501
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Impact of FODMAP Content Restrictions on the Quality of Diet for Patients with Celiac Disease on a Gluten-Free Diet. Nutrients 2019; 11:nu11092220. [PMID: 31540014 PMCID: PMC6770200 DOI: 10.3390/nu11092220] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022] Open
Abstract
Restrictive diets as gluten-free (GFD) or reduced in Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) are used to improve gastrointestinal (GI) symptoms in sensitive individuals. Aiming at comparing the nutritional quality and effects of a regular GFD regimen (R-GFD) and a low-FODMAP GFD (LF-GFD), in 46 celiac patients with persistent GI symptoms we conducted a randomized, double-blind intervention-controlled study. Patients received a personalized diet, either a strict GFD (n = 21) or a LF-GFD (n = 25) for 21 days. A validated food-frequency questionnaire before intervention and a 7-day weighed-food record after the intervention assessed the diets. Patients were 41.1 ± 10.1 years (mean ± SD), 94% women, with mean BMI 21.8 ± 2.9 kg/m2. On day 21, patients on R-GFD still showed poor nutritional adequacy compared to dietary recommendations, with decreased energy intake, even though an improvement in carbohydrates and folates was observed (all p < 0.025). In both groups, intake of iron, calcium, vitamin D, sodium and folates did not meet daily recommendations. As expected, consumption of legumes and grains was lower and that of fruits was higher in the LF-GFD group than in the R-GFD one (all p < 0.05). The nutritional quality of both diets was not different. When restrictive diets are useful to improve the persistent GI symptoms, careful nutritional surveillance and counseling is mandatory.
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502
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Rustgi S, Shewry P, Brouns F, Deleu LJ, Delcour JA. Wheat Seed Proteins: Factors Influencing Their Content, Composition, and Technological Properties, and Strategies to Reduce Adverse Reactions. Compr Rev Food Sci Food Saf 2019; 18:1751-1769. [PMID: 33336954 DOI: 10.1111/1541-4337.12493] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/16/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
Wheat is the primary source of nutrition for many, especially those living in developing countries, and wheat proteins are among the most widely consumed dietary proteins in the world. However, concerns about disorders related to the consumption of wheat and/or wheat gluten proteins have increased sharply in the last 20 years. This review focuses on wheat gluten proteins and amylase trypsin inhibitors, which are considered to be responsible for eliciting most of the intestinal and extraintestinal symptoms experienced by susceptible individuals. Although several approaches have been proposed to reduce the exposure to gluten or immunogenic peptides resulting from its digestion, none have proven sufficiently effective for general use in coeliac-safe diets. Potential approaches to manipulate the content, composition, and technological properties of wheat proteins are therefore discussed, as well as the effects of using gluten isolates in various food systems. Finally, some aspects of the use of gluten-free commodities are discussed.
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Affiliation(s)
- Sachin Rustgi
- Dept. of Plant and Environmental Sciences, School of Health Research, Clemson Univ. Pee Dee Research and Education Centre, Florence, SC, U.S.A.,Dept. of Crop and Soil Sciences, Washington State Univ., Pullman, WA, U.S.A
| | - Peter Shewry
- Rothamsted Research, Harpenden, Hertfordshire, U.K
| | - Fred Brouns
- Dept. of Human Biology, School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht Univ., Universiteitssingel 50, 6200, MD, Maastricht, the Netherlands
| | - Lomme J Deleu
- Laboratory of Food Chemistry and Biochemistry, Leuven Food Science and Nutrition Research Centre (LFoRCe), KU Leuven, Kasteelpark Arenberg 20, B-3001, Leuven, Belgium
| | - Jan A Delcour
- Laboratory of Food Chemistry and Biochemistry, Leuven Food Science and Nutrition Research Centre (LFoRCe), KU Leuven, Kasteelpark Arenberg 20, B-3001, Leuven, Belgium
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503
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Abenavoli L, Dastoli S, Bennardo L, Boccuto L, Passante M, Silvestri M, Proietti I, Potenza C, Luzza F, Nisticò SP. The Skin in Celiac Disease Patients: The Other Side of the Coin. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E578. [PMID: 31505858 PMCID: PMC6780714 DOI: 10.3390/medicina55090578] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/13/2019] [Accepted: 09/05/2019] [Indexed: 02/07/2023]
Abstract
Celiac disease (CD) is an autoimmune enteropathy that primarily affects the small intestine and is characterized by atrophy of intestinal villi. The manifestations of the disease improve following a gluten-free diet (GFD). CD is associated with various extra-intestinal diseases. Several skin manifestations are described in CD patients. The present paper reviews all CD-associated skin diseases reported in the literature and tries to analyze the pathogenic mechanisms possibly involved in these associations. Different hypotheses have been proposed to explain the possible mechanisms involved in every association between CD and cutaneous manifestations. An abnormal small intestinal permeability seems to be implicated in various dermatological manifestations. However, most of the associations between CD and cutaneous diseases is based on case reports and case series and a few controlled studies. To better assess the real involvement of the cutaneous district in CD patients, large multicentric controlled clinical trials are required.
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Affiliation(s)
- Ludovico Abenavoli
- Digestive Physiopathology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy.
| | - Stefano Dastoli
- Dermatology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy.
| | - Luigi Bennardo
- Dermatology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy.
| | - Luigi Boccuto
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, SC 29646, USA.
- Clemson University School of Health Research, Clemson University, Clemson, SC 29634, USA.
| | - Maria Passante
- Dermatology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy.
| | - Martina Silvestri
- Dermatology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy.
| | - Ilaria Proietti
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04110 Terracina, Italy.
| | - Concetta Potenza
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04110 Terracina, Italy.
| | - Francesco Luzza
- Digestive Physiopathology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy.
| | - Steven Paul Nisticò
- Dermatology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy.
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504
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Barros LL, Farias AQ, Rezaie A. Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment. World J Gastroenterol 2019; 25:4414-4426. [PMID: 31496621 PMCID: PMC6710178 DOI: 10.3748/wjg.v25.i31.4414] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/04/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBD), Crohn`s disease and ulcerative colitis, are chronic conditions associated with high morbidity and healthcare costs. The natural history of IBD is variable and marked by alternating periods of flare and remission. Even though the use of newer therapeutic targets has been associated with higher rates of mucosal healing, a great proportion of IBD patients remain symptomatic despite effective control of inflammation. These symptoms may include but not limited to abdominal pain, dyspepsia, diarrhea, urgency, fecal incontinence, constipation or bloating. In this setting, commonly there is an overlap with gastrointestinal (GI) motility and absorptive disorders. Early recognition of these conditions greatly improves patient care and may decrease the risk of mistreatment. Therefore, in this review we describe the prevalence, diagnosis and treatment of GI motility and absorptive disorders that commonly affect patients with IBD.
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Affiliation(s)
- Luísa Leite Barros
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | - Alberto Queiroz Farias
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | - Ali Rezaie
- Division of Gastroenterology, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
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505
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Serra D, Almeida LM, Dinis TCP. Polyphenols in the management of brain disorders: Modulation of the microbiota-gut-brain axis. ADVANCES IN FOOD AND NUTRITION RESEARCH 2019; 91:1-27. [PMID: 32035595 DOI: 10.1016/bs.afnr.2019.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The modulation of the microbiota-gut-brain axis with a view to preventing and treating brain disorders became recently a hot topic for the scientific community. Dietary polyphenols are multifaceted compounds that have demonstrated to be highly advantageous to counteract inflammation, oxidative stress, and neurodegeneration, among other pathological conditions, being useful in the prevention and treatment of several chronic disorders. The potential of these compounds to prevent and treat brain disorders has not been only related to their capacity to reach the brain, depending on their chemical structure, and interact directly with brain cells, but also to their ability to modulate the communication between the brain and the gut, interfering with multiple branches of this axis. Preclinical studies have demonstrated the potential of these food bioactive compounds in brain diseases, namely, neurodevelopmental, such as Down's syndrome and Autism spectrum disorder, neurodegenerative, such as Parkinson's disease and Alzheimer's disease, and psychiatric disorders, such as depression and anxiety. Until now, dietary polyphenols have been recognized as promising nutraceuticals to combat brain disorders. However, the impact of these compounds on the gut-brain interconnection remains poorly elucidated. Also, clinical assays are crucial to further support the beneficial effects of these compounds as demonstrated in preclinical research.
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Affiliation(s)
- Diana Serra
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
| | - Leonor M Almeida
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Teresa C P Dinis
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
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506
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Andrén Aronsson C, Lee HS, Hård af Segerstad EM, Uusitalo U, Yang J, Koletzko S, Liu E, Kurppa K, Bingley PJ, Toppari J, Ziegler AG, She JX, Hagopian WA, Rewers M, Akolkar B, Krischer JP, Virtanen SM, Norris JM, Agardh D. Association of Gluten Intake During the First 5 Years of Life With Incidence of Celiac Disease Autoimmunity and Celiac Disease Among Children at Increased Risk. JAMA 2019; 322:514-523. [PMID: 31408136 PMCID: PMC6692672 DOI: 10.1001/jama.2019.10329] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE High gluten intake during childhood may confer risk of celiac disease. OBJECTIVES To investigate if the amount of gluten intake is associated with celiac disease autoimmunity and celiac disease in genetically at-risk children. DESIGN, SETTING, AND PARTICIPANTS The participants in The Environmental Determinants of Diabetes in the Young (TEDDY), a prospective observational birth cohort study designed to identify environmental triggers of type 1 diabetes and celiac disease, were followed up at 6 clinical centers in Finland, Germany, Sweden, and the United States. Between 2004 and 2010, 8676 newborns carrying HLA antigen genotypes associated with type 1 diabetes and celiac disease were enrolled. Screening for celiac disease with tissue transglutaminase autoantibodies was performed annually in 6757 children from the age of 2 years. Data on gluten intake were available in 6605 children (98%) by September 30, 2017. EXPOSURES Gluten intake was estimated from 3-day food records collected at ages 6, 9, and 12 months and biannually thereafter until the age of 5 years. MAIN OUTCOMES AND MEASURES The primary outcome was celiac disease autoimmunity, defined as positive tissue transglutaminase autoantibodies found in 2 consecutive serum samples. The secondary outcome was celiac disease confirmed by intestinal biopsy or persistently high tissue transglutaminase autoantibody levels. RESULTS Of the 6605 children (49% females; median follow-up: 9.0 years [interquartile range, 8.0-10.0 years]), 1216 (18%) developed celiac disease autoimmunity and 447 (7%) developed celiac disease. The incidence for both outcomes peaked at the age of 2 to 3 years. Daily gluten intake was associated with higher risk of celiac disease autoimmunity for every 1-g/d increase in gluten consumption (hazard ratio [HR], 1.30 [95% CI, 1.22-1.38]; absolute risk by the age of 3 years if the reference amount of gluten was consumed, 28.1%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 34.2%; absolute risk difference, 6.1% [95% CI, 4.5%-7.7%]). Daily gluten intake was associated with higher risk of celiac disease for every 1-g/d increase in gluten consumption (HR, 1.50 [95% CI, 1.35-1.66]; absolute risk by age of 3 years if the reference amount of gluten was consumed, 20.7%; absolute risk if gluten intake was 1-g/d higher than the reference amount, 27.9%; absolute risk difference, 7.2% [95% CI, 6.1%-8.3%]). CONCLUSIONS AND RELEVANCE Higher gluten intake during the first 5 years of life was associated with increased risk of celiac disease autoimmunity and celiac disease among genetically predisposed children.
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Affiliation(s)
| | - Hye-Seung Lee
- Health Informatics Institute, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa
| | | | - Ulla Uusitalo
- Health Informatics Institute, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa
| | - Jimin Yang
- Health Informatics Institute, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa
| | - Sibylle Koletzko
- Dr von Hauner Children’s Hospital, Ludwig Maximilians University, Munich, Germany
- University of Warmia and Mazuri, Olsztyn, Poland
| | - Edwin Liu
- Digestive Health Institute, University of Colorado Denver, Children’s Hospital Colorado, Denver
| | - Kalle Kurppa
- Tampere Centre for Child Health Research, University of Tampere, Tampere University Hospital, Tampere, Finland
| | - Polly J. Bingley
- School of Clinical Sciences, University of Bristol, Bristol, England
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Anette G. Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes eV, Neuherberg, Germany
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, Georgia
| | | | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Jeffrey P. Krischer
- Health Informatics Institute, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa
| | - Suvi M. Virtanen
- National Institute for Health and Welfare, Department of Public Health Solutions, Helsinki, Finland
- Faculty of Social Sciences/Health Sciences, University of Tampere, Tampere, Finland
- Research Center for Child Health, Tampere University, University Hospital, Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Jill M. Norris
- Colorado School of Public Health, Department of Epidemiology, University of Colorado, Aurora
| | - Daniel Agardh
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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507
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Cabanillas B. Gluten-related disorders: Celiac disease, wheat allergy, and nonceliac gluten sensitivity. Crit Rev Food Sci Nutr 2019; 60:2606-2621. [PMID: 31402697 DOI: 10.1080/10408398.2019.1651689] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The consumption of gluten-free products is becoming an increased alimentary habit in the general population. The scientific unfounded perception suggesting that the avoidance of gluten would improve health or that gluten could be toxic for humans are fostering medically unjustified adherences to a gluten-free diet. Currently, only patients diagnosed with celiac disease are advised to follow a strict lifelong gluten-free diet. In the same way, patients diagnosed with IgE-mediated wheat allergy must avoid exposure to wheat in any form. In that context, a third disorder, called nonceliac gluten sensitivity, characterized by distress after gluten consumption and in which neither celiac disease nor IgE-mediated allergy plays a role, has gained increased attention in the last years. Although important scientific advances have been made in the understanding of the pathologic mechanisms behind nonceliac gluten sensitivity, this disorder is still a matter of active debate in the scientific community. In the present review, the most recent advances in the immunopathology, diagnostic biomarkers and susceptibility determinants of gluten-related diseases are summarized and discussed. Furthermore, an updated overview of the new potential therapies that are currently underway for the treatment of gluten-related disorders is also provided.
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Affiliation(s)
- Beatriz Cabanillas
- Department of Dermatology and Allergy, University of Bonn Medical Center, Bonn, Germany
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508
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Chevalier R. siRNA Targeting and Treatment of Gastrointestinal Diseases. Clin Transl Sci 2019; 12:573-585. [PMID: 31309709 PMCID: PMC6853152 DOI: 10.1111/cts.12668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/10/2019] [Indexed: 12/15/2022] Open
Abstract
RNA interference via small interfering RNA (siRNA) offers opportunities to precisely target genes that contribute to gastrointestinal (GI) pathologies, such as inflammatory bowel disease, celiac, and esophageal scarring. Delivering the siRNA to the GI tract proves challenging as the harsh environment of the intestines degrades the siRNA before it can reach its target or blocks its entry into its site of action in the cytoplasm. Additionally, the GI tract is large and disease is often localized to a specific site. This review discusses polymer and lipid‐based delivery systems for protection and targeting of siRNA therapies to the GI tract to treat local disease.
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Affiliation(s)
- Rachel Chevalier
- Children's Mercy Kansas City, Kansas City, Missouri, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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509
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Goel G, Tye-Din JA, Qiao SW, Russell AK, Mayassi T, Ciszewski C, Sarna VK, Wang S, Goldstein KE, Dzuris JL, Williams LJ, Xavier RJ, Lundin KEA, Jabri B, Sollid LM, Anderson RP. Cytokine release and gastrointestinal symptoms after gluten challenge in celiac disease. SCIENCE ADVANCES 2019; 5:eaaw7756. [PMID: 31457091 PMCID: PMC6685723 DOI: 10.1126/sciadv.aaw7756] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/28/2019] [Indexed: 05/10/2023]
Abstract
Celiac disease (CeD), caused by immune reactions to cereal gluten, is treated with gluten -elimination diets. Within hours of gluten exposure, either perorally or extraorally by intradermal injection, treated patients experience gastrointestinal symptoms. To test whether gluten exposure leads to systemic cytokine production time -related to symptoms, series of multiplex cytokine measurements were obtained in CeD patients after gluten challenge. Peptide injection elevated at least 15 plasma cytokines, with IL-2, IL-8, and IL-10 being most prominent (fold-change increase at 4 hours of 272, 11, and 1.2, respectively). IL-2 and IL-8 were the only cytokines elevated at 2 hours, preceding onset of symptoms. After gluten ingestion, IL-2 was the earliest and most prominent cytokine (15-fold change at 4 hours). Supported by studies of patient-derived gluten-specific T cell clones and primary lymphocytes, our observations indicate that gluten-specific CD4+ T cells are rapidly reactivated by antigen -exposure likely causing CeD-associated gastrointestinal symptoms.
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Affiliation(s)
- Gautam Goel
- Division of Gastroenterology and Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Jason A. Tye-Din
- Immunology Division, The Walter and Eliza Hall Institute, Parkville, VIC, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
- Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, VIC, Australia
- Centre for Food and Allergy Research, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Shuo-Wang Qiao
- Department of Immunology and KG Jebsen Coeliac Disease Research Centre, University of Oslo and Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Amy K. Russell
- Immunology Division, The Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Toufic Mayassi
- Department of Pediatrics, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Cezary Ciszewski
- Department of Pediatrics, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Vikas K. Sarna
- Department of Immunology and KG Jebsen Coeliac Disease Research Centre, University of Oslo and Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | | | | | | | | | - Ramnik J. Xavier
- Division of Gastroenterology and Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Knut E. A. Lundin
- Department of Gastroenterology and KG Jebsen Coeliac Disease Research Centre, University of Oslo and Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Bana Jabri
- Department of Pediatrics, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ludvig M. Sollid
- Department of Immunology and KG Jebsen Coeliac Disease Research Centre, University of Oslo and Oslo University Hospital-Rikshospitalet, Oslo, Norway
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510
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Green PHR, Guandalini S. When Is Celiac Disease Celiac Disease? Gastroenterology 2019; 157:293-294. [PMID: 31260660 DOI: 10.1053/j.gastro.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/07/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Peter H R Green
- Celiac Disease Center, Columbia University Medical Center, New York, New York.
| | - Stefano Guandalini
- Celiac Disease Center, University of Chicago, Chicago, Illinois; Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
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511
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Clerx EM, Silvester J, Leffler D, DeGroote M, Fishman LN. Sequence of acquisition of self-management skills to follow a gluten-free diet by adults with celiac disease. Dig Liver Dis 2019; 51:1096-1100. [PMID: 30872088 PMCID: PMC6682428 DOI: 10.1016/j.dld.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/27/2019] [Accepted: 02/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Celiac disease (CD) treatment is lifelong adherence to a gluten-free diet (GFD), requiring mastery of numerous skills to maintain health. AIMS To assess the rate of self-management skill acquisition following diagnosis, and the influence of demographic factors on this rate. METHODS Patients attending a celiac center were invited to complete an anonymous survey which reported demographic information and time for mastery of self-management skills relevant to CD. RESULTS Completed surveys were returned by 137 patients (79% female). Most participants reported mastering skills that involved identifying gluten-containing versus gluten-free foods within 6 months. Explaining CD and GFD to others required 1-2 years. Identifying gluten in medications and supplements required 3-5 years. Traveling internationally with GFD adherence required more than five years to learn. Demographic factors were not associated with the rate of acquisition. CONCLUSIONS This is the first description of a timeline for relevant skill acquisition following diagnosis for CD. A sequence emerges, with most patients learning skills relevant to home, then social settings, then the workplace, and, finally, unfamiliar settings. Awareness of this progression of mastery, and particular recognition of difficult skills will allow physicians and dietitians to provide CD patients with targeted education and resources to facilitate adherence.
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Affiliation(s)
- Emma M. Clerx
- Celiac Center, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston MA 02115,Harvard University, 86 Brattle Street, Cambridge MA 02138
| | - Jocelyn Silvester
- Celiac Center, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston MA 02115,Celiac Center, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA 02115,Division of Gastroenterology, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA 02115
| | - Daniel Leffler
- Celiac Center, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston MA 02115
| | - Maya DeGroote
- Celiac Center, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA 02115
| | - Laurie N. Fishman
- Division of Gastroenterology, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA 02115
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512
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Min F, You Y, Yu F, Yuan J, Mu P, Sang W, Han X, Wu Y, Gao J, Chen H. Assessment of the gluten toxicity of wheat and naan in Xinjiang Uyghur Autonomous Region, China. Int J Food Sci Technol 2019. [DOI: 10.1111/ijfs.14175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Fangfang Min
- State Key Laboratory of Food Science and Technology Nanchang University Nanchang 330047 China
- Sino‐German Joint Research Institute Nanchang University Nanchang 330047 China
- School of Food Science and Technology Nanchang University Nanchang 330031 China
| | - Yijiao You
- State Key Laboratory of Food Science and Technology Nanchang University Nanchang 330047 China
- Sino‐German Joint Research Institute Nanchang University Nanchang 330047 China
- School of Food Science and Technology Nanchang University Nanchang 330031 China
| | - Fenglian Yu
- State Key Laboratory of Food Science and Technology Nanchang University Nanchang 330047 China
- Sino‐German Joint Research Institute Nanchang University Nanchang 330047 China
- School of Food Science and Technology Nanchang University Nanchang 330031 China
| | - Juanli Yuan
- State Key Laboratory of Food Science and Technology Nanchang University Nanchang 330047 China
- School of Pharmacy Nanchang University Nanchang 330031 China
| | - Peiyuan Mu
- Institute of Crop Research Xinjiang Academy of Agricultural and Reclamation Sciences Shihezi 832000 China
| | - Wei Sang
- Institute of Crop Research Xinjiang Academy of Agricultural and Reclamation Sciences Shihezi 832000 China
| | - Xinnian Han
- Institute of Crop Research Xinjiang Academy of Agricultural and Reclamation Sciences Shihezi 832000 China
| | - Yong Wu
- State Key Laboratory of Food Science and Technology Nanchang University Nanchang 330047 China
- Sino‐German Joint Research Institute Nanchang University Nanchang 330047 China
| | - Jinyan Gao
- State Key Laboratory of Food Science and Technology Nanchang University Nanchang 330047 China
- School of Food Science and Technology Nanchang University Nanchang 330031 China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Technology Nanchang University Nanchang 330047 China
- Sino‐German Joint Research Institute Nanchang University Nanchang 330047 China
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513
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Abstract
Celiac disease (CD) is an immune-mediated gastrointestinal (GI) disorder driven by innate and adaptive immune responses to gluten. Presentation of CD has changed over time, with non-GI symptoms, such as anemia and osteoporosis, presenting more commonly. With improved screening and diagnostic methods, the reported prevalence of CD has increased globally, and there is considerable global variation in diagnostic and treatment practices. The objective of this study was to describe the current state of CD diagnosis and treatment patterns. A targeted review of literature from MEDLINE, Embase, the Cochrane Library, and screening of relevant conference abstracts was performed. The generally recommended diagnostic approach is GI endoscopy with small bowel biopsy; however, in selected patients, biopsy may be avoided and diagnosis based on positive serology and clinical symptoms. Diagnosis often is delayed; the average diagnostic delay after symptom onset is highly variable and can last up to 12 years. Barriers to accurate and timely diagnosis include atypical presentation, lack of physician awareness about current diagnostic criteria, misdiagnosis, and limited access to specialists. Currently, strict adherence to a gluten-free diet (GFD) is the only recommended treatment, which is not successful in all patients. Only one-third of patients are monitored regularly following diagnosis. Unmet needs for CD include improvements in the accuracy and timeliness of diagnosis, and the development of treatments for both refractory CD and GFD nonresponsive CD. Further research should investigate the impact of education about gluten-free eating and the availability of gluten-free foods support adherence and improve outcomes in patients with CD.
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514
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Abstract
PURPOSE OF REVIEW Celiac disease (CD) is an autoimmune enteropathy triggered by gluten. The purpose of this review is to examine the major genetic and environmental factors that contribute to CD pathogenesis. RECENT FINDINGS We reviewed the current state of knowledge on the genetic and environmental components that play a role in CD onset. A genome-wide association study (GWAS) analysis has highlighted several genes other than HLA involved in CD. Recent studies have shown that HLA haplotype influences the microbiome composition in infants and that dysbiosis in the intestinal microflora, in turn, contributes to loss of tolerance to gluten. Recently, observational studies have discussed the hypothesis stating that breast-feeding had a protective role against CD onset. CD etiology is influenced by genetic and environmental factors. A better understanding of these components would deepen our knowledge on the mechanisms that lead to loss of tolerance and could help in developing a more "personalized medicine."
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515
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Brouns F, van Rooy G, Shewry P, Rustgi S, Jonkers D. Adverse Reactions to Wheat or Wheat Components. Compr Rev Food Sci Food Saf 2019; 18:1437-1452. [PMID: 33336916 DOI: 10.1111/1541-4337.12475] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 02/06/2023]
Abstract
Wheat is an important staple food globally, providing a significant contribution to daily energy, fiber, and micronutrient intake. Observational evidence for health impacts of consuming more whole grains, among which wheat is a major contributor, points to significant risk reduction for diabetes, cardiovascular disease, and colon cancer. However, specific wheat components may also elicit adverse physical reactions in susceptible individuals such as celiac disease (CD) and wheat allergy (WA). Recently, broad coverage in the popular and social media has suggested that wheat consumption leads to a wide range of adverse health effects. This has motivated many consumers to avoid or reduce their consumption of foods that contain wheat/gluten, despite the absence of diagnosed CD or WA, raising questions about underlying mechanisms and possible nocebo effects. However, recent studies did show that some individuals may suffer from adverse reactions in absence of CD and WA. This condition is called non-celiac gluten sensitivity (NCGS) or non-celiac wheat sensitivity (NCWS). In addition to gluten, wheat and derived products contain many other components which may trigger symptoms, including inhibitors of α-amylase and trypsin (ATIs), lectins, and rapidly fermentable carbohydrates (FODMAPs). Furthermore, the way in which foods are being processed, such as the use of yeast or sourdough fermentation, fermentation time and baking conditions, may also affect the presence and bioactivity of these components. The present review systematically describes the characteristics of wheat-related intolerances, including their etiology, prevalence, the components responsible, diagnosis, and strategies to reduce adverse reactions.
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Affiliation(s)
- Fred Brouns
- Dept. of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht Univ., Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Gonny van Rooy
- Div. of Gastroenterology-Hepatology, Dept. of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht Univ. Medical Center, Maastricht, The Netherlands
| | - Peter Shewry
- Rothamsted Research, Harpenden, Hertfordshire, U.K
| | - Sachin Rustgi
- Dept. of Plant and Environmental Sciences, School of Health Research, Clemson Univ., Florence, SC, 29505, U.S.A.,Dept. of Crop & Soil Sciences, Washington State Univ., Pullman, WA, U.S.A
| | - Daisy Jonkers
- Div. of Gastroenterology-Hepatology, Dept. of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht Univ. Medical Center, Maastricht, The Netherlands
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516
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Kowalczewski PŁ, Walkowiak K, Masewicz Ł, Bartczak O, Lewandowicz J, Kubiak P, Baranowska HM. Gluten-Free Bread with Cricket Powder-Mechanical Properties and Molecular Water Dynamics in Dough and Ready Product. Foods 2019; 8:E240. [PMID: 31277294 PMCID: PMC6678567 DOI: 10.3390/foods8070240] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 01/16/2023] Open
Abstract
Published data indicate that cricket powder (CP) is a good source of not only protein, fat and fiber, but also minerals. Due to the fact that this product naturally does not contain gluten, it is an interesting addition to the enrichment of gluten-free foods. This paper is a report on the results of starch substitution with CP (at 2%, 6% and 10%) on the properties of dough and bread. The rheology of dough and the texture of the final product were studied. While the changes caused in the dough by the introduction of CP were not pronounced, the bread obtained from it was characterized by significantly increased hardness and improved consistency. Analyses of water behavior at the molecular level with the use of 1H Nuclear Magnetic Resonance (NMR) indicated that CP altered both the bound and bulk water fractions. Moreover, examination of water activity revealed a decreased rate of water transport in samples of bread that contained CP. These results indicate improved availability of water to the biopolymers of bread, which likely plays a role in shaping the textural properties of the product.
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Affiliation(s)
| | - Katarzyna Walkowiak
- Department of Physics and Biophysics, Poznań University of Life Sciences, 60-637 Poznań, Poland
| | - Łukasz Masewicz
- Department of Physics and Biophysics, Poznań University of Life Sciences, 60-637 Poznań, Poland
| | - Olga Bartczak
- Students' Scientific Club of Food Technologists, Poznań University of Life Sciences, 60-624 Poznań, Poland
| | - Jacek Lewandowicz
- Chair of Production Engineering and Logistics, Poznan University of Technology, 60-965 Poznań, Poland
| | - Piotr Kubiak
- Department of Biotechnology and Food Microbiology, Poznań University of Life Sciences, 60-627 Poznań, Poland
| | - Hanna Maria Baranowska
- Department of Physics and Biophysics, Poznań University of Life Sciences, 60-637 Poznań, Poland
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517
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Micronutrients Dietary Supplementation Advices for Celiac Patients on Long-Term Gluten-Free Diet with Good Compliance: A Review. ACTA ACUST UNITED AC 2019; 55:medicina55070337. [PMID: 31277328 PMCID: PMC6681258 DOI: 10.3390/medicina55070337] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022]
Abstract
Background and objective: Often micronutrient deficiencies cannot be detected when patient is already following a long-term gluten-free diet with good compliance (LTGFDWGC). The aim of this narrative review is to evaluate the most recent literature that considers blood micronutrient deficiencies in LTGFDWGC subjects, in order to prepare dietary supplementation advice (DSA). Materials and methods: A research strategy was planned on PubMed by defining the following keywords: celiac disease, vitamin B12, iron, folic acid, and vitamin D. Results: This review included 73 studies. The few studies on micronutrient circulating levels in long-term gluten-free diet (LTGFD) patients over 2 years with good compliance demonstrated that deficiency was detected in up to: 30% of subjects for vitamin B12 (DSA: 1000 mcg/day until level is normal, then 500 mcg), 40% for iron (325 mg/day), 20% for folic acid (1 mg/day for 3 months, followed by 400–800 mcg/day), 25% for vitamin D (1000 UI/day or more-based serum level or 50,000 UI/week if level is <20 ng/mL), 40% for zinc (25–40 mg/day), 3.6% of children for calcium (1000–1500 mg/day), 20% for magnesium (200–300 mg/day); no data is available in adults for magnesium. Conclusions: If integration with diet is not enough, starting with supplements may be the correct way, after evaluating the initial blood level to determine the right dosage of supplementation.
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518
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Hanci O, Jeanes YM. Are gluten-free food staples accessible to all patients with coeliac disease? Frontline Gastroenterol 2019; 10:222-228. [PMID: 31281622 PMCID: PMC6583765 DOI: 10.1136/flgastro-2018-101088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/14/2018] [Accepted: 09/23/2018] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Within England the removal of prescribed gluten-free (GF) foods from many Clinical Commissioning Groups has resulted in a greater reliance on commercially available GF food by adults and children with coeliac disease (CD). High cost and limited availability of GF foods are associated with poorer dietary adherence in people with CD. AIM To assess if the rise in popularity of GF diets globally has improved the cost or availability of cereal-based GF foods over the past 6 years. DESIGN Observational study where data were collected on cereal-based GF foods from 50 stores and 10 internet retailers. The number of GF foods within each food category and the cost per 100 g of GF and gluten-containing (GC) foods were compared by store type. RESULTS GF food availability has increased in premium stores and online. The majority (82%) of GF food categories were significantly more expensive online compared with regular supermarkets. On average, GF breads were 400% more expensive compared with GC breads (p<0.001); no narrowing in cost difference over time observed. Convenience stores did not stock any GF bread nor GF pasta and only one of the budget supermarkets stocked them, similar to data reported 6 years ago. CONCLUSIONS GF food availability has increased, predominately in premium markets. The GF food desert within convenience and budget stores will continue to disproportionately impact poor socioeconomic cohorts, the elderly and physically disabled. A lack of accessibility to GF foods impacts GF dietary adherence, increasing related comorbidities and healthcare costs.
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Affiliation(s)
- Ozan Hanci
- Department of Paediatrics, Royal Surrey County Hospital, Guildford, UK
| | - Yvonne M Jeanes
- Department of Life Sciences, Health Sciences Research Centre, University of Roehampton, London, UK
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519
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Lerner BA, Green PHR, Lebwohl B. Going Against the Grains: Gluten-Free Diets in Patients Without Celiac Disease-Worthwhile or Not? Dig Dis Sci 2019; 64:1740-1747. [PMID: 31102129 DOI: 10.1007/s10620-019-05663-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
While the gluten-free diet (GFD) is the only known effective therapy for celiac disease, in recent years it has become increasingly popular in the USA and worldwide, with many believing it to be more "healthful" and others claiming that it has beneficial effects for health conditions, many extraintestinal, other than celiac disease. This review examines the evidence for use of the GFD in patients without celiac disease who self-report intestinal and/or extraintestinal symptoms (non-celiac gluten sensitivity), as well as for enhancement of athletic performance and treatment of autism, rheumatoid arthritis, and psychiatric disorders. Overall, the evidence for use of GFDs in conditions other than celiac disease is poor. Though non-celiac gluten sensitivity may ultimately emerge as a biomarker-defined condition, a large proportion of patients with apparent non-celiac gluten sensitivity have, after careful investigation, an alternative diagnosis. In light of this, and coupled with the potential physical and psychological harms associated with the avoidance of gluten, initiating a GFD should not be encouraged for people who have these other conditions or are seeking physical/athletic enhancement.
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Affiliation(s)
- Benjamin A Lerner
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, 10032, USA
| | - Peter H R Green
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, 10032, USA
| | - Benjamin Lebwohl
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, 10032, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, 10032, USA.
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520
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Chamani E, Sargolzaei J, Tavakoli T, Rezaei Z. microRNAs: Novel Markers in Diagnostics and Therapeutics of Celiac Disease. DNA Cell Biol 2019; 38:708-717. [DOI: 10.1089/dna.2018.4561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Elham Chamani
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
- Department of Biochemistry, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Javad Sargolzaei
- Department of Biology, Faculty of Sciences, Arak University, Arak, Iran
| | - Tahmineh Tavakoli
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
- Gastroenterology Section, Department of Internal Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Zohreh Rezaei
- Department of Biology, University of Sistan and Baluchestan, Zahedan, Iran
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521
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Hamshaw RJT, Barnett J, Gavin J, Lucas JS. Perceptions of Food Hypersensitivity Expertise on Social Media: Qualitative Study. Interact J Med Res 2019; 8:e10812. [PMID: 31254334 PMCID: PMC6625221 DOI: 10.2196/10812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 03/31/2019] [Accepted: 03/31/2019] [Indexed: 12/21/2022] Open
Abstract
Background Seeking and sharing information are the primary uses of the internet and social media. It is therefore vital to understand the processes individuals go through when engaging with information on these diverse platforms, especially in areas such as health- and risk-related information. One important element of such engagement is evaluating and attributing expertise to others. Objective This study aimed to explore how meanings around expertise in relation to food allergy and intolerance (food hypersensitivity) were constructed by 2 groups of social media users: (1) those who use platforms for reasons relating to food hypersensitivity and (2) those seen as experts by this community. Methods Survey participants were asked open-ended questions to identify potential experts in food hypersensitivity issues on social media and to discuss their reasoning for their choices (n=143). Subsequently, 8 adult social media users with experience of managing food hypersensitivity and 5 participants designated as experts by those users took part in email interviews. Survey and interview data were analyzed thematically using Braun and Clarke’s approach. Results Judging expertise on social media is a complex and multifaceted process. Users might be judged as experts through their professional background or their experience living with food hypersensitivities. How users behave on social media and the traces of their Web-based activity can influence how others will see them. Such considerations are both measured and moderated through the social media community itself. Findings highlighted how social media often act as a supportive information tool following a diagnosis, but this also raised concerns regarding the scenario of patients not being able to access suitable vetted information. Conclusions This work has implications for understanding how users perceive expertise on social media in relation to a health concern and how information assessments are made during the management of risks. Findings provide practical insights to both medical and organizational stakeholders involved in the support of those living with life-changing conditions, such as food hypersensitivities.
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Affiliation(s)
| | - Julie Barnett
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Jeff Gavin
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Jane S Lucas
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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522
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Malamut G, Cording S, Cerf-Bensussan N. Recent advances in celiac disease and refractory celiac disease. F1000Res 2019; 8:F1000 Faculty Rev-969. [PMID: 31297187 PMCID: PMC6600866 DOI: 10.12688/f1000research.18701.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 12/21/2022] Open
Abstract
Celiac disease (CeD), defined as gluten-induced enteropathy, is a frequent and largely underdiagnosed disease. Diagnosis relies on the detection of highly specific serum IgA anti-transglutaminase auto-antibodies and on the demonstration of duodenal villous atrophy. Treatment necessitates a strict gluten-free diet, which resolves symptoms and enables histological recovery. However, regular follow-up is necessary to assess mucosal healing, which emerges as an important prognostic factor. Recent work on CeD pathogenesis has highlighted how the cross-talk between gluten-specific CD4 + T cells and interleukin-15 can activate cytotoxic intraepithelial lymphocytes and trigger epithelial lesions. Moreover, acquisition by a subset of intraepithelial lymphocytes of somatic gain-of-function mutations in the JAK-STAT pathway was shown to be a decisive step in the progression toward lymphomas complicating CeD, thus opening new therapeutic perspectives for these rare but life-threatening complications.
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Affiliation(s)
- Georgia Malamut
- Gastroenterology, Hôpital Cochin APHP, Paris, France
- Université Paris Descartes, Paris, France
- Inserm, UMR1163 and Institut Imagine, Laboratory Intestinal Immunity, Paris, France
| | - Sascha Cording
- Université Paris Descartes, Paris, France
- Inserm, UMR1163 and Institut Imagine, Laboratory Intestinal Immunity, Paris, France
| | - Nadine Cerf-Bensussan
- Université Paris Descartes, Paris, France
- Inserm, UMR1163 and Institut Imagine, Laboratory Intestinal Immunity, Paris, France
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523
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Gluten-free diet in French adults without coeliac disease: sociodemographic characteristics, motives and dietary profile. Br J Nutr 2019; 122:231-239. [DOI: 10.1017/s0007114519001053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AbstractThe number of people avoiding gluten is growing in many Western countries. However, little information is available on their sociodemographic and dietary profiles. We aimed to describe sociodemographic, behavioural and dietary profiles of participants avoiding gluten in the NutriNet-Santé cohort. Participants of the NutriNet-Santé cohort – excluding coeliac patients – who completed a questionnaire about food exclusions, with complete data on sociodemographic characteristics and dietary intake were included (n 20 456). Food group consumptions and nutrient intakes according to self-reported avoidance of gluten were estimated using ANCOVA adjusted for age, sex and daily energy intake. Based on principal component analysis, three dietary patterns (DP) were identified. Association between DP and avoidance of gluten was investigated using multivariate logistic regression. All data were weighted on the French census. A total of 10·31 (95 % CI 9·90, 10·73) % of the participants declared avoiding gluten, of which 1·65 % totally. They were more likely to be women, older persons, non-smokers, to have a lower educational level and declared more food intolerances. They had higher consumption of fruit, vegetables and lower consumption of dairy products, salty/sweet and fatty foods and alcohol. After adjustments on confounders, a healthy dietary pattern was positively associated with total gluten avoidance (ORQuintile5vsQuintile1 = 14·44, 95 % CI 8·62, 24·19). Our study highlighted that, in this population, individuals who avoid gluten from their diet tend to have a diet more favourable to health. These results can serve as a basis for future studies investigating the potential consequences of a gluten-free diet in non-coeliac population.
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524
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Dias R, Brás NF, Pérez-Gregorio M, Fernandes I, Mateus N, Freitas V. A multi-spectroscopic study on the interaction of food polyphenols with a bioactive gluten peptide: From chemistry to biological implications. Food Chem 2019; 299:125051. [PMID: 31284245 DOI: 10.1016/j.foodchem.2019.125051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/10/2019] [Accepted: 06/19/2019] [Indexed: 12/13/2022]
Abstract
This study aims to exploit the molecular and cellular mechanisms concerning the functionality of dietary polyphenols (catechin, procyanidin B3, procyanidin C2, epigallocatechin and epigallocatechin gallate) in a nutritional context to prevent Celiac Disease (CD). In that sense, the interaction between the main CD bioactive peptide (32-mer peptide) and some polyphenols was fully characterized at the intestinal level under near physiological conditions by means of different spectroscopic techniques and dynamic simulations. Accordingly, it is proposed that the primarily polyphenol-binding sites on the 32-mer peptide correspond to leucine, tyrosine and phenylalanine containing domains being this interaction entropy-driven. Although procyanidin B3 and trimer C2 had a similar low-affinity constant at 310 K, both procyanidins were able to reduce the 32-mer peptide apical-to-basolateral translocation in in vitro simulated intestinal epithelial barrier thus prospecting the occurrence of additional and still unexplored regulatory mechanisms by which dietary polyphenols might modulate the transepithelial transport of CD bioactive peptides.
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Affiliation(s)
- Ricardo Dias
- QUINOA-LAQV/REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Porto, Portugal
| | - Natércia F Brás
- UCIBIO/REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Porto, Portugal
| | - Maria Pérez-Gregorio
- QUINOA-LAQV/REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Porto, Portugal
| | - Iva Fernandes
- QUINOA-LAQV/REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Porto, Portugal
| | - Nuno Mateus
- QUINOA-LAQV/REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Porto, Portugal
| | - Victor Freitas
- QUINOA-LAQV/REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade do Porto, Porto, Portugal.
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525
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Antiga E, Maglie R, Quintarelli L, Verdelli A, Bonciani D, Bonciolini V, Caproni M. Dermatitis Herpetiformis: Novel Perspectives. Front Immunol 2019; 10:1290. [PMID: 31244841 PMCID: PMC6579917 DOI: 10.3389/fimmu.2019.01290] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023] Open
Abstract
Dermatitis herpetiformis (DH) is an inflammatory disease of the skin, considered the specific cutaneous manifestation of celiac disease (CD). Both DH and CD occur in gluten-sensitive individuals, share the same Human Leukocyte Antigen (HLA) haplotypes (DQ2 and DQ8), and improve following the administration of a gluten-free diet. Moreover, almost all DH patients show typical CD alterations at the small bowel biopsy, ranging from villous atrophy to augmented presence of intraepithelial lymphocytes, as well as the generation of circulating autoantibodies against tissue transglutaminase (tTG). Clinically, DH presents with polymorphic lesions, including papules, vesicles, and small blisters, symmetrically distributed in typical anatomical sites including the extensor aspects of the limbs, the elbows, the sacral regions, and the buttocks. Intense pruritus is almost the rule. However, many atypical presentations of DH have also been reported. Moreover, recent evidence suggested that DH is changing. Firstly, some studies reported a reduced incidence of DH, probably due to early recognition of CD, so that there is not enough time for DH to develop. Moreover, data from Japanese literature highlighted the absence of intestinal involvement as well as of the typical serological markers of CD (i.e., anti-tTG antibodies) in Japanese patients with DH. Similar cases may also occur in Caucasian patients, complicating DH diagnosis. The latter relies on the combination of clinical, histopathologic, and immunopathologic findings. Detecting granular IgA deposits at the dermal-epidermal junction by direct immunofluorescence (DIF) from perilesional skin represents the most specific diagnostic tool. Further, assessing serum titers of autoantibodies against epidermal transglutaminase (eTG), the supposed autoantigen of DH, may also serve as a clue for the diagnosis. However, a study from our group has recently demonstrated that granular IgA deposits may also occur in celiac patients with non-DH inflammatory skin diseases, raising questions about the effective role of eTG IgA autoantibodies in DH and suggesting the need of revising diagnostic criteria, conceivably emphasizing clinical aspects of the disease along with DIF. DH usually responds to the gluten-free diet. Topical clobetasol ointment or dapsone may be also applied to favor rapid disease control. Our review will focus on novel pathogenic insights, controversies, and management aspects of DH.
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Affiliation(s)
- Emiliano Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Roberto Maglie
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Diletta Bonciani
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Veronica Bonciolini
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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526
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Poddighe D, Capittini C, Gaviglio I, Brambilla I, Marseglia GL. HLA-DQB1*02 allele in children with celiac disease: Potential usefulness for screening strategies. Int J Immunogenet 2019; 46:342-345. [PMID: 31187602 DOI: 10.1111/iji.12441] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/18/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Abstract
Through a retrospective analysis of a real-life cohort of children with celiac disease (CD), who underwent HLA-DQ genotyping, we supported our previous findings indicating the presence of HLA-DQB1*02 allele in at least 90%-95% of pediatric patients. In the present study, reporting the HLA-DQ analysis from 184 children (age range: 1-16 years) diagnosed with CD in a single centre, we found that 97.29% of all these CD children (n = 179 out of 184 genotyped patients) resulted to be carriers of at least one copy of HLA-DQB1*02 allele. If a widened screening for CD should result to be appropriate in the pediatric population after further clinical research, this observation might be potentially exploited to consider a two-step screening strategy, starting with the HLA-DQB1*02 targeted analysis followed by the specific serology for CD in these predisposed patients only. However, additional and larger studies are needed to support our findings.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan City (Astana), Kazakhstan.,Department of Pediatrics, University of Pavia, Pavia, Italy
| | - Cristina Capittini
- Department of Clinical Epidemiology and Biometrics, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Ivan Gaviglio
- Department of Pediatrics, University of Pavia, Pavia, Italy
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527
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Stroud C, Almilaji O, Nicholas D, Kirkham S, Surgenor SL, Williams I, Snook J. Evolving patterns in the presentation of coeliac disease over the last 25 years. Frontline Gastroenterol 2019; 11:98-103. [PMID: 32134410 PMCID: PMC7043089 DOI: 10.1136/flgastro-2018-101170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/11/2019] [Accepted: 05/18/2019] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To document changes in the clinical features of coeliac disease (CD) at presentation over the last 25 years. DESIGN Observational study. PATIENTS 802 subjects diagnosed between 1993 and 2017 at a single general hospital. OUTCOME MEASURES Date of diagnosis, age, sex, postcode, symptoms, haematinic deficiency, smoking status, serology, family history and autoimmune phenomena. RESULTS The incidence of diagnosed CD rose threefold during the course of the study, with a rising prevalence of positive coeliac serology and positive family history of CD, and a falling prevalence of symptoms and haematinic deficiencies. There was little change in the female predominance, age at diagnosis or high prevalence of other autoimmune conditions over the 25 years, and a paucity throughout of cigarette smokers, particularly heavy smokers. A cohort of patients with seronegative CD was identified who shared many of the characteristics of seropositive CD, but with a significantly older age at diagnosis and a higher prevalence of cigarette smokers. CONCLUSION There have been major changes in the epidemiology of CD over the last 25 years, of relevance to both our understanding of the aetiopathogenesis of CD and the requirement for service provision. The implications are discussed.
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Cadenhead JW, Wolf RL, Lebwohl B, Lee AR, Zybert P, Reilly NR, Schebendach J, Satherley RM, Green PH. Diminished quality of life among adolescents with coeliac disease using maladaptive eating behaviours to manage a gluten-free diet: a cross-sectional, mixed-methods study. J Hum Nutr Diet 2019; 32:311-320. [PMID: 30834587 PMCID: PMC6467807 DOI: 10.1111/jhn.12638] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Certain approaches to managing a strict gluten-free diet (GFD) for coeliac disease (CD) may lead to impaired psychosocial well-being, a diminished quality of life (QOL) and disordered eating. The present study aimed to understand adolescents' approaches to managing a GFD and the association with QOL. METHODS Thirty adolescents with CD (13-17 years old) following the GFD for at least 1 year completed the Celiac Dietary Adherence Test (CDAT) and QOL survey. Their approaches to GFD management were explored using a semi-structured interview, where key themes were developed using an iterative process, and further analysed using a psychosocial rubric to classify management strategies and QOL. CDAT ratings were compared across groups. RESULTS Gluten-free diet management strategies were classified on a four-point scale. Adaptive eating behaviours were characterised by greater flexibility (versus rigidity), trust (versus avoidance), confidence (versus controlling behaviour) and awareness (versus preoccupation) with respect to maintaining a GFD. Approximately half the sample (53.3%) expressed more maladaptive approaches to maintaining a GFD and those who did so were older with lower CD-Specific Pediatric Quality of Life (CDPQOL) scores, mean subscale differences ranging from 15.0 points for Isolation (t = 2.4, P = 0.03, d.f. = 28) to 23.4 points for Limitations (t = 3.0, P = 0.01, d.f. = 28). CONCLUSIONS Adolescents with CD who manage a GFD with maladaptive eating behaviours similar to known risk factors for feeding and eating disorders experience diminished QOL. In accordance with CD management recommendations, we recommend ongoing follow-up with gastroenterologists and dietitians and psychosocial support referrals, as needed.
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Affiliation(s)
- Jennifer W. Cadenhead
- Department of Health & Behavior Studies, Program in Nutrition, Teachers College, Columbia University, 525 West 120 street, New York, NY 10027 USA
| | - Randi L. Wolf
- Department of Health & Behavior Studies, Program in Nutrition, Teachers College, Columbia University, 525 West 120 street, New York, NY 10027 USA
| | - Benjamin Lebwohl
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, New York, NY 10032 USA
| | - Anne R. Lee
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, New York, NY 10032 USA
| | - Patricia Zybert
- Department of Health & Behavior Studies, Program in Nutrition, Teachers College, Columbia University, 525 West 120 street, New York, NY 10027 USA
| | - Norelle R. Reilly
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, New York, NY 10032 USA
| | - Janet Schebendach
- Department of Psychiatry, 1051 Riverside Drive, Columbia University Medical Center, New York, NY 10032 USA
| | - Rose-Marie Satherley
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Guy’s Campus, 6 Floor Addison House, London, SE1 1UL United Kingdom
| | - Peter H.R. Green
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, New York, NY 10032 USA
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Myléus A, Stenhammar L, Högberg L, Browaldh L, Daniels I, Fagerberg UL, Gudjónsdóttir AH, Malmquist M, Sandström O, Ivarsson A. Questionnaire showed that Swedish paediatric clinics complied well with the revised European guidelines for diagnosing coeliac disease. Acta Paediatr 2019; 108:1140-1143. [PMID: 30496613 DOI: 10.1111/apa.14669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022]
Abstract
AIM In 2012, revised criteria for diagnosing childhood coeliac disease were published by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and incorporated into the revised Swedish guidelines the same year. These made it possible, in certain cases, to diagnose coeliac disease without taking small bowel biopsies. This survey assessed the extent to which the new guidelines were implemented by Swedish paediatric clinics two years after their introduction. METHODS In October 2014, we distributed a paper questionnaire including five questions on diagnostic routines to the 40 paediatric clinics in university or regional hospitals in Sweden that perform small bowel biopsies. RESULTS All 36 (90%) clinics that responded used anti-tissue transglutaminase antibodies as the initial diagnostic test and some also used serological markers. Most clinics (81%) used endoscopy and took multiple duodenal biopsies, whereas only a few (19%) occasionally employed a suction capsule. Almost all clinics (86%) omitted taking small bowel biopsies in symptomatic children with repeatedly high coeliac serology and positive genotyping, thereby avoiding the need for invasive endoscopy under anaesthesia. CONCLUSION The 2012 Swedish Paediatric Coeliac Disease Diagnostic Guidelines had been widely accepted and implemented in routine health care two years after their introduction.
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Affiliation(s)
- Anna Myléus
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Umeå University Umeå Sweden
- Department of Public Health and Clinical Medicine, Family Medicine Umeå University Umeå Sweden
| | - Lars Stenhammar
- Department of Paediatrics and Department of Clinical and Experimental Medicine Linköping University Norrköping Sweden
| | - Lotta Högberg
- Department of Paediatrics and Department of Clinical and Experimental Medicine Linköping University Norrköping Sweden
| | - Lars Browaldh
- Department of Clinical Science and Education Karolinska Institutet and Paediatric Clinic Södersjukhuset Stockholm Sweden
| | - Ing‐Marie Daniels
- Department of Paediatrics Uppsala University Hospital Uppsala Sweden
| | - Ulrika L. Fagerberg
- Department of Paediatrics Centre for Clinical Research Västmanland Hospital, Västerås and Karolinska Institutet Stockholm Sweden
| | - Audur H. Gudjónsdóttir
- Department of Paediatric Gastroenterology Queen Silvia Children′s Hospital Sahlgrenska University Hospital Gothenburg Sweden
| | - Marianne Malmquist
- Department of Paediatric Gastroenterology Queen Silvia Children′s Hospital Sahlgrenska University Hospital Gothenburg Sweden
| | - Olof Sandström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Umeå University Umeå Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Umeå University Umeå Sweden
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Celiac disease in the East and the West: Bridging the gaps between the guidelines and their implementation in daily practice is mandatory. Indian J Gastroenterol 2019; 38:185-189. [PMID: 31313236 DOI: 10.1007/s12664-019-00970-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Casella G, Ingravalle F, Abbate G, Monti C, Bonetti F, Bassotti G, Mansueto P, Villanacci V, Carroccio A. Pneumococcal vaccination in celiac disease. Expert Rev Gastroenterol Hepatol 2019; 13:541-546. [PMID: 30987472 DOI: 10.1080/17474124.2019.1607295] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Celiac disease (CD) is an immune-mediated disorder associated with gluten exposure in genetically predisposed subjects. Areas covered: Infectious disease is one of the causes of morbidity and mortality in CD patients. Invasive streptococcus pneumoniae (pneumococcus) is a particularly dangerous morbid condition in both the general population and celiac patients. Pneumococcal vaccination is the most effective means for its prevention. Expert opinion: In CD, evaluation of spleen function should be useful to select patients who may benefit from vaccination to reduce the risk of pneumococcal disease. Different strategies could be employed: physicians could search for signs of hyposplenism on peripheral blood smear or abdominal ultrasound. However, the best strategy to identify which patients will benefit from pneumococcal vaccination has not yet been defined.
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Affiliation(s)
| | | | - Giorgio Abbate
- c Prevention and Vaccination Center , Corberi-Antonini Hospital - ASST Monza , Limbiate (Monza Brianza) , Italy
| | - Claudio Monti
- a ATS Lecco-Brianza , Limbiate (Monza Brianza) , Italy
| | | | - Gabrio Bassotti
- d Gastroenterology, Hepatology and Digestive Endoscopy Section, Department of Medicine , University of Perugia - Medicine , Perugia , Italy
| | - Pasquale Mansueto
- e Dipartimento Biomedico di Medicina Interna e Specialistica (DiBiMIS) , University of Palermo , Palermo , Italy
| | | | - Antonio Carroccio
- e Dipartimento Biomedico di Medicina Interna e Specialistica (DiBiMIS) , University of Palermo , Palermo , Italy.,g Internal Medicine , Giovanni Paolo II Hospital, Sciacca (ASP Agrigento) , Italy
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Relevance of HLA-DQB1*02 Allele in the Genetic Predisposition of Children with Celiac Disease: Additional Cues from a Meta-Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55050190. [PMID: 31121940 PMCID: PMC6571594 DOI: 10.3390/medicina55050190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/26/2019] [Accepted: 05/14/2019] [Indexed: 12/12/2022]
Abstract
Background and Objectives: Celiac disease (CD) is a multifactorial immune-mediated disorder, triggered by the ingestion of gluten in genetically-predisposed subjects carrying MHC-DQ2 and -DQ8 heterodimers, which are encoded by four HLA-DQ allelic variants, overall. This meta-analysis aims at providing further epidemiological support to the predominant relevance of one specific allele, namely HLA-DQB1*02, in the predisposition and genetic risk of CD. Materials and Methods: We performed a search of MEDLINE/PubMed, Embase, Web of Science, and Scopus, retrieving all publications (case-control study, cross-sectional, and retrospective cohort study) on the association between HLA class II polymorphisms and first-degree relatives (FDRs) of children with CD. After a critical reading of the articles, two investigators independently performed data extraction according to the following inclusion criteria: HLA class II genes, any DQ and DR molecules, and CD diagnosed following the current clinical guidelines. A third participant was consulted for discussion to reach an agreement concerning discrepancies. Results: Our search strategy selected 14 studies as being eligible for inclusion, and those were submitted for data extraction and analysis. These studies were published between 1999 and 2016 and, collectively, enrolled 3063 FDRs. Positive and negative likelihood ratios (LR+ and LR-, respectively) for CD diagnosis, according to the presence of the HLA-DQ genotype coding a complete MHC-DQ2 and/or MHC-DQ8 molecules, were 1.449 (CI 1.279-1.642) and 0.187 (CI 0.096-0.362), respectively. If only the isolated presence of HLA-DQB1*02 allele is considered, the pooled estimation of LR+ was 1.659 (CI 1.302-2.155) and, importantly, the LR- still showed a very good discriminatory power of 0.195 (CI 0.068-0.558). Conclusions: Through our differential meta-analysis, comparing the presence of the genotype coding the full MHC-DQ2 and/or DQ8 molecules with the isolated presence of HLA-DQB1*02 allelic variant, we found that the LR- of the latter analysis maintained the same value. This observation, along with previous evidences, might be useful to consider potential cost-effective widened screening strategies for CD in children.
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Tanner GJ, Colgrave ML, Blundell MJ, Howitt CA, Bacic A. Hordein Accumulation in Developing Barley Grains. FRONTIERS IN PLANT SCIENCE 2019; 10:649. [PMID: 31156692 PMCID: PMC6532529 DOI: 10.3389/fpls.2019.00649] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/30/2019] [Indexed: 05/14/2023]
Abstract
The temporal pattern of accumulation of hordein storage proteins in developing barley grains was studied by enzyme-linked immunosorbent assay (ELISA), western blot and liquid chromatography tandem mass spectrometry (LC-MS/MS). Hordein accumulation was compared to the pattern seen for two abundant control proteins, serpin Z4 (an early accumulator) and lipid transferase protein (LTP1, a late accumulator). Hordeins were detected from 6 days post-anthesis (DPA) and peaked at 30 DPA. Changes in fresh weight indicate that desiccation begins at 20 DPA and by 37 DPA fresh weight had decreased by 35%. ELISA analysis of hordein content, expressed on a protein basis, increased to a maximum at 30 DPA followed by a 17% decrease by 37 DPA. The accumulation of 39 tryptic and 29 chymotryptic hordein peptides representing all classes of hordein was studied by LC-MS/MS. Most peptides increased to a maximum at 30 DPA, and either remained at the maximum or did not decrease significantly. Only five tryptic peptides, members of the related B1- and γ1-hordeins decreased significantly by 21-51% at 37 DPA. Thus, the concentration of some specific peptides was reduced while remaining members of the same family were not affected. The N-terminal signal region was removed by proteolysis during co-translation. In addition to a suite of previously characterized hordeins, two novel barley B-hordein isoforms mapping to wheat low molecular weight glutenins (LMW-GS-like B-hordeins), and two avenin-like proteins (ALPs) sharing homology with wheat ALPs, were identified. These identified isoforms have not previously been mapped in the barley genome. Cereal storage proteins provide significant nutritional content for human consumption and seed germination. In barley, the bulk of the storage proteins comprise the hordein family and the final hordein concentration affects the quality of baked and brewed products. It is therefore important to study the accumulation of hordeins as this knowledge may assist plant breeding for improved health outcomes (by minimizing triggering of detrimental immune responses), nutrition and food processing properties.
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Affiliation(s)
- Gregory J. Tanner
- School of Biosciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michelle L. Colgrave
- Commonwealth Scientific and Industrial Research Organisation Agriculture and Food, St Lucia, QLD, Australia
- School of Science, Edith Cowan University, Joondalup, WA, Australia
| | - Malcolm J. Blundell
- Commonwealth Scientific and Industrial Research Organisation Agriculture and Food, Canberra, ACT, Australia
| | - Crispin A. Howitt
- Commonwealth Scientific and Industrial Research Organisation Agriculture and Food, Canberra, ACT, Australia
| | - Antony Bacic
- School of Biosciences, University of Melbourne, Melbourne, VIC, Australia
- La Trobe Institute for Agriculture and Food, La Trobe University, Bundoora, VIC, Australia
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Abstract
INTRODUCTION Adherence to a gluten-free (GF) diet is the mainstay of therapy for celiac disease. Until now, those wishing to avoid gluten in restaurants had to rely on menu labels, word of mouth, intuition, and restaurant workers' advice, with a relative dearth of supporting data. We used crowd-sourced data from users of a portable gluten detection device to estimate rates of, and identify risk factors for, gluten contamination of supposed GF restaurant foods. METHODS We analyzed data from a portable gluten detection device (Nima), collected across the United States during an 18-month period by users who opted to share the results of their point-of-care tests. Data were sorted by region, time of day, median household income in the restaurant's vicinity, restaurant genre, and food items. We used the χ test for bivariate analysis and multiple logistic regression for multivariate analysis to identify predictors of gluten detection in restaurant food. RESULTS There were 5,624 tests, performed by 804 users, in the examined period. Gluten was detected in 32% of GF labeled foods. Rates of gluten detection differed by meal, with 27.2% at breakfast and 34.0% at dinner (P = 0.0008). GF labeled pizza and pasta were most likely to test positive for gluten, with gluten detected in 53.2% of pizza and 50.8% of pasta samples. On multivariate analysis, GF labeled food was less likely to test positive for gluten in the West than in the Northeast United States (odds ratio 0.80; 95% confidence interval 0.67-0.95). CONCLUSIONS This study of crowd-sourced data suggests that a substantial fraction of GF labeled restaurant foods contain detectable gluten. Although the highly sensitive Nima device may detect gluten at levels <20 parts per million (ppm), leading to gluten exposure of unknown clinical significance, our findings raise a potential concern. In addition, our findings of higher rates of gluten detection in pizza and pasta provide practical data when providing dining strategies for patients with celiac disease.
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535
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Ribeiro M, Picascia S, Rhazi L, Gianfrani C, Carrillo JM, Rodriguez-Quijano M, Branlard G, Nunes FM. Effect of in situ gluten-chitosan interlocked self-assembled supramolecular architecture on rheological properties and functionality of reduced celiac-toxicity wheat flour. Food Hydrocoll 2019. [DOI: 10.1016/j.foodhyd.2018.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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536
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Ríos León R, Crespo Pérez L, Rodríguez de Santiago E, Roy Ariño G, De Andrés Martín A, García Hoz Jiménez C, Sánchez Rodríguez E, Saiz González A, León Prieto F, Albillos A. Genetic and flow cytometry analysis of seronegative celiac disease: a cohort study. Scand J Gastroenterol 2019; 54:563-570. [PMID: 31057009 DOI: 10.1080/00365521.2019.1608466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Seronegative celiac disease (CD) poses a diagnostic challenge. Aims: Characterize and identify differences between seronegative and seropositive CD. Patients and methods: Retrospective cohort study examining adult patients diagnosed with CD (1980-2017). Clinical, analytical, histological, genetic and immunophenotypic data were compiled. Seronegative CD was defined as a anti-tissue transglutaminase type 2 IgA and endomysial antibodies (EMA) negative and HLA-DQ2 and/or DQ8 positive, showing clinical signs of CD plus an abnormal duodenal biopsy, and responding to a gluten-free diet (GFD). Factors associated with seronegative CD were identified through binomial logistic regression. Results: Of 315 CD patients, 289 were seropositive (91.7%) and 26 seronegative (8.3%). Among the seronegative patients, higher prevalence was observed for autoimmune thyroiditis (26.9% vs. 9.7%, p = .016), HLA-DQ8 heterozygosity (23.1% vs. 2.5%, p ˂ .001) and Marsh I lesion (34.6% vs. 3.7%, p ˂ .001). The two groups showed similar flow cytometry-determined duodenal immunophenotypes and rates of refractory CD. Conclusions: Seronegative CD differs mostly in genetic (more HLA-DQ8) and histologic (milder atrophy) features as compared with seropositive. Intestinal intraepithelial immunophenotype by flow cytometry, similar in both modalities, is a useful tool to diagnose seronegative CD.
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Affiliation(s)
- Raquel Ríos León
- a Department of Gastroenterology and Hepatology , Hospital Universitario Ramón y Cajal, University of Alcalá , Madrid , Spain
| | - Laura Crespo Pérez
- a Department of Gastroenterology and Hepatology , Hospital Universitario Ramón y Cajal, University of Alcalá , Madrid , Spain
| | - Enrique Rodríguez de Santiago
- a Department of Gastroenterology and Hepatology , Hospital Universitario Ramón y Cajal, University of Alcalá , Madrid , Spain.,b Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) , Madrid , Spain
| | - Garbiñe Roy Ariño
- c Department of Immunology , Hospital Universitario Ramón y Cajal , Madrid , Spain
| | - Ana De Andrés Martín
- c Department of Immunology , Hospital Universitario Ramón y Cajal , Madrid , Spain
| | | | | | - Ana Saiz González
- d Department of Pathological Anatomy , Hospital Universitario Ramón y Cajal , Madrid , Spain
| | | | - Agustín Albillos
- a Department of Gastroenterology and Hepatology , Hospital Universitario Ramón y Cajal, University of Alcalá , Madrid , Spain.,b Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) , Madrid , Spain
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Abstract
PURPOSE OF REVIEW There has been significant interest in gluten over the last decade, with an increase in interest of gluten-related disorders outside coeliac disease. Particularly, there has been a focus on the role of gluten in noncoeliac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS). There is significant overlap between both of these conditions, with the aim of this review to explore their complex relationship. RECENT FINDINGS Gluten has been demonstrated to generate symptoms in individuals with NCGS. However, there appears to be an increasing role for gluten in symptom generation in patients with IBS also. Other components of wheat, other than gluten, are now also thought to be contributing factors in symptom generation. SUMMARY There appears to be significant overlap between IBS and NCGS. It is likely that a subset of patients presenting with IBS actually have NCGS. In addition, it is likely that individuals with IBS may also have symptoms triggered by gluten. With the pathophysiology of both conditions not fully understood, as well as increasing knowledge of wheat components in symptom generation, further research is required to help distinguish between both.
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538
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Joelson AM, Geller MG, Zylberberg HM, Green PHR, Lebwohl B. Numbers and Features of Patients With a Diagnosis of Celiac Disease Without Duodenal Biopsy, Based on a National Survey. Clin Gastroenterol Hepatol 2019; 17:1089-1097.e2. [PMID: 30213582 DOI: 10.1016/j.cgh.2018.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS According to guidelines, individuals with symptoms of celiac disease should undergo duodenal biopsy analysis to establish a diagnosis, but little is known about physician adherence to these guidelines. We used a patient-powered research network (PPRN) to compare demographics, diagnoses, symptoms, and treatment between groups of patients with celiac disease diagnosed by biopsy analysis and patients with a diagnosis based on results of serology tests. METHODS We analyzed data from iCureCeliac-a voluntary, PPRN hosted and distributed by the Celiac Disease Foundation, from January 30, 2016, through August 25, 2016. We compared data from adults with a diagnosis of celiac disease (mean age, 43.4 years; 85.6% female) based on biopsy analysis (n = 780) vs patients with a diagnosis based on only serologic analysis (n = 202) using univariate and multivariable analyses. We collected demographic information, as well as data on type of health care practitioner, where patients obtain their primary information about celiac disease, and the Celiac Disease Quality of Life score, nutritionist referral rates, adherence to the gluten-free diet, ongoing symptoms and use of supplements. RESULTS Among patients with a diagnosis based on serology results, 33.3% were diagnosed by non-gastroenterologists vs 20.7% in the biopsy diagnosed group (P < .001). Fewer patients with a diagnosis based on serology results sought nutritional counseling at the time of diagnosis (40.1%) than patients with a diagnosis based on biopsy (58.9%) (P < .001). A higher proportion of patients diagnosed by serology without biopsy took dietary supplements to aid in digestion of gluten (19.8%) than patients with a diagnosis based on biopsy (8.9%) (P < .001). After we adjusted for age and sex, patients with a diagnosis based on serology were less likely to seek nutritional counseling after diagnosis (odds ratio [OR], 0.45; 95% CI, 0.33-0.63), less likely to receive a diagnosis from a gastroenterologist (OR, 0.16; 95% CI, 0.07-0.37), and more likely to use digestive supplements (OR, 2.61; 95%, CI 1.62-4.19). CONCLUSIONS In an analysis of data from a PPRN, we found that 21% of adult participants with celiac disease did not have a diagnosis based on a duodenal biopsy. Patients with a diagnosis based on serology results were more likely to be diagnosed by non-gastroenterologists, less likely to seek nutritional counseling, and more likely to use dietary supplements. Patients require more education about management of celiac disease and referral to gastroenterologists for duodenal biopsy confirmation of their disease.
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Affiliation(s)
- Andrew M Joelson
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| | | | - Haley M Zylberberg
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Peter H R Green
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York; Deartment of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York.
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539
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Promotion of Testing for Celiac Disease and the Gluten-Free Diet Among Complementary and Alternative Medicine Practitioners. Am J Gastroenterol 2019; 114:786-791. [PMID: 31082840 DOI: 10.14309/ajg.0000000000000238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We identified the frequency and assessed the validity of marketing claims made by American chiropractors, naturopaths, homeopaths, acupuncturists, and integrative medicine practitioners relating to the diagnosis and treatment of celiac disease and nonceliac gluten sensitivity (NCGS), both of which have increased in prevalence in recent years. METHODS We performed a cross-sectional study analyzing websites of practitioners from 10 cities in the United States and analyzed the websites for any mention of celiac or NCGS as well as specific claims of ability to diagnose, ability to treat, and treatment efficacy. We classified treatments promoted as true, false, or unproven, as assessed independently by 2 authors. RESULTS Of 500 clinics identified, 178 (35.6%) made a claim regarding celiac disease, NCGS, or a gluten-free diet. Naturopath clinic websites have the highest rates of advertising at least one of diagnosis, treatment, or efficacy for celiac disease (40%), followed by integrative medicine clinics (36%), homeopaths (20%), acupuncturists (14%), and chiropractors (12%). Integrative medicine clinics have the highest rates of advertising at least one of diagnosis, treatment, or efficacy for NCGS (45%), followed by naturopaths (37%), homeopaths (14%), chiropractors (14%), and acupuncturists (10%). A geographic analysis yielded no significant variation in marketing rates among clinics from different cities. Of 232 marketing claims made by these complementary and alternative medicine (CAM) clinic websites, 138 (59.5%) were either false or unproven. DISCUSSION A significant number of CAM clinics advertise diagnostic techniques or treatments for celiac disease or NCGS. Many claims are either false or unproven, thus warranting a need for increased regulation of CAM advertising to protect the public.
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540
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Romano B, Lleo A, Sala E, D’Amico G, Marino DI, Ciccocioppo R, Vetrano S. Mesenchymal Stem Cells to Treat Digestive System Disorders: Progress Made and Future Directions. CURRENT TRANSPLANTATION REPORTS 2019. [DOI: 10.1007/s40472-019-00238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Feralgine™ a New Approach for Iron Deficiency Anemia in Celiac Patients. Nutrients 2019; 11:nu11040887. [PMID: 31009990 PMCID: PMC6520849 DOI: 10.3390/nu11040887] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/26/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Celiac disease (CD) is an immunologically-mediated disorder characterized by duodenal mucosa villi atrophy. Iron absorption is usually reduced in celiac patients making every kind of oral iron treatment unhelpful because of malasorption. Feralgine™ is a new product that has been demonstrated to be more bioavailable. As such, the aim of our study was to evaluate the absorption of Feralgine™ in adult patients with CD. Methods: Twenty-six adults affected by Iron Deficiency Anemia (IDA), of which 14 were also affected by CD and 12 were not affected by CD, were enrolled. An oral iron absorption test (OIAT) was performed in each patient by administrating Feralgine™, and serum iron was evaluated at baseline (T0) and after 2 h (T1) from the oral iron ingestion. Results: The OIAT was well tolerated in all patients, and, surprisingly, an equivalent statistically significant improvement in serum iron occurred in the two groups of patients (IDA plus CD: T0 = 28.21 µg/dL vs. T1 = 94.14 µg/dL p = 0.004 and IDA without CD: T0 = 34.91 µg/dL vs. T1 = 118.83 µg/dL, p = 0.0003). Conclusions: These results demonstrated the high absorption of Feralgine™ in celiac patients, confirming our previous data obtained with Ferrous Bysglicinate in children with CD.
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542
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Bartoloni E, Bistoni O, Alunno A, Cavagna L, Nalotto L, Baldini C, Priori R, Fischetti C, Fredi M, Quartuccio L, Carubbi F, Montecucco C, Doria A, Mosca M, Valesini G, Franceschini F, De Vita S, Giacomelli R, Mirabelli G, Bini V, Gabrielli A, Catassi C, Gerli R. Celiac Disease Prevalence is Increased in Primary Sjögren's Syndrome and Diffuse Systemic Sclerosis: Lessons from a Large Multi-Center Study. J Clin Med 2019; 8:jcm8040540. [PMID: 31010199 PMCID: PMC6517955 DOI: 10.3390/jcm8040540] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 02/06/2023] Open
Abstract
Association of celiac disease (CD) with systemic autoimmune diseases (ADs) remains controversial. Awareness of CD in these patients is important to prevent complications, including lymphoproliferative disorders. We evaluated previously diagnosed CD prevalence in systemic lupus erythematosus (SLE), primary Sjögren’s syndrome (pSS) and systemic sclerosis (SSc) patients in comparison to 14,298 matched controls. All patients were screened for subclinical CD. Data from 1458 unselected consecutive SLE (580), pSS (354) and SSc (524) patients were collected. Previously biopsy-proven CD diagnosis and both CD- and AD-specific features were registered. All patients without previous CD were tested for IgA transglutaminase (TG). Anti-endomysium were tested in positive/borderline IgA TG. Duodenal biopsy was performed in IgA TG/endomysium+ to confirm CD. CD prevalence in AD was compared to that observed in 14,298 unselected sex- and age-matched adults who acted as controls. CD was more prevalent in pSS vs controls (6.78% vs 0.64%, p < 0.0001). A trend towards higher prevalence was observed in SLE (1.38%, p = 0.058) and SSc (1.34%, p = 0.096). Higher CD prevalence was observed in diffuse cutaneous SSc (4.5%, p ≤ 0.002 vs controls). Subclinical CD was found in two SLE patients and one pSS patient. CD diagnosis usually preceded that of AD. Primary SS and SSc–CD patients were younger at AD diagnosis in comparison to non-celiac patients. Autoimmune thyroiditis was associated with pSS and CD. CD prevalence is clearly increased in pSS and diffuse SSc in comparison to the general population. The association of CD with diffuse but not limited SSc may suggest different immunopathogenic mechanisms characterizing the two subsets. CD screening may be considered in pSS and diffuse SSc in young patients, particularly at the time of diagnosis.
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
| | - Lorenzo Cavagna
- Department of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, 27100 Pavia, Italy.
| | - Linda Nalotto
- Division of Rheumatology, Department of Medicine, University of Padua, 35128 Padova, Italy.
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, 00185 Rome, Italy.
| | - Colomba Fischetti
- Clinical Medicine, Department of Internal Medicine, Ospedali Riuniti University Hospital, 60030 Ancona, Italy.
| | - Micaela Fredi
- Department of Rheumatology and Clinical Immunology, ASST Spedali Civili, 25133 Brescia, Italy.
| | - Luca Quartuccio
- Department of Medical and Biological Sciences, Rheumatology Clinic, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy.
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Carlomaurizio Montecucco
- Department of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, 27100 Pavia, Italy.
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine, University of Padua, 35128 Padova, Italy.
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, 00185 Rome, Italy.
| | - Franco Franceschini
- Department of Rheumatology and Clinical Immunology, ASST Spedali Civili, 25133 Brescia, Italy.
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy.
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Giulia Mirabelli
- Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
| | - Vittorio Bini
- Internal Medicine, Endocrine and Metabolic Science Section, University of Perugia, 06128 Perugia, Italy.
| | - Armando Gabrielli
- Clinical Medicine, Department of Internal Medicine, Ospedali Riuniti University Hospital, 60030 Ancona, Italy.
| | - Carlo Catassi
- Department of Pediatrics, Marche Polytechnic University, 60121 Ancona, Italy.
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
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543
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Rybicka I, Doba K, Bińczak O. Improving the sensory and nutritional value of gluten‐free bread. Int J Food Sci Technol 2019. [DOI: 10.1111/ijfs.14190] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Iga Rybicka
- Faculty of Commodity Science Poznań University of Economics and Business al. Niepodległości 10 Poznań 61‐875 Poland
| | - Karolina Doba
- Faculty of Commodity Science Poznań University of Economics and Business al. Niepodległości 10 Poznań 61‐875 Poland
| | - Olga Bińczak
- Faculty of Commodity Science Poznań University of Economics and Business al. Niepodległości 10 Poznań 61‐875 Poland
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544
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Lebwohl B, Yom-Tov E. Symptoms Prompting Interest in Celiac Disease and the Gluten-Free Diet: Analysis of Internet Search Term Data. J Med Internet Res 2019; 21:e13082. [PMID: 30958273 PMCID: PMC6475820 DOI: 10.2196/13082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Celiac disease, a common immune-based disease triggered by gluten, has diverse clinical manifestations, and the relative distribution of symptoms leading to diagnosis has not been well characterized in the population. OBJECTIVE This study aimed to use search engine data to identify a set of symptoms and conditions that would identify individuals at elevated likelihood of a subsequent celiac disease diagnosis. We also measured the relative prominence of these search terms before versus after a search related to celiac disease. METHODS We extracted English-language queries submitted to the Bing search engine in the United States and identified those who submitted a new celiac-related query during a 1-month period, without any celiac-related queries in the preceding 9 months. We compared the ratio between the number of times that each symptom or condition was asked in the 14 days preceding the first celiac-related query of each person and the number of searches for that same symptom or condition in the 14 days after the celiac-related query. RESULTS We identified 90,142 users who made a celiac-related query, of whom 6528 (7%) exhibited sustained interest, defined as making a query on more than 1 day. Though a variety of symptoms and associated conditions were also queried before a celiac-related query, the maximum area under the receiver operating characteristic curve was 0.53. The symptom most likely to be queried more before than after a celiac-related query was diarrhea (query ratio [QR] 1.28). Extraintestinal symptoms queried before a celiac disease query included headache (QR 1.26), anxiety (QR 1.10), depression (QR 1.03), and attention-deficit hyperactivity disorder (QR 1.64). CONCLUSIONS We found an increase in antecedent searches for symptoms known to be associated with celiac disease, a rise in searches for depression and anxiety, and an increase in symptoms that are associated with celiac disease but may not be reported to health care providers. The protean clinical manifestations of celiac disease are reflected in the diffuse nature of antecedent internet queries of those interested in celiac disease, underscoring the challenge of effective case-finding strategies.
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Affiliation(s)
- Benjamin Lebwohl
- Celiac Disease Center, Columbia University, New York, NY, United States
| | - Elad Yom-Tov
- Microsoft Research, Herzeliya, Israel.,Technion, Haifa, Israel
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545
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Abstract
OBJECTIVES Available data indicate that liver involvement is present in a significant proportion of children with celiac disease (CD) at the diagnosis (elevated transaminases 15%-57%, autoimmune liver disease 1%-2%). We sought to evaluate prevalence, clinical course, and risk factors for liver involvement in a large cohort of children with CD. METHODS Children (age 0-18 years) diagnosed with CD from March 2010 to April 2016 were enrolled. Liver involvement was considered to be present when alanine transaminase (ALT) levels were >40 U/L (hypertransaminasemia [HTS]). Patients with HTS were re-evaluated after at least 12 months of a gluten-free diet. RESULTS CD was diagnosed in 806 patients during the study period; of these, ALT levels were available for 700 patients (86.9%), and were elevated in 27 (3.9%, HTS group); median ALT and aspartate transaminase levels in the HTS group were 57 U/L (interquartile range 49-80 U/L) and 67 U/L (interquartile range 53-85 U/L), respectively. Younger age, malabsorption symptoms, and low hemoglobin or ferritin were significantly more common in the HTS group at univariate analysis. At multivariate analysis, only age ≤4.27 years correlated with risk of liver involvement (odds ratio 3.73; 95% confidence interval: 1.61-8.66). When retested on a gluten-free diet, all but 3 patients normalized ALT levels; of these, 1 was diagnosed with sclerosing cholangitis. CONCLUSIONS Liver involvement in celiac children is now less frequent than previously reported, possibly due to changing CD epidemiology. Younger age is the only risk factor. Associated autoimmune liver disease is rare.
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546
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Abstract
Coeliac disease (CD) is a chronic gluten-dependent enteropathy very common in the general population and characterized by an extremely heterogeneous clinical picture. Although its prevalence is growing worldwide, case-finding strategy remains the mainstay to diagnosis. Thus, correct identification of high-risk categories of patients who need to be tested for CD is an essential part of medical knowledge to a large number of specialists and primary care providers. In this regard, although CD might have a serious effect on women's reproductive health, a widespread consensus is lacking on which categories of obstetric and gynaecological disorders should be tested for CD. The aim of this review is to critically summarize the current literature relevant to CD and obstetric and gynaecological disorders and to provide practical proposals that may be helpful to clinicians involved in the management of these patients.
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547
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Mehr S, Brown-Whitehorn T. What do allergists in practice need to know about non-IgE-mediated food allergies. Ann Allergy Asthma Immunol 2019; 122:589-597. [PMID: 30935977 DOI: 10.1016/j.anai.2019.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Sam Mehr
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Terri Brown-Whitehorn
- Division of Allergy and Immunology, Department of Pediatric, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
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548
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Lenti MV, Corazza GR. Measuring too much or too little in adult coeliac disease. J Clin Pathol 2019; 72:341-342. [PMID: 30872383 DOI: 10.1136/jclinpath-2018-205667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/23/2019] [Accepted: 02/22/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Marco Vincenzo Lenti
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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549
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Guimarães RM, Pimentel TC, de Rezende TAM, Silva JDS, Falcão HG, Ida EI, Egea MB. Gluten-free bread: effect of soy and corn co-products on the quality parameters. Eur Food Res Technol 2019. [DOI: 10.1007/s00217-019-03261-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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550
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Nonceliac Wheat Sensitivity: An Immune-Mediated Condition with Systemic Manifestations. Gastroenterol Clin North Am 2019; 48:165-182. [PMID: 30711208 PMCID: PMC6364564 DOI: 10.1016/j.gtc.2018.09.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Non-celiac wheat sensitivity (NCWS) is characterized by gastrointestinal and extra-intestinal symptoms following the ingestion of gluten-containing cereals in subjects without celiac disease or wheat allergy. The identity of the molecular triggers in these cereals responsible for the symptoms of NCWS remains to be delineated. Recent research has identified a biological basis for the condition, with the observation of systemic immune activation in response to microbial translocation that appears to be linked to intestinal barrier defects. Ongoing research efforts are aimed at further characterizing the etiology, mechanism, and biomarkers of the condition.
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