Better Diagnosing of Celiac and Crohn’s

Written by on November 3, 2011 in Features - No comments
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By Whitney L.J. Howell

If you’ve ever had a patient with unexplained abdominal distress, you’ve likely grappled with whether to assign a diagnosis of Celiac Disease or Crohn’s Disease. With their similar – and ambiguous – symptoms, pointing definitively to one of these conditions can be complicated. Treating them can be even harder.

In recent years, however, healthcare researchers have made significant advancements; giving you new tools to not only make disease identification easier, but also to offer additional therapies.

Celiac

Once thought to be a rare disease in the United States, Celiac Disease (CD) actually affects one out of every 133 Americans. In fact, debate has swirled in recent years about whether the incidence of the condition is rising. The healthcare industry can thank the advent of a simple blood test for making diagnosis easier and more accurate.

“The blood test is easy for both patient and provider,” says Sheila Crowe, M.D., a University of California-San Diego gastroenterologist and CD expert. “By identifying the antibody transglutaminase, the test helps physicians rule out other gastrointestinal problems and diagnose Celiac without putting the patient through a colonoscopy.”

The antibody test doesn’t diagnose CD, but it does pinpoint the patients with whom you should discuss a small bowel biopsy. An additional genetic test can identify if your patient has the HLA (human leukocyte antigen) DQ2/DQ8 genes needed for CD to develop. Since nearly one-third of people have these genes, their presence only detects who has a congenital predisposition for CD not who has the disease full blown.

Enhanced diagnosis techniques aren’t the only development fueling chatter about a spike in CD incidence, though, Crowe says. Research in 2009 from Joseph Murray, M.D., a gastroenterologist at the Mayo Clinic in Rochester, Minn., found CD is actually four times more common today than 50 years ago.

Murray studied stored blood samples collected from Army soldiers in the same barracks during World War II. Although it’s impossible to state definitively if the men had the disease, Murray’s team identified the CD marker present in all sufferers. This finding, Crowe says, points to one of two changes over generations: either the human diet has moved away from gluten-free grains, such as quinoa, to the high-gluten grains used to make bread, resulting a in poor body reaction, or the hygiene hypothesis is true.

“Our society has become so sterile that people aren’t exposed to pathogens. So, at least in Western societies, we’ve seen a rise in allergies,” she says. “We’ve changed the thermostat on how the body responds to infection, and when you change that balance, because there’s a lack of childhood illness, you see a jump in autoimmune disorders.”

Currently, the only treatment you can prescribe for your CD patients is a gluten-free diet – one that relies on fruits, vegetables, meats, and dairy. However, there is another therapy in the works that could alleviate the stress and worry associated with accidentally eating a small amount of gluten.

The oral medication known as Larazati completed its phase III clinical trials last year with promising results. Basically, the drug works much like pills designed for patients with lactose intolerance who wish to enjoy dairy products. When taken regularly, research findings show, Larazati strengthens the lining of the intestines to prevent gluten from infiltrating and harming the tissue. Trial results also indicated the pharmaceutical could potentially repair previous damage.

It’s unlikely Larazati will eliminate the need for a gluten-free diet, Crowe says, but it could ensure someone with the disease who accidentally eats gluten won’t experience a flare up of symptoms.

Crohn’s

As with CD, there are new diagnosis and treatment strategies available for Crohn’s that will help you identify which of your patients are living with the condition and how you can alleviate their symptoms. These advancements are particularly important because, historically, differentiating between Crohn’s and ulcerative colitis has been difficult.

Two new blood tests can help you diagnose the 10 percent to 15 percent of your patients who have “indeterminate colitis.” These tests search for the antibodies pANCA (perinuclear anti-neutrophil antibody) and ASCA (anti-Saccharomyces cervisiae). Patients with Crohn’s are more likely to have ASCA and not pANCA in their blood, and those with ulcerative colitis tend to have pANCA rather than ASCA. The test isn’t absolute, however, because some Crohn’s patients can only have the pANCA antibody.

In addition, many of your colleagues are also adding imaging tests to their diagnostic arsenal. Instead of relying on the standard barium test to pinpoint the source of abdominal pain, many providers are turning to CT and MRI scans to find out what’s going on in the small intestines, says Edward Loftus, M.D., a Mayo Clinic gastroenterologist and Crohn’s expert.

“A CT or MRI scan makes it a lot easier to know what’s going on,” Loftus says. “The scanning method can improve diagnosis and detection of problems with the bowel wall, fistula, and abscesses.”

CT scans can also help you rule out appendicitis, as well as guide you during abscess drainage.

Although MRI hasn’t been used widely with Crohn’s in the past, the healthcare industry is looking into whether MRI enteroclysis can be an effective alternative to conventional enteroclysis. So far, researchers have found MRI enteroclysis can catch possible disease outside the intestine, and it gives you better images where the bowel folds over itself.

When it comes to treatment, there’s one drug in the pipeline that could help Crohn’s sufferers control how the condition impacts their daily lives, Loftus says. Known as Vedolizumab, this medication is currently in phase III clinical trials and is designed to control the inflammation response without prompting the accompanying immunosuppression. In particular, the drug impacts alpha4beta7 integrin, the antibody that plays an active role in controlling intestinal inflammation. So far, clinical trial results have shown Vedolizumab blocks the inflammatory marker on white blood cells, stopping any inflammatory cells from moving into the intestinal wall.

Whitney Howell
is a seasoned reporter, writer, freelancer and public relations specialist with a master’s degree in international print journalism from The American University in Washington, D.C. She launched my journalism career as a stringer for UPI on Sept. 11, 2001, on Capitol Hill. That day led to a two-year stint as a daily political reporter in Montgomery County, Md. As a staff writer for the Association of American Medical Colleges, a public relations specialist for the Duke University Medical Center and the public relations director for the UNC-Chapel Hill School of Nursing, She’s earned in-depth experience in covering health care, including academic medicine, health care reform, women’s health, pediatrics, radiology, and Medicare.

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