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Cancer risk fears from 9/11 attack eased.

mune response and induce tissue damage. Most individuals with celiac disease experience remission after excluding gluten from their diet. “So we have a very effective treatment—gluten-free diet—but if physicians don’t recognize when to test for the disease, patients are going to suffer needlessly,” Elson said. A definitive diagnosis of celiac disease usually requires a combination of clinical findings and laboratory tests, which must be done while the patient is on a gluten-containing diet. The first step, said the consensus panel, is serological testing. The best tests are the antihuman tissue transglutaminase IgA and endomysial antibody immunofluorescence IgA, both of which seem to have equivalent diagnostic accuracy with high sensitivity and specificity, the panel said. Antigliadin antibody tests are no longer routinely recommended because of their lower sensitivity and specificity. The panel also noted, however, that serological testing for celiac disease may be less useful in young children because the disease’s antibodies may not be present. If patients have a positive serological test for celiac disease, then the next step is to obtain biopsy specimens of the proximal small bowel. Multiple biopsies should be obtained because the histological changes may be focal. Endoscopic evaluation without biopsy is inadequate to confirm or exclude a diagnosis. Positive serological testing and biopsy are enough for a presumptive diagnosis of celiac disease. Definitive diagnosis is then confirmed when symptoms resolve with a gluten-free diet, the panel said. The panel also alerted physicians to various populations that are at higher risk of having celiac disease. Among first-degree relatives of individuals with biopsy-proven celiac disease, the prevalence is between 4% and 12%. Second-degree relatives also appear to have increased risk, although the panel did not offer any percentages. Other individuals with elevated risk are those with type 1 diabetes mellitus (3% to 8% prevalence) and those with Down syndrome (5% to 12% prevalence). Celiac disease is also associated with Turner syndrome, Williams syndrome, selective IgA deficiency, and autoimmune disorders, the panel noted. For patients, the panel offered an acronym that underscores 6 elements essential to treating celiac disease once it is diagnosed: C Consultation with a skilled dietitian E Education about the disease L Lifelong adherence to a glutenfree diet I Identification and treatment of nutritional deficiencies A Access to an advocacy group C Continuous long-term follow-up The consensus statement is available online at http://consensus.nih.gov /cons/118/118cdc_intro.htm.