Expert Postings, Oct - Dec 1997

Copyright by Michael Jones, Bill Elkus, Jim Lyles, and Lisa Lewis 1997 - All rights reserved worldwide.
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This file contains postings made by the following professionals: 
 
   Joseph Murray, M.D.--a gastroenterologist at the University of Iowa, 
   USA, where they have a mutidisciplinary service for the clinical care 
   of people with celiac disease.  They are also involved with clinical 
   research and medical education related to celiac disease. 
 

Date: Wed, 22 Oct 1997 13:28:34 -0500 From: Joseph Murray (Joseph-Murray@MAIL.INT-MED.UIOWA.EDU) Subject: re premenopausal osteoporosis Celiac patients of all ages are prone to bone density decreases. This may be due to osteoporosis or osteomalcia. The latter is caused by vitamin D deficiency. Most studies that have looked at the effect of a GFD on bone density have soon that the pemenopausal women do the best improvement of the bone density. This improvemnt may take 2-3 years. It is imporatant to rule out osteomalcia or hyperparathryoidism which can occur. In the younger patients often all that is needed is a 1200mg calcium diet and adequate vitamin D and appropriate weight bearing exercise. Drugs like fosamax have really not been tested in celiac patients at all. It has not been used to any great extent in premenopausal women either. This is not medical advice Joseph A Murray, MD Coordinator, Celiac Disease Clinic, Associate Professor of Medicine, Division of Gastroenterology/Hepatology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 ========================================================================= From: Joseph Murray (Joseph-Murray@MAIL.INT-MED.UIOWA.edu) Subject: identical twins and genetic risk for celiac disease The recent post on identical twin risk for celiac disease raises an important point on the gene(s) for celiac disease. Identical twins are genetically identical. They share all the same genes. If one has the gene(s) for a disease then the other has the same genes. The studies on the concordance of celiac disease between identical twins suggests that it is less than 100% , more like 70%. This tells us that the disease does have a strong base in genes, but something else is needed, some environmental factor to trigger the disease in a genetically susceptible host. On testing the gentically identical twin. As the risk for celiac disease so high (75%) in a seemingly unaffected twin a very careful search for it should be made and the blood tests alone may not be precise enough to rule it out entirely. There is also a possibility that the twin may not have the disease at this point but may develop it later in life and it may present differently from the other twin. The twin studies serve to illustrate the difference between a disease that is strictly genetic in it nature and one that has a genetic susceptibility. many people can have the genes but never get the disease. This is not medical advice Joseph Murray MD Coordinator, Celiac Disease Clinic University Of Iowa Iowa City IA 52242 ========================================================================= Date: Tue, 9 Dec 1997 09:15:15 -0600 From: Joseph Murray (Joseph-Murray@MAIL.INT-MED.UIOWA.EDU) Subject: re question I read your questions with interest. The questions you ask address what is really unknown in celiac disease research. The gliadin IgG is the least specific of all of the blood tests and least predictive of celiac disease if all of the others are negative. But some celiacs will have just that profile, especially if they have IgA def. That can be tested for by measuring the total IgA in the blood, A simple test that it may be possible to do on the residual serum already taken. If there is IgA def. then a biopsy should be done. If there is no IGA def, another approach is to obtain a skin biopsy for DH, this is less of a deal that an intestinal biopsy and if the correct staining and biopsy preparation is done then it can reliably identify intestinal gluten sensitivity if the patient has dermatitis herpetiformis. Seeking a precise diagnosis may be very important when dealing with these issues in the future. ? difference between gluten sensitivity and celiac disease. Celiac disease is defined by a combination of damage to the gut and a subsequent improvement with a gluten free diet. Gluten sensitivity ( separate from celiac disease) is not well defined and many people mean different things by it. This definition can vary from a typical allergy, hives, wheezing to defining it as a "mild form " of celiac disease. Celiac disease is a definite condition with a definite treatment. The other entities if they exist it is not clear what should be done about those. Not medical advice Joe Murray ========================================================================= Date: Fri, 12 Dec 1997 09:36:50 -0600 From: Joseph Murray (Joseph-Murray@MAIL.INT-MED.UIOWA.EDU) Subject: Less than 100% GFD I do not think it is standard practice to advocate less that a gluten free diet for celiac disease. Not reputable authority on the disease suggests that is a reasonable approach. The consequences of having some gluten in the diet in a celiac does leave them open to continued or new complications and continued ill health. The diet, while challenging, can be and is followed by the vast majority of adult patients that I seem with very rare problems. I myself have tried it for several weeks and it is achievable and I feel that physicians need to give positive encouragement to their patients to aim for that. If they suggest from the outset that the patient will fail then that may happen. Not Medical advice Joseph A Murray, MD Coordinator, Celiac Disease Clinic, Associate Professor of Medicine, Division of Gastroenterology/Hepatology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 =========================================================================
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