Fratellone Medical Associates


Celiac disease occurs in about 1 % of people in  the population. WSE know these rates are increasing as the public is becoming aware. Studies indicate there is a true rise in the incidence rather than awareness I believe the awareness of methylation and those susceptible to environmental factors is a key The clinical manifestations are numerous. I have seen the worst symptoms and the minor symptoms in patients over the years. Some may range from cerebellar ataxia ( unbalance) to constipation to night sweats. There is no uniform array of manifestations

This awareness has been led by actress/author/activist Jennifer Esposito who published My Journey with Celiac Disease two years ago.

The diagnosis does require per conventional standards a presence of  villous atrophy on biopsy to the presence of tissue transglutaminase. There is a strict gluten free lifestyle that must be adhered to . I also see some persistent or recurrent symptoms.  There is a genetic component of the presence of variants of HLA class II genes – HLA DQA-1 and HLA DQA-2. More than 90 % of patients with celiac are DQ2 positive Others in the population do carry these genes so the physician must be aware of this.


Although there is gluten as a cause and these HLA genes–I believe that environmental factor s are equally important. Also the intestinal microbiome of a patient with HLA genes is a key factor. We need to look more at the intestinal microbiome than ever before. It is a new area for some doctors, but it must be discussed and treated.  The medical journal Lancet ( Volume 391, January 6, 2018 ) published excellent review of Celiac Disease

Until tomorrow…