By Tamara Mathias
(Reuters Health) – When a family member has celiac disease, researchers at the Mayo Clinic recommend parents, siblings and children be tested as well, after a new study suggests first-degree relatives also have this condition – often without typical symptoms.
Celiac disease is an autoimmune disease that damages the small intestine when patients consume gluten, protein in wheat, barley and rye, and in any foods containing these grains or their by-products. The only treatment is a gluten-free diet.
A study published in Proe Clinic Proceedings found that 44% of close relatives who had blood tests for celiac disease turned out to be in the condition. Almost all have atypical symptoms or no symptoms.
Senior study author Dr. Imad Absa told Reuters Health that this percentage was higher than his team had expected.
But Dr. Ritu Verma, medical director at the University of Chicago's Celiac Disease Center, said the data confirms what he sees in the clinic.
In fact, in 2004, two of her own children were diagnosed with celiac disease. "One of them had the symptoms and the other ̵
Doctors are comfortable with the idea of testing symptomatic people for celiac disease, she added, "but asymptomatic – I think this is a surprise in terms of data."
Currently, guidelines state that when children are diagnosed with celiac disease, their family members should be tested, but when an adult is diagnosed, testing is only necessary for close relatives who show symptoms.
But Absah notes that in recent years, quite a number of patients have not been diagnosed with classic symptoms, which include weight loss and chronic diarrhea in adults or delayed growth in children.
When the small intestine is damaged in celiac disease, the body cannot absorb nutrients in food. "You eat, but you don't take advantage of what you eat because of damage to your small intestine," Absa explained.
If celiac disease remains undetected, patients run the risk of developing other conditions such as nutritional deficiency, anemia, osteoporosis and even lymphoma.
Absah and colleagues examined 104 patients with celiac disease, who have a total of 477 first-degree relatives. Of the 360 relatives who agreed to take the blood test, 160 were diagnosed with the disease at the median age of 32.
The diagnoses are usually confirmed by a biopsy of the small intestine.
Absah notes that blood tests are cheaper than genetic tests, which only indicate whether someone is at risk of developing the disease, not whether it actually is.
It recommends that children associated with celiac patients be screened every three to five years and more frequently if they develop symptoms.  Verma recommends annual screening until children reach puberty to make sure their growth is unaffected.
However, doctors advise against following a gluten-free diet simply because it is a diagnosed family member.
Dr. Peter Green, director of the Celiac Disease Center at Columbia University in New York, told Reuters Health diets low in gluten increased the risk of heart disease and type 2 diabetes, "possibly because of low intake of whole grains."
Absah said that gluten-free diets in undiagnosed patients can distort the results of screening. If you have been without gluten for a long time, blood tests and biopsies will not be reliable, he said.
Verma said the data is a good starting point for answering bigger questions, such as how often family members should
"I would like to see if those relatives who were not diagnosed with celiac disease in the study, develop the disease later in life, "she said.
"This study will encourage more studies to be done and hopefully increase support for more tests on asymptomatic people who often slip under the radar."
SOURCE: http://bit.ly/ 32ZGI2F Mayo Mayo Clinic Online August 22, 2019