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Mello CRLE, da Silva GAP, Lins MTC, Antunes MMDC. Gluten-free diet adherence in pediatric celiac patients: Evaluating CDAT questionnaire and test for gluten detection in urine. J Pediatr Gastroenterol Nutr 2024; 78:1310-1316. [PMID: 38477385 DOI: 10.1002/jpn3.12180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/31/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVES This study aimed to evaluate the contributions of the Adapted Celiac Dietary Adherence Test (CDAT) and the Rapid Urinary Gluten Detection Test (u-GIP) in assessing gluten-free diet adherence in children and adolescents with celiac disease. METHODS Fifty-four celiac patients from two pediatric gastroenterology outpatient clinics affiliated with university hospitals were evaluated. The original CDAT was adapted for children through a transcultural process, and the original cutoff point was adopted to define adherence. A single examiner carried out the u-GIP test in fresh urine samples. Sociodemographic and clinical factors and family food security status were also evaluated. RESULTS A total of 88.9% of participants (confidence interval [CI]: 77.4-95.8; p<0.001) adhered to the gluten-free diet, as determined by the adapted CDAT score, while 87.0% (CI: 75.1-94.6; p<0.001) had negative u-GIP results. Among the 48 children adhering to the CDAT, six exhibited positive u-GIP results in a urine sample. Of the six nonadherent participants, only one had a positive u-GIP result. Notably, none of the children and adolescents with celiac disease who tested positive for u-GIP reported symptoms on the day of testing, and their growth rates remained stable. CONCLUSIONS Even celiac children and adolescents adhering to the CDAT questionnaire may show a positive u-GIP in a single measurement without accompanying symptoms or growth impairment. The u-GIP could be helpful in complementary tests in specific situations, such as for patients who exhibit compliant behavior but still experience symptoms or maintain persistent positive serology.
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Affiliation(s)
- Carolina R Lins E Mello
- Department of Medical Sciences, Children and Adolescent Health Graduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Gisélia A P da Silva
- Department of Medical Sciences, Children and Adolescent Health Graduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Manuela T C Lins
- Ambulatory of Pediatric Gastroenterology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - Margarida M de C Antunes
- Department of Medical Sciences, Children and Adolescent Health Graduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Falcomer AL, de Lima BR, Farage P, Fabris S, Ritter R, Raposo A, Teixeira-Lemos E, Chaves C, Zandonadi RP. Enhancing life with celiac disease: unveiling effective tools for assessing health-related quality of life. Front Immunol 2024; 15:1396589. [PMID: 38742113 PMCID: PMC11089154 DOI: 10.3389/fimmu.2024.1396589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Celiac disease (CD) is an autoimmune chronic enteropathy provoked by gluten ingestion in genetically predisposed individuals. Considering it´s only safe treatment is a lifelong gluten-free diet, the burden of living with the disease becomes evident, as well as the need to assess CD health-related quality of life (HRQOL). This review aims to identify and analyze the instruments used to evaluate the HRQOL of adults with CD. This integrative review using a systematic approach was designed to achieve high scientific standards. Accordingly, the search strategy was developed and executed as recommended by the guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Detailed individual searches were developed to Pubmed, Science Direct, Scopus, Web of Science, and Google Scholar. After careful analysis of the papers, 43 studies were included, in which seven instruments were identified: Celiac Disease Questionnaire (CDQ) (n=21), Celiac Disease Specific Quality of Life Instrument (CD-QOL) (n=17), Celiac Disease Assessment Questionnaire (CDAQ) (n=4), CeliacQ-7 (n=1), CeliacQ-27 (n=1), Black and Orfila´s self-developed instrument (n=1) and the Coeliac Disease Quality of Life Questionnaire (CDQL) (n=1). The CDQ and CD-QOL were the two most applied instruments. Since the first focuses on the physical and mental symptoms related to the disease and the second focuses on the emotional repercussions of adhering to the GFD treatment for life (dysphoria), the CDQ application is an interesting option for countries that struggle with public policies for CD patients and patients with active CD. The CD-QOL could be used for countries with strict regulations for CD and gluten-free products and populations in remission. When comparing results among different populations, it is preferable to utilize culturally validated instruments, which have been applied across multiple countries, providing greater comparability between study findings.
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Affiliation(s)
- Ana Luísa Falcomer
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
- Department of Nutrition, Centro Universitário IESB, Brasília, Brazil
| | - Bernardo Romão de Lima
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
- Department of Nutrition, Centro Universitário IESB, Brasília, Brazil
| | - Priscila Farage
- Faculty of Nutrition (FANUT), Federal University of Goiás, Goiânia, Brazil
| | - Samantha Fabris
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - Ruth Ritter
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Lisboa, Portugal
| | | | - Cláudia Chaves
- ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, Viseu, Portugal
| | - Renata Puppin Zandonadi
- Department of Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
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Velikova T, Vasilev G, Shumnalieva R, Chervenkov L, Miteva DG, Gulinac M, Priftis S, Lazova S. Autoantibodies related to ataxia and other central nervous system manifestations of gluten enteropathy. World J Clin Cases 2024; 12:2031-2039. [PMID: 38680259 PMCID: PMC11045506 DOI: 10.12998/wjcc.v12.i12.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/07/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related autoantibodies. In this narrative review, we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease, immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and following. We focused on the anti-gliadin antibodies, antibodies to different isoforms of tissue transglutaminase (TG) (anti-TG2, 3, and 6 antibodies), anti-glycine receptor antibodies, anti-glutamine acid decarboxylase antibodies, anti-deamidated gliadin peptides antibodies, etc. Most studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction, presented as different neurological disorders. We also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.
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Affiliation(s)
- Tsvetelina Velikova
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
| | - Georgi Vasilev
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
- Clinic of Neurology and Department of Emergency Medicine, UMHAT "Sv. Georgi", Plovdiv 4000, Bulgaria
| | - Russka Shumnalieva
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
- Department of Rheumatology, Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Sofia 1612, Bulgaria
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University Plovdiv, Plovdiv 4000, Bulgaria
| | - Dimitrina Georgieva Miteva
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
- Department of Genetics, Faculty of Biology, Sofia University "St. Kliment Ohridski", Sofia 1164, Bulgaria
| | - Milena Gulinac
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
- Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Stamatios Priftis
- Department of Healthcare, Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, Sofia 1407, Bulgaria
| | - Snezhina Lazova
- Medical Faculty, Sofia University "St. Kliment Ohridski", Sofia 1407, Bulgaria
- Department of Healthcare, Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, Sofia 1407, Bulgaria
- Department of Pediatric, University Hospital "N. I. Pirogov", Sofia 1606, Bulgaria
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Wang Y, Shi T, Gao F, Tian S, Yu L. Celiac disease diagnosis from endoscopic images based on multi-scale adaptive hybrid architecture model. Phys Med Biol 2024; 69:075014. [PMID: 38306971 DOI: 10.1088/1361-6560/ad25c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/02/2024] [Indexed: 02/04/2024]
Abstract
Objective. Celiac disease (CD) has emerged as a significant global public health concern, exhibiting an estimated worldwide prevalence of approximately 1%. However, existing research pertaining to domestic occurrences of CD is confined mainly to case reports and limited case analyses. Furthermore, there is a substantial population of undiagnosed patients in the Xinjiang region. This study endeavors to create a novel, high-performance, lightweight deep learning model utilizing endoscopic images from CD patients in Xinjiang as a dataset, with the intention of enhancing the accuracy of CD diagnosis.Approach. In this study, we propose a novel CNN-Transformer hybrid architecture for deep learning, tailored to the diagnosis of CD using endoscopic images. Within this architecture, a multi-scale spatial adaptive selective kernel convolution feature attention module demonstrates remarkable efficacy in diagnosing CD. Within this module, we dynamically capture salient features within the local channel feature map that correspond to distinct manifestations of endoscopic image lesions in the CD-affected areas such as the duodenal bulb, duodenal descending segment, and terminal ileum. This process serves to extract and fortify the spatial information specific to different lesions. This strategic approach facilitates not only the extraction of diverse lesion characteristics but also the attentive consideration of their spatial distribution. Additionally, we integrate the global representation of the feature map obtained from the Transformer with the locally extracted information via convolutional layers. This integration achieves a harmonious synergy that optimizes the diagnostic prowess of the model.Main results. Overall, the accuracy, specificity, F1-Score, and precision in the experimental results were 98.38%, 99.04%, 98.66% and 99.38%, respectively.Significance. This study introduces a deep learning network equipped with both global feature response and local feature extraction capabilities. This innovative architecture holds significant promise for the accurate diagnosis of CD by leveraging endoscopic images captured from diverse anatomical sites.
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Affiliation(s)
- Yilei Wang
- College of Software, Xinjiang University, Urumqi, Xinjiang, People's Republic of China
- Key Laboratory of Software Engineering Technology, College of Software, Xin Jiang University, Urumqi, People's Republic of China
| | - Tian Shi
- Department of Gastroenterologys, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang Uyghur Autonomous Region, People's Republic of China
- Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, People's Republic of China
| | - Feng Gao
- Department of Gastroenterologys, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang Uyghur Autonomous Region, People's Republic of China
- Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, People's Republic of China
| | - Shengwei Tian
- College of Software, Xinjiang University, Urumqi, Xinjiang, People's Republic of China
- Key Laboratory of Software Engineering Technology, College of Software, Xin Jiang University, Urumqi, People's Republic of China
| | - Long Yu
- College of Network Center, Xinjiang University, Urumqi, People's Republic of China
- Signal and Signal Processing Laboratory, College of Information Science and Engineering, Xinjiang University, Urumqi, People's Republic of China
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Taavela J, Kurppa K, Jääskeläinen T, Kaartinen NE, Rissanen H, Huhtala H, Mäki M, Kaukinen K. Trends in the prevalence rates and predictive factors of coeliac disease: A long-term nationwide follow-up study. Aliment Pharmacol Ther 2024; 59:372-379. [PMID: 37946663 DOI: 10.1111/apt.17803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The prevalence of coeliac disease doubled in Finland from 1980 to 2000. AIMS To investigate whether this increase is continuing and if there are specific patient-related factors predicting the development of coeliac disease at a population level. METHODS We elicited comprehensive health data in the nationwide Health 2000 and Health 2011 surveys. Serum samples were taken for the measurement of tissue transglutaminase antibodies (TGA); subjects who were seropositive were tested for endomysial antibodies (EmA). Coeliac disease was defined either as a reported diagnosis or as positive TGA and EmA. The surveys comprised, respectively, 6379 and 4056 individuals, forming representative samples for 2,946,057 and 2,079,438 Finnish adults. Altogether 3254 individuals participating in both surveys comprised a prospective follow-up cohort. RESULTS Prevalence of coeliac disease was 2.12% in 2000 and 2.40% in 2011 (p = 0.156). In the prospective cohort, 16 out of the 3254 (0.49%) subjects developed coeliac disease during follow-up from 2000 to 2011, with an annual incidence rate of 45 per 100,000 persons. Positive TGA without EmA (OR: 133, 95% CI: 30.3-584), TGA values in the upper normal range (51.1, 16.0-163), and after adjusting for TGA, previous autoimmune co-morbidity (8.39, 4.98-35.9) in 2000 increased the likelihood of subsequent coeliac disease. CONCLUSIONS The nationwide prevalence of coeliac disease kept on rising from 2.12% in 2000 to 2.40% in 2011 in Finland. Positive TGA without EmA, TGA titres in the upper normal range and a pre-existing autoimmune disease predisposed to coeliac disease during the 10-year follow-up.
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Affiliation(s)
- Juha Taavela
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Gastroenterology, Tampere University Hospital, Tampere, Finland
| | - Kalle Kurppa
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tampere Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- University Consortium of Seinäjoki, Seinäjoki, Finland
| | | | | | - Harri Rissanen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Markku Mäki
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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6
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Li Q, Lei T, Cheng Y, Wei X, Sun DW. Predicting wheat gluten concentrations in potato starch using GPR and SVM models built by terahertz time-domain spectroscopy. Food Chem 2024; 432:137235. [PMID: 37688814 DOI: 10.1016/j.foodchem.2023.137235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/10/2023] [Accepted: 08/20/2023] [Indexed: 09/11/2023]
Abstract
The purpose of this study was for the first time to explore the feasibility of terahertz (THz) spectral imaging for the detection of gluten contents in food samples. Based on the obtained 80 THz spectrum data, Gaussian process regression (GPR) and support vector machine (SVM) models were established to predict wheat gluten concentrations in 40 potato starch mixture samples. The prediction performances of GPR and SVM obtained were R2 = 0.859 and RMSE = 0.070, and R2 = 0.715 and RMSE = 0.101 in the gluten concentration range of 1.3%-100%, respectively, showing that the linear SVM algorithm had better prediction performance. The results indicated that THz spectral imaging combined with GPR could be used to predict the gluten content in food samples. It is thus hoped that this research should provide a novel technique for gluten content detection to ensure gluten-free food samples.
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Affiliation(s)
- Qingxia Li
- Food Refrigeration and Computerized Food Technology (FRCFT), Agriculture and Food Science Centre, University College Dublin, National University of Ireland, Belfield, Dublin 4, Ireland
| | - Tong Lei
- Food Refrigeration and Computerized Food Technology (FRCFT), Agriculture and Food Science Centre, University College Dublin, National University of Ireland, Belfield, Dublin 4, Ireland
| | - Yunlong Cheng
- School of Computer Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Xin Wei
- Food Refrigeration and Computerized Food Technology (FRCFT), Agriculture and Food Science Centre, University College Dublin, National University of Ireland, Belfield, Dublin 4, Ireland
| | - Da-Wen Sun
- Food Refrigeration and Computerized Food Technology (FRCFT), Agriculture and Food Science Centre, University College Dublin, National University of Ireland, Belfield, Dublin 4, Ireland.
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7
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De Giuseppe R, Bergomas F, Loperfido F, Giampieri F, Preatoni G, Calcaterra V, Cena H. Could Celiac Disease and Overweight/Obesity Coexist in School-Aged Children and Adolescents? A Systematic Review. Child Obes 2024; 20:48-67. [PMID: 36602771 DOI: 10.1089/chi.2022.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Celiac disease (CD) is a multifactorial, immune-mediated enteropathic disorder that may occur at any age with heterogeneous clinical presentation. In the last years, unusual manifestations have become very frequent, and currently, it is not so uncommon to diagnose CD in subjects with overweight or obesity, especially in adults; however, little is known in the pediatric population. This systematic review aims to evaluate the literature regarding the association between CD and overweight/obesity in school-age children. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. An electronic database search of articles published in the last 20 years in English was carried out in Web of Sciences, PubMed, and Medline. The quality of the included studies was assessed by using the STrengthening the Reporting of OBservational studies in Epidemiology statement. Results: Of the 1396 articles identified, 9 articles, investigating overweight/obesity in children/adolescents affected by CD or screening CD in children/adolescents with overweight/obesity, met the inclusion criteria. Overall, the results showed that the prevalence of overweight or obesity in school-age children (6-17 years) affected by CD ranged between 3.5% and 20%, highlighting that the coexistence of CD with overweight/obesity in children is not uncommon as previously thought. Conclusion: Although CD has been historically correlated with being underweight due to malabsorption, it should be evaluated also in children with overweight and obesity, especially those who have a familiar predisposition to other autoimmune diseases and/or manifest unusual symptoms of CD.
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Affiliation(s)
- Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Francesca Bergomas
- Scuola di Specializzazione in Scienza dell'Alimentazione, Università degli Studi di Milano, Milano, Italy
| | - Federica Loperfido
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Scuola di Specializzazione in Scienza dell'Alimentazione, Università degli Studi di Pavia, Pavia, Italy
| | - Francesca Giampieri
- Research Group on Food, Nutritional Biochemistry, and Health, Universidad Europea del Atlántico, Santander, Spain
| | - Giorgia Preatoni
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Unit, "V. Buzzi" Children's Hospital, Milano, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy
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Issever K, Kuloglu E, Sengul D, Muhtaroglu A, Dulger AC. Helicobacter Pylori and Celiac Disease Antibody Positivity Have a Higher Prevalence in Patients With Distal Gastrectomy: A Cross-Sectional Retrospective Study. Cureus 2023; 15:e42976. [PMID: 37546692 PMCID: PMC10403781 DOI: 10.7759/cureus.42976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 08/08/2023] Open
Abstract
Aims and objectives Distal gastrectomy was a widely used therapeutic option for peptic ulcer and gastroesophageal reflux disease until quite recently. The consequences of anatomical and physiological changes following surgery in the gastric mucosa have been the object of interest for the scientist. In this study, we aimed to determine whether Helicobacter pylori (HP) infection and celiac disease were more common in patients with a history of distal gastrectomy. Materials and methods This is an observational retrospective study conducted at Giresun University Faculty of Medicine. The medical files of 35 patients with dyspepsia who had a history of distal gastrectomy for benign etiologies (antrectomy group) and 50 patients with dyspepsia (control group) were retrospectively analyzed. Results There were more males and older patients in the antrectomy group. Concerning the lab parameters, platelets, lymphocyte, and albumin levels were significantly lower, and urea, creatinine, anti-Endomisium Ig A (anti-EMA), and anti-tissue transglutaminase IgA (anti-tTGA) antibody positivity were significantly higher in the antrectomy group. Gastric biopsy results revealed a higher positivity of HP, atrophy, neutrophil, and lymphocytes in the antrectomy group. Correlation analysis revealed an inverse correlation between albumin and anti-EMA/atrophy positivity whereas a positive correlation between anti-EMA and HP/atrophy positivity. Conclusions HP infection and coeliac disease (CD) could be the problems that distal gastrectomy patients with dyspepsia can face during their follow-up. Concerning the pre-malignant potential of HP, its screening and eradication should be performed to prevent the malignant transformation of the remnant gastric tissue.
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Affiliation(s)
- Kubilay Issever
- Internal Medicine, Giresun University Faculty of Medicine, Giresun, TUR
| | - Ersin Kuloglu
- Internal Medicine, Giresun University Faculty of Medicine, Giresun, TUR
| | - Demet Sengul
- Pathology, Giresun University Faculty of Medicine, Giresun, TUR
| | - Ali Muhtaroglu
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
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Li T, Feng Y, Wang C, Shi T, Abudurexiti A, Zhang M, Gao F. Assessment of causal associations among gut microbiota, metabolites, and celiac disease: a bidirectional Mendelian randomization study. Front Microbiol 2023; 14:1087622. [PMID: 37250054 PMCID: PMC10213403 DOI: 10.3389/fmicb.2023.1087622] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background A growing number of studies have implicated that gut microbial abundance and metabolite concentration alterations are associated with celiac disease (CD). However, the causal relationship underlying these associations is unclear. Here, we used Mendelian randomization (MR) to reveal the causal effect of gut microbiota and metabolites on CD. Methods Genome-wide association study (GWAS) summary-level data for gut microbiota, metabolites, and CD were extracted from published GWASs. Causal bacterial taxa and metabolites for CD were determined by two-sample MR analyses. The robustness of the results was assessed with sensitivity analyses. Finally, reverse causality was investigated with a reverse MR analysis. Results Genetically, increased genus Bifidobacterium was potentially associated with higher CD risk (odds ratio [OR] = 1.447, 95% confidence interval [CI]: 1.054-1.988, p = 0.022) while phylum Lentisphaerae (OR = 0.798, 95% CI: 0.648-0.983, p = 0.034) and genus Coprobacter (OR = 0.683, 95% CI: 0.531-0.880, p = 0.003) were related to lower CD risk. Moreover, there were suggestive associations between CD and the following seven metabolites: 1-oleoylglycerophosphoethanolamine, 1-palmitoylglycerophosphoethanolamine, 1,6-anhydroglucose, phenylacetylglutamine, tryptophan betaine, 10-undecenoate, and tyrosine. Sensitivity analyses deemed the results reliable without pleiotropy. Conclusion We investigated the causal relationships between gut microbiota, metabolites, and CD with two-sample MR. Our findings suggest several novel potential therapeutic targets for CD treatment. Further understanding of the underlying mechanism may provide insights into CD pathogenesis.
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Affiliation(s)
- Ting Li
- Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Yan Feng
- Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Chun Wang
- Department of Pathology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Tian Shi
- Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Adilai Abudurexiti
- Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Mengxia Zhang
- Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Feng Gao
- Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
- Xinjiang Clinical Research Center for Digestive Diseases, Urumqi, Xinjiang, China
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10
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Oliveira LC, Dornelles AC, Nisihara RM, Bruginski ERD, Santos PID, Cipolla GA, Boschmann SE, Messias-Reason IJD, Campos FR, Petzl-Erler ML, Boldt ABW. The Second Highest Prevalence of Celiac Disease Worldwide: Genetic and Metabolic Insights in Southern Brazilian Mennonites. Genes (Basel) 2023; 14:genes14051026. [PMID: 37239386 DOI: 10.3390/genes14051026] [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: 01/20/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Celiac disease (CD), despite its high morbidity, is an often-underdiagnosed autoimmune enteropathy. Using a modified version of the Brazilian questionnaire of the 2013 National Health Survey, we interviewed 604 Mennonites of Frisian/Flemish origin that have been isolated for 25 generations. A subgroup of 576 participants were screened for IgA autoantibodies in serum, and 391 participants were screened for HLA-DQ2.5/DQ8 subtypes. CD seroprevalence was 1:29 (3.48%, 95% CI = 2.16-5.27%) and biopsy-confirmed CD was 1:75 (1.32%, 95% CI = 0.57-2.59%), which is superior to the highest reported global prevalence (1:100). Half (10/21) of the patients did not suspect the disease. HLA-DQ2.5/DQ8 increased CD susceptibility (OR = 12.13 [95% CI = 1.56-94.20], p = 0.003). The HLA-DQ2.5 carrier frequency was higher in Mennonites than in Brazilians (p = 7 × 10-6). HLA-DQ8 but not HLA-DQ2.5 carrier frequency differed among settlements (p = 0.007) and was higher than in Belgians, a Mennonite ancestral population (p = 1.8 × 10-6), and higher than in Euro-Brazilians (p = 6.5 × 10-6). The glutathione pathway, which prevents reactive oxygen species-causing bowel damage, was altered within the metabolic profiles of untreated CD patients. Those with lower serological positivity clustered with controls presenting close relatives with CD or rheumatoid arthritis. In conclusion, Mennonites have a high CD prevalence with a strong genetic component and altered glutathione metabolism that calls for urgent action to alleviate the burden of comorbidities due to late diagnosis.
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Affiliation(s)
- Luana Caroline Oliveira
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, Paraná, Brazil
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, Paraná, Brazil
| | - Amanda Coelho Dornelles
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, Paraná, Brazil
| | - Renato Mitsunori Nisihara
- Laboratory of Molecular Immunopathology, Department of Clinical Pathology, Clinical Hospital, Federal University of Paraná (UFPR), Rua General Carneiro, 181 Prédio Central, 11° Andar, Alto da Glória, Curitiba 80060-240, Paraná, Brazil
| | - Estevan Rafael Dutra Bruginski
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Bioscience and Mass Spectrometry, Department of Pharmacy, Federal University of Paraná (UFPR), Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba 80210-170, Paraná, Brazil
| | - Priscila Ianzen Dos Santos
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, Paraná, Brazil
- Postgraduate Program in Internal Medicine, Federal University of Paraná (UFPR), Rua General Carneiro, 181 Prédio Central, 11° Andar, Alto da Glória, Curitiba 80060-240, Paraná, Brazil
| | - Gabriel Adelman Cipolla
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, Paraná, Brazil
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, Paraná, Brazil
| | - Stefanie Epp Boschmann
- Laboratory of Molecular Immunopathology, Department of Clinical Pathology, Clinical Hospital, Federal University of Paraná (UFPR), Rua General Carneiro, 181 Prédio Central, 11° Andar, Alto da Glória, Curitiba 80060-240, Paraná, Brazil
- Postgraduate Program in Internal Medicine, Federal University of Paraná (UFPR), Rua General Carneiro, 181 Prédio Central, 11° Andar, Alto da Glória, Curitiba 80060-240, Paraná, Brazil
| | - Iara José de Messias-Reason
- Laboratory of Molecular Immunopathology, Department of Clinical Pathology, Clinical Hospital, Federal University of Paraná (UFPR), Rua General Carneiro, 181 Prédio Central, 11° Andar, Alto da Glória, Curitiba 80060-240, Paraná, Brazil
- Postgraduate Program in Internal Medicine, Federal University of Paraná (UFPR), Rua General Carneiro, 181 Prédio Central, 11° Andar, Alto da Glória, Curitiba 80060-240, Paraná, Brazil
| | - Francinete Ramos Campos
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Bioscience and Mass Spectrometry, Department of Pharmacy, Federal University of Paraná (UFPR), Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba 80210-170, Paraná, Brazil
| | - Maria Luiza Petzl-Erler
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, Paraná, Brazil
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, Paraná, Brazil
| | - Angelica Beate Winter Boldt
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, Paraná, Brazil
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, Paraná, Brazil
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Chaves C, Raposo A, Zandonadi RP, Nakano EY, Ramos F, Teixeira-Lemos E. Quality of Life Perception among Portuguese Celiac Patients: A Cross-Sectional Study Using the Celiac Disease Questionnaire (CDQ). Nutrients 2023; 15:2051. [PMID: 37432200 DOI: 10.3390/nu15092051] [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: 03/15/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 07/12/2023] Open
Abstract
The aim of this study is to assess Portuguese celiac patients' quality of life (QoL) perception. A cross-sectional study was performed with a non-probability convenience sample of Portuguese celiac patients using an online self-administered celiac disease quality of life questionnaire (CDQ), previously validated for the Portuguese population. The final sample comprised 234 celiac patients, which included the following: primarily women (69.2%); aged between 18 and 49 years old (56.4%); with a partner (60.6%); with a high educational level (58.9%-graduated or post-graduated); following a gluten-free diet (GFD) (55.1%); and not using antidepressants (93.1%). The Portuguese CDQ presented good reliability and responsiveness in this sample of Portuguese celiac patients. In general, the CDQ in Portugal was affected by age at diagnosis (p = 0.017), educational level (p = 0.005), and compliance with GFD (p = 0.034). The emotion domain was affected only by using antidepressants (p = 0.036). The social domain was affected by gender (females had lower rates, p = 0.016), age at diagnosis (p = 0.009), educational level (p = 0.000), and compliance with a GFD (p = 0.002). The worries domain did not differ according to socioeconomic data. The symptoms domain was affected by compliance with GFD (p = 0.000), age at diagnosis (p = 0.000), and educational level (p = 0.014). Data on celiac QoL is essential to support the formulation and implementation of strategies to minimize the issues suffered by celiac patients, lowering their physical, emotional, and social burden. Additionally, data on Portuguese celiac disease patients using the CDQ will allow future comparative research among celiac populations from different countries.
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Affiliation(s)
- Cláudia Chaves
- ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
| | - Renata Puppin Zandonadi
- University of Brasília, Faculty of Health Sciences, Nutrition Department, Campus Universitário Darcy Ribeiro, Brasília 70910-900, Brazil
| | | | - Fernando Ramos
- Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
- Associated Laboratory for Green Chemistry (LAQV) of the Network of Chemistry and Technology (REQUIMTE), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - Edite Teixeira-Lemos
- CERNAS-IPV, Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
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12
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Martini N, Kara Tahhan N, Aldarwish MS, Mahmoud J. Rectal prolapse as a manifestation of inflammatory bowel disease with celiac disease in a 2-year-old male: a rare case report. Ann Med Surg (Lond) 2023; 85:1235-1239. [PMID: 37113926 PMCID: PMC10129242 DOI: 10.1097/ms9.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/18/2023] [Indexed: 04/29/2023] Open
Abstract
The co-occurrence of inflammatory bowel disease (IBD) and celiac disease (CeD) is uncommon. The typical sign of this co-occurrence is malabsorption which leads to anemia, diarrhea, and malnutrition. In rare cases, recurrent rectal prolapse may also occur. Case presentation A 2-year-old Syrian male baby presented with failure to thrive and chronic diarrhea for 18 months, along with recurrent rectal prolapse for the last 6 months. Biopsies taken confirmed a diagnosis of stage 3b celiac disease according to the Marsh classification. Furthermore, biopsies taken confirmed a diagnosis of IBD. Then, a high-fiber diet to manage IBD and celiac diet were both needed simultaneously, with signs of rectal prolapse, diarrhea, and bloating, occurring when either or both diets were stopped. Clinical discussion The diagnosis was initially explained by the malnutrition and anemia. Even after the gluten-free diet, the patient showed no improvement in diarrhea and developed inferior gastrointestinal bleeding suggested anal fissure, infectious colitis, polyps, IBD, or solitary rectal ulcer syndrome. The relationship between celiac disease and IBD, in children, is still unclear. Current studies suggest that such co-occurrence is associated with higher risks of developing other autoimmune-related disorders, growth and puberty delay, and comorbidities. Conclusions In the cases of pediatric co-occurrence of IBD and celiac disease, a conservative therapy consisting of two-fold diets for the two diseases should be tried first. If this step succeeds in controlling the clinical picture, it removes the necessity of introducing immunological pharmacologic treatments that may induce unfavorable side effects in a child.
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Affiliation(s)
- Nafiza Martini
- Faculty of Medicine, Damascus University
- Stemosis for Scientific Research
- Corresponding Author. Address: Faculty of Medicine, Damascus University, Mashrou Dummar, Damascus, Syrian Arab Republic. Tel: +963 968 236 051. E-mail address: (N. Martini)
| | - Nour Kara Tahhan
- Faculty of Medicine, Damascus University
- Stemosis for Scientific Research
| | | | - Jaber Mahmoud
- Pediatric University Hospital, Damascus University, Damascus, Syrian Arab Republic
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13
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Meta-Analysis and Systematic Review of HLA DQ2/DQ8 in Adults with Celiac Disease. Int J Mol Sci 2023; 24:ijms24021188. [PMID: 36674702 PMCID: PMC9863503 DOI: 10.3390/ijms24021188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 01/11/2023] Open
Abstract
Although people with human leukocyte antigens (HLA) DQ2 and/or DQ8 are more likely to develop celiac disease (CD), the condition cannot be fully explained by this genetic predisposition alone. Multiple, as yet unidentified, factors contribute to the genesis of CD, including genetics, the environment, and the immune system. In order to provide insight into a prospective possibility and an expanded screening technique, we aim to undertake a comprehensive and meta-analytical study of the assessment and distribution of HLA class II (HLA-DQ2/DQ8) in adult CD patients. A systematic review was conducted using an electronic search of databases (PubMed, Google Scholar, Embase, and Direct Science) from January 2004 to February 2022. DQ2/DQ2 homozygotes have the highest risk of developing CD. DQ2/DQ8 typing is an effective test to exclude CD from the differential diagnosis of a patient with CD symptoms. Although other non-HLA genes have been associated with CD, they are rarely considered at diagnosis because they account for only a small proportion of the heritability of CD. This finding, together with the information gathered previously, may be useful in considering widely available and economically feasible screening options for celiac disease in young people.
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14
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Verma SR, Bains M. The Impact of the Media Portrayal of Coeliac Disease: A Qualitative Study. Cureus 2022; 14:e32444. [DOI: 10.7759/cureus.32444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
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15
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Verma KC. Assessment of squalene variability and its enhancement in Amaranthus (Amaranthus caudatus L.) populations: With application to vaccine development. Biotechnol Appl Biochem 2022; 69:2745-2752. [PMID: 35032134 DOI: 10.1002/bab.2319] [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: 10/06/2021] [Accepted: 01/01/2022] [Indexed: 12/27/2022]
Abstract
Amaranthus (Amaranthus caudatus L.) is the richest source of squalene among all plants. Squalene is used as a component of some adjuvants in vaccines for enhancement of the host immune response. Squalene content was estimated by high-performance liquid chromatography and amino acids profiling was performed using an amino acid analyzer. Squalene content, up to 7.66%, was found in the raw seeds of amaranthus, which was further enhanced to 8.13% by popping. The results revealed that amaranthus populations have wide significant variations (p < 0.05) in 1000 seed weight (0.61-1.13 g), protein content (11.50-19.80%), total phenols (4.36-7.82 μg GAE/mg sample), total flavonoid (0.70-2.32 mg QE/g dw), and squalene (3.23-7.66% in raw seeds and 3.38-8.12% in popped seeds). Genotypic variability in amino acids composition, viz. lysine (4.96-5.90%), arginine (8.48-8.80%), leucine (5.20-6.70%), valine (3.60-4.60%), phenylalanine (5.30-8.00%), methionine (3.08-4.97%), tyrosine (5.92-7.96), threonine (3.20-4.32%), and glycine (6.60-8.20%), was also observed. Wide genetic variability in amaranthus grains may be used for improved varietal development breeding programs. It can be further concluded that an increase of squalene content in amaranthus grains by heat treatment could be helpful to fulfil the demands of cosmetic and pharmaceutical industries, especially with respect to vaccine production against virus-generated pandemics.
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Affiliation(s)
- Kuldip Chandra Verma
- Department of Biochemistry, Lovely Professional University, Phagwara, Punjab, India.,Department of Biochemistry, Govind Ballabh Pant University of Agriculture and Technology, Pantnagar (U. S. Nagar), Uttarakhand, India
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16
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Constante M, Libertucci J, Galipeau HJ, Szamosi JC, Rueda G, Miranda PM, Pinto-Sanchez MI, Southward CM, Rossi L, Fontes ME, Chirdo FG, Surette MG, Bercik P, Caminero A, Verdu EF. Biogeographic Variation and Functional Pathways of the Gut Microbiota in Celiac Disease. Gastroenterology 2022; 163:1351-1363.e15. [PMID: 35810781 DOI: 10.1053/j.gastro.2022.06.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/02/2022] [Accepted: 06/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Genes and gluten are necessary but insufficient to cause celiac disease (CeD). Altered gut microbiota has been implicated as an additional risk factor. Variability in sampling site may confound interpretation and mechanistic insight, as CeD primarily affects the small intestine. Thus, we characterized CeD microbiota along the duodenum and in feces and verified functional impact in gnotobiotic mice. METHODS We used 16S rRNA gene sequencing (Illumina) and predicted gene function (PICRUSt2) in duodenal biopsies (D1, D2 and D3), aspirates, and stool from patients with active CeD and controls. CeD alleles were determined in consented participants. A subset of duodenal samples stratified according to similar CeD risk genotypes (controls DQ2-/- or DQ2+/- and CeD DQ2+/-) were used for further analysis and to colonize germ-free mice for gluten metabolism studies. RESULTS Microbiota composition and predicted function in CeD was largely determined by intestinal location. In the duodenum, but not stool, there was higher abundance of Escherichia coli (D1), Prevotella salivae (D2), and Neisseria (D3) in CeD vs controls. Predicted bacterial protease and peptidase genes were altered in CeD and impaired gluten degradation was detected only in mice colonized with CeD microbiota. CONCLUSIONS Our results showed luminal and mucosal microbial niches along the gut in CeD. We identified novel microbial proteolytic pathways involved in gluten detoxification that are impaired in CeD but not in controls carrying DQ2, suggesting an association with active duodenal inflammation. Sampling site should be considered a confounding factor in microbiome studies in CeD.
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Affiliation(s)
- Marco Constante
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Josie Libertucci
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Heather J Galipeau
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jake C Szamosi
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Gaston Rueda
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Pedro M Miranda
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Maria Ines Pinto-Sanchez
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Carolyn M Southward
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Laura Rossi
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Michelle E Fontes
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Fernando G Chirdo
- Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Instituto de Estudios Inmunológicos y Fisiopatológicos, Universidad Nacional de La Plata-National Scientific and Technical Research Council, La Plata, Argentina
| | - Michael G Surette
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Premysl Bercik
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alberto Caminero
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
| | - Elena F Verdu
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
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Desher KA, Alkalay MJ. Clinical differences among racially diverse children with celiac disease. World J Pediatr 2022; 18:710-714. [PMID: 35960472 DOI: 10.1007/s12519-022-00596-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kaley A Desher
- Department of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- , Preferred postal address is 6605 Vickery Creek Rd, Cumming, GA, 30040, USA.
| | - Michele J Alkalay
- Department of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Jabeen S, Khan AU, Ahmed W, Ahmad MUD, Jafri SA, Bacha U, Ali A, Muzammil HS, Alsagaby SA, Al Abdulmonem W, Abdelgawad MA, Riaz M, Mahwish, Nasir M, Zafar A, Tufail T, Imran M, Anwar Faridi T, Aslam M, Abid Shah SF, Farooq S, Awan TN, Ur-Rehman H. Disease specific symptoms indices in patients with celiac disease—A hardly recognised entity. Front Nutr 2022; 9:944449. [PMID: 36159486 PMCID: PMC9494589 DOI: 10.3389/fnut.2022.944449] [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: 05/15/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Celiac disease (CD) was considered a rare disease before and was perceivably only limited to children but now affects almost 1–2% of the global population. This abrupt increase in prevalence is due to advancements in diagnostic criteria and medical facilities but still many countries lack the basic data that can assess the severity of this health issue. The present study was conducted with the aim to assess the common but rarely diagnosed condition with the identification of its underlying secondary ailments. Materials and methods Patients visiting public sector hospitals were recruited and tested for clinical symptoms secondary to gluten-containing foods (wheat and barley, etc.), followed by serological testing for immunoglobulin A, tissue transglutaminase A, and anti-endomysial antibodies. Only seropositive candidates were included in the endoscopic and biopsy examination for the features of villous atrophy and intestinal cell damage. The secondary ailments including anemia, growth retardation, and gastrointestinal symptoms were also documented for the tested positive patients. The modified European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) criterion was followed throughout the study. Results From 647 suspected cases from March 2018 to July 2019, 113 were confirmed with CD while 58% were female children and 42% were male children. The majority of them were from a lower class (75%) and 26% of them had a positive family history of CD. A total of 67% of patients with CD were underweight while wasting was observed in 38%, and 80% were stunted as well. Of the positively tested patients with CD, 49% had moderate anemia with 15% having severe anemia. Approximately 33% had hypoalbuminemia as well. The majority of them had a mild to severe range of gastrointestinal symptoms, such as abdominal pain, diarrhea, flatus, eructation, diarrhea, and steatorrhea. Conclusion The study finding indicates an increased number of patients diagnosed with CD with an excessive sum of secondary ailments, such as anemia, growth failure, growth retardation, malnutrition, and gastrointestinal symptoms.
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Aerobic Exercise Associated with Fish Oil Supplementation Decreases C-Reactive Protein and Interleukin-6 in Celiac Disease Patients. J Nutr Metab 2022; 2022:3908675. [PMID: 35910449 PMCID: PMC9334128 DOI: 10.1155/2022/3908675] [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: 02/17/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Several studies indicate that celiac disease patients present alterations within anthropometric, metabolic, and inflammatory parameters, while physical exercise and fish oil are known to activate modulatory pathways of such parameters. Objective To investigate the effects of a 12-week-long protocol of aerobic exercise and its association with fish oil supplementation in nineteen adult celiac disease patients. Material and Methods. The celiacs were divided into 2 groups: (A) FOS: supplementation (n = 11); and (B) EXE: supplementation and exercise (n = 8). The celiac groups were compared to the adult healthy control group (CTR) (n 12). Aerobic exercises were performed weekly, in three sessions of 60 minutes each, with a maximal heart rate intensity of 60–70%. The participants received 2 g/day of fish oil, a daily intake of 420 mg of eicosapentaenoic acid, and 230 mg of docosahexaenoic acid. The following measurements were taken in four phases: (A) anthropometry: body mass, height, body mass index, waist-to-hip ratio, fat mass, and fat-free mass; (B) metabolic profile: total cholesterol, triglycerides, HDL, and LDL; and (C) inflammatory profile: C-reactive protein and interleukin-6. Results Supplementation associated with aerobic exercise promoted a significant reduction in C-reactive protein (P < 0.01) and increased the proportion of individuals in the undetectable range of interleukin-6. Conclusions The associated interventions showed a corrective and preventive potential in relation to disorders associated with chronic inflammation; however, the experimental design does not allow us to discriminate between the biological effects that are dependent on the association between interventions and those exclusively dependent on aerobic exercise.
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Muroyama R, Ito H, Takahashi S, Kang DJ, Hamada S. Biochemical analysis of a novel allele of the OsPPDKB gene associated with floury endosperm. J Cereal Sci 2022. [DOI: 10.1016/j.jcs.2022.103529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Rasmussen SN, Vigre H, Madsen CB. Risk of consuming products with or without precautionary wheat or gluten labelling for persons with coeliac disease. Food Chem Toxicol 2022; 166:113231. [PMID: 35710030 DOI: 10.1016/j.fct.2022.113231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
Persons with Coeliac disease (CD) need to keep a lifelong diet without gluten and therefore need to know which foods are safe to eat. The objective of this study was to analyse ordinary foods products without gluten containing ingredients (PWG) with or without the precautionary allergen statement (PAL) "May contain wheat/gluten" or similar wording and use these data to perform a probabilistic risk assessment. Foods with and without PAL were analysed for gluten. Inputs for the risk assessment were analytical results, daily food consumption and data from a 90-days challenge study in coeliac patients (Catassi et al., 2007).20/77 products with PAL and 10/51 without PAL had gluten ≥5 mg/kg 3/77 with PAL and 3/51 without PAL had gluten ≥20 mg/kg. A coconut cookie brand was outlier with 421 mg gluten/kg. The likelihood of developing mucosal damage in the CD population when eating the same PWG for 90 days in addition to certified gluten-free products was low (0.2-3.2%) with little difference between with or without PAL. Including the coconut cookie results increased the risk to 3.8-9.2%. Caution should be taken in connection to foods where there is an obvious chance of contamination.
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Affiliation(s)
- Sisse Nygaard Rasmussen
- National Food Institute, Technical University of Denmark, Denmark; New Nordic Manufacturing ApS, Denmark
| | - Håkan Vigre
- National Food Institute, Technical University of Denmark, Denmark
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Paolini A, Sarshar M, Felli C, Bruno SP, Rostami-Nejad M, Ferretti F, Masotti A, Baldassarre A. Biomarkers to Monitor Adherence to Gluten-Free Diet by Celiac Disease Patients: Gluten Immunogenic Peptides and Urinary miRNAs. Foods 2022; 11:1380. [PMID: 35626950 PMCID: PMC9140451 DOI: 10.3390/foods11101380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 02/01/2023] Open
Abstract
Celiac disease (CD) is a multifactorial autoimmune enteropathy with a prevalence greater than 1% in the pediatric population. The only therapy for CD patients is a strict gluten-free diet (GFD). Gluten-free food contamination by other cereals during packaging and cooking or accidental ingestion of gluten may cause several intestinal and extraintestinal symptoms in CD patients. Therefore, the monitoring of gluten contamination in food and assessing the level of ingested gluten by analytical biomarkers has been of great interest in recent years. To this aim, small gluten immunogenic peptides (GIPs) obtained by the hydrolysis of gluten and present in urine and feces have been studied as biomarkers of gluten intake and to monitor adherence to GFD by CD patients. More recently, the use of circulating, fecal and urinary miRNAs has emerged as a novel diagnostic tool that can be potentially applied to assess adherence to GFD. Moreover, the presence of GIPs and miRNAs in both feces and urine suggests a similar excretion modality and the possibility of using urinary miRNAs, similarly to GIPs, as potential biomarkers of GFD in CD patients.
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Affiliation(s)
- Alessandro Paolini
- Research Laboratories, Bambino Gesù Children’s Hospital-IRCCS, 00146 Rome, Italy; (A.P.); (M.S.); (C.F.); (S.P.B.); (A.B.)
| | - Meysam Sarshar
- Research Laboratories, Bambino Gesù Children’s Hospital-IRCCS, 00146 Rome, Italy; (A.P.); (M.S.); (C.F.); (S.P.B.); (A.B.)
| | - Cristina Felli
- Research Laboratories, Bambino Gesù Children’s Hospital-IRCCS, 00146 Rome, Italy; (A.P.); (M.S.); (C.F.); (S.P.B.); (A.B.)
| | - Stefania Paola Bruno
- Research Laboratories, Bambino Gesù Children’s Hospital-IRCCS, 00146 Rome, Italy; (A.P.); (M.S.); (C.F.); (S.P.B.); (A.B.)
- Department of Science, University Roma Tre, 00146 Rome, Italy
| | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran;
| | - Francesca Ferretti
- Hepato-Gastroenterology and Nutrition Department, Bambino Gesù Children’s Hospital-IRCCS, 00165 Rome, Italy;
| | - Andrea Masotti
- Research Laboratories, Bambino Gesù Children’s Hospital-IRCCS, 00146 Rome, Italy; (A.P.); (M.S.); (C.F.); (S.P.B.); (A.B.)
| | - Antonella Baldassarre
- Research Laboratories, Bambino Gesù Children’s Hospital-IRCCS, 00146 Rome, Italy; (A.P.); (M.S.); (C.F.); (S.P.B.); (A.B.)
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Oliveira DR, Rebelo JF, Maximiano C, Gomes MM, Martins V, Meireles C, Antunes H, Martins S. HLA DQ2/DQ8 haplotypes and anti-transglutaminase antibodies as celiac disease markers in a pediatric population with type 1 diabetes mellitus. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:229-236. [PMID: 35420265 PMCID: PMC9832899 DOI: 10.20945/2359-3997000000457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Evaluate the celiac disease (CD) markers, within the scope of its screening, in a pediatric population with diagnosis of type 1 diabetes (T1D) at Hospital de Braga (HB) and determine the prevalence of CD in the sample. Reflect on CD screening algorithm applied in this pediatric population. Methods Retrospective observational study with 94 patients diagnosed with T1D at age 10 years or younger, followed up at the HB Outpatient Diabetology Consultation, including those referred from other hospitals. Record of clinical information, IgA anti-transglutaminase and anti-endomysium and HLA DQ2/DQ8 haplotypes. Results We obtained positive serological test for CD in 4 patients. This test had 100% sensitivity and specificity. The prevalence of CD was 4.3% (n = 4). Positive HLA screening in 84.6% of patients, with both sensitivity and negative predictive value of 100% and specificity of 16.67%. Diagnosis of CD was made on average 3.40 ± 3.32 years after the diagnosis of TD1. All cases of CD registered non-gastrointestinal manifestations, none had gastrointestinal symptoms. Conclusion This study proved that there is a higher prevalence of CD in pediatric population with TD1, when compared to general population, and clarified the importance of CD screening. Furthermore, it was observed that serological screening for CD antibodies is an excellent screening test and HLA typing, although not the most suitable first line test, can be useful in excluding the possibility of patients with T1D developing CD.
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Affiliation(s)
| | | | | | - Maria Miguel Gomes
- Faculdade de Medicina da Universidade do Minho, Braga, Portugal.,Unidade de Endocrinologia e Diabetologia Pediátrica, Departamento de Pediatria, Hospital de Braga, Braga, Portugal
| | - Vânia Martins
- Serviço de Pediatria, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Carla Meireles
- Serviço de Pediatria, Hospital Senhora da Oliveira-Guimarães, Guimarães, Portugal
| | - Henedina Antunes
- Unidade de Gastroenterologia, Hepatologia e Nutrição, Serviço de Pediatria e Centro Académico Clínico Hospital de Braga, Braga, Portugal.,Instituto de Investigação em Ciências da Vida e da Saúde (ICVS), ICVS/3B's-PT Laboratório Associado do Governo e Faculdade de Medicina da Universidade do Minho, Braga, Portugal
| | - Sofia Martins
- Unidade de Endocrinologia e Diabetologia Pediátrica, Departamento de Pediatria, Hospital de Braga, Braga, Portugal
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Felli C, Baldassarre A, Uva P, Alisi A, Cangelosi D, Ancinelli M, Caruso M, Paolini A, Montano A, Silano M, Vincentini O, Catassi C, Lionetti E, Gatti S, Ferretti F, Masotti A. Circulating microRNAs as novel non-invasive biomarkers of paediatric celiac disease and adherence to gluten-free diet. EBioMedicine 2022; 76:103851. [PMID: 35151110 PMCID: PMC8842006 DOI: 10.1016/j.ebiom.2022.103851] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
Background Celiac Disease (CD) is a multifactorial autoimmune enteropathy (with a prevalence of approximately 1% worldwide) that exhibits a wide spectrum of clinical, serological and histological manifestations. For the diagnosis of paediatric CD, the gold standard is the combination of serological tests (with high TGA-IgA values greater than 10 times the upper limit of normal) and duodenal biopsy (with a positive TGA-IgA but low titer). Therefore, a diagnostic test that totally excludes an invasive approach has not been discovered so far and the discovery of novel biological markers would represent an undoubted advantage for the diagnosis of CD and prognostic evaluation. MicroRNAs (miRNAs), small non-coding RNAs (18–22 nucleotides) that regulate gene expression at post-transcriptional level and play important roles in many biological processes, represent a novel class of potential disease biomarkers. Their presence in biological fluids (i.e., serum, plasma, saliva, urine) provides the opportunity to employ circulating miRNAs as novel non-invasive biomarkers. Methods In our prospective observational study, we examined the expression of circulating miRNAs in a cohort of CD patients (both at diagnosis and on gluten-free diet, respectively referred as CD and GFD) compared to healthy controls. By small RNA-Seq we discovered a set of circulating miRNAs that were further validated by qPCR with specific assays. Findings We found that out of the 13 miRNAs able to discriminate the three groups (i.e., CD, GFD and controls), three of them, namely miR-192-5p, miR-215-5p and miR-125b-5p (alone or in combination), were able to discriminate these three groups with high accuracy and specificity. Interpretation Our conclusions emphasize that these circulating miRNAs can be employed not only for the diagnosis of CD patients with a low TGA-IgA titer but also to monitor the adherence to a gluten-free diet by CD patients. In conclusion, we suggest the use of the circulating miRNAs identified in this work as a novel diagnostic and follow-up tool for paediatric CD. Funding This work was supported by Fondazione Celiachia Onlus (FC) Grant n° 018/FC/2013 and by Italian Ministry of Health (Ricerca Corrente).
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Affiliation(s)
- Cristina Felli
- Research Laboratories, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | | | - Paolo Uva
- Clinical Bioinformatics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Anna Alisi
- Research Laboratories, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy; Research Unit of Molecular Genetics of Complex Phenotypes, Research Laboratories, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Davide Cangelosi
- Clinical Bioinformatics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Monica Ancinelli
- Hepato-Gastroenterology and Nutrition Department, Research Laboratories, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Mariangela Caruso
- Department of Maternal Infantile and Urological Sciences, SAPIENZA University of Rome, Rome, Italy
| | - Alessandro Paolini
- Research Laboratories, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Alessia Montano
- Research Laboratories, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Marco Silano
- Unit of Human Nutrition and Health, Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Olimpia Vincentini
- Unit of Human Nutrition and Health, Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Catassi
- Department of Pediatrics, Polytechnic University of Marche, Ancona, Italy
| | - Elena Lionetti
- Department of Pediatrics, Polytechnic University of Marche, Ancona, Italy
| | - Simona Gatti
- Department of Pediatrics, Polytechnic University of Marche, Ancona, Italy
| | - Francesca Ferretti
- Research Laboratories, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy; Research Unit of Molecular Genetics of Complex Phenotypes, Research Laboratories, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Andrea Masotti
- Research Laboratories, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy.
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Abstract
Celiac disease is a chronic, immune-mediated enteropathy driven by dietary gluten found in genetically susceptible hosts. It has a worldwide distribution, is one of the most common autoimmune disorders globally, and is the only autoimmune condition for which the trigger is known. Despite advances in characterizing mechanisms of disease, gaps in understanding of celiac disease pathogenesis remain. A "frontier" concept is considering what moves an HLA-DQ2 or DQ8-positive individual from asymptomatic gluten tolerance to celiac disease manifestation. In this arena, environmental triggers, including age at the time of initial gluten exposure, the occurrence of usual childhood viral infections, and microbiome alterations have emerged as key events in triggering the symptomatic disease. Pathologists play a major role in frontier aspects of celiac disease. This includes the discovery that duodenal mucosal histology in follow-up biopsies does not correlate with ongoing patient symptoms, antitissue transglutaminase antibody titers and diet adherence in celiac disease patients. Further, in light of recent evidence that the detection of monoclonal T-cell populations in formalin-fixed biopsies is not specific for type II refractory celiac disease, pathologists should resist performing such analyses until common causes of "apparent" refractoriness are excluded. The promise of therapies in celiac disease has led to clinical trials targeting many steps in the inflammatory cascade, which depend upon a pathologist's confirmation of the initial diagnosis and evaluation of responses to therapies. As pathologists continue to be active participants in celiac disease research, partnering with other stakeholders, we will continue to impact this important autoimmune disease.
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Affiliation(s)
- Natalie Patel
- El Camino Pathology Medical Group, Mountain View, CA
| | - Marie E Robert
- Department of Pathology and Medicine, Yale University School of Medicine, New Haven, CT
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26
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Alkalay MJ. Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders. Nutrients 2021; 14:nu14010002. [PMID: 35010876 PMCID: PMC8746545 DOI: 10.3390/nu14010002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/07/2023] Open
Abstract
Lactose malabsorption (LM), celiac disease (CD), non-celiac gluten sensitivity (NCGS), and irritable bowel syndrome (IBS) are conditions associated with food triggers, improvement after withdrawal, treatment with dietary restriction, and subsequent nutritional detriments. LM occurs when there is incomplete hydrolysis of lactose due to lactase deficiency and frequently produces abdominal symptoms; therefore, it can cause lactose intolerance (LI). A lactose-restricted diet is frequently recommended, although it can potentially lead to nutrient deficiencies. Furthermore, lactose is an essential component of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) and is subsequently associated with intolerance to these compounds, especially in IBS. LM commonly presents in CD. Nutritional deficits are common in CD and can continue even on a gluten-free diet (GFD). Conditions triggered by gluten are known as gluten-related disorders (GRDs), including CD, wheat allergy, and NCGS. IBS can also be associated with a gluten sensitivity. A GFD is the treatment for CD, GRDs, and gluten sensitive IBS, although compliance with this restricted diet can be difficult. Strict dietary therapies can have a negative effect on quality of life. This review aims to provide an overview of the difficult nutritional elements of these disorders, which are critical for medical providers to recognize when managing these patients.
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Affiliation(s)
- Michele J Alkalay
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern, Dallas, TX 75235, USA
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27
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Lomash A, Prasad A, Singh R, Kumar S, Gupta R, Dholakia D, Kumar P, Batra VV, Puri AS, Kapoor S. Evaluation of the Utility of Amino Acid Citrulline as a Surrogate Metabolomic Biomarker for the Diagnosis of Celiac Disease. Nutr Metab Insights 2021; 14:11786388211060603. [PMID: 34898991 PMCID: PMC8655831 DOI: 10.1177/11786388211060603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Citrulline is regarded as a biomarker for celiac disease (CD). Its utility for assessment and evaluation of additive predictive value for latent, potential CD and first degree relatives (FDRs) needs exploration. Method Consecutive 558 index cases diagnosed as per European Society for Pediatric Gastroenterology and Nutrition (ESPGHAN) 2012 guidelines and their 1565 FDRs were evaluated over five and half year period. Serology negative FDRs at initial visit and follow ups were served as controls. HLA typing for DQ2 and DQ8 genotypes, along with plasma and dried blood spot (DBS) filter paper citrulline were evaluated. Results Median plasma citrulline values were 20.1 and 37.33 µMol/l in cases and controls (P < .001). Cut off values for Marsh grade 3a, 3b, and 3c were 35.0, 32.8, 25.26 µMol/l in CD patients and 36.51, 30.10, 25.26 µMol/l in biopsy proven FDR. Increasing trends of plasma citrulline levels with decreasing tTG-IgA levels were observed on follow up. Low plasma citrulline levels were observed with HLA DQ 2.5 genotype (P < .05). Agreement between DBS and plasma citrulline was 94.8%. Conclusion Citrulline is a good surrogate biomarker for identification of histopathological grade of damage, extent of mucosal recovery and has negative correlation with tTG-IgA. It identifies the silent and latent phase of CD. DBS citrulline provides adequate information and can be used for monitoring CD patients at remote locations.
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Affiliation(s)
- Avinash Lomash
- Department of Pediatrics, Division of Genetics, Maulana Azad Medical College, New Delhi, India
| | - Anupa Prasad
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Raghvendra Singh
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Somesh Kumar
- Department of Pediatrics, Division of Genetics, Maulana Azad Medical College, New Delhi, India
| | - Rishi Gupta
- Department of PSM- Ex Senior Resident, All India Institute of Medical Sciences, New Delhi, India
| | - Dhwani Dholakia
- Institute of Genomics and Integrative Biology, New Delhi, India
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Vineeta V Batra
- Department of Pathology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Amarender S Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta, New Delhi, India
| | - Seema Kapoor
- Department of Pediatrics, Division of Genetics, Maulana Azad Medical College, New Delhi, India
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Fanaeian MM, Alibeik N, Ganji A, Fakheri H, Ekhlasi G, Shahbazkhani B. Prevalence of migraine in adults with celiac disease: A case control cross-sectional study. PLoS One 2021; 16:e0259502. [PMID: 34788304 PMCID: PMC8598245 DOI: 10.1371/journal.pone.0259502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/20/2021] [Indexed: 01/02/2023] Open
Abstract
AIM Celiac disease (CD) is an immune-mediated disorder with various manifestations. The aim of this study was to evaluate the prevalence of gastrointestinal (GI) and extra-intestinal symptoms of celiac patients, especially migraine, and compare it with healthy individuals. METHODS We compared 1000 celiac subjects (CS) registered at our celiac center with the control group for headache-based on International Classification of Headache Disorders, third edition criteria and their GI symptoms. Besides, CS with migraine and non-migrainous headache were compared in terms of GI symptoms and accompanied conditions. RESULTS Headache was more common in CS than controls (34% vs 27% respectively, P value<0.001) and more prevalent in females (71.9% in females vs 28% in males, P value = 0.004). Moreover, the prevalence of migraine in CS was higher than controls (20.7 vs 11.9% respectively, P value<0.001). Furthermore, migraine was more prevalent in females with CD (80% in females vs 19% in males, P value = 0.033), and often without aura (76%). Abdominal pain (76.9%, P value = 0.025), diarrhea (54.9%, P value = 0.002), and constipation (42.9%, P value = 0.011) were the most common GI symptoms in CS with headache and more prevalent in CS with migraine. Conversely, type 1 diabetes mellitus was less common in CS with migraine than in CS with non-migrainous headache. (P value = 0.001). On multivariate logistic regression analysis, female sex (OR 1.50, 95%CI 1.22-1.83, P value < 0.001), and CD (OR 1.36, 95%CI 1.12-1.65, P value = 0.002) were independent predictors of headache, whereas age more than 60 years (OR 0.70, 95%CI 0.50-0.97, P value = 0.032) had a protective effect. CONCLUSION Headache especially migraine is more prevalent in CS than healthy controls. In addition, abdominal pain, diarrhea, and constipation are more common in CS with migraine than in CS with non-migrainous headaches. Therefore, evaluation of CD in patients with migraine and these simultaneous GI symptoms seems reasonable.
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Affiliation(s)
- Mohammad M. Fanaeian
- Division of Gastroenterology and Liver Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Alibeik
- Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Azita Ganji
- Department of Gastroenterology and Hepatology, Mashhad University of Medical Sciences, Mashahd, Iran
| | - Hafez Fakheri
- Gut and Liver Research Center, Non-communicable Disease InstitueMazandaran University of Medical Sciences, Sari, Iran
| | - Golnaz Ekhlasi
- Golnaz Ekhlasi; Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bijan Shahbazkhani
- Department of Gastroenterology and Liver Diseases, Tehran University of Medical Sciences, Tehran, Iran
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Elmes S, Chakraborti T, Fan M, Uhlig H, Rittscher J. Automated Annotator: Capturing Expert Knowledge for Free. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2664-2667. [PMID: 34891800 DOI: 10.1109/embc46164.2021.9630309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Deep learning enabled medical image analysis is heavily reliant on expert annotations which is costly. We present a simple yet effective automated annotation pipeline that uses autoencoder based heatmaps to exploit high level information that can be extracted from a histology viewer in an unobtrusive fashion. By predicting heatmaps on unseen images the model effectively acts like a robot annotator. The method is demonstrated in the context of coeliac disease histology images in this initial work, but the approach is task agnostic and may be used for other medical image annotation applications. The results are evaluated by a pathologist and also empirically using a deep network for coeliac disease classification. Initial results using this simple but effective approach are encouraging and merit further investigation, specially considering the possibility of scaling this up to a large number of users.
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30
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Pelizzaro F, Marsilio I, Fassan M, Piazza F, Barberio B, D’Odorico A, Savarino EV, Farinati F, Zingone F. The Risk of Malignancies in Celiac Disease-A Literature Review. Cancers (Basel) 2021; 13:cancers13215288. [PMID: 34771450 PMCID: PMC8582432 DOI: 10.3390/cancers13215288] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 12/14/2022] Open
Abstract
Celiac disease (CeD) is an immune-mediated enteropathy precipitated by ingestion of gluten in genetically predisposed individuals. Considering that CeD affects approximately 1% of the Western population, it may be considered a global health problem. In the large majority of cases, CeD has a benign course, characterized by the complete resolution of symptoms and a normal life expectancy after the beginning of a gluten-free-diet (GFD); however, an increased risk of developing malignancies, such as lymphomas and small bowel carcinoma (SBC), has been reported. In particular, enteropathy-associated T-cell lymphoma (EATL), a peculiar type of T-cell lymphoma, is characteristically associated with CeD. Moreover, the possible association between CeD and several other malignancies has been also investigated in a considerable number of studies. In this paper, we aim to provide a comprehensive review of the current knowledge about the associations between CeD and cancer, focusing in particular on EATL and SBC, two rare but aggressive malignancies.
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Affiliation(s)
- Filippo Pelizzaro
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, 35128 Padova, Italy; (F.P.); (I.M.); (B.B.); (A.D.); (E.V.S.); (F.F.)
| | - Ilaria Marsilio
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, 35128 Padova, Italy; (F.P.); (I.M.); (B.B.); (A.D.); (E.V.S.); (F.F.)
| | - Matteo Fassan
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University Hospital of Padova, 35128 Padova, Italy;
- Veneto Oncology Institute, IOV-IRCCS, 35128 Padova, Italy
| | - Francesco Piazza
- Department of Medicine, Hematology, University Hospital of Padova, 35128 Padova, Italy;
| | - Brigida Barberio
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, 35128 Padova, Italy; (F.P.); (I.M.); (B.B.); (A.D.); (E.V.S.); (F.F.)
| | - Anna D’Odorico
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, 35128 Padova, Italy; (F.P.); (I.M.); (B.B.); (A.D.); (E.V.S.); (F.F.)
| | - Edoardo V. Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, 35128 Padova, Italy; (F.P.); (I.M.); (B.B.); (A.D.); (E.V.S.); (F.F.)
| | - Fabio Farinati
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, 35128 Padova, Italy; (F.P.); (I.M.); (B.B.); (A.D.); (E.V.S.); (F.F.)
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, 35128 Padova, Italy; (F.P.); (I.M.); (B.B.); (A.D.); (E.V.S.); (F.F.)
- Correspondence:
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31
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Monachesi C, Verma AK, Catassi GN, Franceschini E, Gatti S, Gesuita R, Lionetti E, Catassi C. Determination of Urinary Gluten Immunogenic Peptides to Assess Adherence to the Gluten-Free Diet: A Randomized, Double-Blind, Controlled Study. Clin Transl Gastroenterol 2021; 12:e00411. [PMID: 34613954 PMCID: PMC8500619 DOI: 10.14309/ctg.0000000000000411] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/22/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The adherence to a gluten-free diet (GFD) is a trending topic in the management of celiac disease. The aim of our study was to evaluate the diagnostic performance of urinary gluten immunogenic peptides (GIP) determination to detect gluten contamination of the GFD. METHODS In study A, 25 healthy adults on a standard GFD performed 6 gluten challenges (0, 10, 50, 100, 500, and 1,000 mg) with quantification of urinary GIP before (T0) and during the following 24 hours. In study B, 12 participants on a gluten contamination elimination diet underwent urinary GIP determination at T0 and after challenge with 5 or 10 mg gluten. Urine GIP concentration was determined by an immunochromatographic assay. RESULTS In study A, 51 of 150 baseline urine samples were GIP+ on GFD and 7 of 17 were GIP+ after the zero-gluten challenge, whereas only 55 of 81 were GIP+ after the 10-1,000 mg gluten challenges. There was no significant change in the 24-hour urinary GIP when increasing gluten from 10 to 1,000 mg. In study B, 24 of 24 baseline urine samples were GIP-, whereas 8 of 24 were GIP+ after 5 or 10 mg of gluten. DISCUSSION Traces of gluten in the standard GFD may cause positivity of urinary GIP determination, whereas a false negativity is common after a gluten intake of 10-1,000 mg. Owing to the impossibility of standardizing the test in normal conditions, it seems unlikely that urinary GIP determination may represent a reliable tool to assess the compliance to the GFD of patients with celiac disease or other gluten-related disorders.
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Affiliation(s)
- Chiara Monachesi
- Celiac Disease Research Laboratory, Polytechnic University of Marche, Ancona, Italy
| | - Anil K. Verma
- Celiac Disease Research Laboratory, Polytechnic University of Marche, Ancona, Italy
| | - Giulia N. Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Elisa Franceschini
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Simona Gatti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Rosaria Gesuita
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Elena Lionetti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, USA
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Kaplan M, Yüksel F, Karaman K. In vitro glycemic index, antioxidant capacity and some physicochemical characteristics of deep-fried sorghum based gluten free chips. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2021; 58:3725-3733. [PMID: 34471296 DOI: 10.1007/s13197-020-04830-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
In this study, deep fried gluten free chips were manufactured using sorghum flour at different concentrations (5, 20, 35 and 50 g/100 g) and in vitro glycemic index, total antioxidant capacity and some physicochemical characteristics (dry matter, ash, oil, protein and color) and overall acceptability of the samples were investigated. Protein, oil and total dietary fiber levels of the samples ranged between 5.39-8.28, 23.58-29.10 and 5.59-6.60 g/100 g, respectively and increase in sorghum flour level resulted in an increase in these studied quality parameters of the chips samples. Ferric reducing antioxidant activity and DPPH radical scavenging performance were affected positively by the addition of sorghum flour. Total starch hydrolysis index and estimated glycemic index values were affected by the sorghum flour addition negatively due to the increased total dietary fiber content of the chips samples. All chips samples enriched with sorghum flour showed similar overall acceptability and increased sorghum concentration decreased the preference scores slightly. All these results could be considered for the manufacturing of the gluten free deep fried sorghum based chips samples.
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Affiliation(s)
- Mahmut Kaplan
- Department of Field Crops, Faculty of Agriculture, Erciyes University, Kayseri, Turkey
| | - Ferhat Yüksel
- Department of Food Engineering, Faculty of Engineering and Natural Sciences, Gümüşhane University, Gümüşhane, Turkey.,Department of Nutrition and Dietetics, Nigde Omer Halisdemir University, Bor, Nigde Turkey
| | - Kevser Karaman
- Department of Agricultural Biotechnology, Faculty of Agriculture, Erciyes University, Kayseri, Turkey
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Rouvroye MD, Oldenburg L, Slottje P, Joosten JHK, de Menezes RX, Reinders ME, Bouma G. Testing for coeliac disease rarely leads to a diagnosis: a population-based study. Scand J Prim Health Care 2021; 39:315-321. [PMID: 34137353 PMCID: PMC8475119 DOI: 10.1080/02813432.2021.1935045] [Citation(s) in RCA: 1] [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] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Coeliac disease (CD) has an estimated prevalence of ∼1% in Europe with a significant gap between undiagnosed and diagnosed CD. Active case finding may help to bridge this gap yet the diagnostic yield of such active case finding in general practice by serological testing is unknown. OBJECTIVE The aim of this study was to determine (1) the frequency of diagnosed CD in the general population, and (2) to investigate the yield of active case finding by general practitioners. METHODS Electronic medical records of 207.200 patients registered in 49 general practices in The Netherlands in 2016 were analysed. An extensive search strategy, based on International Classification of Primary Care codes, free text and diagnostic test codes was performed to search CD- or gluten-related contacts. RESULTS The incidence of CD diagnosis in general practice in 2016 was 0.01%. The prevalence of diagnosed CD reported in the general practice in the Netherlands was 0.19%, and considerably higher than previously reported in the general population. During the one year course of the study 0.95% of the population had a gluten-related contact with their GP; most of them (72%) were prompted by gastrointestinal complaints. Serological testing was performed in 66% (n = 1296) of these patients and positive in only 1.6% (n = 21). CONCLUSION The number of diagnosed CD patients in the Netherlands is substantially higher than previously reported. This suggests that the gap between diagnosed and undiagnosed patients is lower than generally assumed. This may explain that despite a high frequency of gluten-related consultations in general practice the diagnostic yield of case finding by serological testing is low.Key pointsThe diagnostic approach of GPs regarding CD and the diagnostic yield is largely unknownCase finding in a primary health care practice has a low yield of 1.6%CD testing was mostly prompted by consultation for gastrointestinal symptomsThere is a heterogeneity in types of serological test performed in primary care.
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Affiliation(s)
- Maxine D. Rouvroye
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- CONTACT Maxine D. Rouvroye Department of Gastroenterology and Hepatology, Amsterdam UMC, Room PK 2X 136, De Boelelaan 1118, Amsterdam1081HZ, The Netherlands
| | - Lotte Oldenburg
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pauline Slottje
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of General Practice, Academic Network of General Practice, Amsterdam UMC, Amsterdam, The Netherlands
| | - Johanna H. K. Joosten
- Department of General Practice, Academic Network of General Practice, Amsterdam UMC, Amsterdam, The Netherlands
| | - Renee X. de Menezes
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcel E. Reinders
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gerd Bouma
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Taskin DG, Sursal A, Dogan AE, Ozdener F. Evaluation of parameters associated with growth retardation in children with coeliac disease. J Paediatr Child Health 2021; 57:1454-1459. [PMID: 33908087 DOI: 10.1111/jpc.15525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
AIMS Coeliac disease (CD) is an autoimmune disorder with a prevalence ≤2% that causes an immune reaction to gluten. Growth retardation (GR) generally accompanies CD due to gastrointestinal complications and should be treated as early as possible along with initiation of a gluten-free diet. The aim of this study was to determine the indicators of GR in patients with CD. METHODS This single-centre retrospective study included paediatric outpatients with CD. All patients were diagnosed with CD via serological analysis and upper gastrointestinal endoscopy if necessary. Patient records were obtained from Adana City Training and Research Hospital. Patients that were diagnosed with GR accompanying CD were given oral nutritional supplements and followed-up every 3-6 months. Statistical relationships between demographics, and anthropometric measurements, duration of breastfeeding, gluten contact time, diet duration, presenting complaints and serological findings were evaluated. RESULTS This study included 169 paediatric outpatients between ages 1 and 18. Longer symptom duration and shorter breastfeeding duration were significantly correlated with GR accompanying CD (P = 0.007 and P = 0.029, respectively). Vomiting was the only symptom that was correlated with the presence of GR (P = 0.010). Helicobacter pylori infection was not correlated with the presence of GR (P = 0.277). CONCLUSIONS GR should be treated as early as possible to reduce the severity of CD and a 6 months sole breastfeeding followed by solid foods accompanied by breastfeeding for 2 years is crucial for preventing GR. Moreover, vomiting as a presenting complaint in patients with CD might be indicative of the presence of GR.
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Affiliation(s)
- Didem G Taskin
- Department of Pediatric Gastroenterology, Adana City Training and Research Hospital, Adana, Turkey
| | - Alihan Sursal
- Department of Neuroscience, Bahcesehir University, School of Medicine, Istanbul, Turkey
| | - Ali E Dogan
- Medical Department, Nutricia, Advanced Medical Nutrition, Istanbul, Turkey
| | - Fatih Ozdener
- Department of Pharmacology, Bahcesehir University, School of Medicine, Istanbul, Turkey
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Dilek NM, Bilgiçli N. Effect of taro [
Colocasia esculenta
(L.) Schott] flour and different shortening ratio on physical and chemical properties of gluten‐free cookie. J FOOD PROCESS PRES 2021. [DOI: 10.1111/jfpp.15894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nazik Meziyet Dilek
- Department of Nutrition and Dietetics Kadir Yallagöz School of HealthSelçuk University Akşehir, Konya Turkey
| | - Nermin Bilgiçli
- Department of Food Engineering Faculty of Engineering Necmettin Erbakan University Konya Turkey
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Nutritional facts, bio-active components and processing aspects of pseudocereals: A comprehensive review. FOOD BIOSCI 2021. [DOI: 10.1016/j.fbio.2021.101170] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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A glimpse into the black box of celiac disease complications: a case report with a rare presentation. GASTROENTEROLOGY REVIEW 2021; 6:111-116. [PMID: 34276837 PMCID: PMC8275971 DOI: 10.5114/pg.2021.106661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022]
Abstract
The purpose of this article is to report a case of celiac disease in a child with uncommon presentation and severe complications, and briefly review recent literature regarding celiac disease complications in children. We describe a case report of celiac disease in a child (to our knowledge, this is the first to be reported in its unique presentation in the Russian Federation) and precisely review its presenting complications with the exiting works of literature. Many cases of celiac disease in children who are not diagnosed and treated properly suffer from a plethora of complications due to malabsorption and concurrent autoimmune reactions that affect mainly but are not limited to the endocrine system. Complications of celiac disease in children should always be suspected, and evidence-based follow-up recommendations should be introduced as soon as possible because the burden of celiac disease complications in children is remarkable.
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Anafy A, Cohen S, Ben Tov A, Amir A, Weintraub Y, Moran‐Lev H, Dali Levy M, Ankona Bussel M, Yerushalmy Feler A. The effect of gluten-free diet on body mass index in paediatric celiac disease. Acta Paediatr 2021; 110:2233-2239. [PMID: 33529351 DOI: 10.1111/apa.15787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
AIM More normal weight and overweight children are currently diagnosed with celiac disease (CD). We aimed to describe the relation between body mass index (BMI) and the clinical characteristics of paediatric CD and to determine the effect of a gluten-free diet (GFD) on BMI. METHODS Data on all children diagnosed with CD during 7/2010-7/2019 with documented anthropometric data at diagnosis were retrospectively analysed. The children were divided into three groups according to BMI status at diagnosis: underweight, normal weight and overweight (BMIs <5%, 5%-85% and >85%, respectively). RESULTS Of the 236 children [median age 7.87 (4.91-11) years] included in the study, 24 (10.1%) were underweight at diagnosis and 32 (13.6%) were overweight. Diarrhoea as the presenting symptom was significantly more common in the overweight group (p = 0.012), while short stature was more common in the underweight group (p = 0.002). Following a GFD had no significant effect on the children's BMI during a median follow-up of 15.7 (0-85) months, but there was a significant shift of patients between the BMI categories (p < 0.001). CONCLUSION Although a shift of patients between the BMI categories was observed, following a GFD did not significantly affect the overall BMI in children with CD.
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Affiliation(s)
- Adi Anafy
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Amir Ben Tov
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Achiya Amir
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yael Weintraub
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Hadar Moran‐Lev
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Margalit Dali Levy
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Maayan Ankona Bussel
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Anat Yerushalmy Feler
- Pediatric Gastroenterology Unit Dana‐Dwek Children's Hospital Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Up-Regulation of Specific Bioactive Lipids in Celiac Disease. Nutrients 2021; 13:nu13072271. [PMID: 34209150 PMCID: PMC8308317 DOI: 10.3390/nu13072271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/12/2021] [Accepted: 06/25/2021] [Indexed: 12/29/2022] Open
Abstract
Celiac disease (CD) is an autoimmune enteropathy linked to alterations of metabolism. Currently, limited untargeted metabolomic studies evaluating differences in the plasma metabolome of CD subjects have been documented. We engage in a metabolomic study that analyzes plasma metabolome in 17 children with CD treated with a gluten-free diet and 17 healthy control siblings in order to recognize potential changes in metabolic networks. Our data demonstrates the persistence of metabolic defects in CD subjects in spite of the dietary treatment, affecting a minor but significant fraction (around 4%, 209 out of 4893 molecular features) of the analyzed plasma metabolome. The affected molecular species are mainly, but not exclusively, lipid species with a particular affectation of steroids and derivatives (indicating an adrenal gland affectation), glycerophospholipids (to highlight phosphatidic acid), glycerolipids (with a special affectation of diacylglycerols), and fatty acyls (eicosanoids). Our findings are suggestive of an activation of the diacylglycerol-phosphatidic acid signaling pathway in CD that may potentially have detrimental effects via activation of several targets including protein kinases such as mTOR, which could be the basis of the morbidity and mortality connected with untreated CD. However, more studies are necessary to validate this idea regarding CD.
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Syed S, Ehsan L, Shrivastava A, Sengupta S, Khan M, Kowsari K, Guleria S, Sali R, Kant K, Kang SJ, Sadiq K, Iqbal NT, Cheng L, Moskaluk CA, Kelly P, Amadi BC, Ali SA, Moore SR, Brown DE. Artificial Intelligence-based Analytics for Diagnosis of Small Bowel Enteropathies and Black Box Feature Detection. J Pediatr Gastroenterol Nutr 2021; 72:833-841. [PMID: 33534362 PMCID: PMC8767179 DOI: 10.1097/mpg.0000000000003057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Striking histopathological overlap between distinct but related conditions poses a disease diagnostic challenge. There is a major clinical need to develop computational methods enabling clinicians to translate heterogeneous biomedical images into accurate and quantitative diagnostics. This need is particularly salient with small bowel enteropathies; environmental enteropathy (EE) and celiac disease (CD). We built upon our preliminary analysis by developing an artificial intelligence (AI)-based image analysis platform utilizing deep learning convolutional neural networks (CNNs) for these enteropathies. METHODS Data for the secondary analysis was obtained from three primary studies at different sites. The image analysis platform for EE and CD was developed using CNNs including one with multizoom architecture. Gradient-weighted class activation mappings (Grad-CAMs) were used to visualize the models' decision-making process for classifying each disease. A team of medical experts simultaneously reviewed the stain color normalized images done for bias reduction and Grad-CAMs to confirm structural preservation and biomedical relevance, respectively. RESULTS Four hundred and sixty-one high-resolution biopsy images from 150 children were acquired. Median age (interquartile range) was 37.5 (19.0-121.5) months with a roughly equal sex distribution; 77 males (51.3%). ResNet50 and shallow CNN demonstrated 98% and 96% case-detection accuracy, respectively, which increased to 98.3% with an ensemble. Grad-CAMs demonstrated models' ability to learn different microscopic morphological features for EE, CD, and controls. CONCLUSIONS Our AI-based image analysis platform demonstrated high classification accuracy for small bowel enteropathies which was capable of identifying biologically relevant microscopic features and emulating human pathologist decision-making process. Grad-CAMs illuminated the otherwise "black box" of deep learning in medicine, allowing for increased physician confidence in adopting these new technologies in clinical practice.
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Affiliation(s)
- Sana Syed
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Lubaina Ehsan
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Aman Shrivastava
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
- Data Science Institute, University of Virginia, Charlottesville, VA
| | - Saurav Sengupta
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
- Data Science Institute, University of Virginia, Charlottesville, VA
| | - Marium Khan
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kamran Kowsari
- Systems and Information Engineering, University of Virginia, Charlottesville, VA, USA
- University of California Los Angeles, Los Angeles, CA, USA
| | - Shan Guleria
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Rasoul Sali
- Systems and Information Engineering, University of Virginia, Charlottesville, VA, USA
| | - Karan Kant
- Data Science Institute, University of Virginia, Charlottesville, VA
| | - Sung-Jun Kang
- Data Science Institute, University of Virginia, Charlottesville, VA
| | - Kamran Sadiq
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeha T. Iqbal
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Lin Cheng
- Pathology Department, Rush University Medical Center, Chicago, IL, USA
| | | | - Paul Kelly
- Tropical Gastroenterology and Nutrition group, University of Zambia School of Medicine, Lusaka, Zambia
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Beatrice C. Amadi
- Tropical Gastroenterology and Nutrition group, University of Zambia School of Medicine, Lusaka, Zambia
| | - S. Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sean R. Moore
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Donald E. Brown
- Systems and Information Engineering, University of Virginia, Charlottesville, VA, USA
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Dehghani SM, Dara N, Gharesifar B, Shahramian I, Dalili F, Salarzaei M. Prevalence of HLA DQ 2, 8 in children with celiac disease. Hum Antibodies 2021; 29:123-128. [PMID: 33523049 DOI: 10.3233/hab-200437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Celiac disease is a chronic disease that affect small bowel by making its villi become atrophic. Various environmental and genetic factors have been identify as inducing factors for celiac disease. Most of the patients has one of the HLA DQ forms. Although the prevalence of these genes are variable in different areas of the world, we do not have a comprehensive information about this issue in our region. Thus the aim of present study is to investigate the prevalence of HLA DQ typing of patients who visited Emam Reza Gastroenterology clinic of Shiraz(IRAN). METHODS In this case-control study all under 18 years old children who were diagnosed with celiac disease and have visited Emam Reza gastroenterology clinic were investigated. The diagnosis of celiac disease was made by history, physical exam, serologic test, and histopathology of duodenal biopsy. Blood sample was taken and HLA typing performed using PCR method at Motahari clinic cytology laboratory. Also those people who neither them self nor their first degree relatives were not case of celiac disease and underwent HLA typing for other reason were identified as control group. The statistical analysis was done using SPSS 18 software. The p value < 0.05 was identified as statistically significant. RESULTS A total of 139 patients with celiac disease and 146 normal children were studied. The mean age of the patient with celiac disease were 9.1 years old with standard deviation of 3.4 years old. 64% of the celiac patients were girls and 36% were boys. While this proportion was 54.4% for boy and 48.6% for girls in control group. The most common HLA in celiac patients group were HLA DQ2 and 8 but the most common ones in control group were HLA DQ 8 and 5. Failure to Thrive were the most common signs of the celiac patients with a prevalence of 60 children. Total IgA titer were normal in 98.6% of the patients and TTG IgA titer were positive in 93.5% of the patients. The most common co existing disease with the celiac disease were diabetes with a prevalence of 30 children (66.7%). CONCLUSION present study reveals that the prevalence of the HLA DQ2 and 8 among patients with celiac disease is 72.6% and 53% in our normal population.
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Affiliation(s)
- Seyed Mohsen Dehghani
- Gastroenterohepatology Research Center, Shiraz, Iran.,Shiraz Transplant Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naqi Dara
- Pediatric Gastroenterology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrooz Gharesifar
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iraj Shahramian
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | | | - Morteza Salarzaei
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Gao J, Du H, Zhou Z, Liang Z, Liang H, Zhang P, Wei X, Liu S, Fu L, Wang Y, Che H, Xue W, Xin F, Yang D. Thermal and Acidic Treatments of Gluten Epitopes Affect Their Recognition by HLA-DQ2 in silico. Front Nutr 2021; 8:647750. [PMID: 34095188 PMCID: PMC8169964 DOI: 10.3389/fnut.2021.647750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Celiac disease (CD) is a prevalent disorder with autoimmune features. Dietary exposure of wheat gluten (including gliadins and glutenins) to the small intestine activates the gluten-reactive CD4+ T cells and controls the disease development. While the human leukocyte antigen (HLA) is the single most important genetic factor of this polygenic disorder, HLA-DQ2 recognition of gluten is the major biological step among patients with CD. Gluten epitopes are often rich in Pro and share similar primary sequences. Here, we simulated the solution structures changes of a variety of gluten epitopes under different pH and temperatures, to mimic the fermentation and baking/cooking processes. Based on the crystal structure of HLA-DQ2, binding of differently processed gluten epitopes to DQ2 was studied in silico. This study revealed that heating and pH change during the fermentation process impact the solution structure of gluten epitope. However, binding of differently treated gluten epitope peptide (GEP) to HLA-DQ2 mainly depended on its primary amino acid sequence, especially acidic amino acid residues that play a pivotal role in their recognition by HLA-DQ2.
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Affiliation(s)
- Jihui Gao
- Beijing Key Laboratory of Functional Food From Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Haolan Du
- Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Zekun Zhou
- Beijing Key Laboratory of Functional Food From Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Zhongxin Liang
- Beijing Key Laboratory of Functional Food From Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Hongrui Liang
- Beijing Key Laboratory of Functional Food From Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - PeiAo Zhang
- Beijing Key Laboratory of Functional Food From Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xue Wei
- Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Shujun Liu
- Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Linglin Fu
- Food Safety Key Laboratory of Zhejiang Province, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Yanbo Wang
- Food Safety Key Laboratory of Zhejiang Province, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Huilian Che
- Beijing Key Laboratory of Functional Food From Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Wentong Xue
- Beijing Key Laboratory of Functional Food From Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Fengjiao Xin
- Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Dong Yang
- Beijing Key Laboratory of Functional Food From Plant Resources, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
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Achakzai MS, Zarak MS, Arshad Z, Sana H, Tareen HK, Khan K, Baloch A, Kakar S, Nasim A. Relationship Between Villous Atrophy and tTGA Levels in Dyspeptic Patients: A Case Series. Cureus 2021; 13:e15043. [PMID: 34150394 PMCID: PMC8202817 DOI: 10.7759/cureus.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim The objective of the study was to observe the association of villous atrophy with anti-tissue transglutaminase levels in the identified subjects that met our addressed inclusion criteria. Methods A case series study was conducted among 40 patients presenting with dyspepsia along with signs and symptoms of celiac disease at the Bolan Medical Complex Hospital, Quetta over a period of five months from 25/5/17 to 25/10/17. The patients were referred to undergo tissue transglutaminase antibody serum test. The positive ones underwent biopsies to assess pathological entities including villous atrophy, blunting (focal or total), crypts, Intestinal layers and the number of Intraepithelial lymphocytes. The results collected were analyzed by using IBM SPSS version 20 (IBM Corp., Armonk, NY). Results There was a weak, negative correlation between tTGA and focal villous blunting (r = -0.345, p = 0.029) showing that high levels of tTGA are associated with lower risk of focal villous blunting. Correlation of tTGA and total villous blunting was a weak positive correlation (r = 0.282, p = 0.07) showing that high levels of tTGA are associated with increased risk of total villous blunting. There was a weak, negative correlation between tTGG and focal villous blunting (r = 0.409, p = 0.009) showing thathigh levels of tTGG are associated with a greater risk of focal villous blunting (p < 0.01) while tTGG and total villous blunting was a weak negative correlation (r = -0.330, p = 0.03) showing that high levels of tTGG are associated with lower risk of total villous blunting. Conclusion The study concludes by providing evidence of the absence of tissue transglutaminase antibodies in patients with histology-proven celiac disease. It implies that serology tests may be negative in some of the patients with typical chronic symptoms. Therefore, in such cases, histopathology may be conclusive in defining the status of celiac disease.
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Affiliation(s)
| | | | - Zara Arshad
- Medicine, Bolan Medical College, Quetta, PAK
| | - Hamaiyal Sana
- Internal Medicine, Bolan Medical College, Quetta, PAK
| | | | | | | | | | - Aqeel Nasim
- Pharmacy, University of Balochistan, Quetta, PAK
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Durban R, Groetch M, Meyer R, Coleman Collins S, Elverson W, Friebert A, Kabourek J, Marchand SM, McWilliam V, Netting M, Skypala I, Van Brennan T, Vassilopoulou E, Vlieg-Boerstra B, Venter C. Dietary Management of Food Allergy. Immunol Allergy Clin North Am 2021; 41:233-270. [PMID: 33863482 DOI: 10.1016/j.iac.2021.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Worldwide food allergy prevalence is increasing, especially in children. Food allergy management strategies include appropriate avoidance measures and identifying suitable alternatives for a nutritionally sound diet. Individualized dietary intervention begins teaching label reading, which differs among countries or regions. Dietary intervention must result in a nutritionally sound plan including alternatives to support optimal growth and development. Inappropriate or incomplete dietary advice may increase the risk of adverse reactions, growth faltering, and nutrient deficiencies. Evidence indicates input from a registered dietitian improves nutritional outcomes. Nutritional input plays a critical role managing nutritional disorders related to food allergy.
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Affiliation(s)
- Raquel Durban
- Carolina Asthma & Allergy Center, 2600 E 7th St unit a, Charlotte, NC 28204, USA
| | - Marion Groetch
- Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1198, New York, NY 10029, USA
| | - Rosan Meyer
- Department of Pediatrics, Imperial College, London, UK
| | | | - Wendy Elverson
- Boston Children's Hospital Center for Nutrition, 333 Longwood Avenue, 4th floor, Boston, MA 02115, USA
| | - Alyssa Friebert
- Allergy and Immunology Clinic, 13123 East 16th Avenue Box 270, Aurora, CO 80045, USA
| | - Jamie Kabourek
- University of Nebraska-Lincoln, Food Innovation Center, Room 279c, 1901 North 21 Street, Lincoln, NE 68588, USA
| | - Stephanie M Marchand
- Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, 593 Eddy Street, Providence, RI 02903, USA; Food and Nutrition Services, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02903, USA
| | - Vicki McWilliam
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Merryn Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006, Australia; Department of Pediatrics, University of Adelaide, Adelaide, South Australia, Australia; Nurition Department, Women's and Children's Health Network, North Adelaide 5006, South Australia, Australia
| | - Isabel Skypala
- Imperial College, London, UK; Department of Allergy and Clinical Immunology, Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, 4th Floor Fulham Wing, Sydney Street, London SW3 6NP, UK
| | - Taryn Van Brennan
- Children's Hospital of Colorado, 13123 East 16th Avenue Box B518 Anschutz Medical Campus, Aurora CO 80045, USA
| | - Emillia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki 57400, Greece
| | - Berber Vlieg-Boerstra
- Department of Pediatrics, OLVG Hospital, PO Box 95500, Amsterdam 1090HM, The Netherlands
| | - Carina Venter
- Children's Hospital of Colorado, 13123 East 16th Avenue Box B518 Anschutz Medical Campus, Aurora CO 80045, USA.
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Doya LJ, Naamah M, Karkamaz N, Hajo N, Bijow FW, Ibrahim A, Issa R. An unusual case of chronic abdominal pain: an association between Celiac disease and Crohn's disease. Oxf Med Case Reports 2021; 2021:omab008. [PMID: 33948181 PMCID: PMC8081011 DOI: 10.1093/omcr/omab008] [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: 07/08/2020] [Revised: 12/14/2020] [Accepted: 01/13/2021] [Indexed: 11/14/2022] Open
Abstract
Inflammatory bowel diseases (IBD) and Celiac disease (CeD) are immune-mediated gastrointestinal diseases with incompletely understood etiology. Both diseases show a multifactorial origin with a complex interplay between genetic, environmental factors, and some components of the commensal microbiota. The coexistence of celiac disease with Crohn's disease is rarely reported in the literature. Here, we report a case of a 13-year-old Syrian male who presented with a history of abdominal pain, anorexia and pallor. CeD and Crohn's disease was documented on gastrointestinal endoscopy and histological study. The patient was treated with a gluten-free, low fiber, high caloric diet, and a course of oral corticosteroids with an improvement in growth rate and abdominal pain.
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Affiliation(s)
- Leen Jamel Doya
- Department of Pediatrics, Tishreen university hospital, Lattakia, Syria
| | - Maria Naamah
- Department of Pediatrics, Tishreen university hospital, Lattakia, Syria
| | - Noura Karkamaz
- Department of Pediatrics, Tishreen university hospital, Lattakia, Syria
| | - Narmin Hajo
- Department of Pediatrics, Tishreen university hospital, Lattakia, Syria
| | | | - Ali Ibrahim
- Department of Pediatrics, Professor of Gastroenterology and Hepatology, Tishreen university hospital, Lattakia, Syria
| | - Rana Issa
- Department of Pathology, Professor of pathology, Tishreen university hospital, Lattakia, Syria
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Norström F, Myléus A, Nordyke K, Carlsson A, Högberg L, Sandström O, Stenhammar L, Ivarsson A, Lindholm L. Is mass screening for coeliac disease a wise use of resources? A health economic evaluation. BMC Gastroenterol 2021; 21:159. [PMID: 33836647 PMCID: PMC8034082 DOI: 10.1186/s12876-021-01737-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/25/2021] [Indexed: 11/21/2022] Open
Abstract
Background Living with undiagnosed symptomatic coeliac disease is connected with deteriorated health, and persons with coeliac disease often wait a long time for their diagnosis. A mass screening would lower the delay, but its cost-effectiveness is still unclear. Our aim was to determine the cost-effectiveness of a coeliac disease mass screening at 12 years of age, taking a life course perspective on future benefits and drawbacks. Methods The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model. As a basis for our assumptions, we mainly used information from the Exploring the Iceberg of Celiacs in Sweden (ETICS) study, a school-based screening conducted in 2005/2006 and 2009/2010, where 13,279 12-year-old children participated and 240 were diagnosed with coeliac disease, and a study involving members of the Swedish Coeliac Association with 1031 adult participants. Results The cost for coeliac disease screening was 40,105 Euro per gained QALY. Sensitivity analyses support screening based on high compliance to a gluten-free diet, rapid progression from symptom-free coeliac disease to coeliac disease with symptoms, long delay from celiac disease with symptoms to diagnosis, and a low QALY score for undiagnosed coeliac disease cases. Conclusions A coeliac disease mass screening is cost-effective based on the commonly used threshold of 50,000 Euro per gained QALY. However, this is based on many assumptions, especially regarding the natural history of coeliac disease and the effects on long-term health for individuals with coeliac disease still eating gluten. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01737-1.
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Affiliation(s)
- Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Anna Myléus
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Katrina Nordyke
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Annelie Carlsson
- Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lotta Högberg
- Department of Paediatrics, Norrköping Hospital, Linköping University, Norrköping, Sweden
| | - Olof Sandström
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.,Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Lars Stenhammar
- Department of Paediatrics, Norrköping Hospital, Linköping University, Norrköping, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
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47
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Norström F, Namatovu F, Carlsson A, Högberg L, Ivarsson A, Myléus A. Family socio-economic status and childhood coeliac disease seem to be unrelated-A cross-sectional screening study. Acta Paediatr 2021; 110:1346-1352. [PMID: 32885467 PMCID: PMC7983879 DOI: 10.1111/apa.15562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022]
Abstract
Aim The aim of our study was to examine whether there is a difference in coeliac disease prevalence in regard to parents' education level and occupation, and whether this differs between screened and clinically diagnosed children at the age of 12 years. Methods The study, Exploring the Iceberg of Celiacs in Sweden (ETICS), was a school‐based screening study of 12‐year‐old children that was undertaken during the school years 2005/2006 and 2009/2010. Data on parental education and occupation were reported from parents of the children. Specifically, by parents of 10 710 children without coeliac disease, 88 children diagnosed with coeliac disease through clinical care, and 231 who were diagnosed during the study. Results There were no statistically significant associations between occupation and coeliac disease for either the clinically detected (prevalence ratio 1.16; confidence interval 0.76‐1.76) or screening‐detected coeliac disease cases (prevalence ratio 0.86; confidence interval 0.66‐1.12) in comparison with children with no coeliac disease. Also, there were no statistically significant associations for parental education and coeliac disease diagnosis. Conclusion There was no apparent relationship between coeliac disease and socio‐economic position. Using parents' socio‐economic status as a tool to help identify children more likely to have coeliac disease is not recommended.
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Affiliation(s)
- Fredrik Norström
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
| | - Fredinah Namatovu
- Department of Historical, Philosophical and Religious Studies Umeå University Umeå Sweden
| | - Annelie Carlsson
- Department of Pediatrics Clinical Sciences Skåne University Hospital Lund University Lund Sweden
| | - Lotta Högberg
- Department of Paediatrics Norrköping Hospital Linköping University Norrköping Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
| | - Anna Myléus
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
- Department of Public Health and Clinical Medicine Family Medicine Umeå University Umeå Sweden
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Dutta R, Iqbal A, Das P, Palanichamy JK, Singh A, Mehtab W, Chauhan A, Aggarwal A, Sreenivas V, Ahuja V, Datta Gupta S, Makharia GK. Liver involvement in patients with coeliac disease: proof of causality using IgA/anti-TG2 colocalisation techniques. J Clin Pathol 2021; 74:766-773. [PMID: 33789921 DOI: 10.1136/jclinpath-2020-206735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/09/2020] [Accepted: 09/07/2020] [Indexed: 12/20/2022]
Abstract
AIMS Despite clinical evidence of liver involvement in patients with coeliac disease (CeD), there is a lack of a method to prove this association. METHODS Of 146 treatment-naive patients with CeD, 26 had liver dysfunction. Liver biopsies and corresponding small intestinal biopsies were obtained from these 26 patients. Multicolour immunohistochemical and immunofluorescence confocal microscopic studies were performed on paraffin-embedded tissue to detect the IgA/anti-TG2 deposits. Follow-up liver biopsies were taken after a gluten-free diet. RESULTS Twenty-six out of the 146 patients (17.8%) with suspected coeliac-associated liver disease on histological examination revealed irregular sinusoidal dilatation in 15 (57.6%), steatohepatitis in 4 (15.3%), non-specific chronic hepatitis in 3 (11.5%), autoimmune hepatitis in 2 (7.6%) biopsies, including cirrhosis in one of them, irregular perisinusoidal fibrosis and changes of non-cirrhotic portal fibrosis in one biopsy each (3.8%). IgA/anti-tTG deposits were observed in 22 (84.6%) liver biopsies by dual immunohistochemistry technique, and in 24 (92.3%) by confocal immunofluorescence technique and in all corresponding duodenal biopsies (100%). Overall, IgA/anti-tTG deposits showed 100% sensitivity, 77% specificity and 85% positive predictive value for establishing an association of extraintestinal pathology and CeD using archived tissues. Follow-up liver biopsies could be obtained in five patients; four of them showed not only resolution of the histological lesions but disappearance of IgA/anti-tTG co-localisation. CONCLUSIONS Data of the present study adds to the body of evidence that liver lesions in patients with CeD are disease related and may have been caused by a similar pathogenic mechanism that causes intestinal changes.
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Affiliation(s)
- Rimlee Dutta
- Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Asif Iqbal
- Gastroenetrology & Human Nutritions, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Prasenjit Das
- Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Alka Singh
- Gastroenetrology & Human Nutritions, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Wajiha Mehtab
- Gastroenetrology & Human Nutritions, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Ashish Chauhan
- Gastroenetrology & Human Nutritions, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Ashish Aggarwal
- Gastroenetrology & Human Nutritions, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Vineet Ahuja
- Gastroenetrology & Human Nutritions, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Govind K Makharia
- Gastroenetrology & Human Nutritions, All India Institute of Medical Sciences, New Delhi, Delhi, India
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TAŞKIN B, SAVLAK N. Public awareness, knowledge and sensitivity towards celiac disease and gluten-free diet is insufficient: a survey from Turkey. FOOD SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1590/fst.07420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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50
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Gliadin Sequestration as a Novel Therapy for Celiac Disease: A Prospective Application for Polyphenols. Int J Mol Sci 2021; 22:ijms22020595. [PMID: 33435615 PMCID: PMC7826989 DOI: 10.3390/ijms22020595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/13/2022] Open
Abstract
Celiac disease is an autoimmune disorder characterized by a heightened immune response to gluten proteins in the diet, leading to gastrointestinal symptoms and mucosal damage localized to the small intestine. Despite its prevalence, the only treatment currently available for celiac disease is complete avoidance of gluten proteins in the diet. Ongoing clinical trials have focused on targeting the immune response or gluten proteins through methods such as immunosuppression, enhanced protein degradation and protein sequestration. Recent studies suggest that polyphenols may elicit protective effects within the celiac disease milieu by disrupting the enzymatic hydrolysis of gluten proteins, sequestering gluten proteins from recognition by critical receptors in pathogenesis and exerting anti-inflammatory effects on the system as a whole. This review highlights mechanisms by which polyphenols can protect against celiac disease, takes a critical look at recent works and outlines future applications for this potential treatment method.
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