Helen Hauschild, RN, Farmington, MO
Lifeline, Summer 1992, Vol X, No 3, pp 1
Those of us with chronic illnesses benefit greatly from simple, inexpensive screening tools that lead to diagnosis and, in some cases, help to monitor the progress of treatment. Urine testing for sugar has now been available by Benedict's solution for more than fifty years and now Clinitest kits, Test Tape, and Diastix have furthered the recognition and control of diabetes. Blood pressure screenings have advanced the diagnosis of hypertension while the tuberculin skin test is standard for identifying those who need X-ray evaluation.
In the notes from the Third International Symposium on Celiac Disease held in 1977, work on a skin test to identify gluten intolerance was to be continued; apparently this proved to be a difficult task. The variety of screening methods currently available to us are as follows:
When this test was conducted with 50 healthy volunteers, 34 untreated celiac patients, 40 celiacs on a gluten-free diet, and 40 patients with other small intestine diseases, the untreated celiacs had higher H2 levels than the healthy controls and the treated celiacs, but not significantly higher than those patients with bacterial overgrowth. After treatment with a gluten-free diet, H2 levels fell to normal for celiacs. (Therefore this test has the advantage of being non-invasive and useful in monitoring treatment progress, but it is not specific for CD.)
When crude gliadin was substituted for alpha gliadin in the screening for IgA antibodies in the saliva of celiacs, the rate of both sensitivity and specificity was 100% in a study involving 31 untreated celiacs, 20 healthy subjects, 30 treated celiacs, and 39 disease controls. The ease of obtaining the specimen and the usefulness in monitoring the progress on a gluten-free diet makes this test appealing to the patient. The specimen of saliva is analyzed in much the same way as blood serum in the laboratory.
As early as 1970, there was a report of changes in the depth of the ridges of celiac children but the study was promptly discontinued by two other groups of researchers. Twenty years later, a paper from Israel states that 69% of celiac children (but only 28% of controls) were found to have four or more whorls (circular patterns) in their fingerprints while 44% of celiacs had four or less ulnar loops (loops facing the ulna, the bone on the thumb side of the wrist) as compared with 19% of controls. This interesting paper has limited screening value since a large number of celiacs do not have those dermatolglyphic markers.
Case studies concerning enamel defects in children with celiac disease had been reported, but no large scale studies were published until 1986. In an examination of the teeth of the teeth of 86 celiac children, 96% of those with permanent teeth were found to have enamel defects and 75% of their permanent teeth were affected as compared to 8% of the 150 controls. In two separate studies, 83% of adult celiacs were found to have dental enamel defects as compared with 4% of controls while 80% of dermatitis herpetiformis patients also had the typical defects associated with gluten intolerance. Overall, it appears that we may have had our most practical screening tool available all these years. We had to wait for an astute orthodontist to open our eyes and our mouths.
Dr. Lisa Aine gained interest in our dental problems because of her daughter's celiac classmate. After searching the literature for reports of enamel defects in other celiacs, she was inspired to choose this topic for her research and thesis. Her paper was published in the Finnish language along with an English abstract in the Proceedings of the Finnish Dental Society but we had been able to obtain the total work through the outreach program of the University of Missouri Dental Library in Kansas City. Hence, Dr. Aine's writings comprised a major source of our Celiac Sprue Awareness effort in 1989.
Updates of her work since that time were mailed out in March, 1992, to dental schools, state dental societies, and dental health officers of the various state health departments. We encourage each of or members to share the information from Lifeline concerning dental enamel defects with their own dentist. Contributing to the diagnosis of another celiac can be a special joy!
For the confirming diagnosis of celiac disease, the primary test remains the jejunal biopsy.
CSA Library Series is a collection of articles that pertain to celiac disease and dermatitis herpetiformis. Most of these articles have appeared in CSA’s quarterly newsletter, Lifeline, which all CSA members receive. Historic articles included in these resources may or may not include updated notes. Updated information indicated in red type. Articles represent the work of the author.