am thinking of (mainly FFT), but like I said I really didn't know the person. Can anyone shed some light on this? (And yes, I know there's a chain of supermarkets called Wegman's) Mattygabe 22:07, 20 February 2007 (UTC)

It gets 101 Google hits, few of which serious. It is not listed on Whonamedit[5]. Whatever it may have been, that doctor should use more useful terminology. JFW | T@lk 23:19, 6 March 2007 (UTC)

[edit] 1728

Coeliac passion - Ephraim Chambers in 1728. How striking. JFW | T@lk 02:17, 7 March 2007 (UTC)

[edit] Constipation

In the following sentence, the "and even constipation is seen" clause appears (to me, on my initial reading) to be a parenthetical remark but the sentence makes no sense without it. Instead, the final clause appears to give some indication of the frequency of constipation. So, could the sentence be rephrased or split?

However, the variety of gastrointestinal symptoms that may be present in patients with coeliac disease is great, and even constipation is seen, in some series comprising up to a third of patients.

The use of the medical jargon "series ... of patients" will be unfamiliar to the lay reader. Additionally, the reader may not appreciate the difference between the frequency in a patient group (esp. if being studied in a tertiary hospital that only gets the difficult cases) and the frequency in the whole coeliac population. If the latter really is as high as one third, then surely the "and even ..." is inappropriate since one third is pretty common. Finally, can you clarify if the patients with constipation also have diarrhoea (at different times, presumably), or is this instead of.

Colin°^Talk 14:25, 7 March 2007 (UTC)

I have no idea. I think the point is that one can have constipation but still be coeliac. I'll look into this. JFW | T@lk 01:07, 8 March 2007 (UTC)

[edit] Epidemiology

There's some unusual linking going on here, which is too subtle for the reader to guess take advantage of. Most readers will think those words just link to the appropriate continents/countries.

• Europe → HLA DR3-DQ2#DR2.5 is Nodal in Sardinia and Western Ireland
• African → HLA DR3-DQ2#DQ2.5 Spread Late in Human Evolution
• Japanese & Chinese → HLA DR3-DQ2#DQ3-DR2 East of the Urals

Saharawi is linked to Sahara rather than Saharawi – is there a reason for this?

The phrase "DQ a5ß2 isoform" (a "major susceptibility factor") will confuse the lay reader. The only clue that this is a genetic concept is probably that they will remember getting lost among all the DQs earlier in the Genetics section. This "a5ß2" terminology wasn't used then. The jargon "isoform" could be linked to protein isoform and probably also briefly explained here, or in the Genetics section.

Colin°^Talk 21:31, 7 March 2007 (UTC)

The whole section needs dumbing down. JFW | T@lk 01:07, 8 March 2007 (UTC)

[edit] Why UK-centric coeliac and not celiac?

1,100,000 Google hits for coeliac 3,000,000 Google hits for celiac

Yet, we've standardized on the rarer spelling. Why? (No, I'm not American.)

Remember, vital medical information is useful only if people read it, and Google searches don't do the translation automatically (yet.)

Ndaniels 20:57, 10 March 2007 (UTC)

Before I reply, please do not use news articles as sources. If there are academic cites, please use these preferentially. When citing academic work, please use the citation style employed in the remainder of the article.

Once a Wikipedia article has been composed in a particular spelling, it is well-precedented policy not to change that spelling. This policy (see WP:NC for pointers) is not really open for discussion here. JFW | T@lk 21:12, 10 March 2007 (UTC)

Oh, and Google will pick up the American spelling in the intro offered as the second alternative. JFW | T@lk 21:16, 10 March 2007 (UTC)

Ndaniels, If you look further up the talk page, you'll find two previous discussions on the name. One of these was a formal requested move, which was rejected. BTW: celiac will redirect here so folk searching by that name will still find it. Colin°^Talk 21:20, 10 March 2007 (UTC)

You've quite missed my point re the spelling - a host of people will look in Google for specific information and won't be redirected within the Wikipedia article that has the information. Not to be melodramatic, but again, over millions of queries this will result in at least some unnecessary deaths. I did look for the discussion, but no title seemed to match. Sorry to have missed that, but the problem remains, surely. Sometimes one has to mention issues with very significant consequences, even if one suspects others aren't going to agree quickly to remedy anything. Ethically, there's sometimes no other choice.

A Google search for "celiac disease" currently gives this article as the seventh hit; every hit before it is to reliable, non-commercial sources, such as the NIH and Celiac.org. Searches for "celiac treatment" or "celiac diagnosis" and other likely terms do not direct here, but neither do searches for the same terms with UK spelling. I think we can safely assume people searching on Google will either come here or go to an equally excellent resource. Fvasconcellos 21:44, 10 March 2007 (UTC)

You're right, at the moment Google prefers www.answering-christianity.com/breast_feeding.htm to Wikipedia for one complex query about coeliac disease that I tried. But this may not always be so.

I don't wish to be contentious, if the stakes weren't high I wouldn't be taking the pain of typing on about this, much less taking up anybody else's time. If everyone will always be safe, and always get the information they want without Wikipedia, none of us should be wasting a moment working here. We all believe we are helping to put information in front of people, and I suspect that's often true, and that Wikipedia is worthwhile, in practical terms, as more than a "cheat sheet". I'm not sure all policies and attitudes here reflect that, however, and where the stakes are high, feel obliged to mention it, although I badly want to slap up mlb.tv instead right now.

Pardon the scruples of someone who was BBSing before there was a web, but no more smileys to express disagreement, please (much less direct contradiction of another.) This is simply not proper etiquette, and hasn't been for maybe twenty years. Ndaniels 22:21, 10 March 2007 (UTC)

Smiley removed, and it was not meant as contradiction, simply as irony, and not towards your comment—towards my own, as many may not consider Wikipedia "equally excellent" when compared to more "official" resources. Fvasconcellos 22:26, 10 March 2007 (UTC)

If you disagree with the policy, please raise your points on Wikipedia talk:Naming conventions. Otherwise I think we can rely on the precendent of the previous move request :-). JFW | T@lk 22:27, 10 March 2007 (UTC)

Thanks, I'll do that. Note, however that the previous discussion did not mention the practical consequences, and seems to me to be a wholly separate argument on different, abstract and linguistic points, without significant overlap. :-) Ndaniels 22:46, 10 March 2007 (UTC)

That would apply, mutatis mutandis, to any other health- or safety-related article. JFW | T@lk 22:56, 10 March 2007 (UTC)

Well, here's hoping it would - why not do the greatest good, after all - and I've assumed everyone who reads the point will understand that adversus solem ne loquitor. Even so, there may be no sharper case than the most common genetic disorder which is also one of, if not the, most missed diagnosis, and very capable of causing death.Ndaniels 02:11, 11 March 2007 (UTC)

[edit] Dramatic increase in diagnosis, and possibly incidence, now omitted, as indicated

I've now omitted, after it was edited out:

Celiac is diagnosed 100 times more often than it was 50 years ago.^[1]

Since the only source I have is Paul G. Donahue, M.D. - he wasn't impugned, but he published in the wrong media for an editor here.

Note that here, too, underdiagnosis of this illness - the most common genetic disorder - is disabling and even killing very large numbers of people. Underlining the new knowledge of how threatening this illness is, to how many, would save lives. Keeping citations pristine by omitting facts with apparently lesser citations, has, I'm sorry to say, the opposite effect. It is always more comfortable to believe our actions have no, or few, consequences (the topic of "moral self-indulgence" within Philosophy). But we owe others a degree of reflection on the possible consequences to them, as well.

I'm sure no-one means harm, and that improving the quality of citations is a very worthy goal - but there are always trade-offs in life, and for medical articles in particular, consideration of this has to be part of the balance struck. Ndaniels 21:56, 10 March 2007 (UTC)

Without an academic cite, there's little we can do to support the point. A random reply by a physician is not, in my mind, a reliable source. It may be his personal experience. Your philosophical objections miss the point that this is meant to be a reliable article; without a solid source the reliability of the article suffers. JFW | T@lk 22:23, 10 March 2007 (UTC)

You've stated your reasons well - I'd be amazed if a M.D.'s syndicated column didn't have a fact checker, but you may be better informed. Not to cavil, but I do take issue with putative loss of life being called "a philosophical point"; surely that's the exact opposite of a philosophical point. An interesting reversal to make, though, if you'll pardon my saying so. Ndaniels 22:41, 10 March 2007 (UTC)

Is mentioning a statistic of diagnosis on the scale of "putative loss of life"? This is entirely rhetorical. As I stated, the M.D. in question may have been speaking from experience, and in a syndicated column would be forgiven for doing so. Unless a more reliable (read: academic) source is made available we should not be introducing this point into the article. JFW | T@lk 22:45, 10 March 2007 (UTC)

The whole point I'm trying to make is that, in this instance, knowing that your doctor is very unlikely to diagnose this common illness, or that you as a doctor are likely to overlook it; will surely cause second looks and result in more diagnoses and longer lives. This is logic, together with real consequences - in both ways the opposite, in common parlance, of "rhetoric." I used putative to mean something I have suggested, I did not mean to imply any general assumption; and withdraw that word if it has been taken amiss. But even with a mistake in my meaning, this isn't "rhetoric." I will grant that your invoking the dismissive term "rhetoric" is natural enough because it's threatening to all humans (myself included) to imagine that our decisions have dramatic consequences. But as every decent parent knows, it is nonetheless, and often sadly, so. I and everyone else finds at least one opportunity a day to deny just how much difference my choices may make to others, but this is a bad issue upon which to succumb to that tendency, I have suggested. If you follow Trivers on the unconscious, this kind of denial may be the very reason we all have unconscious minds; so it's unsurprising to encounter it more than once here today, given what I've suggested. However since the reasonable statistical guess is that multiple other people's lives probably do hang in the balance over the next decades, let's fight this natural human tendency.

On a smaller point: I personally doubt something as specific as "%15 after age 65" is a guess in the dark from personal experience, but why bring this up at all since I've already ceded to your judgment? It's harder for people to be a good losers if others won't be good winners and take the win. You guys are working me awfully hard today - harder than I personally prefer to work volunteers (even when I'm one myself, just at a higher level.) Typing is costly to me, I will soon install Dragon Naturally Speaking to reduce pain, but haven't yet. Less cavilling today and that might be onboard, now. Ndaniels 02:44, 11 March 2007 (UTC)

I think you are mistaken about the fact that doctors are "likely" to overlook it. Of course I'm not aware of your personal experiences, but as with any other illness there needs to be sufficient information for a doctor to take the step of suspecting the disease to be there. If the symptoms are too subtle, it is equally likely that there are other explanations. Most tiredness is caused by stress and poor sleeping and not by coeliac disease. I wouldn't screen for coeliac in someone complaining of tiredness without at least one more triggering piece of information (e.g. weight loss, anaemia). I think practicing doctors could be forgiven for using the same decision making process.

Screening is now much more common. In the U.K. practically every patient who develops iron deficiency anaemia is now tested for coeliac disease, as per the BSG guidelines. This is likely to yield quite a few cases, keeping in mind that anaemia is a very common finding (present in 60-80% of cases). JFW | T@lk 07:30, 11 March 2007 (UTC)

If most doctors are seeing dozens or hundreds of cases and diagnosing precisely zero, as the cited survey says, then "likely to overlook" is quite an understatement, statistically speaking. (I can't comment re tiredness, not sure how that came in.) HOWEVER I'm very much with you in not blaming doctors here for many reasons, not least that most patients with new symptoms of any kind don't obtain a specific diagnosis on one visit and never have, because life is extremely complex; and because coeliac may (may) be ballooning in incidence, etc. Not to mention that there may still be doctors out there whose practice began before it's discovery. Fifty years is not that long a time. (I rather wish it were possible to shoehorn that sentiment into the article.) But by the same token patients should be clearly warned when it might actually be dangerous to assume infallibility on the part of their physicians - or even adequate competence (re this one disease.) See my soon to be actual if unsatisfactory bio, but I can't claim personal experience with celiac, and don't know anyone with the illness (to my knowledge) for that matter. I'm just going by the studies I've encountered. No agenda.Ndaniels 21:58, 13 March 2007 (UTC)

[edit] Breastfeeding under "triggers"

Would it be reasonable to put at least a "see triggers" in the diet section? I can understand that a repetition of the breastfeeding meta-analysis is unwanted, but it seems a little odd to put breastfeeding under triggers since it has the reverse effect; and does not have that effect, so far as we know, because it reduces or is an antagonist for some trigger.

Given that this study suggests we could cut the (phenotype) numbers of the most common genetic illness roughly in half at a stroke with breastfeeding, it's probably important to put this in a place where it would be seen. However, I'm quite unsure where that would be, given that we now have sections that clearly overlap (at least, diet and triggers). I don't feel I have enough experience here to be rearranging sections, however, and may have created enough fuss for one day, anyway. :) Ndaniels 03:09, 11 March 2007 (UTC)

"Triggers" is probably the wrong name for that section. Who says the timing of gluten introduction is a trigger and not a risk modifier?

PLEASE start using full academic references rather than just an URL to the Pubmed page. You can see many examples in the page's other references. To automatically generate a good reference, here is a tool that will help you (just type the PMID into the applet). JFW | T@lk 07:30, 11 March 2007 (UTC)

Maybe a "Causes" section (Etiology being pretentious and unnecessarily obscure here) that could be subdivided into Environment which could be cleaved into "triggers" or "risk factors", etc? (Then further cleaved into Diet !? ... hmm, that doesn't sound altogether felicitous either.) I think "risk factor" would probably be understood by a tenth grade reader, but I'm not the one to ask.

As for refs, I definitely should have used brackets, not the ref tag, with the PMIDs, so the URLs would click through. My bad. Silly of me to assume they would click through, I suppose. However, I can't help thinking that maybe putting in an extra, indirect link to the true link rather defeats the whole purpose of the WWW: you know, direct hyperlinks and all that. PMIDs are permanent, so link loss isn't an issue. Looking properly (or just pretentiously) academic shouldn't get in the way of getting more information (including the abstract) to the interested reader, ASAP, surely? I don't know many people, even myself usually, who skip articles and just want to read the bibliography, but if they do, then I'm wrong. In any case, however sadly, volunteers do what they can do. I have the URLS I have, strict limits on the time I can spend and I know PMIDs are common in Wikipedia. So this may not change quickly, I'm sorry to say.Ndaniels 21:44, 13 March 2007 (UTC)

[edit] Large forehead sign

I don't think this "phenomenon" is established sufficiently to be included into this article: PMID 15919249. JFW | T@lk 07:36, 11 March 2007 (UTC)

I may disagree here. There are some quite recent truly bizarre (yet apparently solid) correlations between bone overgrowth (possibly due to mild comorbid collagen formation disorders?) or malformation and various chronic illnesses. The ghost of phrenology makes it psychologically uncomfortable to believe the evidence, but there it is. However, if you really want to be freaked out, try this BBC story Time changes modern human's face: "The scientists said the differences between past and present skull shapes were "striking"." [[6]]

I think it may be worth noting, but not emphasizing.

Included only for amusement, (feel free to delete) a quote from Darwin:

"That my mind became developed through my pursuits during the voyage is rendered probable by a remark made by my father, who was the most acute observer whom I ever saw, of a sceptical disposition, and far from being a believer in phrenology; for on first seeing me after the voyage, he turned round to my sisters, and exclaimed, "Why, the shape of his head is quite altered." "

PS, lemme know if it's bad form to tack this to someone else's comment.Ndaniels 22:15, 13 March 2007 (UTC)

[edit] Update for pathologists

PMID 17021129 looks like it's very recent and rather up-to-date on both the serology and the pathology. JFW | T@lk 07:45, 11 March 2007 (UTC)

[edit] Persistent villous atrophy

Persistent villous atrophy, even when asymptomatic, predisposes for refractory sprue and malignancy. JFW | T@lk 22:30, 19 March 2007 (UTC)

[edit] History

PMID 4595183. JFW | T@lk 00:54, 20 March 2007 (UTC)

Thanks. I'll take that and develop the history further. Colin°^Talk 14:33, 20 March 2007 (UTC)

I've added some more but didn't feel the need need to cite this article due to having both original papers available. Another article that may be useful is History of coeliac disease by S. Auricchio and R. Troncone but I don't have access. Colin°^Talk 13:59, 21 March 2007 (UTC)

Care to add to Samuel Gee as well? Fvasconcellos 14:34, 21 March 2007 (UTC)

Sure. JFW's paper will be useful there. Colin°^Talk 14:53, 21 March 2007 (UTC)

Done. Colin°^Talk 14:54, 23 March 2007 (UTC)

History of the Coeliac Condition Another source of pointers for research (lacks author/citations sadly). Colin°^Talk 16:23, 21 March 2007 (UTC)

Note PMID 4601230 is a Letter in response to PMID 4595183 above. It states that Matthew Baillie gave an earlier modern description in 1814. Baillie observes "some patients have appeared to derive considerable advantage from living almost entirely on rice". (Baillie M (1815), Observations on a Particular Species of Purging, Medical Transactions of the Royal College of Physicians, 5, 166.). Being just a letter, albeit in a respected journal, I'm not sure this counts as a reliable source for the citation. However, Google believes PMID 15124851 (online via Acta Paediatric) also contains a citation. I don't have access to that paper. Thoughts? Colin°^Talk 14:54, 23 March 2007 (UTC)

[edit] DM1

PubMed is down (!!!) so I'm linking some references here to look at later:

• PMID 11318836
• PMID 14618956
• PMID 9518950 (screening)

JFW | T@lk 15:53, 21 March 2007 (UTC)

[edit] Things not being mentioned at the moment

The link between cerebral calcifications and coeliac is quite well established. Perhaps it should be mentioned explicitly, rather than lumped with the other less specific neurological syndromes.

We should perhaps mention slightly abnormal LFTs and septal fibrosis/portal lymphocytic infiltration.

Older diagnostic modalities, such as the 3 day faecal fat estimation and the D-xylose–absorption test.

We don't quote a fairly recent NEJM review by Farrell & Kelly (2000) PMID 11796853. JFW | T@lk 23:24, 25 March 2007 (UTC)

[edit] Mortality

DOI:10.1111/j.1572-0241.2007.01111.x suggests that coeliac disease diagnosed in childhood has a 3x elevated mortality. Still low in absolute terms, but very high in relative ones. This somewhat undermines the hypothesis that "undiagnosed" coeliac disease can do life-threatening damage. I need to read the fulltext paper before working it into the "prognosis" section. JFW | T@lk 14:48, 1 April 2007 (UTC)

I just looked at the full text of this paper. If true, it is extremely important. They have good outcome data for a sizeable cohort of former children with early dx. Unfortunately, the validity hinges on the comparability of the matched population and the validity of the mortality stats for that population, and that is only sketchily described in the methods. Finally, even if true, the mechanism proposed ("risk taking" because of the psychological burden of the diagnosis) may not be the right link. For example, what is the parental separation rate after a child is diagnosed with celiac?-- it rises dramatically after the diagnosis of juvenile diabetes. What happens to the socioeconomic status of a family after diagnosis of celiac? Did lower social risk (i.e., better off, better educated) patients disproportionately move away from Lothian during the decades studied? I am just tossing out other possible explanations. This paper is either crucially important to the drive for early diagnosis of asymptomatic children (i.e., DON'T) or it is misleading crap. Not sure yet which. Different interpretation anyone? alteripse 22:32, 6 April 2007 (UTC)

[edit] Newer Testing procedures

I'd love to see some of our more qualified readers add a section on some of the newer popular testing procedures. The big name I hear on all the forums is entero labs and their fecal testing https://www.enterolab.com/Home.htm with some of their educational material located here https://www.enterolab.com/StaticPages/Frame_Resources.htm There's a lot of happy users but as far as I can tell Dr. Fine has yet to publish his methodology for peer review.

I'm by nature a skeptic and very much love peer reviewed quality research. Certainly no disrespect meant to the online celiac communities, they have helped me, but there seems to be alot of desperate people looking for answers and help. When a person who sees a naturopath says this test is accurate, my skeptic alarm is running full tilt and I'd really like to see what others more educated in medicine than myself think of his work. At the core I certainly agree that testing to arrive at a diagnosis before one reaches villous atrophy is very necessary. --johncm Unsigned by 75.129.206.98 (talk • contribs)

This webpage is very unhelpful. It does not readily explain how the test works, but it indicates that it is meant to replace small bowel biopsies! One needs very carefully designed studies to prove that claim. It worries me that this doctor is already starting an Intestinal Health Institute. Coeliac can be diagnosed before villous atrophy sets in - read the article. Serology is very sensitive, and picks up latent cases.

I worked a lot on this Wikipedia page to provide unbiased and readily available information for coeliac patients. When Dr Fine's test has been thoroughly evaluated and is ready for prime time we can debate whether it should be included in our article. JFW | T@lk 21:32, 7 April 2007 (UTC)