So, it turns out the "gold standard" biopsy isn't always so golden. Maybe we should rename it the "old standard"?
This is very good news for people that couldn't get a definitive diagnosis of celiac disease, but knew that gluten made them sick. Yes, back in the day you had to just trust your gut. [Sorry, but I couldn't resist.]
Also, this might make you think twice about cheating on the diet, even if you are "only" gluten sensitive.
Read the article:
MORTALITY IN CELIAC DISEASE, INTESTINAL INFLAMMATION, AND GLUTEN SENSITIVITY
Peter H. R. Green
JAMA. 2009;302(11):1225-1226 (doi:10.1001/jama.2009.1366)
Interesting that only an estimated 5% of cases of celiac disease have been diagnosed in the US.
My favorite part of this study was the last paragraph:
"Until recently, gluten sensitivity has received little attention in the traditional medical literature, although there is increasing evidence for its presence in patients with vari-
ous neurological disorders and psychiatric problems. The study by Ludvigsson and colleagues reinforces the importance of celiac disease as a diagnosis that should be sought by physicians. It also suggests that more attention should be given to the lesser degrees of intestinal inflammation and gluten sensitivity.
Another interesting point was that the incidence of celiac disease has increased 4 times in the last 50 years. This was concluded from stored serum samples, not from just the increase in current diagnosis.
I also liked this paragraph:
"Accompanying this increase in disease prevalence is a change in the clinical manifestations, so that the classic presentation of diarrhea and malabsorption syndrome is now less common than other presentations.The disease now manifests more often as a multisystem disorder. Anemia, osteoporosis, peripheral neuropathy or ataxia, irritable bowel syndrome, and dyspepsia are all possible presentations. Many patients are asymptomatic, with the disease detected by screening performed because of their presence in a high risk group such as being a family member or having an associated autoimmune disease, type 1 diabetes, or Down syndrome. Increasingly, those with autoimmune thyroid disease are also screened." [bold type added by me.]