by Elena Meli
In the future, a new marker could help in the diagnosis of many who do not eat gluten on their own initiative; the tests to be performed, the checks for celiacs
Self-diagnosing a gluten intolerance is a frequent (bad) habit in our country, where it is estimated that around 12 percent of the population has eliminated gluten from their diet without having had a diagnosis of celiac disease from their doctor. In these cases, finding out if you really have celiac disease can become difficult, but a new marker could help distinguish patients who are truly gluten intolerant from those who are not.
Correct diagnosis
In fact, the diagnosis of celiac disease is possible with blood tests performed while eating a free diet, because being on a gluten-free diet could distort the results. Anti-transglutaminase antibodies (anti-tTG) of the IgA class must be measured together with total IgA: 2-5 percent of celiacs have an IgA deficiency, so it is important to evaluate them in relation to their total dosage. In those who are positive for this marker, an esophagogastroduodenoscopy is performed with a duodenal sample, which is then observed under the microscope: in celiacs the intestinal villi necessary for the absorption of nutrients are flattened, atrophic and there is an infiltration of lymphocytes in the mucosa indicative of a intense inflammation. Also in this case, a diet already purified of gluten complicates the evaluation of the test. For diagnostic confirmation, villous biopsy is essential in adults; in children with classic symptoms and high levels of auto-antibodies, the diagnosis can be made without an endoscopic examination, which is invasive and more difficult in children.
A marker to understand
To still be able to reach the diagnosis in cases in which gluten intake has been suspended, a group of Spanish researchers has identified a genetic marker, UBE2L3, whose expression measured in the blood seems to be indicative of celiac disease regardless of the consumption of gluten. The authors have patented the test, which however is not yet available in clinics: for this reason it is important that in case of suspicion of celiac disease an adequate diagnostic procedure, indicated by the doctor, is followed. Even once the diagnosis has been made, however, it is important to continue to monitor patients for the possible appearance of associated autoimmune diseases (such as type 1 diabetes, thyroiditis, psoriasis, more frequent in celiacs) and metabolic alterations, but also to diagnose as early as possible. possible complications, including intestinal lymphoma or adenocarcinoma of the small intestine, which are extremely rare but must be recognized promptly. After diagnosis, bone mass and thyroid function must also be periodically assessed.
November 4, 2023 (changed November 4, 2023 | 08:45)
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