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A randomised, double-blind, cross-over trial to evaluate bread, in which gluten has been pre-digested by prolyl endoprotease treatment, in subjects self-reporting benefits of adopting a gluten-free or low-gluten diet. Br J Nutr 2019; 119:496-506. [PMID: 29508689 DOI: 10.1017/s0007114517003749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of the present study was to determine if the enzyme Aspergillus niger prolyl endoprotease (ANPEP), which degrades the immunogenic proline-rich residues in gluten peptides, can be used in the development of new wheat products, suitable for gluten-sensitive (GS) individuals. We have carried out a double-blind, randomised, cross-over trial with two groups of adults; subjects, self-reporting benefits of adopting a gluten-free or low-gluten diet (GS, n 16) and a control non-GS group (n 12). For the trial, volunteers consumed four wheat breads: normal bread, bread treated with 0·8 or 1 % ANPEP and low-protein bread made from biscuit flour. Compared with controls, GS subjects had a favourable cardiovascular lipid profile - lower LDL (4·0 (sem 0·3) v. 2·8 (sem 0·2) mmol/l; P=0·008) and LDL:HDL ratio (3·2 (sem 0·4) v. 1·8 (sem 0·2); P=0·005) and modified haematological profile. The majority of the GS subjects followed a low-gluten lifestyle, which helps to reduce the gastrointestinal (GI) symptoms severity. The low-gluten lifestyle does not have any effect on the quality of life, fatigue or mental state of this population. Consumption of normal wheat bread increased GI symptoms in GS subjects compared with their habitual diet. ANPEP lowered the immunogenic gluten in the treated bread by approximately 40 %. However, when compared with the control bread for inducing GI symptoms, no treatment effects were apparent. ANPEP can be applied in the production of bread with taste, texture and appearance comparable with standard bread.
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Lerner A, Arleevskaya M, Schmiedl A, Matthias T. Microbes and Viruses Are Bugging the Gut in Celiac Disease. Are They Friends or Foes? Front Microbiol 2017; 8:1392. [PMID: 28824555 PMCID: PMC5539691 DOI: 10.3389/fmicb.2017.01392] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/10/2017] [Indexed: 12/17/2022] Open
Abstract
The links between microorganisms/viruses and autoimmunity are complex and multidirectional. A huge number of studies demonstrated the triggering impact of microbes and viruses as the major environmental factors on the autoimmune and inflammatory diseases. However, growing evidences suggest that infectious agents can also play a protective role or even abrogate these processes. This protective crosstalk between microbes/viruses and us might represent a mutual beneficial equilibrium relationship between two cohabiting ecosystems. The protective pathways might involve post-translational modification of proteins, decreased intestinal permeability, Th1 to Th2 immune shift, induction of apoptosis, auto-aggressive cells relocation from the target organ, immunosuppressive extracellular vesicles and down regulation of auto-reactive cells by the microbial derived proteins. Our analysis demonstrates that the interaction of the microorganisms/viruses and celiac disease (CD) is always a set of multidirectional processes. A deeper inquiry into the CD interplay with Herpes viruses and Helicobacter pylori demonstrates that the role of these infections, suggested to be potential CD protectors, is not as controversial as for the other infectious agents. The outcome of these interactions might be due to a balance between these multidirectional processes.
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Affiliation(s)
- Aaron Lerner
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of TechnologyHaifa, Israel.,Department of Research, AESKU.KIPP InstituteWendelsheim, Germany
| | - Marina Arleevskaya
- Central Research Laboratory, Kazan State Medical Academy KazanKazan, Russia
| | - Andreas Schmiedl
- Department of Research, AESKU.KIPP InstituteWendelsheim, Germany
| | - Torsten Matthias
- Department of Research, AESKU.KIPP InstituteWendelsheim, Germany
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Moheb-Alian A, Forouzesh F, Rostami-Nejad M, Rostami K. Mesenchymal stem cells as potential therapeutic approaches in celiac disease. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2016; 9:S1-S7. [PMID: 28224021 PMCID: PMC5310793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As a chronic immune complication, celiac disease has a broad spectrum of clinical manifestations and gluten ingestion as an external trigger will induce the onset of this disease in genetically predisposed individuals. Because of the complex nature of celiac disease and various cascades of immunological pathways, therapies which are tend to target a single pathway or factor, often have unsatisfactory results. Thus, it should be considered that the new emerging area of cellular therapy by targeting multiple pathways may hold the key for treating celiac affected patients with complicated forms of this disease. The aim of this review is to discuss different pathways which are affected by celiac disease and to compare how various strategies, mainly cellular therapies, can regulate these pathways.
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Affiliation(s)
- Ali Moheb-Alian
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterologyand Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Flora Forouzesh
- Department of Genetics, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamran Rostami
- Department of Gastroenterology Milton Keynes University Hospital, United Kingdom
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Rostami-Nejad M, Javad Ehsani-Ardakani M, Assadzadeh H, Shahbazkhani B, Ierardi E, Losurdo G, Zojaji H, Alizadeh AM, Naderi N, Sadeghi A, Zali MR. Pathological and Clinical Correlation between Celiac Disease and Helicobacter Pylori Infection; a Review of Controversial Reports. Middle East J Dig Dis 2016; 8:85-92. [PMID: 27252814 PMCID: PMC4885617 DOI: 10.15171/mejdd.2016.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/12/2016] [Indexed: 12/14/2022] Open
Abstract
There are overwhelming reports and descriptions about celiac associated disorders. Although there is a clear genetic association between celiac disease (CD) and some gastrointestinal disorders, there are controversial reports claiming an association between CD and Helicobacter pylori (H. pylori) infection. Different studies indicated the possible association between lymphocytic gastritis and both CD and H. pylori infection, although this evidence is not consistently accepted. Also it was shown that an increase in intraepithelial lymphocytes count is associated with both H. pylori infection and celiac disease. Therefore the following questions may raise: how far is this infection actually related to CD?, which are the underlying patho-mechanisms for these associations? what are the clinical implications? what is the management? and what would be the role of gluten free diet in treating these conditions? PubMed (PubMed Central), Ovid, ISI of web knowledge, and Google scholar were searched for full text articles published between 1985 and 2015. The associated keywords were used, and papers described particularly the impact of pathological and clinical correlation between CD and H. pylori infection were identified. In this review we tried to answer the above questions and discussed some of the recent developments in the pathological and clinical aspects of CD and H. pylori infection.
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Affiliation(s)
- Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Ehsani-Ardakani
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Assadzadeh
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bijan Shahbazkhani
- Gastroenterology unit, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Homayon Zojaji
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhoshang Mohammad Alizadeh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nosratollah Naderi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Smyk D, Rigopoulou EI, Bizzaro N, Bogdanos DP. Hair dyes as a risk for autoimmunity: from systemic lupus erythematosus to primary biliary cirrhosis. AUTOIMMUNITY HIGHLIGHTS 2012; 4:1-9. [PMID: 26000137 PMCID: PMC4389085 DOI: 10.1007/s13317-011-0027-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 10/17/2011] [Indexed: 12/12/2022]
Abstract
Environmental and genetic factors appear to be involved in the pathogenesis of primary biliary cirrhosis (PBC), a chronic cholestatic liver disease characterized by immune-mediated destruction of the small and medium sized intrahepatic bile ducts. Environmental factors include exposure to various infectious, xenobiotic and chemical compounds. These exposures may occur occupationally, through water or air contamination, pharmacological administration or by elective exposure, to name a few. Hair dyes are compounds that have been implicated in the development of several autoimmune diseases, including systemic lupus erythematosus (SLE) and PBC. So far, only epidemiological studies have addressed the role of hair dyes in PBC, with limited results. Hair dyes in SLE have been examined, and have recently demonstrated an association, both epidemiologically and immunologically. This follows a series of negative studies, which may not have taken into account several features of hair dye use. This review will examine the literature surrounding hair dye use and SLE, and compare this to data surrounding PBC. Treating physicians should be prepared for questions surrounding the need to take precautions against repeated hair dye use and this topic is discussed further.
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Affiliation(s)
- Daniel Smyk
- Institute of Liver Studies and Liver Unit, Transplantation Immunology and Mucosal Biology, King's College London, School of Medicine, King's College Hospital, Denmark Hill Campus, London, SE5 9RS UK
| | - Eirini I Rigopoulou
- Department of Medicine, University of Thessaly Medical School, Thessaly, Mezourlo, 41222 Larissa, Greece
| | - Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale Civile, Tolmezzo, Italy
| | - Dimitrios P Bogdanos
- Institute of Liver Studies and Liver Unit, Transplantation Immunology and Mucosal Biology, King's College London, School of Medicine, King's College Hospital, Denmark Hill Campus, London, SE5 9RS UK
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Shahraki T, Rostami K, Shahraki M, Bold J, Danciu M, Al Dulaimi D, Villanacci V, Bassotti G. Microscopic Enteritis; clinical features and correlations with symptoms. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2012; 5:146-54. [PMID: 24834216 PMCID: PMC4017477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 05/06/2012] [Indexed: 10/26/2022]
Abstract
AIM To assess the clinical characteristic of CD as well as correlation of symptoms and the degrees of intestinal mucosal lesions in Iranian children. BACKGROUND Microscopic Enteritis (Marsh 0-II) is associated with malabsorption. PATIENTS AND METHODS From August 2005 to September 2009, 111 cases with malabsorption and classical gastrointestinal symptoms were evaluated. RESULTS The mean (±SD) age of children with CD was 4.9±3.5 years (range, 6 month - 16 years) and the mean duration of symptoms was 8 ± 20.5 months. 50 cases (45%) were female and 61 cases (55%) were male. The most common clinical presentation was failure to thrive in 72%, chronic diarrhea in 65.8% and Iron deficiency anemia in 59.5%. Sensitivity of EMA was 100% in patients with Marsh IIIb and Marsh IIIc. EMA was also positive in 77% of cases with Marsh 0, 18% in Marsh I, 44% in Marsh II and 81.8% in patients with Marsh IIIa. CONCLUSION Histopathology did not reflect the severity of gluten sensitivity. This would suggest that the degree of intestinal mucosal damage might not be a reliable prognostic factor. Significant symptoms can be present with minor histological change on biopsy.
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Affiliation(s)
- Touran Shahraki
- Department of Pediatrics, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Kamran Rostami
- School of Clinical and Experimental Medicine, University of Birmingham, United Kingdom
| | - Mansour Shahraki
- Department of Nutrition, and Research Center for Children and Adolescent Health, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Justine Bold
- Institute of Health, Social Care and Psychology University of Worcester UK
| | - Mihai Danciu
- Department of Pathology, University of Medicine and Pharmacy Iasi, Romania
| | - David Al Dulaimi
- Department of Gastroenterology, Alexander Hospital, Redditch, UK
| | | | - Gabrio Bassotti
- Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia, Italy
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Rostami Nejad M, Rostami K, Yamaoka Y, Mashayekhi R, Molaei M, Dabiri H, Al Dulaimi D, Mirsattari D, Zojaji H, Norouzinia M, Zali MR. Clinical and histological presentation of Helicobacter pylori and gluten related gastroenteropathy. ARCHIVES OF IRANIAN MEDICINE 2011; 14:115-8. [PMID: 21361718 DOI: 011142/aim.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Celiac disease has been reported to be associated with gastric abnormalities. The aim of this study was to assess the relationship between the prevalence of celiac disease and Helicobacter pylori infection in an Iranian population of 250 patients. METHODS Biopsies were taken from the gastric antrum and duodenum. Morphology and histology were evaluated using the updated Sydney system and modified Marsh criteria, respectively. To simplify the interpretation of gastric lesions we classified gastritis in macroscopic and microscopic stages. Serology for anti-tissue transglutaminase antibody was performed to determine the presence of celiac disease. RESULTS Among 250 patients, 232 (93%) had histological evidence of Helicobacter pylori infection. Histological abnormalities (Marsh I to IIIc) were present in 24 (10%). Of 24 patients, 20 (83%) with histological abnormalities were infected with Helicobacter pylori. Of 250 patients, 25 (10%) had a positive anti-tissue transglutaminase antibody. Of 25 anti-tissue transglutaminase antibody positive patients, 9 (3.6%) had microscopic and macroscopic enteritis (Marsh I to IIIc). CONCLUSIONS Clinical presentation of celiac disease was not distinguishable from cases infected with Helicobacter pylori. Histology, even in patients with positive serology, was non-specific and unhelpful. We found a high prevalence of Helicobacter pylori infection and chronic gastritis, but neither was associated with celiac disease, in agreement with studies in Western populations.
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Affiliation(s)
- Mohammad Rostami Nejad
- Research Institute of Gastroenterology and Liver Disease, Shahid Beheshti University, M.C., Tehran, Iran
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Nejad MR, Rostami K, Yamaoka Y, Mashayekhi R, Molaei M, Dabiri H, Al Dulaimi D, Mirsattari D, Zojaji H, Norouzinia M, Zali MR. Clinical and histological presentation of Helicobacter pylori and gluten related gastroenteropathy. ARCHIVES OF IRANIAN MEDICINE 2011; 14:115-8. [PMID: 21361718 PMCID: PMC3126917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Celiac disease has been reported to be associated with gastric abnormalities. The aim of this study was to assess the relationship between the prevalence of celiac disease and Helicobacter pylori infection in an Iranian population of 250 patients. METHODS Biopsies were taken from the gastric antrum and duodenum. Morphology and histology were evaluated using the updated Sydney system and modified Marsh criteria, respectively. To simplify the interpretation of gastric lesions we classified gastritis in macroscopic and microscopic stages. Serology for anti-tissue transglutaminase antibody was performed to determine the presence of celiac disease. RESULTS Among 250 patients, 232 (93%) had histological evidence of Helicobacter pylori infection. Histological abnormalities (Marsh I to IIIc) were present in 24 (10%). Of 24 patients, 20 (83%) with histological abnormalities were infected with Helicobacter pylori. Of 250 patients, 25 (10%) had a positive anti-tissue transglutaminase antibody. Of 25 anti-tissue transglutaminase antibody positive patients, 9 (3.6%) had microscopic and macroscopic enteritis (Marsh I to IIIc). CONCLUSIONS Clinical presentation of celiac disease was not distinguishable from cases infected with Helicobacter pylori. Histology, even in patients with positive serology, was non-specific and unhelpful. We found a high prevalence of Helicobacter pylori infection and chronic gastritis, but neither was associated with celiac disease, in agreement with studies in Western populations.
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Affiliation(s)
- Mohammad Rostami Nejad
- Research Institute of Gastroenterology and Liver Disease, Shahid Beheshti University, M.C., Tehran, Iran
| | | | - Yoshio Yamaoka
- Department of Medicine-Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA
| | - Reza Mashayekhi
- Research Institute of Gastroenterology and Liver Disease, Shahid Beheshti University, M.C., Tehran, Iran
| | - Mahsa Molaei
- Research Institute of Gastroenterology and Liver Disease, Shahid Beheshti University, M.C., Tehran, Iran
| | - Hossein Dabiri
- Research Institute of Gastroenterology and Liver Disease, Shahid Beheshti University, M.C., Tehran, Iran
| | - David Al Dulaimi
- Department of Gastroenterology, Alexandra Hospital, Redditch, UK
| | - Dariush Mirsattari
- Research Institute of Gastroenterology and Liver Disease, Shahid Beheshti University, M.C., Tehran, Iran
| | - Homayoun Zojaji
- Research Institute of Gastroenterology and Liver Disease, Shahid Beheshti University, M.C., Tehran, Iran
| | - Mohsen Norouzinia
- Research Institute of Gastroenterology and Liver Disease, Shahid Beheshti University, M.C., Tehran, Iran
| | - Mohammad Reza Zali
- Research Institute of Gastroenterology and Liver Disease, Shahid Beheshti University, M.C., Tehran, Iran
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Epidemiology of celiac disease in iran: a review. Middle East J Dig Dis 2011; 3:5-12. [PMID: 25197526 PMCID: PMC4154929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 01/29/2011] [Indexed: 11/04/2022] Open
Abstract
Celiac disease (CD) was traditionally believed to be a chronic enteropathy, almost exclusively affecting people of European origin. Celiac disease is the permanent intolerance to dietary gluten, the major protein component of wheat. The availability of new, simple, very sensitive and specific serological tests has shown that CD is as common in Middle Eastern countries as in Europe, Australia and New Zealand where the major dietary staple is wheat. A high prevalence of CD has been found in Iran, in both the general population and the at-risk groups, i.e. patients with type 1 diabetes or irritable bowel syndrome (IBS). In developing countries, serological testing in at risk groups is necessary for early identification of celiac patients. Clinical studies show that presentation with non-specific symptoms or a lack of symptoms is as common in the Middle East as in Europe. Wheat is a major component of the Iranian diet and exposure to wheat proteins induces some degree of immune tolerance, leading to milder symptoms that may be mistaken with other GI disorders. The implementation of gluten free diet (GFD) is a major challenge for both patients and clinicians in Iran, especially since commercial gluten-free products are not available in this area.
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Nejad MR, Hogg-Kollars S, Ishaq S, Rostami K. Subclinical celiac disease and gluten sensitivity. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2011; 4:102-8. [PMID: 24834166 PMCID: PMC4017418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 06/18/2011] [Indexed: 11/04/2022]
Abstract
Atypical presentation is the most common form of celiac disease (CD). Although the terminologies like latent, silent and potential have expressed different aspects of clinical and pathological behaviour of CD, they also have contributed in some extent to confusion between clinicians and patients due to the multiple definitions and uncertainty around them. In the light of new advances and the discovery of entities such as non-celiac gluten sensitivity, using subclinical instead of silent and atypical instead of potential/latent may simplify the understanding behind the clinical behaviour of atypical CD. The evidence behind a lower threshold for starting a gluten free diet (GFD) in non-celiac gluten sensitive patients would strongly support applying a GFD treatment strategy in any forms of CD.
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Affiliation(s)
- Mohammad Rostami Nejad
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sauid Ishaq
- Dudley Group of Hospital NHS Foundation Trust, UK
| | - Kamran Rostami
- School of Immunity and Infection, University of Birmingham, UK,Dudley Group of Hospital NHS Foundation Trust, UK
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