Stool Test for Celiac Disease
Celiac disease (coeliac disease, coeliac sprue or gluten allergy) is an autoimmune disorder of the small bowel that occurs in genetically predisposed individuals in all age groups after early infancy. Coeliac disease is caused by an abnormal reaction to gliadin, a gluten protein found in wheat, spelt, barley, rye and to a lesser amount in oats.
The breakdown of gluten is induced by the enzyme tissue transglutaminase, which binds to this substance. In some people who have a genetic disposition these gluten-transglutaminase complexes are recognised as foreign by the immune system. The immune system reacts by producing auto-immune antibodies against gluten, transglutaminase and these complexes as well as producing immune regulatory substances. Due to the antibodies against the transglutaminase this enzyme is blocked and cannot fulfil its natural functions, one of which is activating tissue growth factors. This leads to the atrophy of the gut mucosa. At the same time immune modulators like interleukines and cytokines are produced which fuel a constant inflammatory process in the mucosa. This exacerbates the damaging effect. Affected people suffer from malabsorption of nutrients leading to vitamin and mineral deficiencies, anaemia, osteoporosis and many other problems.The only effective treatment is a diet, lifelong in principle, from which gluten is absent. This usually results in improvement, or even disappearance, of the damage to the lining of the bowel. However, the damage will recur if gluten is re-introduced into the diet.
The condition is often diagnosed in childhood after weaning when cereals are introduced into the diet, although it can be diagnosed at any age. Symptoms may include diarrhoea, failure to thrive (in children), fatigue or even infertility but these may be absent. The symptoms can be subtle and the person may just feel unwell for no apparent reason for some time before the diagnosis is made.
The condition affects approximately 1 in 200 people in the European population, though it is significantly under diagnosed.
HOW DOES THE STOOL TEST WORK?
It is important to diagnose the coeliac disease in early stages to prevent long term damage. Usually a medical doctor will order a blood test and an endoscopy with a biopsy of the small bowel, an invasive and uncomfortable procedure which requires going into hospital. The Dr. Hauss Laboratory uses a method which was only developed in 1997 (Dietrich et al. 10097). From a simple stool sample this test can detect specific intestinal sIgAs against the enzyme tissue transglutaminase. This is more specific than the blood test for anti-gliadin antibodies, uninvasive, simple and cost effective. Only in case of a positive result a biopsy and an additional blood test is recommended to verify the diagnosis.
THE PATIENT/PRACTITIONER BENEFIT
- simple test to exclude coeliac disease with unclear and persistent symptoms
- uninvasive procedure
- cost effective
- easy monitoring of therapy success
The symptoms of coeliac disease can be very different. However, this list can give a guideline.
- Typical symptoms in adults
Chronic diarrhoea, tiredness, Weight loss, bloating, lack of iron or folic acid, menstruation irregularities, nausea and vomiting, abdominal bloating, cramps and pain, IBS symptoms.
- Typical symptoms in children
Chronic diarrhoea with bulky, nasty smelling and fatty stool, Constipation in 15% of all cases, dystrophia with lack of subcutaneous fat, bloated abdomen, symptoms of rickets through lack of vitamin D, infection susceptibility, reduced growth, anorexia and paleness, muscle wastage, lethargic and weepy behavior.
- Atypical symptoms in children and adults
Anaemia (iron therapy resistant), restricted growth, dermatitis mostly on elbows and knees (called dermatitis herpetiformis), bone disease, high amino-transferase (GOT, GPT), psychiatric problems, alopecia, mouth ulcers etc.(Holmes 1996; Barr and Graham 1998; Branski and Troncone 1998, modified)
Coeliac in diabetes mellitus patients
A high prevalence of coeliac disease is found in patients with diabetes (up to 20% in children, up to 5.6% in adults). Because the clinical symptoms are usually atypical we recommend screening all diabetes patients with a coealic stool test.
Infertility and abortion tendency
Different studies have found a connection between coeliac disease and a tendency to have spontaneous abortions. In a study with 2 control groups the abortion rate of women with coeliac disease was reduced significantly under a gluten free diet. (Ciacci et al. 1996).
Sample requirement for the BTS stool test
One single stool sample.
Important!!! The patient has to consume gluten for at least one week before the test. Otherwise no antibodies will be found.