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Ramedani N, Seidita A, Asri N, Azimirad M, Yadegar A, Jahani-Sherafat S, Sharifan A, Mansueto P, Carroccio A, Rostami-Nejad M. The Gliadin Hydrolysis Capacity of B. longum, L. acidophilus, and L. plantarum and Their Protective Effects on Caco-2 Cells against Gliadin-Induced Inflammatory Responses. Nutrients 2023; 15:2769. [PMID: 37375673 DOI: 10.3390/nu15122769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Non-celiac wheat sensitivity (NCWS) is a poorly understood gluten-related disorder (GRD) and its prominent symptoms can be ameliorated by gluten avoidance. This study aimed to determine the effectiveness of a probiotic mixture in hydrolyzing gliadin peptides (toxic components of gluten) and suppressing gliadin-induced inflammatory responses in Caco-2 cells. METHODS Wheat dough was fermented with a probiotic mix for 0, 2, 4, and 6 h. The effect of the probiotic mix on gliadin degradation was monitored by SDS-PAGE. The expression levels of IL-6, IL-17A, INF-γ, IL-10, and TGF-β were evaluated using ELISA and qRT-PCR methods. RESULTS According to our findings, fermenting wheat dough with a mix of B. longum, L. acidophilus, and L. plantarum for 6 h was effective in gliadin degradation. This process also reduced levels of IL-6 (p = 0.004), IL-17A (p = 0.004), and IFN-γ (p = 0.01) mRNA, as well as decreased IL-6 (p = 0.006) and IFN-γ (p = 0.0009) protein secretion. 4 h fermentation led to a significant decrease in IL-17A (p = 0.001) and IFN-γ (p = 0.003) mRNA, as well as reduced levels of IL-6 (p = 0.002) and IFN-γ (p < 0.0001) protein secretion. This process was also observed to increase the expression levels of IL-10 (p < 0.0001) and TGF-β (p < 0.0001) mRNA. CONCLUSIONS 4 h fermentation of wheat flour with the proposed probiotic mix might be a good strategy to develop an affordable gluten-free wheat dough for NCWS and probably other GRD patients.
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Affiliation(s)
- Najmeh Ramedani
- Department of Food Science and Technology, Science and Research Branch, Islamic Azad University, Tehran 9311634719, Iran
| | - Aurelio Seidita
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Nastaran Asri
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran
| | - Masoumeh Azimirad
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran
| | - Somayeh Jahani-Sherafat
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1416634793, Iran
| | - Anousheh Sharifan
- Department of Food Science and Technology, Science and Research Branch, Islamic Azad University, Tehran 9311634719, Iran
| | - Pasquale Mansueto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Antonio Carroccio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Mohammad Rostami-Nejad
- Celiac Disease and Gluten Related Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran
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Sergi C, Villanacci V, Carroccio A. Non-celiac wheat sensitivity: rationality and irrationality of a gluten-free diet in individuals affected with non-celiac disease: a review. BMC Gastroenterol 2021; 21:5. [PMID: 33407153 PMCID: PMC7788993 DOI: 10.1186/s12876-020-01568-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 12/03/2020] [Indexed: 02/08/2023] Open
Abstract
Non-celiac gluten or wheat sensitivity (NCWS) is a “clinical entity induced by the ingestion of wheat leading to intestinal and/or extraintestinal symptoms that improve once the wheat-containing foodstuff is removed from the diet, and celiac disease and wheat allergy have been excluded”. This mostly accepted definition raises several points that remain controversial on this condition. In the present review, the authors summarize the most recent advances in the clinic and research on NCWS through an accurate analysis of different studies. We screened PubMed, Medline, Embase, and Scopus using the keywords “non-celiac gluten sensitivity”, “non-celiac wheat sensitivity”, and “diagnosis”. We would like to emphasize two main points, including (A) the controversial clinical and etiological aspects in different trials and experiences with particular attention to the Salerno criteria for the diagnosis of NCWS and (B) the histological aspects. The etiology of NCWS remains controversial, and the relationship with irritable bowel syndrome is obscure. Histologically, the duodenal mucosa may show a variable pattern from unremarkable to a slight increase in the number of T lymphocytes in the superficial epithelium of villi. The endorsement of this disease is based on a positive response to a gluten-free diet for a limited period, followed by the reappearance of symptoms after gluten challenge. The Salerno expert criteria may help to diagnose NCWS accurately. Social media and inaccurate interpretation of websites may jeopardize the diagnostic process if individuals self-label as gluten intolerant.
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Affiliation(s)
- Consolato Sergi
- Department of Laboratory Medicine and Pathology, Stollery Children's Hospital, University of Alberta, 8440 112 St., Edmonton, AB, T6G 2B7, Canada.
| | | | - Antonio Carroccio
- Internal Medicine Unit, "V Cervello Hospital", Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90129, Palermo, Italy
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Abstract
Abstract
Gluten consumption has been controversially associated with obesity in previous studies. We sought to examine this association at the worldwide level.
Country specific data were obtained from 168 countries. Scatter plots, bivariate, partial correlation and multiple linear regression models were used to explore and compare the coincidence between obesity prevalence and consumption of gluten, non-gluten cereal protein and total cereal protein respectively. The established risk factors of obesity: caloric intake, sedentary lifestyle, urbanization, socioeconomic status, meat protein intake and sugar consumption were included in analyses as potential confounders. The 168 countries were also stratified into developing and developed country groupings for further examination of the relationships.
Worldwide, bivariate correlation analyses revealed that the strength and direction of correlations between all variables (independent, dependent and potential confounders) were at similar levels. Obesity prevalence was positively correlated to gluten consumption but was negatively correlated to consumption of non-gluten cereal protein, and was in almost nil correlation to total cereal protein consumption. These relationships were similar across all countries (n= 168), developed country grouping (N=44) and developing country grouping (n=124). When caloric intake, Gross Domestic Product at Purchasing Power Parity, sedentary lifestyle and urbanization were kept statistically constant in the partial correlation analysis, obesity was significantly correlated to gluten consumption in all countries, developed country grouping and developing country grouping, and was significantly but inversely and weakly correlated to non-gluten cereal protein in all countries and developing countries, and was in almost nil correlation to total cereal protein in all country groupings. Globally, stepwise multiple regression analysis, when all the independent variables and potential confounding factors were included, selected consumption of sugar as the variable having the greatest influence on obesity with R2 = 0.510, while gluten was placed second increasing R2 to 0.596. Gluten consumption may have been emerging as an inconspicuous, but significant cause of obesity. While Westernization has driven the diet patterns worldwide to incorporate more gluten crops, obesity prevalence projection methods may estimate future obesity rates poorly if gluten consumption is not considered.
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Isasi C, Stadnitsky A, Casco F, Tejerina E, Royuela A, Esteban B, Puga NF. Non-celiac gluten sensitivity and chronic refractory low back pain with spondyloarthritis features. Med Hypotheses 2020; 140:109646. [PMID: 32145444 DOI: 10.1016/j.mehy.2020.109646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To propose the hypothesis that non-celiac gluten sensitivity is associated with chronic low-back pain related to spondyloarthritis, and a gluten free diet has a therapeutic benefit in a subgroup of patients. Gut involvement is a well-known association of spondyloarthritis but limited to a few disorders such as inflammatory bowel disease. Currently the therapeutic implication of this association is pharmacologic treatment for inflammation with immunosupresive drugs for both diseases. Here is a case series of patients with chronic low-back pain, spondyloarthritis related features, and response to gluten free diet despite celiac disease being ruled out. METHODS Retrospective case report of 110 patients from a tertiary hospital rheumatology clinic specialized in chronic pain and gluten sensitivity. These are patients with refractory low-back pain and spondyloarthritis features who followed a gluten free diet despite celiac disease being ruled out. Demanding improvement was defined based on the achievement of at least one of the following objectives: asymptomatic status, remission of chronic low-back pain, returning to normal life, returning to work, changing from confinement to bed/wheelchair to being able to walk, returning to self-sufficiency for hygiene and personal care, discontinuation of opioids. RESULTS Average age at low-back onset pain was 30. Average disease duration was 15 years. 87 (79%) of the patients experienced improvement. 69 (62%) of the patients achieved demanding improvement. Average duration of gluten-free diet in patients with demanding improvement was 60 months. 56 out of 69 patients with demanding improvement ingested gluten. Of these 56 patients, 54 experienced clinical worsening and were considered as having non-celiac gluten sensitivity. Oral aphthae and having a relative with celiac disease were associated with demanding improvement. Out of 28 patients retrospectively classified as having axial spondyloarthritis, 23 had demanding improvement. Out of 16 patients with uveitis, 13 had demanding improvement. Out of 83 patients with fibromyalgia, 48 had demanding improvement. CONCLUSION These observational data support the proposed hypothesis and offer information regarding possible clinical predictors of response to diet.
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Affiliation(s)
- Carlos Isasi
- Rheumatology Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Alexander Stadnitsky
- Family Medicine at Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Fernando Casco
- Pathological Anatomy Department of Unilabs, Madrid, Spain
| | - Eva Tejerina
- Pathological Anatomy Department of Hospital Universitario Puerta de Hierro, Majadahonda Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain
| | - Blanca Esteban
- Asociación de celíacos y sensibles al gluten de Madrid (Association of Celiacs and Gluten-Sensitives of Madrid, Spain
| | - Natalia Fernandez Puga
- Digestive Medicine Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Pediatric Nonceliac Gluten Sensitivity: A Gluten-related Disorder Treatment Center Experience. J Pediatr Gastroenterol Nutr 2019; 69:200-205. [PMID: 30908383 DOI: 10.1097/mpg.0000000000002335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of the study was to identify the prevalence and clinical characteristics of children with nonceliac gluten sensitivity (NCGS) presenting to a tertiary care center specialized for evaluation of gluten-related disorders. METHODS The medical records of all patients aged 0 to 18 years who presented to our center over a 4-year period (July 2013-June 2018) and consented to participate in our research registry were reviewed. Patients meeting the clinical criteria for NCGS were reviewed in detail. RESULTS Among 500 pediatric patients who volunteered to participate in the registry during the study period, we identified 26 (5.2%) with NCGS. Both gastrointestinal and extraintestinal symptoms associated with gluten ingestion were common with abdominal pain (57.7%), bloating (53.9%), rash (53.9%), diarrhea/loose stool (42.3%), and emotional/behavioral issues (42.3%) emerging as the predominant complaints. In addition, children with NCGS demonstrated a high personal history (61.5%) and family history (61.5%) of concomitant allergic/atopic disease. CONCLUSIONS Even within our highly specialized population of patients with a suspected gluten-related disorder, pediatric NCGS is relatively uncommon. The estimated prevalence and clinical features mirror those previously reported in a similarly highly selective population of adults. In the absence of celiac disease, clinical suspicion for NCGS should arise in a child with gastrointestinal and/or extraintestinal complaints alleviated with gluten removal and considered in symptomatic patients with associated allergic/atopic disease. Proper and adequate exclusion of celiac disease and other potential causes of the clinical complaints is essential to justify adoption of the gluten-free diet according to an appropriate stringency and with dietitian supervision to avoid nutritional deficiencies.
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Motoyama M, Yamada H, Motonishi M, Matsunaga H. Elevated anti-gliadin IgG antibodies are related to treatment resistance in schizophrenia. Compr Psychiatry 2019; 93:1-6. [PMID: 31276901 DOI: 10.1016/j.comppsych.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Mikuni Motoyama
- Department of Neuropsychiatry, Hyogo College of Medicine, 1-1, Mukogawa, Nishinomiya, Hyogo 663-8501, Japan.
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, 1-1, Mukogawa, Nishinomiya, Hyogo 663-8501, Japan.
| | | | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, 1-1, Mukogawa, Nishinomiya, Hyogo 663-8501, Japan.
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Diagnostic accuracy of a fully automated multiplex celiac disease antibody panel for serum and plasma. ACTA ACUST UNITED AC 2019; 57:1207-1217. [DOI: 10.1515/cclm-2019-0088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/20/2019] [Indexed: 12/21/2022]
Abstract
Abstract
Background
An automated multiplex platform using capillary blood can promote greater throughput and more comprehensive studies in celiac disease (CD). Diagnostic accuracy should be improved using likelihood ratios for the post-test probability of ruling-in disease.
Methods
The Ig_plex™ Celiac Disease Panel on the sqidlite™ automated platform measured IgA and IgG antibodies to tTG and DGP in n = 224 CD serum or plasma samples. Diagnostic accuracy metrics were applied to the combined multiplex test results for several CD populations and compared to conventional single antibody ELISA tests.
Results
With multiple positive antibody results, the post-test probability for ruling-in untreated and treated CD increased to over 90%. The number of samples positive for more than one antibody also increased in untreated CD to ≥90%. Measurement of all four CD antibodies generate cut-off dependent accuracy profiles that can monitor response to treatment with the gluten-free diet (GFD). Higher positive tTG and DGP antibodies are seen more frequently in confirmed CD without (81%–94%) than with GFD treatment (44%–64%). In CD lacking biopsy confirmation, overall agreement of plasma to serum was ≥98% for all antibodies, and 100% for venous to capillary plasma.
Conclusions
The Ig_plex Celiac Disease Panel increases the likelihood of confirming CD based on the post-test probability of disease results for multi-reactive markers. Specific positivity profiles and cut-off intervals can be used to monitor GFD treatment and likely disease progression. Using serum, venous and capillary plasma yield comparable and accurate results.
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Non-Celiac Gluten Sensitivity: A Review. ACTA ACUST UNITED AC 2019; 55:medicina55060222. [PMID: 31142014 PMCID: PMC6630947 DOI: 10.3390/medicina55060222] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/12/2022]
Abstract
Background and objectives: Grain food consumption is a trigger of gluten related disorders: celiac disease, non-celiac gluten sensitivity (NCGS) and wheat allergy. They demonstrate with non-specific symptoms: bloating, abdominal discomfort, diarrhea and flatulence. Aim: The aim of the review is to summarize data about pathogenesis, symptoms and criteria of NCGS, which can be helpful for physicians. Materials and Methods: The PubMed and Google Scholar databases were searched in January 2019 with phrases: 'non-celiac gluten sensitivity', non-celiac gluten sensitivity', non-celiac wheat gluten sensitivity', non-celiac wheat gluten sensitivity', and gluten sensitivity'. More than 1000 results were found. A total of 67 clinical trials published between 1989 and 2019 was scanned. After skimming abstracts, 66 articles were chosen for this review; including 26 clinical trials. Results: In 2015, Salerno Experts' Criteria of NCGS were published. The Salerno first step is assessing the clinical response to gluten free diet (GFD) and second is measuring the effect of reintroducing gluten after a period of treatment with GFD. Several clinical trials were based on the criteria. Conclusions: Symptoms of NCGS are similar to other gluten-related diseases, irritable bowel syndrome and Crohn's disease. With Salerno Experts' Criteria of NCGS, it is possible to diagnose patients properly and give them advice about nutritional treatment.
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Abstract
Food allergies are on the rise, for reasons that are not fully understood. However, there is a tendency to overestimate their frequency, mostly based on parents' reports or on the assumption that a positive skin or blood IgE test implies the existence of clinically relevant allergy. It is imperative to base food allergy diagnosis on well-defined criteria, avoiding "alternative" tests that are available to the general public. Non-celiac gluten sensitivity is a misnomer and should be abandoned in favor of non-celiac wheat intolerance, an entity suffering from lack of biomarkers and still not convincingly described in children.
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Affiliation(s)
- Catherine DeGeeter
- Division of Gastroenterology, Hepatology, Pancreatology, and Nutrition, Stead Family Department of Pediatrics, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Stefano Guandalini
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Chicago, 5721 S. Maryland Avenue, Chicago, IL 60637, USA.
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Casellas F, Burgos R, Marcos A, Santos J, Ciriza de los Ríos C, García Manzanares Á, Polanco I, Puy Portillo M, Villarino A, Lema Marqués B, Vázquez Alférez MDC. Consensus document on exclusion diets in irritable bowel syndrome (IBS). REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:806-824. [DOI: 10.17235/reed.2018.5941/2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cui C, Basen T, Philipp AT, Yusin J, Krishnaswamy G. Celiac disease and nonceliac gluten sensitivity. Ann Allergy Asthma Immunol 2017; 118:389-393. [PMID: 28390579 DOI: 10.1016/j.anai.2017.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Chongwei Cui
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Tyler Basen
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ami Thakor Philipp
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Joseph Yusin
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Guha Krishnaswamy
- Wake Forest School of Medicine and Wake Baptist Hospital, Winston Salem, North Carolina; W.G. (Bill) Hefner Veterans Affairs Medical Center and Affiliated Clinics, Salisbury, North Carolina.
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Lerner A, Shoenfeld Y, Matthias T. Adverse effects of gluten ingestion and advantages of gluten withdrawal in nonceliac autoimmune disease. Nutr Rev 2017; 75:1046-1058. [DOI: 10.1093/nutrit/nux054] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Gélinas P, Gagnon F. Inhibitory activity towards human α-amylase in wheat flour and gluten. Int J Food Sci Technol 2017. [DOI: 10.1111/ijfs.13605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Pierre Gélinas
- Saint-Hyacinthe Research and Development Centre; Agriculture and Agri-Food Canada; Saint-Hyacinthe QC Canada J2S 8E3
| | - Fleur Gagnon
- Saint-Hyacinthe Research and Development Centre; Agriculture and Agri-Food Canada; Saint-Hyacinthe QC Canada J2S 8E3
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Abstract
OBJECTIVES This study compared the clinical and histopathological characteristics of children with eosinophilic esophagitis (EoE) and elevated anti-transglutaminase (TTG Ab) with those with EoE and normal TTG Ab titres. METHODS Single-center chart and blinded histopathological review of patients diagnosed with EoE for a 4-year period, who had esophageal and duodenal biopsies taken at time of endoscopy, and TTG Ab measured within 6 months of biopsy. Patients with histology-proven CD were excluded. RESULTS Elevated TTG Ab was present in 19/34 (54%) of the study cohort, representing 23% of all patients diagnosed with EoE during the study period. Eight had titers >6× upper limit of normal (ULN) and 4 had >10× ULN. TTG Ab-positive patients were classified as having either potential CD with (n = 3, 16%) and without lymphocytic duodenosis (LD; n = 12, 63%), and no CD (n = 4, 21%) on human leukocyte antigen typing. There was an increase in duodenal eosinophils in patients with elevated TTG Ab (P = 0.01), which remained when patients with LD were excluded (P = 0.018). Of 19 patients with EoE and elevated TTG Ab, 5 responded to elimination diet involving exclusion of wheat, including 2 with a sole wheat trigger and TTG Ab >10× ULN that were CD-associated human leukocyte antigen-negative. CONCLUSIONS Serum TTG Ab was elevated in almost one-quarter of our total EoE cohort, and at least 20% of these patients did not have potential CD, suggesting EoE is a heterogeneous disease with differing immune mechanisms activated in some patients. These findings also support routine esophageal biopsy during upper endoscopy in children with elevated TTG Ab.
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Celiac Disease Treatment: Is It the Chicken or the Egg Yolk? Dig Dis Sci 2017; 62:1113-1115. [PMID: 28194597 DOI: 10.1007/s10620-017-4489-y] [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: 12/09/2022]
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Alvisi P, De Fazio L, Valerii MC, Cavazza E, Salerno A, Lacorte D, Dinelli G, Spisni E. Responses of blood mononucleated cells and clinical outcome of non-celiac gluten sensitive pediatric patients to various cereal sources: a pilot study. Int J Food Sci Nutr 2017; 68:1005-1012. [PMID: 28420279 DOI: 10.1080/09637486.2017.1315058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Non-celiac gluten sensitivity (NCGS) is a clinical entity recently documented by the scientific community in pediatric patients. Nevertheless, its triggering mechanisms remain largely unsettled. We studied 11 children with NCGS who were diagnosed based on a clear-cut relationship between wheat consumption and development of symptoms, after excluding celiac disease (CD) and wheat allergy, matched with 18 children with active CD. Sixteen pediatric patients were also enrolled as controls. Cultured peripheral blood mononucleated cells (PBMCs) obtained from NCGS, CD and control patients were cultured in the presence of wheat proteins extracted from ancient and modern cultivars. Results demonstrated that wheat proteins induced an overactivation of the proinflammatory chemokine CXCL10 in PBMC from NCGS pediatric patients and that this overexpression also depended on the wheat cultivar from which proteins were extracted. Proteins from modern wheat cultivar activated CXCL10 to a greater extent than those extracted from ancient wheat genotypes.
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Affiliation(s)
- Patrizia Alvisi
- a Gastroenterology of Pediatric Unit , Maggiore Hospital , Bologna , Italy
| | - Luigia De Fazio
- b Department of Biological, Geological and Environmental Sciences , University of Bologna , Bologna , Italy
| | - Maria Chiara Valerii
- b Department of Biological, Geological and Environmental Sciences , University of Bologna , Bologna , Italy
| | - Elena Cavazza
- b Department of Biological, Geological and Environmental Sciences , University of Bologna , Bologna , Italy
| | - Angela Salerno
- c Anatomy, Histology and Cytodiagnostic Unit , Maggiore Hospital , Bologna , Italy
| | - Doriana Lacorte
- d Graduate School of Pediatrics , University of Ferrara , Ferrara , Italy
| | - Giovanni Dinelli
- e Department of Agricultural Sciences , University of Bologna , Bologna , Italy
| | - Enzo Spisni
- b Department of Biological, Geological and Environmental Sciences , University of Bologna , Bologna , Italy
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Abstract
PURPOSE OF REVIEW Symptoms attributed to gluten consumption are frequently reported evoking the need for differentiating nonceliac gluten sensitivity (NCGS) from other gluten-related disorders such as celiac disease and wheat allergy. This review discusses diagnostic criteria and research to date on the pathogenesis and diagnosis of NCGS. RECENT FINDINGS There is recent evidence to support NCGS as a distinct clinical entity. The symptoms attributed to NCGS are nonspecific, overlapping with those reported in patients with celiac disease and irritable bowel syndrome. In contrast to celiac disease and wheat allergy, the diagnosis of NCGS is more challenging because there are no specific clinical biomarkers and because the pathogenesis of NCGS is largely not well understood. The pathogenesis of NCGS may reflect alterations in innate immunity to gluten or other components of wheat, may be linked with autoimmunity, or is a result of a reaction to gluten as a fermentable carbohydrate. SUMMARY NCGS is a newly characterized and evolving clinical entity that requires ruling out other causes of wheat-related or gluten-related gastrointestinal symptoms, including celiac disease and wheat allergy, coupled with double-blind placebo-controlled crossover challenge with gluten.
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Caffarelli C, Santamaria F, Di Mauro D, Mastrorilli C, Mirra V, Bernasconi S. Progress in pediatrics in 2015: choices in allergy, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, nephrology, neurology, nutrition, oncology and pulmonology. Ital J Pediatr 2016; 42:75. [PMID: 27566421 PMCID: PMC5002164 DOI: 10.1186/s13052-016-0288-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/10/2016] [Indexed: 12/29/2022] Open
Abstract
This review focuses key advances in different pediatric fields that were published in Italian Journal of Pediatrics and in international journals in 2015. Weaning studies continue to show promise for preventing food allergy. New diagnostic tools are available for identifying the allergic origin of allergic-like symptoms. Advances have been reported in obesity, short stature and autoimmune endocrine disorders. New molecules are offered to reduce weight gain and insulin-resistance in obese children. Regional investigations may provide suggestions for preventing short stature. Epidemiological studies have evidenced the high incidence of Graves' disease and Hashimoto's thyroiditis in patients with Down syndrome. Documentation of novel risk factors for celiac disease are of use to develop strategies for prevention in the population at-risk. Diagnostic criteria for non-celiac gluten sensitivity have been reported. Negative effect on nervous system development of the supernumerary X chromosome in Klinefelter syndrome has emerged. Improvements have been made in understanding rare diseases such as Rubinstein-Taybi syndrome. Eltrombopag is an effective therapy for immune trombocytopenia. Children with sickle-cell anemia are at risk for nocturnal enuresis. Invasive diseases caused by Streptococcus pyogenes are still common despite of vaccination. No difference in frequency of antibiotic prescriptions for acute otitis media between before the publication of the national guideline and after has been found. The importance of timing of iron administration in low birth weight infants, the effect of probiotics for preventing necrotising enterocolitis and perspectives for managing jaundice and cholestasis in neonates have been highlighted. New strategies have been developed to reduce the risk for relapse in nephrotic syndrome including prednisolone during upper respiratory infection. Insights into the pathophysiology of cerebral palsy, arterial ischemic stroke and acute encephalitis may drive advances in treatment. Recommendations on breastfeeding and complementary feeding have been updated. Novel treatments for rhabdomyosarcoma should be considered for paediatric patients. Control of risk factors for bronchiolitis and administration of pavilizumab for preventing respiratory syncytial virus infection may reduce hospitalization. Identification of risk factors for hospitalization in children with wheezing can improve the management of this disease. Deletions or mutations in genes encoding proteins for surfactant function may cause diffuse lung disease.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Dora Di Mauro
- Clinica Pediatrica, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Carla Mastrorilli
- Clinica Pediatrica, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Virginia Mirra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Sergio Bernasconi
- Pediatrics Honorary Member University Faculty, G D’Annunzio University of Chieti-Pescara, Chieti, Italy
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Reilly NR. The Gluten-Free Diet: Recognizing Fact, Fiction, and Fad. J Pediatr 2016; 175:206-10. [PMID: 27185419 DOI: 10.1016/j.jpeds.2016.04.014] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/07/2016] [Accepted: 04/06/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Norelle R Reilly
- Division of Pediatric Gastroenterology, Columbia University Medical Center, New York, NY; Celiac Disease Center, Columbia University Medical Center, New York, NY.
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Di Liberto D, Mansueto P, D’Alcamo A, Lo Pizzo M, Lo Presti E, Geraci G, Fayer F, Guggino G, Iacono G, Dieli F, Carroccio A. Predominance of Type 1 Innate Lymphoid Cells in the Rectal Mucosa of Patients With Non-Celiac Wheat Sensitivity: Reversal After a Wheat-Free Diet. Clin Transl Gastroenterol 2016; 7:e178. [PMID: 27388423 PMCID: PMC5543480 DOI: 10.1038/ctg.2016.35] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/20/2016] [Accepted: 04/30/2016] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Non-celiac wheat sensitivity (NCWS) is defined as a reaction to ingested wheat after exclusion of celiac disease and wheat allergy. As its pathogenesis is incompletely understood, we evaluated the inflammatory response in the rectal mucosa of patients with well-defined NCWS. METHODS The prospective study included 22 patients with irritable bowel syndrome (IBS)-like clinical presentation, diagnosed with NCWS by double-blind placebo-controlled challenge. Eight IBS patients not improving on wheat-free diet were used as controls. Two weeks after oral challenge was performed with 80 grams of wheat daily, cells were isolated from rectal biopsies and thoroughly characterized by fluorescence-activated cell sorting analysis for intracellular cytokines and surface markers. RESULTS Rectal biopsies from wheat-challenged NCWS patients showed that a significant mucosal CD45(+) infiltrate consisted of CD3(+) and CD3(-) lymphocytes, with the latter spontaneously producing more interferon (IFN)-γ than IBS controls. About 30% of IFN-γ-producing CD45(+) cells were T-bet(+), CD56(-), NKP44(-), and CD117(-), defining them as a type-1 innate lymphoid cells (ILC1). IFN-γ-producing ILC1 cells significantly decreased in 10 patients analyzed 2 weeks after they resumed a wheat-free diet. CONCLUSIONS These data indicate that, in patients with active NCWS, IFN-γ-producing ILC1 cells infiltrate rectal mucosa and support a role for this innate lymphoid cell population in the pathogenesis of NCWS.
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Affiliation(s)
- Diana Di Liberto
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), University of Palermo, Palermo, Italy
- Dipartimento di Biopatologia e Biotecnologie Mediche (DIBIMED), University of Palermo, Palermo, Italy
| | - Pasquale Mansueto
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
| | - Alberto D’Alcamo
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
| | - Marianna Lo Pizzo
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), University of Palermo, Palermo, Italy
- Dipartimento di Biopatologia e Biotecnologie Mediche (DIBIMED), University of Palermo, Palermo, Italy
| | - Elena Lo Presti
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), University of Palermo, Palermo, Italy
- Dipartimento di Biopatologia e Biotecnologie Mediche (DIBIMED), University of Palermo, Palermo, Italy
| | | | - Francesca Fayer
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
| | - Giuliana Guggino
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), University of Palermo, Palermo, Italy
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
| | - Giuseppe Iacono
- Pediatric Gastroenterology, ARNAS Di Cristina Hospital, Palermo, Italy
| | - Francesco Dieli
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), University of Palermo, Palermo, Italy
- Dipartimento di Biopatologia e Biotecnologie Mediche (DIBIMED), University of Palermo, Palermo, Italy
| | - Antonio Carroccio
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Internal Medicine, Giovanni Paolo II Hospital, Sciacca (ASP Agrigento), Palermo, Italy
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Abstract
Dietary exclusion of gluten-containing products has become increasingly popular in the general population, and currently ∼30% of people in the United States are limiting gluten ingestion. Although celiac disease (CD), wheat allergy (WA), and nonceliac gluten sensitivity (NCGS) constitute a spectrum of gluten-related disorders that require exclusion of gluten from the diet, together these account for a relatively small percentage of those following a gluten-free diet, and the vast majority has no medical necessity for doing so. Differentiating between CD, WA, and NCGS has important prognostic and therapeutic implications. Because of the protean manifestations of gluten-related disorders, it is not possible to differentiate between them on clinical grounds alone. This clinical report will compare and contrast the manifestations of gluten-related disorders, emphasize the importance of differentiating between these conditions, discuss initial and subsequent tests needed to confirm the diagnosis, and provide recommendations on treatment and follow-up for each condition.
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Gélinas P, McKinnon C. Gluten weight in ancient and modern wheat and the reactivity of epitopes towards R5 and G12 monoclonal antibodies. Int J Food Sci Technol 2016. [DOI: 10.1111/ijfs.13151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Pierre Gélinas
- Saint-Hyacinthe Research and Development Centre, Agriculture and Agri-Food Canada; Saint-Hyacinthe QC Canada J2S 8E3
| | - Carole McKinnon
- Saint-Hyacinthe Research and Development Centre, Agriculture and Agri-Food Canada; Saint-Hyacinthe QC Canada J2S 8E3
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Gélinas P, McKinnon C, Gagnon F. Fructans, water-soluble fibre and fermentable sugars in bread and pasta made with ancient and modern wheat. Int J Food Sci Technol 2015. [DOI: 10.1111/ijfs.13022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Pierre Gélinas
- Agriculture and Agri-Food Canada; Food Research and Development Centre; Saint-Hyacinthe Quebec J2S 8E3 Canada
| | - Carole McKinnon
- Agriculture and Agri-Food Canada; Food Research and Development Centre; Saint-Hyacinthe Quebec J2S 8E3 Canada
| | - Fleur Gagnon
- Agriculture and Agri-Food Canada; Food Research and Development Centre; Saint-Hyacinthe Quebec J2S 8E3 Canada
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Carroccio A, D'Alcamo A, Cavataio F, Soresi M, Seidita A, Sciumè C, Geraci G, Iacono G, Mansueto P. High Proportions of People With Nonceliac Wheat Sensitivity Have Autoimmune Disease or Antinuclear Antibodies. Gastroenterology 2015; 149:596-603.e1. [PMID: 26026392 DOI: 10.1053/j.gastro.2015.05.040] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/16/2015] [Accepted: 05/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is much interest in wheat sensitivity among people without celiac disease (CD), but little is known about any risks associated with the condition. We evaluated the prevalence of autoimmune diseases (ADs) among patients with nonceliac wheat sensitivity (NCWS), and investigated whether they carry antinuclear antibodies (ANA). METHODS We performed a retrospective study of 131 patients diagnosed with NCWS (121 female; mean age, 29.1 years) at 2 hospitals in Italy from January 2001 through June 2011. Data were also collected from 151 patients with CD or irritable bowel syndrome (IBS) (controls). Patient medical records were reviewed to identify those with ADs. We also performed a prospective study of 42 patients (38 female; mean age, 34 years) diagnosed with NCWS from July 2011 through March 2014 at 3 hospitals in Italy. One hundred age- and sex-matched subjects with CD or IBS served as controls. Serum samples were collected from all subjects and ANA levels were measured by immunofluorescence analysis. Participants completed a questionnaire and their medical records were reviewed to identify those with ADs. RESULTS In the retrospective analysis, similar portions of subjects with NCWS (29%) and CD (29%) developed ADs (mainly Hashimoto's thyroiditis, 29 cases), compared with a smaller proportion of subjects with IBS (4%) (P < .001). In the prospective study, 24% of subjects with NCWS, 20% of subjects with CD, and 2% of subjects with IBS developed ADs (P < .001). In the retrospective study, serum samples tested positive for ANA in 46% of subjects with NCWS (median titer, 1:80), 24% of subjects with CD (P < .001), and 2% of subjects IBS (P < .001); in the prospective study, serum samples were positive for ANA in 28% of subjects with NCWS, 7.5% of subjects with CD (P = .02), and 6% of subjects with IBS (P = .005 vs patients with NCWS). ANA positivity was associated with the presence of the HLA DQ2/DQ8 haplotypes (P < .001). CONCLUSIONS Higher proportions of patients with NCWS or CD develop autoimmune disorders, are ANA positive, and showed DQ2/DQ8 haplotypes compared with patients with IBS.
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Affiliation(s)
- Antonio Carroccio
- DiBiMIS University of Palermo, Palermo, Italy; Internal Medicine, Giovanni Paolo II Hospital, Sciacca (ASP Agrigento), Italy.
| | | | | | | | | | - Carmelo Sciumè
- Surgery Department, University of Palermo, Palermo, Italy
| | | | - Giuseppe Iacono
- Pediatric Gastroenterology, ARNAS Di Cristina Hospital, Palermo, Italy
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