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Fidissimus
Joined: 17 Mar 2006
Posts: 1455
Location: Portland, OR.
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 Posted: Tue May 01, 2007 11:08 pm Post subject: Rectal Challenge |
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I was reading Dangerous Grains by Braly & Hoggan they were talking about a Rectal Challenge as another form of testing for celiac. I hadn't heard of this from anyone until I read about it and was wondering if it had fallen out of favor with the medical community? Was anyone here dx'd this way or had this procedure done and what did you think of it - was it as accurate as Braly & Hoggan claim?
The reason I ask is my sis who went GF was thinking of getting tested now but she's been on the diet for a few months... She won't go back to eating gluten. Funny that. She ate (on purpose) a bite or two of something yummy and gluteny that she used to eat all the time and had a massive reaction that really shocked her... She kinda didn't *really* think she had a propensity for Celiac even though she feels better eating gluten free but now she's not so sure and is considering a test to check for CD. Oh! And on that note I've noticed my mom has started eating wheat free(ish) - though she won't give it up entirely because in her words, "it's too hard" and "well there's nothing really wrong with me anyway" and "I'm too old to change my ways".  But she's eating a lot less crap although now I can't keep her away from my GF Chocolate Chip Cookies because they don't make her feel "kinda icky" after she eats them, unlike the "regular" kind that my Dad buys for her. I hope she just eases into it until she doesn't even notice that she's gone 100% GF. 
| Quote: | It is a procedure that can be conducted in the doctor's office using plastic instruments, and clear, quantified results and be available in a matter of hours.
As the name suggests, it is a procedure that first involves taking a biopsy of the rectal mucosa. Then gluten slurry is placed into the biopsy site, followed by a second biopsy from the same area four or more hours later. Computer analysis of these tissue samples identifies immune reactions to gluten if they are present, thus leading to a diagnosis of celiac disease. While our description is somewhat oversimplified, the critical issue is that this test differentiates those whose immune systems are sensitized to gluten from those who do not react to it.
When the rectal challenge was first introduced in the late 1980's, it was not well received. The most common objections was that it identifies too many people as having celiac disease. Many authorities considered it impossible that so many people could have this disease.
Since that time, innovative blood-testing methods such as EMA tests and IgG, IgA and tTG ELISA tests have dramatically increased the rate at which celiac disease was diagnosed to the point where it is now found in about 1 percent of the general population when it is sought. In ELISA blood testing, a scanner is used to identify molecular complexes attacked by endomysium antibodies and can be used to gauge the reaction of a range of antibodies to gluten and to detect many food allergies. Therefore, the most common objection to the rectal challenge is therefore not a legitimate one, as shown by the growing use of blood tests.
The second most common statement of resistance to this test is the embarrassing nature of the entire procedure. The AGA, EMA and tTG ELISA tests are certainly more comfortable, convenient and less invasive. We can only acknowledge this criticism of the rectal challenge as valid and recognize that this will deter many from seeking this test. The EMA and tTG offer accurate, reproducible lab results but, when negative, do not completely rule out gluten sensitivity or celiac disease. For those individuals with stout hearts and a willingness to undergo this procedure, it can be very valuable.
RECTAL CHALLENGE ADVANTAGE
1. Unlike the intestinal biopsy, it identifies and immune reaction to gluten and only gluten
2. It costs much less than a biopsy.
3. It is a little more embarrassing but a lot less invasive than the biopsy.
4. It reduces the risk of error-related patch intestinal lesions.
5. It will not miss the milder cases of celiac disease that are missed by blood testing alone.
6. It will reliably identify celiac disease for a full six months after beginning a gluten-free diet, unlike any other test for celiac disease.
7. The biopsies are analyzed by means of a computer. This eliminates the risk of human error due to variations in perception from one person to the next, which is a problem in some types of blood tests, as seen in jejunal biopsies and EMA.
8. the results are reported in a single numerical form, so their interpretation is infinitely less subjective and lend themselves to standardization.
9. Patients can receive their test results much more rapidly, usually by the following day, although that will soon be overshadowed by the speed with which iTG test results can be made available.
10. There is a reduced risk of complications due to the test. Although they are extremely rare in jejunal biopsies, the risk is even smaller when taking a rectal biopsy, especially since only one day's procedure is necessary for a firm diagnosis. this added safety is especially important for infants, pregnant women, the elderly and the gravely ill. |
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Cheers!
Jenn
GF BD: Feb. 2001
Free of wheat, barley, rye, oats, rice, dairy, eggs, almonds, pineapple and brewers yeast.
http://graindamaged.blogspot.com/ |
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RD/LD
Joined: 13 Dec 2006
Posts: 88
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| Posted: Wed May 02, 2007 1:50 pm Post subject: |
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Yeah, I remember reading about that also and wondered..humm never heard of that one before, but then didn't think about it again until you brought it up here.
If you look in the back of the book where they list references by chapter (chapter 4) you'll see the research article he used.
Loft, D.E, Marsh, M.N., Sandle, G.I., Crowe, P.T, Garner, V., Gordon, D. and Baker, R. "Studies of intestinal lymphoid tissue. XII. Epithelial lymphocyte and mucosal responses to rectal gluten challenge in celiac sprue." Gastroenterology 1989 Jul; 97 (1):29-37 You'll notice one of the names looks highly familiar- Dr. M.N. Marsh. It's a very long article, it makes me wonder too why it isn't more commonly used.
I'm going to see if I can find a link to the article, it's old enough now that it should be available at no charge. I'll list it here if I can find it. Anyone here have access to Gastroenterology from a University or Hospital?
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Debra,
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RD/LD
Joined: 13 Dec 2006
Posts: 88
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| Posted: Wed May 02, 2007 2:12 pm Post subject: Abstract and link |
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Well, here's the abstract and a link to Gastoenterologist
Studies of intestinal lymphoid tissue. XII. Epithelial lymphocyte and mucosal responses to rectal gluten challenge in celiac sprue
FULL-TEXT PDF (1058 KB)
Duncan E. Loft abc2, Michael N. Marsh abc1, Geoffrey I. Sandle abc1, Peter T. Crowe abc, Victor Garner abc, Derek Gordon abc and Rosemary Baker abc
| Quote: | Received 8 June 1988; accepted 30 January 1989.
Abstract
The immunopathologic, structural, and functional changes within rectal mucosa of known celiac sprue subjects were quantitated during local challenge with a peptic-tryptic digest of gluten. In the celiac sprue patients challenged with 2 g of digest, major effects occurred in lamina propria, submucosa, and local microvasculature. The lamina propria swelling was biphasic, starting 1–2 h after challenge with widespread extravascular deposition of fibrinogen, indicative of increased microvascular permeability, receding by 24 h postchallenge. A rapid fall in mast cells together with granule discharge suggested their involvement in this response. The late-phase swelling (48–72 h) was preceded by a rapid influx of neutrophils and basophils, the latter showing evidence of degranulation beyond 72 h. Reestablishment of vessel lumina, a rise in mast cells, and loss of neutrophils indicated tapering of the inflammatory cellular cascade by 96 h. Lymphocytes, first seen to enter the lamina by 2 h postchallenge, increased progressively, thereby resulting in substantial infiltration between 36 and 96 h. A marked rise in epithelial lymphocytes, maximal at 6–8 h, waned by 24 h. Volumes of surface and crypt epithelium remained constant throughout. In another challenge series with 4 g of gluten digest, electrical potential difference across rectal mucosa decreased significantly 12 h postchallenge, but the associated decreases in net sodium and chloride absorptive fluxes were insignificant. It is concluded that rectal mucosa is sensitized to gluten in celiac sprue disease and thus offers a promising and convenient in vivo substrate for investigative and diagnostic purposes. |
No full text is available. To read the body of this article, please view the PDF online.
http://www.gastrojournal.org/article/PII001650858991411X/abstract
Jenn,
Do you think Dr. Marsh still considers this viable since tTg? Where dose Dr. Marsh practice?
another link to Challenging the gluten challenge: http://www.celiac.com/st_prod.html?p_prodid=1281
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Debra,
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Fidissimus
Joined: 17 Mar 2006
Posts: 1455
Location: Portland, OR.
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| Posted: Thu May 03, 2007 10:24 pm Post subject: |
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It would seem that Dr. Marsh resides in England. (Dr. M. N. Marsh, Department of Medicine, University of Medicine, and Hope Hospital, Eccles Old Road, Salford M6 8HD, England) By the way you have to sign up to read the full text .pdf of his article.
I don't know if it makes this form of testing less viable with being able to test for tTG now. I think anyone that's started down the GF path and wants a dx might still find the R.C. applicable.
And I always appreciate an article by Dr. Ron Hoggan. His writing style is pretty down to earth, clear and concise.
_________________
Cheers!
Jenn
GF BD: Feb. 2001
Free of wheat, barley, rye, oats, rice, dairy, eggs, almonds, pineapple and brewers yeast.
http://graindamaged.blogspot.com/ |
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