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Medical student's apparent celiac disease responded to giardiasis treatment

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Re: Medical student's apparent celiac disease responded to giardiasis treatment

#61

Post by macobrien »

itronitron wrote: post #19

>> the person has symptoms provoked by gluten, but they don’t have evidence of celiac disease Sigh, it would be useful to know what specific tests for celiac were performed that came back inconclusive or even just stating what doctors consider to be definitive evidence of celiac disease.

When I was diagnosed back in the mid 00s, the tests were:

- A blood test for elevated levels of tTG-IgA antibodies, which are produced by the celiac autoimmune reaction. This has something like a 5% false negative and 10% false positive rate, so it's generally a strong indicator but doesn't totally confirm the diagnosis. - An EGD/biopsy of the small intestine. The lining of the small intestine is damaged by anti-tTG antibodies in a way that's recognizable under a microscope.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#62

Post by jancsika »

dcx wrote: post #13

Oh wow, I have the first half of this situation. I went through a period where my digestion was so bad that it was affecting my ability to function from day to day. I didn't get anything useful from my gastro; I even had a negative celiac antibody test. Eventually I started rigorously tracking everything I ate against my symptoms, and after a few months I was able to draw a strong correlation with gluten intake. From…

> I even had a negative celiac antibody test.

Note you can also check your genetic config.log to see if there was a -DALLOW_CELIAC flag in your source build.

Unfortunately your body's settings dialog is shit and does not show you whether or not that feature is set to on or off. But if you were built without that flag then you lack the code for the Celiac algorithm altogether and are good to go. (There may be other sensitivities to gluten, but at least nothing that corrupts your nutrient slurping event loop.)

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#63

Post by engineer_22 »

fl0id wrote: post #27
dcx wrote: post #13

Oh wow, I have the first half of this situation. I went through a period where my digestion was so bad that it was affecting my ability to function from day to day. I didn't get anything useful from my gastro; I even had a negative celiac antibody test. Eventually I started rigorously tracking everything I ate against my symptoms, and after a few months I was able to draw a strong correlation with gluten intake. From…

For testing: As the article says, find a doctor that has experience with it and ask for an antigen test. The below capacity thing can be very real, supposedly a different parasite in the us is responsible for people in southern us having the stereotype of lazy. In that case it could infect you through your feet from tainted soil. https://www.pbs.org/wgbh/nova/article/how-a-worm-gave-the-so...

It's true though, southerners aren't as productive as yanks.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#64

Post by nradov »

spease wrote: post #58
dcx wrote: post #30

Earlier quoted context omitted.

Thanks, I'm certainly going to try that. I was more asking if anyone has experience getting tests done properly in light of their low accuracy. From what I understand, an antigen test is still a stool test, meaning they are only 50% accurate. As a commenter on this post shared, managing the health system is challenging in this area. I just did a bit of googling, and found a couple of leads here: > CDC recommends coll…

> From what I understand, an antigen test is still a stool test, meaning they are only 50% accurate. “Accuracy” is too vague. You want to find out what the sensitivity and specificity are. https://ebn.bmj.com/content/23/1/2 For instance, a rapid covid test might have low sensitivity but high specificity. Meaning if it’s negative, you could still have the disease. But if it’s positive, you’re almost certainly sick. Ie…

Technically a "rapid covid test" only detects the presence of certain viral genetic material. This usually means the patient is or recently was infected with SARS-CoV-2 (the virus) but it doesn't indicate anything about whether the patient has COVID-19 (the disease). Many infections are asymptomatic and thus not medically classified as a disease state.

This distinction might seem pedantic but it's important to be precise when discussing medical issues.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#65

Post by ben7799 »

I'm wondering if the country he was living in doesn't do an endoscopy + biopsy when checking for celiac?

He should have come back negative on that.

My wife and son have Celiac, and I've been tested that way after an incident 15 years ago a lot like the patient in the article.

At the time the doctors were absolutely saying they wouldn't use a negative blood antibody test to determine a negative diagnosis, they wanted the biopsy.

I got tested for Giardia too. My symptoms started after a hiking/biking trip.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#67

Post by nightpool »

ben7799 wrote: post #65

I'm wondering if the country he was living in doesn't do an endoscopy + biopsy when checking for celiac? He should have come back negative on that. My wife and son have Celiac, and I've been tested that way after an incident 15 years ago a lot like the patient in the article. At the time the doctors were absolutely saying they wouldn't use a negative blood antibody test to determine a negative diagnosis, they wanted…

TFA: "But doctors never definitively diagnosed Johnson with celiac disease. His doctors wanted to do a biopsy to get a definite answer, but that would require eating gluten again, something Johnson wasn’t willing to chance"

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#68

Post by ben7799 »

itronitron wrote: post #19

>> the person has symptoms provoked by gluten, but they don’t have evidence of celiac disease Sigh, it would be useful to know what specific tests for celiac were performed that came back inconclusive or even just stating what doctors consider to be definitive evidence of celiac disease.

If you're in an area with excellent health care any GI doctor should be able to explain that the blood test can be conclusive for a positive but not for a negative.

If there is any question they should be doing an endoscopy and taking a biopsy of the small intestine. Celiac disease causes the body to destroy villi and they can see that under the microscope.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#69

Post by dustyventure »

jim-jim-jim wrote: post #26
Theodores wrote: post #18

Earlier quoted context omitted.

I am not sure what to make about the increasing amount of people with a real or an imagined gluten intolerance. By imagined, I mean someone that has a generally unhealthy diet, for them to not see the doctor, but decide for themselves that wheat is the enemy, rather than the garbage they have in their sandwich, in their burger or on their pizza. Bread is getting a bad name, yet whole civilisations have been founded o…

This is good general advice, but for as long as I've been an independent adult, I've cooked three fresh meals a day. Even with breakfast I usually do fish and rice instead of something quicker and easier. Like the individual in the OP story, I'm more inclined to suspect a specific undetected infection rather than a lack of dietary discipline. I just don't know how to explore this without having my sanity questioned.

Using a dish washer for all of that? I tend to question whether small amounts of dish washer detergent or SLS/etc in toothpaste might change us as environments for our bacteria and replacement bacteria. But that's also a tough area for rigorous scientific study.

Re: Medical student's apparent celiac disease responded to giardiasis treatment

#70

Post by IX-103 »

catlikesshrimp wrote: post #47
dcx wrote: post #30

Earlier quoted context omitted.

Thanks, I'm certainly going to try that. I was more asking if anyone has experience getting tests done properly in light of their low accuracy. From what I understand, an antigen test is still a stool test, meaning they are only 50% accurate. As a commenter on this post shared, managing the health system is challenging in this area. I just did a bit of googling, and found a couple of leads here: > CDC recommends coll…

Where I live, microbiologists work the diagnosis by examining stool through a microscope. Nowadays, though, doctors are lazy and just prescribe antiparasitaries without a diagnosis. I was taught to suspect worms only in children and immunicompromised adults. And I never found the exception.

Odd that you never found what you weren't looking for ...
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