Close relatives of celiac disease patients show gluten-sensitivity without celiac disease

By: Peter on April 25, 2011

It is becoming increasingly clear that there is a spectrum of gluten-sensitivity ranging from a mild response to full-blown celiac disease.  It is well known that close family members of people with celiac disease have a much higher risk of contracting the disease themselves .  A clinical study published this month has been able to uncover a form of gluten sensitivity in close relatives of celiac patients, even though these relatives lacked the classical celiac diagnostic traits .  The journal abstract describes a study of 22 family members of celiac patients who were genetically predisposed to celiac disease, but were diagnosed as negative for celiac.  Strikingly, a large fraction (68%) of these family members had intestinal symptoms in the presence of dietary gluten which were relieved on a gluten-free diet; in other words, they were gluten-sensitive.

Antibodies present in the intestine but not the blood

The presence of antibodies against tissue transglutaminase 2 in the blood is generally considered to be a prerequisite for a positive diagnosis of celiac disease .  The authors of this study developed a novel test which can detect the presence of the antibody in the cells from an intestinal biopsy.  About two thirds of the family members had anti-tranglutaminase in their tissue samples, and most of these individuals (87%) also had intestinal symptoms.  After shifting to a gluten-free diet, most of these people (87%) no longer had the transglutaminase antibody in a further tissue biopsy.  (As a “control” for this study, tissue samples from 12 healthy individuals were tested and found to be negative).

The future of celiac disease diagnosis

This work is still at the research stage, and it is too soon to tell whether it could lead to a routine diagnostic test for non-celiac gluten-sensitivity.  It will be interesting to see if any of these family members eventually go on to develop classical celiac disease; is this phenomenon an early precursor of full-blown celiac disease, or do they just have a mild form of gluten toxicity? Either way, this report will no doubt stimulate further discussion about the definition of celiac disease, and may also suggest that some individuals may need to go on a gluten-free diet even if they have not been diagnosed with celiac disease.

References:

Ref. 1:  Stratifying risk for celiac disease in a large at risk United States population by using HLA alleles. Clin Gastroenterol Hepatol 2009; 7:966-971 Pietzak, M., Scholfield, TC., et al.

Ref. 2: Cryptic genetic gluten intolerance revealed by intestinal antitransglutaminase antibodies and response to gluten-free diet Gut doi:10.1136/gut.2010.232900 Not, T., Ziberna, F., et al.

Ref. 3:  Celiac Disease Curr Opin Gastroenterol. 2010;26(2):116-122 Rubio-Tapia, A, Joseph A. Murray, JA