151
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Bascuñán KA, Pérez-Bravo F, Gaudioso G, Vaira V, Roncoroni L, Elli L, Monguzzi E, Araya M. A miRNA-Based Blood and Mucosal Approach for Detecting and Monitoring Celiac Disease. Dig Dis Sci 2020; 65:1982-1991. [PMID: 31781909 DOI: 10.1007/s10620-019-05966-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of microRNAs (miRNAs) in celiac disease (CD) is unclear. AIMS We evaluated inflammation-related miRNA-146a, miRNA-155, miRNA-21, and miRNA-125b expression in peripheral blood and intestinal mucosa of CD adults. METHODS Thirty patients with CD were included: patients with active CD on a gluten-containing diet (CD-active, n = 10), patients on a gluten-free diet (for at least 1 year), and patients with negative blood antibodies (CD-inactivePE, n = 10). In addition, ten healthy volunteers formed the comparison/control group. MiRNA expression was measured in duodenal biopsies from patients (CD-inactiveMU, n = 10) after in vitro exposure to PT gliadin and 33-mer peptide. MiRNAs expression was measured in plasma and in peripheral blood mononuclear cells (PBMCs) and monocytes, before and after in vitro exposure to native gliadin (gliadinN). RESULTS Expression levels of miRNA-146a, miRNA-155, and miRNA-21 in PBMCs, miRNA-155 in monocytes and miRNA-155, miRNA-21, and miRNA-125b in plasma were elevated in both groups of celiac patients. After in vitro exposure with gliadinN, miRNA-146a and miRNA-155 expression markedly increased in PBMCs and monocytes, while miRNA-155 and miRNA-21 increased in the CD-active group. MiRNAs expression in intestinal mucosa did not change. MiRNA-146a and miRNA-155 expression showed high sensitivity and specificity for the presence of CD, irrespective of the current dietary treatment. CONCLUSIONS Selected inflammation-related miRNAs expression is elevated in the peripheral blood of celiac. This suggests their participation in the immune processes underlying the pathology. Their similar response in active and inactive CD suggests that they should be further evaluated, as potential diagnostic biomarkers for CD.
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Affiliation(s)
- Karla A Bascuñán
- Department of Nutrition, School of Medicine, University of Chile, Av. Independencia 1027, Independencia, 8380453, Santiago, Chile. .,Center for the Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy.
| | - Francisco Pérez-Bravo
- Department of Nutrition, School of Medicine, University of Chile, Av. Independencia 1027, Independencia, 8380453, Santiago, Chile.,Laboratory of Immunogenetics, Institute of Nutrition and Food Technology, INTA, University of Chile, Av. El Líbano, 5524, Macul, Santiago, Chile
| | - Gabriella Gaudioso
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
| | - Valentina Vaira
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan Medical School, Milan, Italy
| | - Leda Roncoroni
- Center for the Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Luca Elli
- Department of Pathophysiology and Transplantation, University of Milan Medical School, Milan, Italy.,Center for the Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Erika Monguzzi
- Department of Pathophysiology and Transplantation, University of Milan Medical School, Milan, Italy.,Center for the Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Magdalena Araya
- Laboratory of Immunogenetics, Institute of Nutrition and Food Technology, INTA, University of Chile, Av. El Líbano, 5524, Macul, Santiago, Chile.,Human Nutrition, Institute of Nutrition and Food Technology, INTA, University of Chile, Av. El Líbano, 5524, Macul, Santiago, Chile
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152
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Potter MD, Hunt JS, Walker MM, Jones M, Liu C, Weltman M, Talley NJ. Duodenal eosinophils as predictors of symptoms in coeliac disease: a comparison of coeliac disease and non-coeliac dyspeptic patients with controls. Scand J Gastroenterol 2020; 55:780-784. [PMID: 32536237 DOI: 10.1080/00365521.2020.1775880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: Duodenal eosinophilia is a key feature of functional dyspepsia, particularly in those with early satiety. Duodenal eosinophilia is also recognised in coeliac disease, although its relevance to symptoms is not understood. We aimed to determine if duodenal eosinophilia is present in patients with coeliac disease presenting with dyspepsia, and whether other histological characteristics were associated with clinical features on presentation.Methods: The coeliac study population comprised 61 patients with a new presentation of coeliac disease to a single centre from 2003 to 2013. A standard symptom assessment was documented for all patients. The control population (55 adults) presenting for endoscopy without coeliac disease was drawn from the same centre with similar demographics for age and gender. Duodenal biopsies from both groups were assessed for eosinophil counts and histological features.Results: Dyspepsia was present in 18.0% of coeliac patients and early satiety in 24.6%. The eosinophil counts were significantly higher in the stomach (12.1/mm2 vs. 4.0/mm2, p < .001) and duodenum (60.4/mm2 vs. 18.0/mm2, p < .001) of coeliac patients compared with controls. There was no significant difference in the mean duodenal eosinophil count in coeliac disease with and without early satiety (55.4/mm2 vs. 66.9/mm2, p = .51). Duodenal eosinophilia was not associated with the severity of coeliac enteropathy. The degree of villous atrophy was associated with iron deficiency at presentation (p = .01), but not symptoms.Conclusions: Although duodenal eosinophil counts are higher in coeliac disease than controls, we were not able to demonstrate an association with presenting symptoms or markers of disease severity.
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Affiliation(s)
- Michael D Potter
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Department of Gastroenterology and Hepatology, John Hunter Hospital, Newcastle, Australia
| | - James S Hunt
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, Australia
| | - Marjorie M Walker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Mike Jones
- Psychology Department, Macquarie University, Sydney, Australia
| | - Cheng Liu
- Department of Pathology, Nepean Hospital, Sydney, Australia
| | - Martin Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nicholas J Talley
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Department of Gastroenterology and Hepatology, John Hunter Hospital, Newcastle, Australia
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153
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Passanisi S, Dipasquale V, Romano C. Vaccinations and Immune Response in Celiac Disease. Vaccines (Basel) 2020; 8:vaccines8020278. [PMID: 32517026 PMCID: PMC7349995 DOI: 10.3390/vaccines8020278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
Immune response to vaccinations in celiac patients is of growing scientific interest. However, some aspects of the relationship between celiac disease (CD) and vaccines are still unclear. A comprehensive search of published literature using the PubMed database was carried out using the following key terms: "adaptive immunity", "celiac disease", "humoral immune response", "immunization", and "vaccination". To date, there is no evidence showing any causative association between vaccines and CD development. Therefore, vaccinations may be administered according to the modalities and timing of the National Immunization Schedule for each country. The rotavirus vaccine is currently recommended for the general population, and according to some data, it appears to reduce the risk for the development of CD autoimmunity in the early years of life. Regarding the hepatitis B virus, a booster dose of the vaccine is often required due to the low or the lost immune response rate in CD. Furthermore, determination of hepatitis B antibody titers could be useful in newly diagnosed CD subjects regardless of age at diagnosis. Finally, pneumococcal vaccines may be administered in patients with advancing age at diagnosis and concomitant risk factors. Future clinical practice guidelines for vaccination and monitoring programs in celiac patients could be recommended.
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154
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Ethan D, Meleo-Erwin Z, Fera J, Garcia P, Basch CH. Readability of Online Information on Celiac Disease: A Brief Report. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2020. [DOI: 10.1080/15398285.2020.1752028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Danna Ethan
- Department of Health Sciences, Lehman College, The City University of New York, Bronx, New York, USA
| | - Zoe Meleo-Erwin
- Department of Public Health, William Paterson University, Wayne, New Jersey, USA
| | - Joseph Fera
- Department of Mathematics, Lehman College, The City University of New York, Bronx, New York, USA
| | - Phillip Garcia
- Department of Public Health, William Paterson University, Wayne, New Jersey, USA
| | - Corey H. Basch
- Department of Public Health, William Paterson University, Wayne, New Jersey, USA
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155
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Hamdani AM, Wani IA, Bhat NA. Gluten free cookies from rice-chickpea composite flour using exudate gums from acacia, apricot and karaya. FOOD BIOSCI 2020. [DOI: 10.1016/j.fbio.2020.100541] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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156
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Aureli A, Aboulaghras S, Oumhani K, Del Beato T, Sebastiani P, Colanardi A, El Aouad R, Ben El Barhdadi I, Piancatelli D. CD1 gene polymorphism and susceptibility to celiac disease: Association of CD1E*02/02 in Moroccans. Hum Immunol 2020; 81:361-365. [PMID: 32467040 DOI: 10.1016/j.humimm.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/26/2020] [Accepted: 05/12/2020] [Indexed: 11/16/2022]
Abstract
CD1 glycoproteins are a class of antigen presenting molecules that bind and present non-peptidic antigens (lipids and glycolipids) for immune recognition. CD1 polymorphisms, although limited, could have a critical role in antimicrobial, anticancer, and autoimmune responses and disease susceptibility. Ethnic differences and interactions between genetic and environmental factors make it attractive the study of these molecules in autoimmune inflammatory disorders, such as celiac disease (CD), in which a strong genetic predisposition (HLA-DQ2/DQ8) and pressure of environmental factors have a central role. CD1A, CD1D and CD1E polymorphisms in exon 2 were assessed in patients from Morocco affected by CD, using direct sequencing analysis, in order to investigate possible associations with the disease in a North African population. Differences in genotype and haplotype distribution of CD1E between celiac patients and controls were found: in particular, an increase of CD1E*02/02 homozygous (OR 2.93, CI 1.30-6.59, p = 0.007) and CD1A*02-E*02 estimated haplotypes in CD, compared with controls. Frequencies of CD1A and CD1D genotypes/alleles were not different between groups. CD1E*02/02, previously suggested as a potential immune protective genotype to malaria susceptibility, could be an additional gene involved in celiac risk in this geographic area.
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Affiliation(s)
- Anna Aureli
- National Research Council (CNR)-Institute of Translational Pharmacology (IFT), L'Aquila, Italy
| | - Sara Aboulaghras
- Laboratoire d'Immunologie, Institut National d'Hygiene, Rabat, Morocco
| | - Khadija Oumhani
- Laboratoire d'Immunologie, Institut National d'Hygiene, Rabat, Morocco
| | - Tiziana Del Beato
- National Research Council (CNR)-Institute of Translational Pharmacology (IFT), L'Aquila, Italy
| | - Pierluigi Sebastiani
- National Research Council (CNR)-Institute of Translational Pharmacology (IFT), L'Aquila, Italy
| | - Alessia Colanardi
- National Research Council (CNR)-Institute of Translational Pharmacology (IFT), L'Aquila, Italy
| | - Rajae El Aouad
- Hassan II Academy of Science and Technology, Rabat, Morocco
| | | | - Daniela Piancatelli
- National Research Council (CNR)-Institute of Translational Pharmacology (IFT), L'Aquila, Italy.
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157
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The Influence of Small Intestinal Bacterial Overgrowth in Digestive and Extra-Intestinal Disorders. Int J Mol Sci 2020; 21:ijms21103531. [PMID: 32429454 PMCID: PMC7279035 DOI: 10.3390/ijms21103531] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023] Open
Abstract
Small intestinal bacterial overgrowth (SIBO) is a condition hallmarked by an increase in the concentration of colonic-type bacteria in the small bowel. Watery diarrhea, bloating, abdominal pain and distension are the most common clinical manifestations. Additionally, malnutrition and vitamin (B12, D, A, and E) as well as minerals (iron and calcium) deficiency may be present. SIBO may mask or worsen the history of some diseases (celiac disease, irritable bowel disease), may be more common in some extra-intestinal disorders (scleroderma, obesity), or could even represent a pathogenetic link with some diseases, in which a perturbation of intestinal microbiota may be involved. On these bases, we performed a review to explore the multiple links between SIBO and digestive and extra-intestinal diseases.
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158
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Bokhari HA, Shaik NA, Banaganapalli B, Nasser KK, Ageel HI, Al Shamrani AS, Rashidi OM, Al Ghubayshi OY, Shaik J, Ahmad A, Alrayes NM, Al-Aama JY, Elango R, Saadah OI. Whole exome sequencing of a Saudi family and systems biology analysis identifies CPED1 as a putative causative gene to Celiac Disease. Saudi J Biol Sci 2020; 27:1494-1502. [PMID: 32489286 PMCID: PMC7254030 DOI: 10.1016/j.sjbs.2020.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/15/2022] Open
Abstract
Celiac disease (CD) is a gastrointestinal disorder whose genetic basis is not fully understood. Therefore, we studied a Saudi family with two CD affected siblings to discover the causal genetic defect. Through whole exome sequencing (WES), we identified that both siblings have inherited an extremely rare and deleterious CPED1 genetic variant (c.241 A > G; p.Thr81Ala) segregating as autosomal recessive mutation, suggesting its putative causal role in the CD. Saudi population specific minor allele frequency (MAF) analysis has confirmed its extremely rare prevalence in homozygous condition (MAF is 0.0004). The Sanger sequencing analysis confirmed the absence of this homozygous variant in 100 sporadic Saudi CD cases. Genotype-Tissue Expression (GTEx) data has revealed that CPED1 is abundantly expressed in gastrointestinal mucosa. By using a combination of systems biology approaches like protein 3D modeling, stability analysis and nucleotide sequence conservation analysis, we have further established that this variant is deleterious to the structural and functional aspects of CPED1 protein. To the best of our knowledge, this variant has not been previously reported in CD or any other gastrointestinal disease. The cell culture and animal model studies could provide further insight into the exact role of CPED1 p.Thr81Ala variant in the pathophysiology of CD. In conclusion, by using WES and systems biology analysis, present study for the first-time reports CPED1 as a potential causative gene for CD in a Saudi family with potential implications to both disease diagnosis and genetic counseling.
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Affiliation(s)
- Hifaa A Bokhari
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia
| | - Noor Ahmad Shaik
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.,Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Babajan Banaganapalli
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.,Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalidah Khalid Nasser
- Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Ali Saad Al Shamrani
- Department of Pedidatrics, Maternity and Children Hospital, Makkah, Saudi Arabia
| | - Omran M Rashidi
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia
| | | | - Jilani Shaik
- Dept of Biochemistry, Genome Research Chair, Faculty of Science, King Saud University, Saudi Arabia
| | - Aftab Ahmad
- Department of Health Information Technology, Faculty of Applied Studies, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nuha Mohammad Alrayes
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jumana Yousuf Al-Aama
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.,Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ramu Elango
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.,Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar Ibrahim Saadah
- Pediatric Gastroenterology Unit, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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159
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Yazıcı A, Yıldırım AE, Konduk BT. Does celiac disease cause autoimmune sensorineural hearing loss? TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:776-781. [PMID: 31530521 DOI: 10.5152/tjg.2019.18918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS The primary aim of this study is to identify whether an autoimmune sensorineural hearing loss is an extraintestinal neurological manifestation in adult CD patients. The secondary aim is to identify whether the duration of a gluten-free diet has an effect on the hearing levels of CD patients. MATERIALS AND METHODS This prospective study consisting of 103 adult CD patients and 79 healthy controls between May 2012 and August 2018 at the University of Gaziantep Gastroenterology and Otorhinolaryngology Departments. CD patients were divided into two groups as remission or active, according to their gluten-free diet duration and serum levels of anti-t-TG. The control group was checked both for CD symptoms and anti-t-TG serum levels. Both participants performed a pure tone audiometry after detailed ear nose and throat examination. RESULTS Only 4 of 103 CD patients showed sensorineural hearing loss. There was no statistically significant difference between hearing levels of the CD patients and the control group in both measurements of air and bone conductions. The hearing levels comparing the remission and active CD patients did not show any difference in air and bone conduction frequencies. CONCLUSION In this study with a higher number of CD patients when compared with the previous studies, it has been shown that CD does not appear to cause autoimmune sensorineural hearing loss. In addition, the status of the patients regarding the activeness or the remission of CD did not display a differ between the CD patients in terms of hearing levels.
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Affiliation(s)
- Alper Yazıcı
- Department of Otorhinolaryngology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Abdullah Emre Yıldırım
- Department of Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Buğra Tolga Konduk
- Department of Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkey
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160
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Micic D, Rao VL, Semrad CE. Celiac Disease and Its Role in the Development of Metabolic Bone Disease. J Clin Densitom 2020; 23:190-199. [PMID: 31320223 DOI: 10.1016/j.jocd.2019.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/22/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
Celiac disease (CD) is an immune-mediated enteropathy that occurs in genetically susceptible hosts with the ingestion of gluten-containing products. Ongoing gluten consumption leads to intestinal damage, characterized by villous blunting and increased intraepithelial lymphocytes, resulting in malabsorption. Pertinent to the development of bone disease, malabsorption of calcium and vitamin D leads to secondary hyperparathyroidism and metabolic bone disease among individuals with CD. In this article, we review the pathogenesis of CD and the effects of malabsorption on bone health. Imbalances in bone resorption and formation particularly in individuals with CD and persistent disease activity ultimately lead to a state of bone loss and impaired mineralization. Initiation of a gluten-free diet is critical in the management of CD-related metabolic bone disease, demonstrating improvements in bone mineral density within the first year of dietary adherence.
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Affiliation(s)
- Dejan Micic
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA.
| | - Vijaya L Rao
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA
| | - Carol E Semrad
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA
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161
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Damoiseaux M, van Doorn W, van Lochem E, Damoiseaux J. Testing for IgA anti-tissue transglutaminase in routine clinical practice: Requesting behaviour in relation to prevalence of positive results. J Transl Autoimmun 2020; 3:100045. [PMID: 32743526 PMCID: PMC7388373 DOI: 10.1016/j.jtauto.2020.100045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Due to the high awareness of coeliac disease and improvement of serological tests, the number of requested laboratory tests has increased substantially over the years. In the current study we have evaluated the requesting behaviour of distinct clinical disciplines in relation to the prevalence of positive results and in the context of existing guidelines. METHODS Data were retrospectively extracted from the laboratory information system over a time-span of 5 years in a tertiary hospital and compared with the situation in a secondary hospital. RESULTS Data reveal that for initial testing (n=18,183) the percentage positive results for IgA anti-TTG is <2%. Paediatricians have a slightly higher percentage of seropositive results (2.4-4.0%). Early confirmation (<2 months) of positive results by IgA anti-endomysium antibodies in an independent sample is only performed in a minority of paediatric patients. The majority of positive patients, however, have follow-up measurements (<14 months) in order to examine compliance to a gluten-free diet. Interestingly, initial requests for paediatric patients reveal an equal distribution between boys and girls, while in adult patients there is a two times preponderance of requests in female patients, similar to the female/male ratio in patients with positive results, being either paediatric or adult patients. CONCLUSION Although laboratory testing for coeliac disease may be primarily used to exclude the disease, it is evident that the percentage positive results for IgA anti-TTG is extremely low. This may indicate that the clinical manifestations that warrant testing, should be further specified in order to increase the pre-test probability. As the specific serology is important to bypass a biopsy in the diagnosis of coeliac disease according to the paediatric guideline, the confirmation in an independent sample needs to get more attention.
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Affiliation(s)
- Maurits Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - William van Doorn
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ellen van Lochem
- Department of Microbiology and Immunology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
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162
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Schmucker C, Meerpohl JJ, Lehane C, Zähringer J, Al Said S, Schwingshackl L. Effects of a gluten-reduced or gluten-free diet for the primary prevention of cardiovascular disease. Hippokratia 2020. [DOI: 10.1002/14651858.cd013556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christine Schmucker
- Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; Institute for Evidence in Medicine; Breisacher Str. 153 Freiburg Germany D-79110
| | - Joerg J Meerpohl
- Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; Institute for Evidence in Medicine; Breisacher Str. 153 Freiburg Germany D-79110
| | - Cornelius Lehane
- University Heart Center Freiburg, Bad Krozingen; Department of Anesthesiology; Freiburg Germany
| | - Jasmin Zähringer
- Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; Institute for Evidence in Medicine; Breisacher Str. 153 Freiburg Germany D-79110
| | - Samer Al Said
- University of Heidelberg; Department of Medicine III; Heidelberg Germany
| | - Lukas Schwingshackl
- Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; Institute for Evidence in Medicine; Breisacher Str. 153 Freiburg Germany D-79110
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163
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Bogaert L, Cauchie M, Van Hoovels L, Vermeersch P, Fierz W, De Hertogh G, Hoffman I, Bossuyt X. Optimization of serologic diagnosis of celiac disease in the pediatric setting. Autoimmun Rev 2020; 19:102513. [PMID: 32173515 DOI: 10.1016/j.autrev.2020.102513] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The clinical presentation of celiac disease (CD) varies between children. The objective of this study was to document the pre-test probability for CD based on symptoms and routine laboratory test and to evaluate the performance of two IgA anti-tissue transglutaminase (tTG) assays. We critically reviewed the concept of using multiples of the manufacturer's upper limit of normal (ULN), as proposed in the ESPGHAN guidelines (if IgA tTG is >10 times ULN, no biopsy is needed). METHODS The retrospective study included 91 children with newly diagnosed CD and 605 controls (<16 years). All underwent upper endoscopy with small bowel biopsies. Four laboratory parameters and 16 symptoms were registered. All patients were tested for IgA anti-tTG antibodies with assays from Inova Diagnostics and Thermo Fisher Scientific. RESULTS Some combinations of clinical symptoms and laboratory parameters had a high pre-test probability for CD, such as (combinations of) anorexia, failure to thrive, low ferritin level and elevated AST. The diagnostic performance of both IgA anti-tTG assays was excellent and comparable (no difference in ROC curve area under the curve). At a threshold that corresponds to a specificity of 100% (5 times ULN for Inova Diagnostics and 2 times ULN for Thermo Fisher), the sensitivity was 82% for both assays. At the 10 times ULN threshold, the sensitivity differed between the assays (77% vs. 57%), indicating that such threshold does not completely align interpretation across companies. CONCLUSIONS Our study showed that some combinations of symptoms and aberrant laboratory parameters had a high pre-test probability. The use of the ESPGHAN non-biopsy approach could reduce small bowel biopsies, but thresholds for IgA-tTG levels are not aligned across assays and should be based on predefined likelihood ratios or specificity.
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Affiliation(s)
- Laura Bogaert
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium; Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Mathieu Cauchie
- Department of Laboratory Medicine, Europe Hospitals, Brussels, Belgium
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Pieter Vermeersch
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Walter Fierz
- Schweizerischer Verband der Diagnostikindustrie (SVDI), Bern, Switzerland
| | - Gert De Hertogh
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Ilse Hoffman
- Department of Paedriatrics, University Hospital Leuven, Leuven, Belgium
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium.
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Barone M, Gemello E, Viggiani MT, Cristofori F, Renna C, Iannone A, Di Leo A, Francavilla R. Evaluation of Non-Celiac Gluten Sensitivity in Patients with Previous Diagnosis of Irritable Bowel Syndrome: A Randomized Double-Blind Placebo-Controlled Crossover Trial. Nutrients 2020; 12:nu12030705. [PMID: 32155878 PMCID: PMC7146412 DOI: 10.3390/nu12030705] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background. To date, there is no reliable marker for the diagnosis of non-celiac gluten sensitivity (NCGS), which benefits from a gluten-free diet (GFD). This condition is characterized by functional gastrointestinal symptoms similar to those occurring in the course of irritable bowel syndrome (IBS). However, IBS has a higher prevalence, and often benefits from the administration of a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet. The overlap of symptoms between these two pathologies has led to an overestimation of self-made diagnosis NCGS. Aims. To better identify NCGS in subjects with a previous diagnosis of IBS. Methods. All subjects received a low FODMAP diet that was also gluten-free (low FODMAP-GFD), and those presenting an improvement of symptoms were exposed to gluten or placebo (double-blind challenge with wash-out and crossover). The response to dietary treatments was evaluated by visual analogue scale (VAS). Results. Of 30 patients (23 women, seven men, aged 42.2 ± 12.5 years, body mass index (BMI ) 24.7 ± 4.1 kg/m2), 26 benefited from the administration of low FODMAP-GFD and were exposed to the gluten/placebo challenge. After the challenge, using an increase of visual analogue scale VAS (Δ-VAS) ≥30%, 46.1% of the patients were NCGS+. However, this percentage became only 19.2% using a different method (mean ∆-VAS score plus two standard deviations). Conclusions. FODMAP intolerance could hide the response to a challenge test with gluten for the identification of NCGS in IBS patients. A low FODMAP-GFD followed by gluten/placebo challenge is able to identify patients with NCGS better. ClinicalTrials.gov registration number NCT04017585.
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Affiliation(s)
- Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70100 Bari, Italy; (M.T.V.); (A.I.); (A.D.L.)
- Correspondence: ; Tel.: +39-080-5593514; Fax: +39-080-5593177
| | - Eugenio Gemello
- Center for the Study and Treatment of Eating Disorders ASL/LE, 73100 Lecce, Italy; (E.G.); (C.R.)
| | - Maria Teresa Viggiani
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70100 Bari, Italy; (M.T.V.); (A.I.); (A.D.L.)
| | - Fernanda Cristofori
- Interdisciplinary Department of Medicine, Paediatric Section, University of Bari “Aldo Moro”, 70100 Bari, Italy; (F.C.); (R.F.)
| | - Caterina Renna
- Center for the Study and Treatment of Eating Disorders ASL/LE, 73100 Lecce, Italy; (E.G.); (C.R.)
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70100 Bari, Italy; (M.T.V.); (A.I.); (A.D.L.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70100 Bari, Italy; (M.T.V.); (A.I.); (A.D.L.)
| | - Ruggiero Francavilla
- Interdisciplinary Department of Medicine, Paediatric Section, University of Bari “Aldo Moro”, 70100 Bari, Italy; (F.C.); (R.F.)
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165
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Meleo-Erwin Z, Basch CH, Fera J, Smith B. #celiacdisease: The Use of Instagram in Contending with Chronic Illness. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2020. [DOI: 10.1080/15398285.2019.1711004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Zoe Meleo-Erwin
- Department of Public Health, William Paterson University, Wayne, New Jersey, USA
| | - Corey H. Basch
- Department of Public Health, William Paterson University, Wayne, New Jersey, USA
| | - Joseph Fera
- Department of Mathematics, Lehman College, The City University of New York, New York, New York, USA
| | - Bonnie Smith
- Department of Public Health, William Paterson University, Wayne, New Jersey, USA
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166
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Fasano A, Leonard MM, Mitchell DM, Eng G. Case 1-2020: An 11-Year-Old Boy with Vomiting and Weight Loss. N Engl J Med 2020; 382:180-189. [PMID: 31914246 PMCID: PMC8176458 DOI: 10.1056/nejmcpc1913469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Alessio Fasano
- From the Departments of Pediatrics (A.F., M.M.L., D.M.M.) and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Pediatrics (A.F., M.M.L., D.M.M.) and Pathology (G.E.), Harvard Medical School - both in Boston
| | - Maureen M Leonard
- From the Departments of Pediatrics (A.F., M.M.L., D.M.M.) and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Pediatrics (A.F., M.M.L., D.M.M.) and Pathology (G.E.), Harvard Medical School - both in Boston
| | - Deborah M Mitchell
- From the Departments of Pediatrics (A.F., M.M.L., D.M.M.) and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Pediatrics (A.F., M.M.L., D.M.M.) and Pathology (G.E.), Harvard Medical School - both in Boston
| | - George Eng
- From the Departments of Pediatrics (A.F., M.M.L., D.M.M.) and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Pediatrics (A.F., M.M.L., D.M.M.) and Pathology (G.E.), Harvard Medical School - both in Boston
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167
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Lototskaya PS, Manina MA, Tertychnyy AS, Zamyatnin AA, Erdes SI. Duodenal Ulceration in a Child with Coeliac Disease. Diagnostics (Basel) 2020; 10:diagnostics10010031. [PMID: 31936445 PMCID: PMC7168337 DOI: 10.3390/diagnostics10010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/29/2019] [Accepted: 01/07/2020] [Indexed: 11/25/2022] Open
Abstract
Coeliac disease (CD) is a gluten-dependent inflammatory disease of the small bowel that affects up to 1% of the global population. Herein, the presence of ulcers, erosions, or strictures in the duodenum for non-advanced cases of CD is a rarity. Case report: We present a clinical case of a 17-year-old girl, who from the age of 9, had suffered from erosive Helicobacter pylori (HP)-associated gastritis and erosive duodenitis. At 16, she was diagnosed with a duodenal ulcer, complicated by cicatricial deformity of the bulb. While an atypical course in the development of the disease had led to the initial delay in diagnosis, a serum study and an intestinal biopsy confirmed CD. Discussion: A recent study found an elevated rate of peptic ulcer disease in patients with CD. From literature searches, comorbid HP infection and CD have indeed been widely reported, whereas cases highlighting the prevalence of CD-associated peptic ulcers have been observed and reported in only a few instances. Consequently, greater awareness is warranted and must be exercised for identifying the origins of ulcerative lesions that may be CD-related or -derived.
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Affiliation(s)
- Polina S. Lototskaya
- Filatov Clinical Institute of Child Health, Sechenov First Moscow State Medical University, 119991 Moscow, Russia; (P.S.L.); (M.A.M.)
| | - Marina A. Manina
- Filatov Clinical Institute of Child Health, Sechenov First Moscow State Medical University, 119991 Moscow, Russia; (P.S.L.); (M.A.M.)
| | - Aleksandr S. Tertychnyy
- Department of Pathological Anatomy, Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Andrey A. Zamyatnin
- Institute of Molecular Medicine, Sechenov First Moscow State Medical University, 119991 Moscow, Russia
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia
- Correspondence: (A.A.Z.J.); (S.I.E.)
| | - Svetlana I. Erdes
- Filatov Clinical Institute of Child Health, Sechenov First Moscow State Medical University, 119991 Moscow, Russia; (P.S.L.); (M.A.M.)
- Correspondence: (A.A.Z.J.); (S.I.E.)
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168
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Potter MDE, Jones MP, Walker MM, Koloski NA, Keely S, Holtmann G, Talley Ac NJ. Incidence and prevalence of self-reported non-coeliac wheat sensitivity and gluten avoidance in Australia. Med J Aust 2020; 212:126-131. [PMID: 31909482 DOI: 10.5694/mja2.50458] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 08/13/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the incidence of self-reported non-coeliac wheat sensitivity (SR-NCWS) and factors associated with its onset and resolution; to describe the prevalence of factors associated with gluten avoidance. DESIGN Longitudinal cohort study; analysis of responses to self-administered validated questionnaires (Digestive Health and Wellbeing surveys, 2015 and 2018). SETTING, PARTICIPANTS Subset of an adult population sample randomly selected in 2015 from the electoral rolls for the Newcastle and Gosford regions of New South Wales. MAIN OUTCOME MEASURES Prevalence of SR-NCWS (2015, 2018) and incidence and resolution of SR-NCWS, each by demographic and medical factors; prevalence of gluten avoidance and reasons for gluten avoidance (2018). RESULTS 1322 of 2185 eligible participants completed the 2018 survey (response rate, 60.5%). The prevalence of SR-NCWS was similar in 2015 (13.8%; 95% CI, 12.0-15.8%) and 2018 (13.9%; 95% CI, 12.1-15.9%); 69 of 1301 respondents (5.3%) reported developing new onset (incident) SR-NCWS between 2015 and 2018 (incidence, 1.8% per year). Incident SR-NCWS was significantly associated with a diagnosis of functional dyspepsia, and negatively associated with being male or older. Gluten avoidance was reported in 2018 by 24.2% of respondents (20.5% partial, 3.8% complete avoidance); general health was the most frequent reason for avoidance (168 of 316 avoiders, 53%). All 13 participants with coeliac disease, 56 of 138 with irritable bowel syndrome (41%), and 69 of 237 with functional dyspepsia (29%) avoided dietary gluten. CONCLUSIONS The prevalence of SR-NCWS was similar in 2015 and 2018. Baseline (2015) and incident SR-NCWS (2018) were each associated with functional gastrointestinal disorders. The number of people avoiding dietary gluten exceeds that of people with coeliac disease or SR-NCWS, and general health considerations and abdominal symptoms are the most frequently reported reasons for avoidance.
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Affiliation(s)
- Michael DE Potter
- University of Newcastle, Newcastle, NSW.,John Hunter Hospital, Newcastle, NSW
| | | | | | - Natasha A Koloski
- University of Queensland, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
| | | | - Gerald Holtmann
- University of Queensland, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
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169
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Nutritional Status, Dietary Intake, and Adherence to the Mediterranean Diet of Children with Celiac Disease on a Gluten-Free Diet: A Case-Control Prospective Study. Nutrients 2020; 12:nu12010143. [PMID: 31947949 PMCID: PMC7019969 DOI: 10.3390/nu12010143] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/29/2019] [Accepted: 01/02/2020] [Indexed: 01/09/2023] Open
Abstract
The only effective treatment for celiac disease (CD) is a life-long strict gluten-free diet (GFD). Nutritional adequacy of the GFD has remained controversial and a matter of debate for a long time. No large case-control studies on children regarding the nutritional adequacy of the GFD has been performed. In this study, children diagnosed with CD on a GFD for ≥ 2 years were recruited. Controls were age and gender-matched healthy children not affected with CD. In both groups, anthropometric measurements and energy expenditure information were collected. Dietary assessment was performed by a 3-day food diary. Adherence to the Mediterranean diet was estimated by the KIDMED index. Overall, 120 children with CD and 100 healthy children were enrolled. No differences were found between CD children and controls in anthropometric measurements and energy expenditure. In the CD group, the daily intake of fats was significantly higher while the consumption of fiber was lower in comparison with the control group. The median KIDMED index was 6.5 in CD children and 6.8 in healthy controls. The diet of children with CD in this study was nutritionally less balanced than controls, with a higher intake of fat and a lower intake of fiber, highlighting the need for dietary counseling.
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170
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Evaluation of N-terminal labeling mass spectrometry for characterization of partially hydrolyzed gluten proteins. J Proteomics 2020; 210:103538. [DOI: 10.1016/j.jprot.2019.103538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/17/2019] [Accepted: 09/27/2019] [Indexed: 02/07/2023]
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171
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Abstract
Recent statistics report that 3 million people, or 1% of the population in the United States (U.S.), are affected by celiac disease (CD). In addition, in the U.S., as many as 1 in 80 children is affected with CD. However, CD can be challenging to diagnose and many children are not correctly diagnosed or live without a diagnosis for several years. Symptoms, if present, are often nonspecific and may be common manifestations of many pediatric illnesses. The purpose of this review is to examine the current evidence regarding incidence, pathophysiology, diagnosis, and treatment of a child with CD. Clinical implications for nurses caring for children and families are discussed.
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172
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Valero C, García MJ. Bone Metabolism in Inflammatory Bowel Disease and Celiac Disease. Clin Rev Bone Miner Metab 2019. [DOI: 10.1007/s12018-019-09269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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173
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Defining the Celiac Disease Transcriptome using Clinical Pathology Specimens Reveals Biologic Pathways and Supports Diagnosis. Sci Rep 2019; 9:16163. [PMID: 31700112 PMCID: PMC6838157 DOI: 10.1038/s41598-019-52733-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/21/2019] [Indexed: 01/30/2023] Open
Abstract
Celiac disease is provoked by gluten exposure, but the complete pathogenic process in the duodenum and the loss of tolerance to gluten is not well understood. We aimed to define the core celiac transcriptomic signature and pathologic pathways in pre-treatment formalin-fixed paraffin-embedded (FFPE) duodenum biopsies used for clinical diagnosis. We use mRNAseq to define pre-treatment diagnostic duodenum gene expression in 54 pediatric celiac patients and non-celiac controls, and we validate our key findings in two independent cohorts of 67 adults and pediatric participants that used fresh frozen biopsies. We further define similar and divergent genes and pathways in 177 small bowel Crohn disease patients and controls. We observe a marked suppression of mature epithelial metabolic functions in celiac patients, overlapping substantially with the Crohn disease signature. A marked adaptive immune response was noted for the up-regulated signature including interferon response, alpha-beta, and gamma-delta T-cells that overlapped to some extent with the Crohn disease signature. However, we also identified a celiac disease specific signature linked to increased cell proliferation, nuclear division, and cell cycle activity that was localized primarily to the epithelia as noted by CCNB1 and Ki67 staining. Lastly, we demonstrate the utility of the transcriptomic date to correctly classify disease or healthy states in the discovery and validation cohorts. Our data supplement recently published datasets providing insights into celiac pathogenesis using clinical pathology FFPE samples, and can stimulate new approaches to address this highly prevalent condition.
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174
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Franceschini E, Lionetti ME, D'Adamo G, D'Angelo E, Gatti S, Naspi Catassi G, Malamisura B, Catassi C. Misuse of serological screening tests for celiac disease in children: A prospective study in Italy. Dig Liver Dis 2019; 51:1547-1550. [PMID: 31383458 DOI: 10.1016/j.dld.2019.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite a well-established diagnostic algorithm for celiac disease, it remains unclear whether prescriptions for celiac serological tests comply with the current pediatric guidelines. AIM To analyze the appropriateness of test prescription in children investigated for celiac disease in Italy, compared to the current European pediatric guidelines. METHODS All children who had performed a first evaluation for celiac disease were prospectively enrolled. Prescribed tests and related indications for testing were recorded, and compared to the European pediatric guidelines. RESULTS Overall, 202 children were enrolled (females 59%, mean age 7.1 years ±4.1) in two centers. The reasons for celiac disease testing were typical, atypical symptoms or celiac disease-associated conditions in 46.5%, 49%, and 4.5% of cases, respectively. First-line tests were IgA and IgG anti-transglutaminase antibodies in 88.1% and 29.7% of children, IgA and IgG anti-deamidated gliadin peptide antibodies in 43% and 47%, IgA and IgG anti native gliadin in 15.8%, IgA anti-endomysium antibodies in 44.5%, HLA predisposing genes in 10% of patients. Test redundancy was very common, and the current diagnostic guidelines were correctly followed only in 23/202 patients (11.4%). CONCLUSIONS Diagnostic European guidelines for celiac disease screening are often disregarded in Italy. Intervention to implement adherence to these guidelines is needed, with the aim of improving resource utilization, and quality of patient care.
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Affiliation(s)
- Elisa Franceschini
- Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy
| | | | - Grazia D'Adamo
- Department of Pediatrics, University Hospital of Salerno, Salerno, Italy
| | - Elisa D'Angelo
- Department of Pediatrics, University Hospital of Salerno, Salerno, Italy
| | - Simona Gatti
- Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy
| | | | - Basilio Malamisura
- Department of Pediatrics, University Hospital of Salerno, Salerno, Italy
| | - Carlo Catassi
- Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, MA 02114, USA.
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175
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The Gut Microbiota in Celiac Disease and probiotics. Nutrients 2019; 11:nu11102375. [PMID: 31590358 PMCID: PMC6836185 DOI: 10.3390/nu11102375] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023] Open
Abstract
Celiac disease (CeD) is an immune-mediated enteropathy, and unique in that the specific trigger is known: gluten. The current mainstay of therapy is a gluten-free diet (GFD). As novel therapies are being developed, complementary strategies are also being studied, such as modulation of the gut microbiome. The gut microbiota is involved in the initiation and perpetuation of intestinal inflammation in several chronic diseases. Intestinal dysbiosis has been reported in CeD patients, untreated or treated with GFD, compared to healthy subjects. Several studies have identified differential bacterial populations associated with CeD patients and healthy subjects. However, it is still not clear if intestinal dysbiosis is the cause or effect of CeD. Probiotics have also been considered as a strategy to modulate the gut microbiome to an anti-inflammatory state. However, there is a paucity of data to support their use in treating CeD. Further studies are needed with therapeutic microbial formulations combined with human trials on the use of probiotics to treat CeD by restoring the gut microbiome to an anti-inflammatory state.
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176
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Freeman LM, Strong AT, Sharma G, Punchai S, Rodriguez JH, Kirby DF, Kroh M. Implications of Celiac Disease Among Patients Undergoing Gastric Bypass. Obes Surg 2019; 28:1546-1552. [PMID: 29235012 DOI: 10.1007/s11695-017-3046-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Bariatric surgery is generally safe and effective, but co-existing malabsorptive processes may increase the risk of complications or nutritional deficiencies. Bariatric surgery has not been well studied in the setting of pre-existing celiac disease. MATERIALS AND METHODS Patients who underwent Roux-en-Y gastric bypass (RYGB) from January 2002 to December 2015 were retrospectively reviewed for either diagnosis of or serum testing for celiac disease. Identified patients were re-reviewed for adherence to American Gastroenterological Association (AGA) diagnostic criteria. Patient demographics, operative data, and post-operative weight loss and nutritional parameters were collected. RESULTS Of the > 12,000 patients who underwent bariatric surgery during this study period, there were 342 patients that had abnormal serology or pathology results. Expert review confirmed three patients (0.8%) with celiac disease diagnosed before RYGB procedure. All were female, with an average age of 33 years and a mean BMI of 44.07 kg/m2. At the time of surgery, two of the three patients were following a gluten-free diet. At 6 months follow-up, mean % excess weight loss was 76.5%. The patients following a gluten-free diet preoperatively continued post-operatively. No patients were anemic nor had vitamin B12 or iron deficiencies at 12-month follow-up. Two patients had vitamin D insufficiencies and responded to daily oral supplementation. CONCLUSION Though many bariatric patients may carry a presumptive diagnosis of celiac disease, a small percentage of these meet AGA diagnostic criteria. RYGB appears safe in this population with comparable weight loss in non-celiac counterparts. Increased attention to vitamin D levels may be warranted post-operatively.
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Affiliation(s)
- Lindsey M Freeman
- Case Western Reserve School of Medicine, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH, 44106, USA.
| | - Andrew T Strong
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Gautam Sharma
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Suriya Punchai
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - John H Rodriguez
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Donald F Kirby
- Center for Human Nutrition, Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Matthew Kroh
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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177
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Pinto-Sanchez MI, Bai JC. Toward New Paradigms in the Follow Up of Adult Patients With Celiac Disease on a Gluten-Free Diet. Front Nutr 2019; 6:153. [PMID: 31632977 PMCID: PMC6781794 DOI: 10.3389/fnut.2019.00153] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/11/2019] [Indexed: 12/14/2022] Open
Abstract
Gluten free diet is the only available treatment for celiac disease (CeD). Patients with CeD who do not adhere to a strict gluten-free diet (GFD) have been found to have complications involving nutritional deficiencies, increased risk of bone fractures, increased risk of mortality, and certain types of cancers. Complete removal of gluten from the diet in a patient with CeD often results in symptomatic, serologic, and histologic remission. However, strict compliance with the diet is challenging. Long-term follow-up care is needed to assure treatment compliance and positive health outcomes. Monitoring celiac specific serology, nutrient deficiencies, bone mineral density, and assessment of GFD compliance have been recommended in clinical practice. However, there is no consensus on which specific tests and how often they should be performed during the follow up. Here, we have performed a review of the literature on current strategies to follow up patients with CeD. There are new tools for monitoring adherence to the GFD which could change some paradigms in following up treated patients.
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Affiliation(s)
- Maria I. Pinto-Sanchez
- Department of Medicine, Gastroenterology Division, McMaster University Medical Center, Hamilton, ON, Canada
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada
| | - Julio C. Bai
- Research Institute, Universidad del Salvador, Buenos Aires, Argentina
- Hospital de Gastroenterologia Dr. C. Bonorino Udaondo, Buenos Aires, Argentina
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Shirwaikar Thomas A, Schwartz M, Quigley E. Gastrointestinal lymphoma: the new mimic. BMJ Open Gastroenterol 2019; 6:e000320. [PMID: 31645987 PMCID: PMC6782046 DOI: 10.1136/bmjgast-2019-000320] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background Gastrointestinal (GI) lymphomas comprise a group of distinct clinicopathological entities of B- or T- cell type, with primary gastrointestinal Hodgkin lymphoma being extremely uncommon. The GI tract is the predominant site of extranodal non-Hodgkin lymphoma accounting for 30–40% of all extranodal lymphomas. In the Western world, the stomach is the most commonly involved site followed by the small bowel. Several chronic inflammatory and immune-mediated disorders which predispose to accelerated cell turnover may lead to the malignant transformation of gut lymphocytes and ultimately manifest as GI lymphoma. The challenge for the clinical gastroenterologist is that these tumors may have varied presentations, ranging from nonspecific symptoms such as dyspepsia or bloating to abdominal pain, nausea, vomiting, GI bleeding, diarrhea, weight loss or bowel obstruction. Objective We illustrate the range of presentations of GI lymphoma with examples based on consecutive cases evaluated at our institution over a 6-month period. These cases demonstrate how appropriately directed endoscopic evaluation with biopsies has the potential to provide a definitive diagnosis and allow the patient to proceed to definitive therapy. Conclusions The GI tract is the most commonly involved site for extranodal lymphoma with the stomach being most frequently involved organ. Chronic Helicobacter pylori infection, celiac disease, inflammatory bowel disease and autoimmune disorders may predispose to GI lymphoma. This heterogenous group of diseases has varied presentations that may mimic several other GI clinico-pathologic entities. GI lymphomas may be diagnosed with appropriately directed endoscopic evaluation coupled with generous tissue sampling and expert pathologic assessment. Management may range from antibiotic therapy, in the case of Helicobacter pylori-associated gastric MALT lymphoma, to chemotherapy with or without radiation and, in rare instances, surgery. There are presently no guidelines to direct endoscopic surveillance of GI lymphomas following treatment.
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Affiliation(s)
- Anusha Shirwaikar Thomas
- Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary Schwartz
- Hepatology and Nutrition, Houston Methodist Hospital, Houston, Texas, USA
| | - Eamonn Quigley
- Hepatology and Nutrition, Houston Methodist Hospital, Houston, Texas, USA
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179
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Elliott B, Czuzoj-Shulman N, Spence AR, Mishkin DS, Abenhaim HA. Effect of celiac disease on maternal and neonatal outcomes of pregnancy. J Matern Fetal Neonatal Med 2019; 34:2117-2123. [PMID: 34016019 DOI: 10.1080/14767058.2019.1658733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Celiac disease (CD) is a permanent immune reaction to gluten that is likely related to genetic factors. Some studies have linked CD to adverse maternal and/or neonatal outcomes but the data has been contradictory. The purpose of this study was to evaluate the effect of CD on pregnancy outcomes. MATERIALS AND METHODS We used data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS) of the USA to conduct a population-based retrospective cohort study of women who delivered between 1999 and 2014. Pregnancies were categorized as having CD if corresponding ICD-9 code was present. Unconditional logistic regression models were used to estimate the adjusted effect on maternal and fetal outcomes. RESULTS There were 14,513,587 births during the study period of which 2755 were to women with CD, for an overall prevalence of 1.9 cases/10,000 births and with rates increasing over the study period. Women with CD tended to be older, Caucasian and to have pre-existing comorbidities, especially other autoimmune diseases. Women with CD were at greater risk of hyperemesis gravidarum, 4.52 (3.68-5.57), Clostridium difficile colitis, 7.56 (3.14-18.20), and venous thromboembolic events, 2.93 (2.07-4.15), as well as, hospital stays >3 d, 2.06 (1.75-2.43). Infants of women with CD were more likely to be growth restricted, 1.80 (1.46-2.21) and have congenital malformations, 3.51 (2.68-4.58). CONCLUSIONS CD in pregnancy is associated with increased adverse maternal and newborn complications. These pregnancies should be considered high risk and may benefit from increased surveillance.
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Affiliation(s)
- Brittney Elliott
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
| | - Andrea R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
| | | | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
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180
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Truitt KE, Daveson AJM, Ee HC, Goel G, MacDougall J, Neff K, Anderson RP. Randomised clinical trial: a placebo-controlled study of subcutaneous or intradermal NEXVAX2, an investigational immunomodulatory peptide therapy for coeliac disease. Aliment Pharmacol Ther 2019; 50:547-555. [PMID: 31407810 DOI: 10.1111/apt.15435] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/24/2019] [Accepted: 07/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nexvax2 contains three gluten-derived peptides, intended to tolerize coeliac disease patients to gluten. Sequences cover six epitopes that trigger immune activation in human leucocyte antigen-DQ2.5-positive patients, most notably after an initial dose. Patients experience gastrointestinal symptoms with increases in serum interleukin-2. Consistent with Nexvax2's induction of non-responsiveness, reactivity disappears after repeated doses, or is avoided with gradual dose escalation. Early clinical trials used intradermal dosing, but pharmacokinetics and rapid onset of effect suggest that subcutaneous delivery may also be effective. AIMS To document the relative bioavailability of Nevax2 peptides after subcutaneous and intradermal dosing, and the tolerability and ability of subcutaneous dosing to induce non-responsiveness to Nexvax2 peptides. METHODS A randomised, double-blind, placebo-controlled study was conducted to assess plasma pharmacokinetics after subcutaneous and intradermal Nexvax2 dosing in HLA DQ2.5-positive patients, who had symptoms after an oral gluten challenge. Randomisation was to semi-weekly Nexvax2 (n = 12) or placebo (n = 2) injections, over a 5-week subcutaneous dose escalation and 2-week maintenance period, the latter with four doses of 900 µg, two subcutaneous and two intradermal. Post-dose circulating peptide and interleukin-2 levels were assessed. Investigators recorded adverse events experienced by patients. RESULTS Subcutaneous dosing resulted in slightly greater exposure. Interleukin-2 responses were seen with the gluten challenge but not after subcutaneous or intradermal dosing of 900 µg. Adverse events were generally mild and self-limited. CONCLUSIONS Subcutaneous and intradermal dosing of Nexvax2 yield similar bioavailability of constituent peptides; subcutaneous dose escalation avoids an immune response to dominant gluten epitopes.
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Affiliation(s)
| | | | - Hooi C Ee
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Gautam Goel
- ImmusanT, Inc., Cambridge, Massachusetts, USA
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181
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Grode L, Møller Jensen T, Parkner T, Agerholm IE, Humaidan P, Hammer Bech B, Ramlau-Hansen C. Diagnostic Accuracy of a Point-of-Care Test for Celiac Disease Antibody Screening among Infertile Patients. Inflamm Intest Dis 2019; 4:123-130. [PMID: 31559264 PMCID: PMC6751420 DOI: 10.1159/000501520] [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: 04/26/2019] [Accepted: 06/17/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Screening for celiac disease among infertile patients has been suggested. Several rapid point-of-care (POC) tests aimed at detecting celiac disease antibodies have been developed. It has been suggested that these POC tests can be implemented as a replacement for standard laboratory tests. OBJECTIVE To evaluate the diagnostic accuracy of a POC test (Simtomax®) that detects celiac disease antibodies compared with standard laboratory tests when screening for celiac disease among patients referred for fertility treatment in 2 Danish fertility clinics. METHODS Serum samples were analyzed for IgA anti-tissue transglutaminase (TGA) as the reference standard test with a cutoff of ≥7 kU/L and by the index POC test based on IgA and IgG antibodies against deamidated gliadin peptides (DGP). In IgA deficiency, the reference standard test was IgG DGP with a cutoff of ≥7 kU/L. Participants answered a questionnaire on gluten intake, symptoms, and risk factors. Diagnostic confirmation was made by duodenal biopsies. IgA TGA/IgG DGP were used as the reference standard to calculate positive and negative predictive values. RESULTS A total of 622 men and women (51.6%) were enrolled during 2015. The reference standard IgA TGA/IgG DGP was positive in 7 participants (1.1% [95% CI 0.5-2.3]) and the POC test was positive in 84 participants (13.5% [95% CI 10.9-16.4]), 3 of whom also had positive reference standard tests. This yields a sensitivity of the index POC test of 42.9% (95% CI 9.9-81.6) and a specificity of 86.8% (95% CI 83.9-89.4). Positive and negative predictive values were 3.57% (95% CI 0.7-10.1) and 99.3% (95% CI 98.1-99.8). CONCLUSION The sensitivity of the POC test was low; however, the specificity was moderately good. The POC test had a high negative predictive value in this low prevalent population but missed 1 patient with biopsy-confirmed celiac disease. However, because of many false-positive tests, it cannot be recommended as replacement for standard laboratory tests but rather as a triage test to decide if the standard serology tests should be performed.
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Affiliation(s)
- Louise Grode
- Department of Medicine, Horsens Regional Hospital, Horsens, Denmark
| | | | - Tina Parkner
- Department of Clinical Biochemistry, Arhus University Hospital, Aarhus, Denmark
| | - Inge Errebo Agerholm
- Department of Clinical Biochemistry, Arhus University Hospital, Origio, Måløv, Denmark
| | - Peter Humaidan
- Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Faculty of Health, Aarhus University, Aarhus, Denmark
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182
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Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, Fasano A. Celiac disease: a comprehensive current review. BMC Med 2019; 17:142. [PMID: 31331324 PMCID: PMC6647104 DOI: 10.1186/s12916-019-1380-z] [Citation(s) in RCA: 445] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Celiac disease remains a challenging condition because of a steady increase in knowledge tackling its pathophysiology, diagnosis, management, and possible therapeutic options. MAIN BODY A major milestone in the history of celiac disease was the identification of tissue transglutaminase as the autoantigen, thereby confirming the autoimmune nature of this disorder. A genetic background (HLA-DQ2/DQ8 positivity and non-HLA genes) is a mandatory determinant of the development of the disease, which occurs with the contribution of environmental factors (e.g., viral infections and dysbiosis of gut microbiota). Its prevalence in the general population is of approximately 1%, with female predominance. The disease can occur at any age, with a variety of symptoms/manifestations. This multifaceted clinical presentation leads to several phenotypes, i.e., gastrointestinal, extraintestinal, subclinical, potential, seronegative, non-responsive, and refractory. Although small intestinal biopsy remains the diagnostic 'gold standard', highly sensitive and specific serological tests, such as tissue transglutaminase, endomysial and deamidated gliadin peptide antibodies, have become gradually more important in the diagnostic work-up of celiac disease. Currently, the only treatment for celiac disease is a life-long, strict gluten-free diet leading to improvement in quality of life, ameliorating symptoms, and preventing the occurrence of refractory celiac disease, ulcerative jejunoileitis, and small intestinal adenocarcinoma and lymphoma. CONCLUSIONS The present review is timely and provides a thorough appraisal of various aspects characterizing celiac disease. Remaining challenges include obtaining a better understanding of still-unclear phenotypes such as slow-responsive, potential (minimal lesions) and seronegative celiac disease. The identification of alternative or complementary treatments to the gluten-free diet brings hope for patients unavoidably burdened by diet restrictions.
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Affiliation(s)
- Giacomo Caio
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy
- Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Umberto Volta
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Anna Sapone
- Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114 USA
- Takeda Pharmaceuticals International Co, Cambridge, MA 02139 USA
| | - Daniel A. Leffler
- Takeda Pharmaceuticals International Co, Cambridge, MA 02139 USA
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02115 USA
| | - Roberto De Giorgio
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy
| | - Carlo Catassi
- Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114 USA
- Department of Pediatrics, Center for Celiac Research, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Alessio Fasano
- Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, MA 02114 USA
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183
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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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184
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Di Nardo G, Villa MP, Conti L, Ranucci G, Pacchiarotti C, Principessa L, Raucci U, Parisi P. Nutritional Deficiencies in Children with Celiac Disease Resulting from a Gluten-Free Diet: A Systematic Review. Nutrients 2019; 11:E1588. [PMID: 31337023 PMCID: PMC6683263 DOI: 10.3390/nu11071588] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/04/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A strictly gluten-free diet (GFD) is the basis for managing celiac disease (CD). Numerous studies have reported nutritional deficiencies/imbalances ascribable to a GFD. The aim of this review is to describe nutritional deficiencies observed in children with celiac disease on a GFD, to discuss the clinical consequences related to these nutritional imbalances, and to identify strategies that may be adopted to treat them. METHODS We reviewed the MEDLINE and EMBASE databases between January 1998 and January 2019. RESULTS Children are, regardless of whether they are on a gluten-free diet or not, at risk of consuming too much fat and insufficient fiber, iron, vitamin D, and calcium. These imbalances may be exacerbated when children are on a gluten-free diet. In particular, the intake of folate, magnesium, zinc, and foods with a high glycemic index in children with CD who are on a GFD is significantly altered. CONCLUSIONS Therapeutic protocols should include nutritional education to help teach subjects affected by disorders such as CD the importance of labels, the choice of foods, and the combination of macro- and micronutrients. Children with CD on a GFD should be encouraged to rotate pseudo-cereals, consume gluten-free commercial products that have been fortified or enriched, and use foods that are local and naturally gluten-free.
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Affiliation(s)
- Giovanni Di Nardo
- Chair of Pediatrics, School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, S. Andrea University Hospital, 00189 Rome, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, S. Andrea University Hospital, 00189 Rome, Italy
| | - Laura Conti
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Giusy Ranucci
- Pediatric Unit, AORN Santobono-Pausilipon, 80129 Naples, Italy
| | - Claudia Pacchiarotti
- Chair of Pediatrics, School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, S. Andrea University Hospital, 00189 Rome, Italy
| | - Luigi Principessa
- Chair of Pediatrics, School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, S. Andrea University Hospital, 00189 Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, S. Andrea University Hospital, 00189 Rome, Italy.
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185
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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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186
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Eke CB, Brown RA, De Lacy RJ, Pillay K, Goddard EA. Collagenous gastritis: An unusual cause of generalized oedema in a child. J Trop Pediatr 2019; 65:305-308. [PMID: 30085268 DOI: 10.1093/tropej/fmy048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Collagenous gastritis is an uncommon gastrointestinal disease in children. Its cause remains uncertain. It may present as severe hypoproteinaemia manifesting as generalized oedema. We report a 15 months old female who presented with pica, generalized body oedema and diarrhoea. Diagnostic workup revealed gastric replacement of the lamina propria by hyalinized collagen on histology. This case seeks to highlight the need for early paediatric gastroenterology referral including oesophagogastroduodenoscopy with multiple tissue biopsies as part of a broad diagnostic workup in children with non-specific gastrointestinal symptoms to improve diagnostic yield and enable accurate histologic diagnosis, so that appropriate therapy can be timeously applied.
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Affiliation(s)
- Christopher B Eke
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Robin A Brown
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Ronalda J De Lacy
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Komala Pillay
- Department of Pathology, Red Cross War Memorial Children's Hospital, National Health Sciences Laboratories, University of Cape Town, Cape Town, South Africa
| | - Elizabeth A Goddard
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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187
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Puñales M, Bastos MD, Ramos ARL, Pinto RB, Ott EA, Provenzi V, Geremia C, Soledade MA, Schonardie AP, da Silveira TR, Tschiedel B. Prevalence of celiac disease in a large cohort of young patients with type 1 diabetes. Pediatr Diabetes 2019; 20:414-420. [PMID: 30737863 DOI: 10.1111/pedi.12827] [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: 10/05/2018] [Revised: 12/01/2018] [Accepted: 01/27/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Serological screening for celiac disease (CD) allows the identification of individuals genetically predisposed, as type 1 diabetes mellitus (T1DM). However, the diagnosis is confirmed by intestinal biopsy. The aim was to determine the prevalence of immunoglobulin-A anti-tissue transglutaminase antibodies (IgA-tTG) and CD in a large cohort of young T1DM patients. METHODS Screening for CD was randomly conducted in 881 T1DM by IgA-tTG and total IgA. Individuals with positive antibodies were referred to endoscopy/duodenal biopsy. RESULTS The age of the cohort at the screening was 14.3 ± 5.9 years and at T1DM onset was 7.9 ± 4.4 years. The prevalence of positive serology was 7.7%. Median IgA-tTG levels were 117.7 U/mL (interquartile range [IQR] 35.7-131.5 U/mL). Of the 62 duodenal biopsy, CD was diagnosed in 79.0%, yielding an overall prevalence of 5.6%. The mean age of CD patients was 15.6 ± 6.5 years and, at T1DM onset was 6.3 years (4.0-9.9 years). The modified Marsh-Oberhuber histological classification was 22.5% (3a), 36.7% (3b), and 40.8% (3c). In the biopsy-proven patients, T1DM onset occurred at slightly younger ages (6.3 vs 9.7 years, P = 0.1947), gastrointestinal (GI) manifestations, predominantly abdominal pain and distension, were more prevalent (71.4% vs 38.5%, P = 0.027) and higher IgA-tTG titers (128.0 vs 26.3 U/mL, P = 0.0003) were found than in those with negative-biopsies. CONCLUSION Our results demonstrate the prevalence of 7.7% of IgA-tTG and 5.6% of CD in T1DM patients in South Brazil and, emphasize the importance of the screening in high-risk individuals. Furthermore, the presence of GI manifestations and higher IgA-tTG titers strongly suggest the diagnosis of CD.
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Affiliation(s)
- Marcia Puñales
- Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil.,Pediatric Endocrinology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Marilia Dornelles Bastos
- Post-Graduation Program in Adolescent and Child Health, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Medical Course, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Ana Regina L Ramos
- Pediatric Gastroenterology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Raquel Borges Pinto
- Pediatric Gastroenterology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Eduardo A Ott
- Endoscopy Service, Nossa Senhora da Conceição Hospital (HNSC), Conceição Hospital Group (GHC), Porto Alegre, RS, Brazil
| | - Valentina Provenzi
- Pathology Service, Nossa Senhora da Conceição Hospital (HNSC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - César Geremia
- Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil.,Pediatric Endocrinology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Maria Antônia Soledade
- Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Ana Paula Schonardie
- Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
| | - Themis R da Silveira
- Post-Graduation Program in Adolescent and Child Health, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Santo Antônio Child Hospital, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Balduino Tschiedel
- Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil
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188
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Liu X, Mu T, Sun H, Zhang M, Chen J, Fauconnier ML. Effect of ingredients on the quality of gluten-free steamed bread based on potato flour. Journal of Food Science and Technology 2019; 56:2863-2873. [PMID: 31205342 DOI: 10.1007/s13197-019-03730-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 01/19/2023]
Abstract
Response surface methodology was used to analyze effects of the amounts of pregelatinized potato flour (PGPF), hydroxypropylmethylcellulose (HPMC), egg white protein (EWP), and water on the dough fermentation and physical properties of gluten-free (GF) steamed bread based on potato flour. The results showed that PGPF, HPMC, EWP, and water at the appropriate amounts improved the maximum dough height (H m), specific volume (SV) and hardness, as well as H m correlated with SV (R 2 = 0.6993) and hardness (R 2 = 0.7273). Moreover, the optimal formulation contained 4.84 g/100 g PGPF, 1.68 g/100 g HPMC, 5.87 g/100 g EWP, and 69.69 g/100 g water, potato flour basis. Furthermore, the dietary fiber, total polyphenol content, antioxidant activity, and estimated glycemic index of the steamed GF bread were, respectively, 3.17-, 1.56-, 1.44-, and 0.75-fold of those of steamed wheat bread. The optimized steamed GF bread was found to be acceptable according to the results of sensory analysis. Information collected within this study may provide further insight for optimizing the formulation of steamed GF bread based on potato flour.
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Affiliation(s)
- Xingli Liu
- 1School of Food and Biological Engineering, Zhengzhou University of Light Industry, Zhengzhou, 450000 People's Republic of China
| | - Taihua Mu
- 2Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs; Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, 2 Yuanmingyuan west road, Haidian, Beijing, 100193 People's Republic of China
| | - Hongnan Sun
- 2Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs; Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, 2 Yuanmingyuan west road, Haidian, Beijing, 100193 People's Republic of China
| | - Miao Zhang
- 2Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs; Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, 2 Yuanmingyuan west road, Haidian, Beijing, 100193 People's Republic of China
| | - Jingwang Chen
- 2Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs; Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, 2 Yuanmingyuan west road, Haidian, Beijing, 100193 People's Republic of China
- 3Laboratory of General and Organic Chemistry, University of Liege, Gembloux Agro-Bio Tech, Passage des Déportés, 2-5030 Gembloux, Belgium
| | - Marie Laure Fauconnier
- 3Laboratory of General and Organic Chemistry, University of Liege, Gembloux Agro-Bio Tech, Passage des Déportés, 2-5030 Gembloux, Belgium
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189
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Leonard MM, Bai Y, Serena G, Nickerson KP, Camhi S, Sturgeon C, Yan S, Fiorentino MR, Katz A, Nath B, Richter J, Sleeman M, Gurer C, Fasano A. RNA sequencing of intestinal mucosa reveals novel pathways functionally linked to celiac disease pathogenesis. PLoS One 2019; 14:e0215132. [PMID: 30998704 PMCID: PMC6472737 DOI: 10.1371/journal.pone.0215132] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/27/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND & AIMS The early steps in the pathophysiology of celiac disease (CD) leading to loss of tolerance to gluten are poorly described. Our aim was to use RNA sequencing of duodenal biopsies in patients with active CD, CD in remission, and non-CD controls to gain insight into CD pathophysiology, identify additional genetic signatures linked to CD, and possibly uncover targets for future therapeutic agents. METHODS We performed whole transcriptome shotgun sequencing of intestinal biopsies in subjects with active and remission CD and non-CD controls. We also performed functional pathway analysis of differentially expressed genes to identify statistically significant pathways that are up or down regulated in subjects with active CD compared to remission CD. RESULTS We identified the upregulation of novel genes including IL12R, ITGAM and IGSF4 involved in the immune response machinery and cell adhesion process in the mucosa of subjects with active CD compared to those in remission. We identified a unique signature of genes, related to innate immunity, perturbed exclusively in CD irrespective of disease status. Finally, we highlight novel pathways of interest that may contribute to the early steps of CD pathogenesis and its comorbidities such as the spliceosome, pathways related to the innate immune response, and pathways related to autoimmunity. CONCLUSIONS Our study confirmed previous findings based on GWAS and immunological studies pertinent to CD pathogenesis and describes novel genes and pathways that with further validation may be found to contribute to the early steps in the pathogenesis of CD, ongoing inflammation, and comorbidities associated with CD.
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Affiliation(s)
- Maureen M. Leonard
- Mass General Hospital for Children and Division of Pediatric Gastroenterology and Nutrition, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Celiac Research and Treatment, Mucosal Immunology and Biology Research Center, Boston, Massachusetts, United States of America
- Celiac Research Program, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Yu Bai
- Regeneron Pharmaceuticals, Tarrytown, New York, United States of America
| | - Gloria Serena
- Center for Celiac Research and Treatment, Mucosal Immunology and Biology Research Center, Boston, Massachusetts, United States of America
- Celiac Research Program, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kourtney P. Nickerson
- Center for Celiac Research and Treatment, Mucosal Immunology and Biology Research Center, Boston, Massachusetts, United States of America
| | - Stephanie Camhi
- Center for Celiac Research and Treatment, Mucosal Immunology and Biology Research Center, Boston, Massachusetts, United States of America
| | - Craig Sturgeon
- Graduate Program in Life Sciences, University of Maryland, Baltimore, Maryland, United States of America
| | - Shu Yan
- Center for Celiac Research and Treatment, Mucosal Immunology and Biology Research Center, Boston, Massachusetts, United States of America
| | - Maria R. Fiorentino
- Center for Celiac Research and Treatment, Mucosal Immunology and Biology Research Center, Boston, Massachusetts, United States of America
| | - Aubrey Katz
- Mass General Hospital for Children and Division of Pediatric Gastroenterology and Nutrition, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Barbara Nath
- Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - James Richter
- Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Matthew Sleeman
- Regeneron Pharmaceuticals, Tarrytown, New York, United States of America
| | - Cagan Gurer
- Regeneron Pharmaceuticals, Tarrytown, New York, United States of America
| | - Alessio Fasano
- Mass General Hospital for Children and Division of Pediatric Gastroenterology and Nutrition, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Celiac Research and Treatment, Mucosal Immunology and Biology Research Center, Boston, Massachusetts, United States of America
- Celiac Research Program, Harvard Medical School, Boston, Massachusetts, United States of America
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190
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Abstract
Celiac disease (CD) is an autoimmune enteropathy triggered by gluten. Gluten-free diets can be challenging because of their restrictive nature, inadvertent cross-contaminations, and the high cost of gluten-free food. Novel nondietary therapies are at the preclinical stage, clinical trial phase, or have already been developed for other indications and are now being applied to CD. These therapies include enzymatic gluten degradation, binding and sequestration of gluten, restoration of epithelial tight junction barrier function, inhibition of tissue transglutaminase-mediated potentiation of gliadin oligopeptide immunogenicity or of human leukocyte antigen-mediated gliadin presentation, induction of tolerance to gluten, and antiinflammatory interventions.
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Affiliation(s)
- Gloria Serena
- Division of Pediatric Gastroenterology and Nutrition, Mucosal Immunology and Biology Research Center, MassGeneral Hospital for Children, 175 Cambridge Street, CPZS - 574, Boston, MA 02114, USA; Celiac Research Program, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Ciaran P Kelly
- Celiac Research Program, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Alessio Fasano
- Division of Pediatric Gastroenterology and Nutrition, Mucosal Immunology and Biology Research Center, MassGeneral Hospital for Children, 175 Cambridge Street, CPZS - 574, Boston, MA 02114, USA; Celiac Research Program, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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191
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Elli L, Ferretti F, Orlando S, Vecchi M, Monguzzi E, Roncoroni L, Schuppan D. Management of celiac disease in daily clinical practice. Eur J Intern Med 2019; 61:15-24. [PMID: 30528262 DOI: 10.1016/j.ejim.2018.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/06/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023]
Abstract
Celiac disease (CD) is the most common autoimmune enteropathy worldwide. In CD, dietary gluten triggers a T cell driven small intestinal inflammation in a subset of genetically predisposed subjects, expressing the HLA DQ2 and/or DQ8 genes on their antigen presenting cells. HLA DQ2/DQ8 can bind gluten peptides after their prior modification by the CD autoantigen, tissue transglutaminase (TG2). This process leads to the activation of gluten reactive T cells, small bowel villous atrophy, crypt hyperplasia and intraepithelial lymphocytosis, the histological hallmarks of CD. The clinical picture of CD is extremely heterogeneous including intestinal (especially diarrhea, abdominal pain, bloating) and extraintestinal (especially associated autoimmune diseases, anemia, osteoporosis) manifestations. The prevalence of CD in most parts of the world is estimated at 1:100-1:150 and its diagnosis is based on the presence of circulating autoantibodies (anti-TG2) and the histological detection of villous atrophy. Treatment is a lifelong gluten free diet but adjunctive therapies are in development. Although CD is a well-characterized disease, it is grossly underdiagnosed, despite the severe consequences of long-term gluten ingestion in CD, such as enhanced autoimmunity, refractory CD and intestinal T cell lymphoma. The aim of the presented review is to provide a clinical guide and to summarize the most recent clinical progress in CD research.
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Affiliation(s)
- Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy.
| | - Francesca Ferretti
- Center for Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono, 20122 Milano, Italy
| | - Stefania Orlando
- Center for Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Maurizio Vecchi
- Center for Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono, 20122 Milano, Italy
| | - Erika Monguzzi
- Center for Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono, 20122 Milano, Italy; Institute for Translational Immunology, Research Center for Immunotherapy (FZI), Johannes Gutenberg University (JGU) Medical Center, 55101 Mainz, Germany
| | - Leda Roncoroni
- Center for Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono, 20122 Milano, Italy; Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Via Festa del Perdono, 20122 Milano, Italy
| | - Detlef Schuppan
- Institute for Translational Immunology, Research Center for Immunotherapy (FZI), Johannes Gutenberg University (JGU) Medical Center, 55101 Mainz, Germany; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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192
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Hota D, Bhalla K, Nanda S, Gupta A, Mehra S. Beneficial effects of gluten free diet on IgA tissue transglutaminase levels and various growth parameters in celiac disease patients. J Family Med Prim Care 2019; 8:823-827. [PMID: 31041208 PMCID: PMC6482799 DOI: 10.4103/jfmpc.jfmpc_56_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Context: In the resource poor country like India it is difficult to get HLA screening and EMA testing in patients with celiac disease in small centres. Aims: To study the effect of gluten free diet on IgA tissue transglutaminase levels and various growth parameters in patients with celiac disease. Settings and Design: This was a prospective study conducted in the department of paediatrics of a tertiary referral hospital in north India in 3 stages viz. on presentation, after 3 months and 6 months of initial presentation. Materials and Methods: 392 patients with symptoms suggestive of celiac disease were screened for IgA tTG levels more than 10 folds of upper limit of normal. 50 cases (who followed up for 6 months regularly) were enrolled in the study. Spectrum of various growth and clinical parameters were also studied. Statistical analysis used: Statistical analysis was performed by the SPSS version 20.0. Data were checked for normality before statistical analysis. p value less than 0.05 was considered statistically significant. Results: 50 cases were enrolled in study. After initiation of gluten free diet, improvements were seen in various growth factors like height (12.71%) and weight (3.47 cm) after 6 months. Serum tTG(IgA) levels decreased to 94.88±55.35 U/mL from baseline level of 202±83.96 U/mL after 6 months. Conclusions: Gluten free diet has major role in improvement in growth parameters as well as anemia. So, early detection of celiac disease is an important step in prevention of morbidity associated with this chronic disease.
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Affiliation(s)
- Dayanand Hota
- Department of Paediatrics, All India Institutes of Medical Sciences, Raipur, Chhattisgarh, India
| | - Kapil Bhalla
- Department of Paediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjiv Nanda
- Department of Paediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Ashish Gupta
- Department of Trauma Centre, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shuchi Mehra
- Department of Microbiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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193
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Long-Term Outcome of Potential Celiac Disease in Genetically at-Risk Children: The Prospective CELIPREV Cohort Study. J Clin Med 2019; 8:jcm8020186. [PMID: 30764503 PMCID: PMC6406363 DOI: 10.3390/jcm8020186] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The long-term outcome of potential celiac disease (CD) is still a debated issue. We aimed to evaluate the progression of potential CD versus overt CD after 10-years of follow-up in a cohort of children genetically predisposed to CD. METHODS The CELIPREV study is prospectively following from birth 553 children with CD-predisposing HLA genes. Children with a diagnosis of potential CD continued to receive a normal diet and repeated the serological screening for CD every year. An intestinal biopsy was taken in presence of persistent positive serology. RESULTS Overall, 26 (4.7%) children received a diagnosis of potential CD (50% females, median age 24 months). All children were symptom-free. Twenty-three children continued a gluten-containing diet; at 10 years from the first biopsy, three children developed overt CD (13%), 19 (83%) became antibodies negative at 1 year from the first biopsy and remained negative up to 10 years of follow-up and one subject (4%) had fluctuating antibody course with transiently negative values and persistently negative biopsy. CONCLUSIONS In children genetically predisposed to CD with a diagnosis of potential CD the risk of progression to overt CD while on a gluten-containing diet is very low in the long-term.
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194
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Santos FG, Aguiar EV, Capriles VD. Analysis of ingredient and nutritional labeling of commercially available gluten-free bread in Brazil. Int J Food Sci Nutr 2019; 70:562-569. [DOI: 10.1080/09637486.2018.1551336] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Fernanda G. Santos
- Departamento de Biociências, Universidade Federal de São Paulo, Santos, Brasil
| | - Etiene V. Aguiar
- Departamento de Biociências, Universidade Federal de São Paulo, Santos, Brasil
| | - Vanessa D. Capriles
- Departamento de Biociências, Universidade Federal de São Paulo, Santos, Brasil
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195
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Dumic I, Nordin T, Jecmenica M, Stojkovic Lalosevic M, Milosavljevic T, Milovanovic T. Gastrointestinal Tract Disorders in Older Age. Can J Gastroenterol Hepatol 2019; 2019:6757524. [PMID: 30792972 PMCID: PMC6354172 DOI: 10.1155/2019/6757524] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 02/07/2023] Open
Abstract
Considering an increase in the life expectancy leading to a rise in the elderly population, it is important to recognize the changes that occur along the process of aging. Gastrointestinal (GI) changes in the elderly are common, and despite some GI disorders being more prevalent in the elderly, there is no GI disease that is limited to this age group. While some changes associated with aging GI system are physiologic, others are pathological and particularly more prevalent among those above age 65 years. This article reviews the most important GI disorders in the elderly that clinicians encounter on a daily basis. We highlight age-related changes of the oral cavity, esophagus, stomach, small and large bowels, and the clinical implications of these changes. We review epidemiology and pathophysiology of common diseases, especially as they relate to clinical manifestation in elderly. Details regarding management of specific disease are discussed in detail if they significantly differ from the management for younger groups or if they are associated with significant challenges due to side effects or polypharmacy. Cancers of GI tract are not included in the scope of this article.
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Affiliation(s)
- Igor Dumic
- 1Division of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
- 2Mayo Clinic College of Medicine and Sciences, Rochester, MN, USA
| | - Terri Nordin
- 2Mayo Clinic College of Medicine and Sciences, Rochester, MN, USA
- 3Department of Family Medicine, Mayo Clinic Health System, Eau Claire WI, USA
| | - Mladen Jecmenica
- 4Gastroenterology Fellowship Program, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | | | - Tomica Milosavljevic
- 5Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia
- 6School of Medicine, Belgrade University, Belgrade, Serbia
| | - Tamara Milovanovic
- 5Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia
- 6School of Medicine, Belgrade University, Belgrade, Serbia
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196
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Contribution of Oral Hygiene and Cosmetics on Contamination of Gluten-free Diet: Do Celiac Customers Need to Worry About? J Pediatr Gastroenterol Nutr 2019; 68:26-29. [PMID: 30119098 DOI: 10.1097/mpg.0000000000002129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The only available treatment for celiac disease (CD) is the gluten-free diet. It is unclear whether the presence of gluten in oral hygiene products and cosmetics that are applied on the mouth is a reason of concern for CD patients. The aim of this study was to test the level of gluten contamination in oral hygiene and cosmetic products available in the Italian market. METHODS A total of 66 products (toothpastes = 37; dental tablets = 2; mouthwashes = 5; lip-balms = 10; lipsticks = 12) labelled gluten-free or with unknown gluten content were randomly collected from different supermarkets and pharmacies. The gluten quantification was determined by the R5 ELISA method approved by EU regulations. RESULTS Out of 66 oral hygiene and cosmetics, 62 products (94%) were found to be gluten-free (gluten level <20 ppm), while 4 (6%) (toothpastes = 3; lipsticks = 1) showed a gluten level >20 ppm (toothpastes: 20.7, 31.4, and 35 ppm; lipstick: 27.4 ppm). None of the selected products had ingredient derived from wheat, barley, or rye. CONCLUSIONS Gluten contamination is currently not an issue in a wide array of cosmetic and oral hygiene products that are commonly in the market.
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197
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Cronin O, Flanagan E, Dowling D. Coeliac disease in the modern era: Severity of small bowel mucosal injury at diagnosis with analysis of clinical correlates and rate of improvement on a gluten free diet. World J Gastrointest Pharmacol Ther 2018; 9:55-62. [PMID: 30568843 PMCID: PMC6288493 DOI: 10.4292/wjgpt.v9.i6.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/09/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the relationships between pre-diagnosis coeliac serology, duodenal histopathology, primary presenting symptoms, coeliac-related comorbidity and response to treatment in a modern cohort with new diagnosis of coeliac disease (CD).
METHODS A retrospective cohort study including 99 participants diagnosed with CD between 1999 and 2013. All patients had the following data recorded: baseline characteristics, coeliac serology, small bowel histopathology. A subset of this cohort underwent a repeat small bowel biopsy. Independent associations were assessed with logistic regression.
RESULTS The mean age at diagnosis was 43 years (Interquartile range 30-53 years) and 68% of the cohort was female. At diagnosis 49 (49%) patients had total villous blunting (MS 3c), 12 (12%) had subtotal villous blunting (MS 3b), and 29 (29%) had partial villous blunting (MS 3a). The prevalence of symptoms pre diagnosis was not related to the severity of villous blunting (P = 0.490). 87 (88%) of the cohort underwent repeat small bowel biopsy after a median of 7 mo (IQR 6-11 mo). 34 (39%) patients had biopsy results ≥ MS 3a which compared to 90 (90%) at the initial biopsy. 24 (71%) of this group reported adherence to a gluten free diet (GFD). Persistent MS ≥ 3a at repeat biopsy was not associated with symptoms (P = 0.358) or persistent positive coeliac serology (P = 0.485).
CONCLUSION Neither symptoms nor serology predict the severity of the small bowel mucosal lesion at CD diagnosis. Whilst a GFD was associated with histological improvement many patients with newly diagnosed CD had persistent mucosal damage despite many months of gluten restriction. Negative CD serology did not exclude ongoing mucosal injury.
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Affiliation(s)
- Oliver Cronin
- Department of Gastroenterology, University Hospital Geelong, Geelong 3220, Australia
| | - Emma Flanagan
- Department of Gastroenterology, St Vincent’s Hospital, Fitzroy 3065, Australia
| | - Damian Dowling
- Department of Gastroenterology, University Hospital Geelong, Geelong 3220, Australia
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198
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Potter MDE, Walker MM, Keely S, Talley NJ. What's in a name? 'Non-coeliac gluten or wheat sensitivity': controversies and mechanisms related to wheat and gluten causing gastrointestinal symptoms or disease. Gut 2018; 67:2073-2077. [PMID: 30061187 DOI: 10.1136/gutjnl-2018-316360] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/26/2018] [Accepted: 07/12/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Michael D E Potter
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New Lambton Heights, New South Wales, Australia.,Department of Gastroenterology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Marjorie M Walker
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Simon Keely
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New Lambton Heights, New South Wales, Australia.,Department of Gastroenterology, John Hunter Hospital, Newcastle, New South Wales, Australia
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199
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Więch P, Chmiel Z, Bazaliński D, Sałacińska I, Bartosiewicz A, Mazur A, Korczowski B, Binkowska-Bury M, Dąbrowski M. The Relationship between Body Composition and a Gluten Free Diet in Children with Celiac Disease. Nutrients 2018; 10:E1817. [PMID: 30469383 PMCID: PMC6266332 DOI: 10.3390/nu10111817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/02/2018] [Accepted: 11/17/2018] [Indexed: 12/16/2022] Open
Abstract
The primary and proven therapy, in cases of celiac disease (CD), is a rigorous gluten-free diet (GFD). However, there are reports of its negative effects in the form of nutritional deficiencies, obesity, and adverse changes in body composition. The study aimed to assess the impact of a GFD on the body composition of children with CD. In a case-controlled study (n = 41; mean age 10.81 y; SD = 3.96) children with CD, in various stages of treatment, underwent medical assessment. The control group consisted of healthy children and adolescents, strictly matched for gender and age in a 1:1 case-control manner. More than half of the examined children (n = 26) followed a GFD. CD children had significantly higher mean values of the fat free mass (FFM% = 80.68 vs. 76.66, p = 0.015), and total body water (TBW% = 65.22 vs. 60.47, p = 0.012), and lower mean values of the fat mass (FM% = 19.32 vs. 23.34, p = 0.015). Children who were on a GFD presented slightly higher, but not statistically significant, mean values of FM and FFM, than children who did not follow dietary recommendations (FM [kg] = 7.48 vs. 5.24, p = 0.064; FM% = 20.81 vs. 16.73, p = 0.087; FFM [kg] = 28.19 vs. 22.62, p = 0.110). After minimum one year of a GFD, CD children showed significantly higher values of FFM [kg] (p = 0.001), muscle mass (MM) [kg] (p < 0.001), TBW [L] (p < 0.001) and body cell mass (BCM) [kg] (p < 0.001). Furthermore, CD children who were on a GFD presented a significantly higher increase in weight (p = 0.034) and body mass index (BMI) (p = 0.021). The children adhering to a GFD demonstrate a tendency towards higher indices of selected body composition components.
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Affiliation(s)
- Paweł Więch
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
| | - Zdzisława Chmiel
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
| | - Dariusz Bazaliński
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
| | - Izabela Sałacińska
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
| | - Anna Bartosiewicz
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
| | - Artur Mazur
- Pediatric Department, Clinical Provincial Hospital No. 2 in Rzeszów, Faculty of Medicine, University of Rzeszów, 35301 Rzeszów, Poland.
| | - Bartosz Korczowski
- Pediatric Department, Clinical Provincial Hospital No. 2 in Rzeszów, Faculty of Medicine, University of Rzeszów, 35301 Rzeszów, Poland.
| | - Monika Binkowska-Bury
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
| | - Mariusz Dąbrowski
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
- Diabetic Outpatient Clinic, Medical Center "Beta-Med" Rzeszów, 35073 Rzeszów, Poland.
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200
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Corleto VD, Di Marino VP, Galli G, Antonelli G, Coluccio C, Di Cerbo A, Uccini S, Annibale B. Improving basic skills in celiac-like disease diagnosis: a case report. BMC Gastroenterol 2018; 18:162. [PMID: 30390626 PMCID: PMC6215663 DOI: 10.1186/s12876-018-0894-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/23/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The diagnosis of Coeliac disease (CD) requires a combination of sign/symptoms, positivity of specific antibodies and duodenal histological evidence of villous atrophy. Duodenal villous atrophy, despite representing the CD landmark, is not specific since it is found in many gastrointestinal disorders. Giardiasis is one of the most common human intestinal protozoan infestations in industrialized countries whose histological duodenal mucosa damage could mimic that of CD. The present report shows how a wise clinical and laboratory assessment led us shortly to a correct diagnosis. CASE PRESENTATION A 42-year-old outpatient woman without previous significant gastrointestinal diseases, was referred with dyspeptic symptoms, fatigue and mild diarrhea from 4 months. Her first investigations including immunoglobulin A (IgA) anti-tissue transglutaminase antibodies (anti-tTG) and stool parasitological and cultural analysis were negative. An esophagogastroduodenoscopy (EGDS) showed no mucosal alteration. But histology demonstrated a Helicobacter Pylori (HP) pan-gastritis while duodenal mucosa showed villous atrophy consistent with a diagnosis of CD Marsh type 3b. While on gluten-free diet (GFD) the patient didn't experience any improvement of symptoms. Duodenal biopsies were then reviewed showing the presence of trophozoites of Giardia on the luminal surface of the duodenal wall and at the same time, a second stool examination revealed the presence of trophozoites and cysts of Giardia. Treated with metronidazole, 500 mg twice daily for 6 days the patient reduced diarrhea after few days. After about 2 months of GFD she was invited to discontinue it. At the same time stool examination was repeated with negative results. She subsequently performed eradication for Hp with triple therapy (Pylera®). Around 6 months later, the patient did not complain any gastrointestinal symptoms. Serological tests were normal and at a follow-up EGDS, duodenal mucosa had normal histology with normal finger-like villi and absence of Giardia trophozoites. CONCLUSION This case report shows how CD diagnosis can sometimes be manifold. Intestinal villous atrophy alone may not automatically establish a diagnosis of CD. In the present case the clinical scenario could be fully explained by giardiasis. Indeed, different diagnostic tools and a multi-step approaches have been used to determine the final correct diagnosis.
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Affiliation(s)
- Vito Domenico Corleto
- grid.7841.aGastroenterology and Gastrointestinal Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
- grid.7841.aDigestive Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Vincenza Patrizia Di Marino
- grid.7841.aPaedriatic Allergology, Allergology Unit, “Policlinico Umberto I” University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Gloria Galli
- grid.7841.aGastroenterology and Gastrointestinal Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Giulio Antonelli
- grid.7841.aGastroenterology and Gastrointestinal Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Chiara Coluccio
- grid.7841.aGastroenterology and Gastrointestinal Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Arcangelo Di Cerbo
- grid.7841.aPathology Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Stefania Uccini
- grid.7841.aPathology Unit, Azienda Ospedaliera Sant’Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Bruno Annibale
- grid.7841.aGastroenterology and Gastrointestinal Endoscopy Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
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