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Shi T, Li J, Li N, Chen C, Chen C, Chang C, Xue S, Liu W, Reyim AM, Gao F, Lv X. Rapid diagnosis of celiac disease based on plasma Raman spectroscopy combined with deep learning. Sci Rep 2024; 14:15056. [PMID: 38956075 PMCID: PMC11219885 DOI: 10.1038/s41598-024-64621-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
Celiac Disease (CD) is a primary malabsorption syndrome resulting from the interplay of genetic, immune, and dietary factors. CD negatively impacts daily activities and may lead to conditions such as osteoporosis, malignancies in the small intestine, ulcerative jejunitis, and enteritis, ultimately causing severe malnutrition. Therefore, an effective and rapid differentiation between healthy individuals and those with celiac disease is crucial for early diagnosis and treatment. This study utilizes Raman spectroscopy combined with deep learning models to achieve a non-invasive, rapid, and accurate diagnostic method for celiac disease and healthy controls. A total of 59 plasma samples, comprising 29 celiac disease cases and 30 healthy controls, were collected for experimental purposes. Convolutional Neural Network (CNN), Multi-Scale Convolutional Neural Network (MCNN), Residual Network (ResNet), and Deep Residual Shrinkage Network (DRSN) classification models were employed. The accuracy rates for these models were found to be 86.67%, 90.76%, 86.67% and 95.00%, respectively. Comparative validation results revealed that the DRSN model exhibited the best performance, with an AUC value and accuracy of 97.60% and 95%, respectively. This confirms the superiority of Raman spectroscopy combined with deep learning in the diagnosis of celiac disease.
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Affiliation(s)
- Tian Shi
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
- Xinjiang Clinical Research Center for Digestive Diseases, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
| | - Jiahe Li
- College of Software, Xinjiang University, Urumqi, 830046, China
| | - Na Li
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
- Xinjiang Clinical Research Center for Digestive Diseases, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
| | - Cheng Chen
- College of Software, Xinjiang University, Urumqi, 830046, China
| | - Chen Chen
- College of Software, Xinjiang University, Urumqi, 830046, China
| | - Chenjie Chang
- College of Software, Xinjiang University, Urumqi, 830046, China
| | - Shenglong Xue
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
- Xinjiang Clinical Research Center for Digestive Diseases, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
| | - Weidong Liu
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
- Xinjiang Clinical Research Center for Digestive Diseases, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
| | - Ainur Maimaiti Reyim
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
- Xinjiang Clinical Research Center for Digestive Diseases, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
| | - Feng Gao
- Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China.
- Xinjiang Clinical Research Center for Digestive Diseases, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China.
| | - Xiaoyi Lv
- College of Software, Xinjiang University, Urumqi, 830046, China.
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Elwenspoek M, Banks J, Desale PP, Watson J, Whiting P. Exploring factors influencing quality of life variability among individuals with coeliac disease: an online survey. BMJ Open Gastroenterol 2024; 11:e001395. [PMID: 38830687 PMCID: PMC11149133 DOI: 10.1136/bmjgast-2024-001395] [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: 03/14/2024] [Accepted: 04/21/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Patients with coeliac disease (CD) need to follow a strict gluten-free diet to manage symptoms and prevent complications. Restrictions imposed by the diet can be challenging and affect quality of life (QoL). We explored sources of variation in QoL among patients with CD. DESIGN We conducted an online survey of coeliac patients in the UK, including a CD-specific QoL tool (CD-QOL V.1.0), questions on diet adherence and an optional comment box at the end. The survey was disseminated via social media and went live between January and March 2021. We performed multiple linear regression and free text analysis. RESULTS We found a median CD-QOL score of 61 (IQR 44-76, range 4-100, n=215) suggesting good QoL (Good >59); however, the individual QoL scores varied significantly. Regression analyses showed that people who found diet adherence difficult and people adhering very strictly had a lower QoL. Free text comments suggested that people who adhered very strictly may do so because they have symptoms with minimal gluten exposure. People who found diet adherence difficult may be people who only recently started the diet and were still adjusting to its impact. Comments also highlighted that individuals with CD often perceive a lack of adequate follow-up care and support after diagnosis. CONCLUSION Better support and follow-up care is needed for people with CD to help them adjust to a gluten-free diet and minimise the impact on their QoL. Better education and increased awareness are needed among food businesses regarding cross-contamination to reduce anxiety and accidental gluten exposure.
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Affiliation(s)
- Martha Elwenspoek
- University of Bristol Population Health Sciences, Bristol, UK
- NIHR ARC West, Bristol, UK
| | - Jonathan Banks
- University of Bristol Population Health Sciences, Bristol, UK
- NIHR ARC West, Bristol, UK
| | | | - Jessica Watson
- University of Bristol Population Health Sciences, Bristol, UK
- NIHR ARC West, Bristol, UK
| | - Penny Whiting
- University of Bristol Population Health Sciences, Bristol, UK
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Romaniello R, Barrasso AE, Perone C, Tamborrino A, Berardi A, Leone A. Optimisation of an Industrial Optical Sorter of Legumes for Gluten-Free Production Using Hyperspectral Imaging Techniques. Foods 2024; 13:404. [PMID: 38338540 PMCID: PMC10855930 DOI: 10.3390/foods13030404] [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: 12/31/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
The market demand for gluten-free food is increasing due to the growing gluten sensitivity and coeliac disease (CD) in the population. The market requires grass-free cereals to produce gluten-free food. This requires sorting methods that guarantee the perfect separation of gluten contaminants from the legumes. The objective of the research was the development of an optical sorting system based on hyperspectral image processing, capable of identifying the spectral characteristics of the products under investigation to obtain a statistical classifier capable of enabling the total elimination of contaminants. The construction of the statistical classifier yielded excellent results, with a 100% correct classification rate of the contaminants. Tests conducted subsequently on an industrial optical sorter validated the result of the preliminary tests. In fact, the application of the developed classifier was able to correctly select the contaminants from the mass of legumes with a correct classification percentage of 100%. A small proportion of legumes was misclassified as contaminants, but this did not affect the scope of the work. Further studies will aim to reduce even this small share of waste with investigations into optimising the seed transport systems of the optical sorter.
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Affiliation(s)
- Roberto Romaniello
- Department of Agriculture, Food, Natural Resource and Engineering, University of Foggia, 71122 Foggia, Italy; (R.R.); (A.E.B.); (C.P.)
| | - Antonietta Eliana Barrasso
- Department of Agriculture, Food, Natural Resource and Engineering, University of Foggia, 71122 Foggia, Italy; (R.R.); (A.E.B.); (C.P.)
| | - Claudio Perone
- Department of Agriculture, Food, Natural Resource and Engineering, University of Foggia, 71122 Foggia, Italy; (R.R.); (A.E.B.); (C.P.)
| | - Antonia Tamborrino
- Department of Soil, Plant and Food Science (DISSPA), University of Bari Aldo Moro, Via Amendola 165/a, 70126 Bari, Italy; (A.T.); (A.L.)
| | - Antonio Berardi
- Department of Soil, Plant and Food Science (DISSPA), University of Bari Aldo Moro, Via Amendola 165/a, 70126 Bari, Italy; (A.T.); (A.L.)
| | - Alessandro Leone
- Department of Soil, Plant and Food Science (DISSPA), University of Bari Aldo Moro, Via Amendola 165/a, 70126 Bari, Italy; (A.T.); (A.L.)
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Qureshi MH. The Correlation Between Serum Anti-tissue Transglutaminase (Anti-tTG) Antibody Levels and Histological Severity of Celiac Disease in Adolescents and Adults: A Meta-Analysis. Cureus 2023; 15:e51169. [PMID: 38283435 PMCID: PMC10814693 DOI: 10.7759/cureus.51169] [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] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Celiac disease is an autoimmune disorder characterized by a broad spectrum of histological damage to the intestinal mucosa. Comprehension and understanding of the association between anti-tissue transglutaminase (anti-tTG) antibody levels and the histological severity of celiac disease are not well established, prompting the need for meta-analysis. This study aims to offer insights into the diagnostic abilities of anti-tTG antibody levels in determining the histological severity of celiac disease by providing quantitative evidence based on a diverse range of studies. An extensive search was conducted across four electronic research databases to identify primary research articles reporting serum anti-tTG antibody levels in correlation with different Marsh grades, signifying the histological severity of celiac disease. The software tool RevMan 5.4 (the Cochrane Collaboration, London, UK) was used to compile standardized mean differences (SMD) alongside their respective confidence intervals. A total of 13 studies were included in the meta-analysis, with a patient pool of 2505 patients. Marsh grade I and II were found to have higher anti-tTG antibody levels compared to those with grade 0 (SMD 1.50; 95% CI: 1.12, 1.87; p-value <0.00001). Antibody levels were higher in Marsh grade IIIa when compared to both grade 0 (SMD 0.97; 95% CI: 0.67, 1.28; p-value <0.00001) and grade ≤2 (SMD 0.61; 95% CI: 0.44, 0.79; p-value <0.00001). Patients with Marsh IIIb also reported greater anti-tTG levels compared to grade 0 (SMD 1.48; 95% CI: 0.99, 1.96; p-value <0.00001) and grade ≤2 (SMD 0.98; 95% CI: 0.79, 1.18; p-value <0.00001). Likewise, Marsh grade ≥IIIc reported high levels of anti-tTG antibodies in comparison with grade 0 (SMD 1.06; 95% CI: 0.72, 1.39; p-value <0.00001) and grade ≤2 (SMD 1.18; 95% CI: 1.02, 1.34; p-value <0.00001). Our meta-analysis revealed a consistent, robust correlation between anti-tTG antibody levels and the histological severity of celiac disease, with a clear trend of increasing antibody levels corresponding to the severity of mucosal damage. Large-scale primary research initiatives are needed to reach definitive conclusions.
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Affiliation(s)
- Muhammad Hassan Qureshi
- Medicine, Combined Military Hospital, Lahore, PAK
- Health, Medicine, and Social Care, Anglia Ruskin University, Cambridge, GBR
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Mouslih A, El Rhazi K, Bahra N, Lakhdar Idrissi M, Hida M. Celiac Disease in Moroccan Children: Diagnostic Characteristics and Determinants of Diagnosis Delay. Cureus 2023; 15:e50800. [PMID: 38125690 PMCID: PMC10731523 DOI: 10.7759/cureus.50800] [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: 12/19/2023] [Indexed: 12/23/2023] Open
Abstract
Advances in the field of celiac disease have led to a better understanding of the disease, but it remains underdiagnosed and poses a daily challenge to clinicians to make a timely diagnosis. This study aims to analyze and describe diagnosis characteristics, diagnosis delay, and the factors influencing this delay in Moroccan children. Our study included 324 children diagnosed during the study period from January 01, 2010, to December 30, 2019, at the Department of Pediatrics, Hassan II University Hospital in Fez, Morocco. Data were collected using a collection grid and then analyzed using SPSS 26 software (IBM Corp., Armonk, NY). The results showed a female predominance (n=197, 60.8%), with a diagnosis age of 73.8±46.8 months. The mean age onset of symptoms was 51.3±41.2 months, and the diagnosis delay was 22.2±22.6 months, with only 32.7% (n=106) diagnosed less than 12 months after symptom onset. The most common consultation reason was diarrhea (n=149, 46%) and growth delay (n=105, 32.4%) and 50.5% (n=98) of parents consulted a pediatrician first. The three clinical, serologic, and histologic criteria made it possible to agree on the diagnosis, with the clinical profile dominated by the digestive form at 84.9% (n=279), serologic with the presence of IgA transglutaminase antibodies (95.7%; n=310), and histologic with villous atrophy at 91.7% (n=297). Unfortunately, 14.8% (n=48) of the children were diagnosed with a celiac crisis. The multivariate logistic regression analysis showed that as symptoms onset age increased, so did the risk of late diagnosis (OR=0.96, 95% CI: 0.94 to 0.97, p<0.001). Age of diagnosis was also associated with delayed diagnosis (OR=19.68, 95% CI: 8.77 to 44.15, p<0.001). The combination of these variables and the diagnosis delay argues in favor of adopting a diagnosis strategy that includes raising awareness among healthcare professionals of the need to identify typical and atypical cases early in order to reduce the adverse effects of late diagnosis and the complications that can result. This methodology for improving diagnoses may also unearth previously unknown aspects of celiac disease in Moroccan children.
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Affiliation(s)
- Assia Mouslih
- Laboratory of Epidemiology and Health Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, MAR
| | - Karima El Rhazi
- Laboratory of Epidemiology and Health Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, MAR
| | - Nassiba Bahra
- Laboratory of Epidemiology and Health Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, MAR
| | - Mounia Lakhdar Idrissi
- Department of Pediatrics, Faculty of Medicine and Pharmacy/ Epidemiology and Health Science Research Laboratory, Hassan II University Hospital, Fez, MAR
- Laboratory of Epidemiology and Health Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, MAR
| | - Moustapha Hida
- Department of Pediatrics, Faculty of Medicine and Pharmacy/ Epidemiology and Health Science Research Laboratory, Hassan II University Hospital, Fez, MAR
- Laboratory of Epidemiology and Health Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, MAR
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Soto CJ, Addi Palle LR, Berhanu M, Negassi YG, Batool S, Holder SS. Celiac Disease Masquerading as Extreme Thrombocytosis and Severe Anemia in a 52-Year-Old Female Patient: A Rare Case Presentation and Literature Review. Cureus 2023; 15:e41416. [PMID: 37546121 PMCID: PMC10403150 DOI: 10.7759/cureus.41416] [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] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Celiac disease (CD) is a chronic autoimmune disorder characterized by an immune-mediated response to gluten, resulting in small intestinal mucosal damage. While gastrointestinal (GI) symptoms are commonly associated with CD, atypical presentations can pose diagnostic challenges, particularly when hematological abnormalities are the primary manifestation. We report a case of a 52-year-old female patient who presented with paraesthesia, numbness in her hands and feet, marked thinness, extreme thrombocytosis, severe anemia, and mild electrolyte imbalance. Physical examination was unremarkable, except for the notable thinness. GI symptoms were absent, and there was no family history of gastroenterological diseases. Diagnostic evaluations, including serological tests and duodenal biopsy, confirmed the diagnosis of CD with grade 4 Marsh 3C classification. This case emphasizes the significance of considering CD as a potential cause for atypical hematological manifestations, such as extreme thrombocytosis secondary to severe anemia. Prompt recognition and appropriate management, including adherence to a gluten-free diet, can lead to symptom improvement and resolution of hematological abnormalities. It is crucial for healthcare professionals to recognize and be familiar with these atypical presentations to promote early diagnosis and enhance patient outcomes.
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Affiliation(s)
- Cuauhtemoc Jeffrey Soto
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lokeshwar Raaju Addi Palle
- Surgery, Kamala Children's Hospital, Chennai, IND
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mefthe Berhanu
- Health Sciences, University of Texas Health Science Center at Houston, Houston, USA
| | - Yordanos G Negassi
- Internal Medicine, Learn and Live Wholestic Health Services Clinic, Alexandria, USA
| | - Saima Batool
- Internal Medicine, Hameed Latif Hospital, Lahore, PAK
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shaniah S Holder
- Medicine, American University of Barbados School of Medicine, Bridgetown, BRB
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Roldan GA, Jamot S, Kopec K, Charoen A, Leffler D, Feller ER, Shah SA. Celiac Disease Presenting in a Community-Based Gastroenterology Practice: Obesity and Bone Disease Are Common. Dig Dis Sci 2023; 68:860-866. [PMID: 35650415 DOI: 10.1007/s10620-022-07521-9] [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] [Received: 06/09/2021] [Accepted: 04/12/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND The description of the clinical presentation of celiac disease (CeD) has usually come from studies at referral centers. Data about CeD presentation in the community are sparse. AIMS We aim to describe the clinical presentation of patients with biopsy-proven CeD at a community-based adult gastroenterology practice and compare it to a referral center. METHODS We performed a retrospective study of two cohorts of patients diagnosed with CeD between 2000-2007 (n = 117) and 2013-2016 (n = 91) in a community practice, and a third cohort (n = 188) diagnosed between 2000 and 2007 in a tertiary referral center. The clinical presentation, body mass index, tissue-transglutaminase levels, DEXA scan, vitamin D levels, and vaccine recommendations were assessed. RESULTS Celiac disease presentation changed over time in the two community cohorts. Recently, fewer patients presented with diarrhea and anemia, but constipation and neurologic symptoms were more common. The most recent cohort had a higher proportion of patients who were overweight or obese than the first cohort. However, the body mass index in both community cohorts was higher than in the tertiary referral center. The frequency of osteopenia and osteoporosis was high in both community cohorts. The tertiary referral center patients were younger, presented with a higher proportion of diarrhea and a lower body mass index. CONCLUSIONS The clinical presentation of CeD differs between the community setting and a tertiary referral center. Patients with CeD presenting to the community setting tended to be older, overweight, and to have a high proportion of mineral bone disease.
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Affiliation(s)
- Giovanni A Roldan
- Internal Medicine Department, Jackson Memorial Hospital, University of Miami, Miami, FL, 33136, USA
- Celiac Center at Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Sehrish Jamot
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | | | - Amber Charoen
- Division of Gastroenterology, Department of Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, 02904, USA
| | - Daniel Leffler
- Celiac Center at Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Edward R Feller
- Division of Medical Education, Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Samir A Shah
- Division of Gastroenterology, Department of Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, 02904, USA.
- Gastroenterology Associates, Inc., 44 West River Street, Providence, RI, 02904, USA.
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Zubkiewicz-Kucharska A, Jamer T, Chrzanowska J, Akutko K, Pytrus T, Stawarski A, Noczyńska A. Prevalence of haplotype DQ2/DQ8 and celiac disease in children with type 1 diabetes. Diabetol Metab Syndr 2022; 14:128. [PMID: 36096955 PMCID: PMC9465882 DOI: 10.1186/s13098-022-00897-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED Type 1 diabetes (T1D) and celiac disease (CD) coexist very often. Identification of the human leukocyte antigen (HLA) DQ2/DQ8 can confirm the genetic predisposition to CD. Negative result of this test allows to exclude CD with a high probability. It was suggested that in individuals with higher risk of CD, including T1D patients, the implementation of genetic testing should reduce the number of patients requiring systematic immunological screening. The aim of this study was to analyze the prevalence of different haplotypes predisposing to CD in children and adolescents with previously diagnosed T1D. MATERIAL AND METHODS A retrospective analysis was performed on 166 T1D children (91 girls) in whom HLA DQ2/DQ8 alleles were tested. In 9.6% CD was also diagnosed. RESULTS In 12.7% both HLA DQ2/DQ8 were negative. In 87.3% patients HLA DQ2 and/or DQ8 was positive, including 27.7% patients with both haplotypes DQ2.5 and DQ8 positive. In all CD patients the disease predisposing alleles were positive, while none of the HLA DQ2/DQ8 negative children were diagnosed with CD. CONCLUSIONS The prevalence of HLA DQ2.5 and the HLA DQ2.5 / HLA DQ8 configuration is higher in patients with T1D, and CD compared to children with T1D alone. The combination of HLA DQ2 and HLA DQ8 most significantly increases the risk of developing CD. The group of HLA DQ2/DQ8 negative patients with improbable CD diagnosis, is relatively small. Most of T1D patients HLA DQ2/DQ8 positive need further regular antibody assessment. In patients with T1D, who are at high risk of developing CD, genetic testing may be considered to select those who require further systematic serological evaluation. Due to its retrospective nature, the study was not registered in the database of clinical trials and the Clinical trial registration number is not available.
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Affiliation(s)
- Agnieszka Zubkiewicz-Kucharska
- Department of Pediatric Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Wroclaw, Poland
| | - Tatiana Jamer
- Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland.
| | - Joanna Chrzanowska
- Department of Pediatric Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Akutko
- Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Pytrus
- Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Stawarski
- Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Noczyńska
- Department of Pediatric Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Wroclaw, Poland
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Bernardes EN, Flôres SH, Thys RCS. Are Psyllium Fiber and Flaxseed Flour An Exciting Combination of Ingredients in the Development of Gluten-free Vegan Bread? JOURNAL OF CULINARY SCIENCE & TECHNOLOGY 2022. [DOI: 10.1080/15428052.2022.2060160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Esther Nogueira Bernardes
- Institute of Food Science and Technology, Federal University of Rio Grande Do Sul (Icta-ufrgs). Av. Bento Goncalves, Porto Alegre, Brazil
| | - Simone Hickmann Flôres
- Institute of Food Science and Technology, Federal University of Rio Grande Do Sul (Icta-ufrgs). Av. Bento Goncalves, Porto Alegre, Brazil
| | - Roberta Cruz Silveira Thys
- Institute of Food Science and Technology, Federal University of Rio Grande Do Sul (Icta-ufrgs). Av. Bento Goncalves, Porto Alegre, Brazil
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10
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Alvarez JB. Spanish Spelt Wheat: From an Endangered Genetic Resource to a Trendy Crop. PLANTS (BASEL, SWITZERLAND) 2021; 10:2748. [PMID: 34961216 PMCID: PMC8707452 DOI: 10.3390/plants10122748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/04/2021] [Accepted: 12/09/2021] [Indexed: 05/05/2023]
Abstract
Spelt wheat (Triticum aestivum L. ssp. spelta Thell.) is an ancient wheat that was widely cultivated in the past. This species derived from a cross between emmer wheat (T. turgidum spp. dicoccum Schrank em. Thell.) and Aegilops tauschii Coss. Its main origin was in the Fertile Crescent (Near East), with a secondary center of origin in Europe due to a second hybridization event between emmer and hexaploid wheat. This species has been neglected in most of Europe; however, the desire for more natural foods has driven a revival in interest. Iberian spelt is classified as a geographical group differing to the rest of European spelt. In this review, the particularities, genetic diversity and current situation of Spanish spelt, mainly for quality traits, are discussed.
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Affiliation(s)
- Juan B Alvarez
- Edificio Gregor Mendel, Departamento de Genética, Campus de Rabanales, Escuela Técnica Superior de Ingeniería Agronómica y de Montes, Universidad de Córdoba, CeiA3, ES-14071 Córdoba, Spain
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11
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Genomic analysis for the prediction of prognosis in small-bowel cancer. PLoS One 2021; 16:e0241454. [PMID: 34014970 PMCID: PMC8136681 DOI: 10.1371/journal.pone.0241454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
The current understanding of clinicopathological features and genomic variants of small-bowel cancer is limited, in part due to the rarity of the disease. However, understanding of these factors is necessary for the development of novel therapeutic agents for small-bowel cancer. Thus, we aimed to identify the clinicopathological features and genomic variants associated with its prognosis and recurrence. We retrospectively examined 24 consecutive patients with primary small-bowel cancer surgically treated between May 2005 and August 2018 and collected 29 tumor specimens. The 29 lesions were subjected to mismatch repair status evaluation, using immunohistochemistry (IHC), and targeted genomic sequencing, after which they were analyzed using a panel of 90 cancer-related genes. IHC revealed that 45% (13/29) of the lesions exhibited deficient mismatch repair. The most common genomic variants in small-bowel cancers were in TP53 (48%, 13/27), followed by KRAS (44%, 12/27), ARID1A (33%, 9/27), PIK3CA (26%, 7/27), APC (26%, 7/27), and SMAD4, NOTCH3, CREBBP, PTCH1, and EP300 (22%, 6/27 each). Overall survival and disease-specific survival of patients with tumor mutational burden (TMB) ≥10 mutations/Mb (n = 17) were significantly better than those of patients with TMB <10 mutations/Mb (n = 6). Additionally, patients with a mutant SMAD4 had poorer recurrence-free survival than those with wild-type SMAD4. Our results suggested that TMB and SMAD4 mutations were associated with the prognosis of small-bowel cancer patients. Thus, cancer genomic analysis could be useful in the search for biomarkers of prognosis prediction in small-bowel cancers.
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Benjamin J, Sim L, Owens MT, Schwichtenberg A, Harrison T, Harbeck-Weber C. Postural Orthostatic Tachycardia Syndrome and Disordered Eating: Clarifying the Overlap. J Dev Behav Pediatr 2021; 42:291-298. [PMID: 33181565 DOI: 10.1097/dbp.0000000000000886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Postural orthostatic tachycardia syndrome (POTS) is estimated to occur in up to 1% of adolescents, with symptoms of dizziness, fatigue, and pain impacting daily functioning. However, many risk factors and symptoms for POTS overlap with those of youth with disordered eating, and adolescents with POTS may be at increased risk for developing eating disorders. Therefore, the present study sought to better understand this overlap. We hypothesized that patients with POTS would have higher than expected rates of weight change, restrictive eating patterns, and food sensitivities. METHODS We conducted a retrospective chart review of 96 adolescents and young adults diagnosed with POTS who were participating in a 3-week intensive interdisciplinary pain rehabilitation program. We conducted descriptive and correlational statistical analyses on data from self-report measures, biomarkers of nutritional status, and abstracted information about eating and weight concerns from medical notes. RESULTS Nearly 3 quarters of participants described engaging in restrictive eating, and more than half of them described experiencing weight loss. They also endorsed experiencing food allergies, celiac disease, and eating disorder at higher rates than would be expected in the general population. One-fifth of the sample had experienced invasive interventions to correct for nutritional imbalances, such as having a feeding tube. CONCLUSION Weight and eating are clear areas of risk for patients with orthostatic intolerance. It is essential that treatment team members thoroughly screen for eating disturbances and make recommendations that support regular and balanced eating habits.
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Affiliation(s)
- Julia Benjamin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN Dr. Benjamin is now with the Department of Health Psychology, American Family Children's Hospital -UW Health, Madison, WI
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN Dr. Benjamin is now with the Department of Health Psychology, American Family Children's Hospital -UW Health, Madison, WI
| | - Michele Tsai Owens
- Department of Anesthesiology and Pain Medicine, Division of Pain Medicine, Seattle Children's Hospital, University of Washington Medicine, Seattle, WA
| | | | - Tracy Harrison
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, MN
| | - Cindy Harbeck-Weber
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN Dr. Benjamin is now with the Department of Health Psychology, American Family Children's Hospital -UW Health, Madison, WI
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Ben Houmich T, Admou B. Celiac disease: Understandings in diagnostic, nutritional, and medicinal aspects. Int J Immunopathol Pharmacol 2021; 35:20587384211008709. [PMID: 33878915 PMCID: PMC8064516 DOI: 10.1177/20587384211008709] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Celiac disease (CD) is characterized by clinical polymorphism, with classic, asymptomatic or oligosymptomatic, and extra-intestinal forms, which may lead to diagnostic delay and exposure to serious complications. CD is a multidisciplinary health concern involving general medicine, pediatric, and adult gastroenterology, among other disciplines. Immunology and pathology laboratories have a fundamental role in diagnosing and monitoring CD. The diagnosis consists of serological testing based on IgA anti-transglutaminase (TG2) antibodies combined with IgA quantification to rule out IgA deficiency, a potential misleading factor of CD diagnosis. Positive TG2 serology should be corroborated by anti-endomysium antibody testing before considering an intestinal biopsy. Owing to multiple differential diagnoses, celiac disease cannot be confirmed based on serological positivity alone, nor on isolated villous atrophy. In children with classical signs or even when asymptomatic, with high levels of CD-linked markers and positive HLA DQ2 and/or DQ8 molecules, the current trend is to confirm the diagnosis on basis of the non-systematic use of the biopsy, which remains obligatory in adults. The main challenge in managing CD is the implementation and compliance with a gluten-free diet (GFD). This explains the key role of the dietitian and the active participation of patients and their families throughout the disease-management process. The presence of the gluten in several forms of medicine requires the sensitization of physicians when prescribing, and particularly when dispensing gluten-containing formulations by pharmacists. This underlines the importance of the contribution of the pharmacist in the care of patients with CD within the framework of close collaboration with physicians and nutritionists.
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Affiliation(s)
- Taoufik Ben Houmich
- Laboratory of Immunology, Center of Clinical Research, University Hospital Mohammed VI, Marrakech, Morocco
| | - Brahim Admou
- Laboratory of Immunology, Center of Clinical Research, University Hospital Mohammed VI, Marrakech, Morocco.,Bioscience Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
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Derrou S, El Guendouz F, Benabdelfedil Y, Chakri I, Ouleghzal H, Safi S. The profile of autoimmunity in Type 1 diabetes patients. Ann Afr Med 2021; 20:19-23. [PMID: 33727507 PMCID: PMC8102891 DOI: 10.4103/aam.aam_8_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/12/2020] [Accepted: 05/06/2020] [Indexed: 01/01/2023] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) is an autoimmune disorder caused by pancreatic β-cells destruction. Anti-pancreatic antibodies are the witness of β-cell destruction and their dosage is mainly used for etiological diagnosis. Patients with T1DM are at increased risk of developing other autoimmune reactions, which may involve other organs, resulting in organ specific autoimmune disease. The most frequently encountered are autoimmune thyroid disease, followed by celiac and gastric disease and other rare autoimmune diseases. Objectives The purpose of this study is to investigate the prevalence of autoimmune markers in patients with T1DM. Methods The study was conducted at the Department of Endocrinology of the Military Hospital Moulay Ismail in Meknes Morocco, from January 2016 to December 2018. All Type 1 diabetes patients consulting during the study period were included in the study. Their clinical and biochemical data were collected at their first presentation, made up of anti-pancreatic antibodies (glutamic acid decarboxylase [GAD] antibody, tyrosine phosphatase antibody, and islet cell antibody) and other organ-specific antibodies: the thyroid (antithyroid peroxidase antibody, antithyroglobulin antibody, and antithyroid-stimulating hormone receptor antibody), the intestine (IgA antitissue transglutaminase antibody), the adrenal gland (anti-21 hydroxylase antibody), and the stomach (antigastric parietal cell antibody and anti-intrinsic factor antibody). Results Fifty-four patients were included, with an average age of 26 years. GAD, tyrosine phosphatase, and islet cell antibodies were detected in 74%, 22%, and 3.7%, respectively, of the 54 patients examined. The prevalence of extrapancreatic autoimmunity was 45% with a large preponderance among different immunities of those from thyroid and celiac diseases (CDs). Conclusion Our results confirm that patients with Type 1 diabetes should be investigated for the presence of autoimmune diseases mainly from thyroid and CDs.
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Affiliation(s)
- Sara Derrou
- Department of Endocrinology, Diabetology and Nutrition, Military Hospital Moulay Ismail, Meknes, Morocco
- Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Fayçal El Guendouz
- Department of Endocrinology, Diabetology and Nutrition, Military Hospital Moulay Ismail, Meknes, Morocco
- Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Yousra Benabdelfedil
- Department of Endocrinology, Diabetology and Nutrition, Military Hospital Moulay Ismail, Meknes, Morocco
- Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Imad Chakri
- Department of Clinical Research and Community Health Laboratory, Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Hassan Ouleghzal
- Department of Endocrinology, Diabetology and Nutrition, Military Hospital Moulay Ismail, Meknes, Morocco
- Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Somaya Safi
- Department of Endocrinology, Diabetology and Nutrition, Military Hospital Moulay Ismail, Meknes, Morocco
- Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fez, Morocco
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Persistent Alterations in Plasma Lipid Profiles Before Introduction of Gluten in the Diet Associated With Progression to Celiac Disease. Clin Transl Gastroenterol 2020; 10:1-10. [PMID: 31082858 PMCID: PMC6602763 DOI: 10.14309/ctg.0000000000000044] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Celiac disease (CD) is a chronic enteropathy characterized by an autoimmune reaction in the small intestine of genetically susceptible individuals. The underlying causes of autoimmune reaction and its effect on host metabolism remain largely unknown. Herein, we apply lipidomics to elucidate the early events preceding clinical CD in a cohort of Finnish children, followed up in the Type 1 Diabetes Prediction and Prevention study.
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Chermnykh ES, Alpeeva EV, Vorotelyak EA. Transglutaminase 3: The Involvement in Epithelial Differentiation and Cancer. Cells 2020; 9:cells9091996. [PMID: 32872587 PMCID: PMC7563467 DOI: 10.3390/cells9091996] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
Transglutaminases (TGMs) contribute to the formation of rigid, insoluble macromolecular complexes, which are essential for the epidermis and hair follicles to perform protective and barrier functions against the environment. During differentiation, epidermal keratinocytes undergo structural alterations being transformed into cornified cells, which constitute a highly tough outermost layer of the epidermis, the stratum corneum. Similar processes occur during the hardening of the hair follicle and the hair shaft, which is provided by the enzymatic cross-linking of the structural proteins and keratin intermediate filaments. TGM3, also known as epidermal TGM, is one of the pivotal enzymes responsible for the formation of protein polymers in the epidermis and the hair follicle. Numerous studies have shown that TGM3 is extensively involved in epidermal and hair follicle physiology and pathology. However, the roles of TGM3, its substrates, and its importance for the integument system are not fully understood. Here, we summarize the main advances that have recently been achieved in TGM3 analyses in skin and hair follicle biology and also in understanding the functional role of TGM3 in human tumor pathology as well as the reliability of its prognostic clinical usage as a cancer diagnosis biomarker. This review also focuses on human and murine hair follicle abnormalities connected with TGM3 mutations.
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Jouanin A, Gilissen LJWJ, Schaart JG, Leigh FJ, Cockram J, Wallington EJ, Boyd LA, van den Broeck HC, van der Meer IM, America AHP, Visser RGF, Smulders MJM. CRISPR/Cas9 Gene Editing of Gluten in Wheat to Reduce Gluten Content and Exposure-Reviewing Methods to Screen for Coeliac Safety. Front Nutr 2020; 7:51. [PMID: 32391373 PMCID: PMC7193451 DOI: 10.3389/fnut.2020.00051] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 03/30/2020] [Indexed: 12/20/2022] Open
Abstract
Ingestion of gluten proteins (gliadins and glutenins) from wheat, barley and rye can cause coeliac disease (CD) in genetically predisposed individuals. The only remedy is a strict and lifelong gluten-free diet. There is a growing desire for coeliac-safe, whole-grain wheat-based products, as consumption of whole-grain foods reduces the risk of chronic diseases. However, due to the large number of gluten genes and the complexity of the wheat genome, wheat that is coeliac-safe but retains baking quality cannot be produced by conventional breeding alone. CD is triggered by immunogenic epitopes, notably those present in α-, γ-, and ω-gliadins. RNA interference (RNAi) silencing has been used to down-regulate gliadin families. Recently, targeted gene editing using CRISPR/Cas9 has been applied to gliadins. These methods produce offspring with silenced, deleted, and/or edited gliadins, that overall may reduce the exposure of patients to CD epitopes. Here we review methods to efficiently screen and select the lines from gliadin gene editing programs for CD epitopes at the DNA and protein level, for baking quality, and ultimately in clinical trials. The application of gene editing for the production of coeliac-safe wheat is further considered within the context of food production and in view of current national and international regulatory frameworks.
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Affiliation(s)
- Aurelie Jouanin
- Plant Breeding, Wageningen University and Research, Wageningen, Netherlands
- John Bingham Laboratory, NIAB, Cambridge, United Kingdom
| | - Luud J. W. J. Gilissen
- Plant Breeding, Wageningen University and Research, Wageningen, Netherlands
- Bioscience, Wageningen University and Research, Wageningen, Netherlands
| | - Jan G. Schaart
- Plant Breeding, Wageningen University and Research, Wageningen, Netherlands
| | - Fiona J. Leigh
- John Bingham Laboratory, NIAB, Cambridge, United Kingdom
| | - James Cockram
- John Bingham Laboratory, NIAB, Cambridge, United Kingdom
| | | | - Lesley A. Boyd
- John Bingham Laboratory, NIAB, Cambridge, United Kingdom
| | | | | | - A. H. P. America
- Bioscience, Wageningen University and Research, Wageningen, Netherlands
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Saadah OI, ALNosani NM. Celiac disease in Saudi children with isolated short stature: is it rare or are we not screening rigorously enough? J Pediatr Endocrinol Metab 2020; 33:89-93. [PMID: 31804962 DOI: 10.1515/jpem-2019-0348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/11/2019] [Indexed: 11/15/2022]
Abstract
Background Celiac disease (CeD) is an immune-mediated enteropathy induced by gluten exposure in individuals with genetic susceptibility. Short stature (SS) can be the sole clinical manifestation of CeD, in the absence of gastrointestinal (GI) symptoms. This study aimed to determine the prevalence of CeD in Saudi Arabian children with SS. Patients and methods Medical records were reviewed in a total number of 275 retrospective cases (during the period 2002-2014) of children with isolated SS from King Abdulaziz University Hospital, Jeddah. Their serum samples were tested with tissue transglutaminase (tTG) antibodies. Patients with a positive serology were scheduled for an upper endoscopy and intestinal biopsy to confirm CeD diagnosis before starting a gluten-free diet (GFD). Clinical, anthropometric and laboratory data were recorded for all patients. Results A total of 275 children with SS were included. The mean age ± standard deviation (SD) was 9.4 ± 4.0 years (range, 2.6-16.9 years) and males constituted the predominant gender group (151/275; 54.9%) over females (124/275; 45.1%). The mean ± SD height for age z score (HAZ) was -2.9 ± 1.0.Thirty-eight (13.8%) had positive serology, and 16 (5.8%) had biopsy-proven CeD. Apart from the difference in duration of delayed bone age between CeD patients and CeD-negative serology subjects (mean ± SD, 39.6 ± 10.5 vs. 18.6 ± 16.8, p = 0.02), no other major difference in other clinical or laboratory parameters was evident. Conclusions The prevalence rate of CeD in Saudi Arabian SS children was 5.8%, which is comparable to published reports of a number of other countries. Regular screening of children with SS is therefore justifiable.
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Affiliation(s)
- Omar I Saadah
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Nouf M ALNosani
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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Cassisi JE, Ross EJ, Vivier H, James N, Su LC. The Impact of a Gluten-Free Diet on Celiac Disease: A Comprehensive Evaluation of Two Cases Using NIH Patient Reported Outcome Measures (PROMIS, NTCB, and Neuro-QoL). J Clin Psychol Med Settings 2020; 27:444-453. [DOI: 10.1007/s10880-020-09698-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
The population of Americans suffering from celiac, gluten intolerance, and wheat allergy is 1 in every 14 people. Also, many are choosing gluten-free (GF) diets nowadays because of the perception that it is a healthier option for them. Therefore, in the last decade, the GF market in the US and all over the world has seen significant growth. Globally, GF product sales reached 4.63 billion USD in 2017, and are expected to reach 6.47 billion USD by 2023, a projected compound annual growth rate of 7.6%. Several grains like millet, corn, sorghum, and pseudocereals like amaranth, quinoa, and teff are the main ingredients for a gluten diet. Though most of them have a comparable nutrient profile as common grains, the main challenge to their acceptability is the quality departure from gluten-containing counterparts and imbalance nutrients that ensue when food processing aids like starch, gums, and enzymes are used. In this review, we profiled some of the common grains, their characteristics, functionality and the various food types they are used for. We also reviewed the impact of some of the current food processing aids like starch, hydrocolloids used for improving functionality, and processing techniques like extrusion suitable for making remarkable GF foods.
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Affiliation(s)
- Joseph S Woomer
- Department of Biosystems and Agricultural Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Akinbode A Adedeji
- Department of Biosystems and Agricultural Engineering, University of Kentucky, Lexington, Kentucky, USA
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Olojede A, Sanni A, Banwo K. Effect of legume addition on the physiochemical and sensorial attributes of sorghum-based sourdough bread. Lebensm Wiss Technol 2020. [DOI: 10.1016/j.lwt.2019.108769] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Agin M, Batun I, Ozdemir S, Doran F, Tumgor G. Prevalence of Helicobacter pylori in Turkish children with celiac disease and its effect on clinical, histopathological, and laboratory parameters. Arch Med Sci 2019; 15:1475-1481. [PMID: 31749876 PMCID: PMC6855148 DOI: 10.5114/aoms.2019.83699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/08/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The aim of the study was to assess the prevalence of Helicobacter pylori (HP) in children with celiac disease (CD) and its relationship with clinical, histopathological, and laboratory parameters. MATERIAL AND METHODS Two hundred and fifty-six patients with serologically and histopathologically diagnosed CD at the Pediatric Gastroenterology Department, Turkey, from January 2012 to March 2017, were included in the study, as well as 1012 patients with dyspeptic complaints. Biopsies of the duodenum and antrum were taken; the existence of HP and the histological level of damage were studied. HP (+) and HP (-) cases were compared according to age, sex, noted complaints, and clinical and laboratory features. RESULTS Seventy (27.4%) CD patients and 270 (26.7%) patients with dyspeptic complaints were HP (+). The diagnostic age was higher in HP (+) cases, and diarrhea and abdominal distension were significantly higher. Although hemoglobin, ferritin, vitamin B12, and transferrin saturation were lower in HP (+) cases, the differences were not statistically significant. The serum folate level in the HP (+) group was significantly lower compared to the HP (-) group. CONCLUSIONS The prevalence of HP was not increased in cases of CD. The CD was diagnosed later in HP (+) cases, distension and diarrhea complaints were more frequent, and folate deficiency was significant.
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Affiliation(s)
- Mehmet Agin
- Department of Pediatric Gastroenterology, Medical Faculty, Cukurova University, Adana, Turkey
| | - Inci Batun
- Department of Pediatrics, Medical Faculty, Cukurova University, Adana, Turkey
| | - Semine Ozdemir
- Department of Pediatrics, Medical Faculty, Cukurova University, Adana, Turkey
| | - Figen Doran
- Department of Pathology, Medical Faculty, Cukurova University, Adana, Turkey
| | - Gokhan Tumgor
- Department of Pediatric Gastroenterology, Medical Faculty, Cukurova University, Adana, Turkey
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Caminero A, Verdu EF. Metabolism of wheat proteins by intestinal microbes: Implications for wheat related disorders. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.gastre.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Metabolism of wheat proteins by intestinal microbes: Implications for wheat related disorders. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:449-457. [DOI: 10.1016/j.gastrohep.2019.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/14/2019] [Indexed: 12/22/2022]
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Jouanin A, Schaart JG, Boyd LA, Cockram J, Leigh FJ, Bates R, Wallington EJ, Visser RGF, Smulders MJM. Outlook for coeliac disease patients: towards bread wheat with hypoimmunogenic gluten by gene editing of α- and γ-gliadin gene families. BMC PLANT BIOLOGY 2019; 19:333. [PMID: 31370789 PMCID: PMC6670228 DOI: 10.1186/s12870-019-1889-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/17/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND Wheat grains contain gluten proteins, which harbour immunogenic epitopes that trigger Coeliac disease in 1-2% of the human population. Wheat varieties or accessions containing only safe gluten have not been identified and conventional breeding alone struggles to achieve such a goal, as the epitopes occur in gluten proteins encoded by five multigene families, these genes are partly located in tandem arrays, and bread wheat is allohexaploid. Gluten immunogenicity can be reduced by modification or deletion of epitopes. Mutagenesis technologies, including CRISPR/Cas9, provide a route to obtain bread wheat containing gluten proteins with fewer immunogenic epitopes. RESULTS In this study, we analysed the genetic diversity of over 600 α- and γ-gliadin gene sequences to design six sgRNA sequences on relatively conserved domains that we identified near coeliac disease epitopes. They were combined in four CRISPR/Cas9 constructs to target the α- or γ-gliadins, or both simultaneously, in the hexaploid bread wheat cultivar Fielder. We compared the results with those obtained with random mutagenesis in cultivar Paragon by γ-irradiation. For this, Acid-PAGE was used to identify T1 grains with altered gliadin protein profiles compared to the wild-type endosperm. We first optimised the interpretation of Acid-PAGE gels using Chinese Spring deletion lines. We then analysed the changes generated in 360 Paragon γ-irradiated lines and in 117 Fielder CRISPR/Cas9 lines. Similar gliadin profile alterations, with missing protein bands, could be observed in grains produced by both methods. CONCLUSIONS The results demonstrate the feasibility and efficacy of using CRISPR/Cas9 to simultaneously edit multiple genes in the large α- and γ-gliadin gene families in polyploid bread wheat. Additional methods, generating genomics and proteomics data, will be necessary to determine the exact nature of the mutations generated with both methods.
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Affiliation(s)
- Aurélie Jouanin
- Wageningen University and Research, Plant Breeding, Wageningen, The Netherlands
- The John Bingham Laboratory, NIAB, Huntingdon Road, Cambridge, UK
| | - Jan G. Schaart
- Wageningen University and Research, Plant Breeding, Wageningen, The Netherlands
| | - Lesley A. Boyd
- The John Bingham Laboratory, NIAB, Huntingdon Road, Cambridge, UK
| | - James Cockram
- The John Bingham Laboratory, NIAB, Huntingdon Road, Cambridge, UK
| | - Fiona J. Leigh
- The John Bingham Laboratory, NIAB, Huntingdon Road, Cambridge, UK
| | - Ruth Bates
- The John Bingham Laboratory, NIAB, Huntingdon Road, Cambridge, UK
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Bittker SS, Bell KR. Potential risk factors for celiac disease in childhood: a case-control epidemiological survey. Clin Exp Gastroenterol 2019; 12:303-319. [PMID: 31308721 PMCID: PMC6615019 DOI: 10.2147/ceg.s210060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Celiac disease (CD) prevalence has increased significantly in recent decades in some developed countries. Yet the environmental factors in the existing literature do not appear to provide a satisfactory explanation for this increase. Objective: To determine whether nine variables are associated with CD in children. These variables are: incidence of ear infection before 2 years old, courses of antibiotics before 2 years old, duration of breastfeeding, vitamin D drop exposure in infancy, vitamin D supplement exposure between 2–3 years old, age at gluten introduction into the diet, fat content of cow’s milk consumed between 2–3 years old, quantity of cow’s milk consumed between 2–3 years old, and type of water consumed at 2 years old. Methods: An Internet-based survey was conducted among parents living in the US with at least one biological child between 3 and 12 years old. Potential participants were informed about the survey through social media, websites, electronic newsletters, and advertisements. Results: After exclusions, there remained 332 responses associated with children with CD (cases), and 241 responses associated with children who do not have CD (controls). In this data set, skim milk as the primary form of liquid cow’s milk consumed between 2–3 years old (adjusted odds ratio [aOR]=3.556, CI=1.430–10.22, P=0.010), vitamin D drops administered for more than 3 months (aOR=1.749, CI=1.079–2.872, P=0.025), courses of antibiotics (aOR=1.133, CI=1.037–1.244, P=0.007), and incidence of ear infection (aOR=1.183, CI=1.041–1.348, P=0.010) are all associated with CD in children. Conclusions: This study is the first to find an association between skim milk consumption and CD and vitamin D drop use for greater than 3 months and CD. It also adds to evidence that early life exposure to antibiotics and early life infection, specifically ear infection, are associated with CD. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/y9aThwSZHoE
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Affiliation(s)
- Seth Scott Bittker
- Interdisciplinary Center for Innovative Theory and Empirics (INCITE), Columbia University, New York, New York, US
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Neves FS, Barros AS, Cerqueira GA, Cruz GA, Reis AA, Alves LB, Crusoé-Rebello I. Assessment of fractal dimension and panoramic radiomorphometric indices in women with celiac disease. Oral Radiol 2019; 36:141-147. [DOI: 10.1007/s11282-019-00388-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/20/2019] [Indexed: 12/11/2022]
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Gazi MA, Das S, Mahfuz M, Hasan MM, Hossain MS, Fahim SM, Alam MA, Noor Z, Gilchrist CA, Petri WA, Rahman MM, Mazumder RN, Haque R, Sarker SA, Ahmed T. Screening for coeliac disease in children and adults living in a slum of Dhaka, Bangladesh. BMJ Open Gastroenterol 2019; 6:e000294. [PMID: 31139429 PMCID: PMC6506126 DOI: 10.1136/bmjgast-2019-000294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/28/2019] [Accepted: 04/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background and objective Serological screening with a confirmation through biopsy has improved the understanding of coeliac disease (CD) epidemiology worldwide. Prevalence of CD in Bangladesh is not yet explored and therefore, we aimed to assess the seroprevalence of CD in slum-dwelling malnourished children and adults in Dhaka. Methods Serum samples were collected from three different cohorts: stunted (length-for-age Z-scores (LAZ) <−2) and at risk of stunting children (LAZ <−1 to −2) and malnourished adults (body mass index <18.5 kg/m2). Samples from all the participants were assessed for anti-tissue transglutaminase antibody (tTG-IgA) and total serum IgA by ELISA. Positive tTG-IgA and randomly selected low IgA values were reconfirmed using anti-tTG-IgG and gliadin IgG ELISA. CD was diagnosed when second screening tests were found positive and the participants were further investigated by small bowel biopsy. Results A total of 818 participants (240 stunted, 272 at risk of stunting children and 306 malnourished adults) were enrolled in the study. Overall, anti-tTG-IgA was positive in 5/818 (0.6%; 95% CI 0.25% to 1.46%). Of the five positive cases, anti-tTG-IgG and gliadin IgG were found positive in only one participant. Duodenal biopsy of positive participant revealed characteristic lesions of CD. Randomly selected low IgA values were found negative in tTG-IgG and gliadin IgG for all the participants. No participant was found total IgA deficient. Conclusion The incidence of coeliac autoimmunity is low in malnourished slum dwellers regardless of age in Bangladesh. It is important to investigate the nationwide prevalence to reveal the definite picture.
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Affiliation(s)
- Md Amran Gazi
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Subhasish Das
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Md Mehedi Hasan
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Md Shabab Hossain
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Md Ashraful Alam
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Zannatun Noor
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Carol A Gilchrist
- Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | - William A Petri
- Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | - M Masudur Rahman
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | | | - Rashidul Haque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
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Martinez M, Gómez-Cabellos S, Giménez MJ, Barro F, Diaz I, Diaz-Mendoza M. Plant Proteases: From Key Enzymes in Germination to Allies for Fighting Human Gluten-Related Disorders. FRONTIERS IN PLANT SCIENCE 2019; 10:721. [PMID: 31191594 PMCID: PMC6548828 DOI: 10.3389/fpls.2019.00721] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/16/2019] [Indexed: 05/15/2023]
Abstract
Plant proteases play a crucial role in many different biological processes along the plant life cycle. One of the most determinant stages in which proteases are key protagonists is the plant germination through the hydrolysis and mobilization of other proteins accumulated in seeds and cereal grains. The most represented proteases in charge of this are the cysteine proteases group, including the C1A family known as papain-like and the C13 family also called legumains. In cereal species such as wheat, oat or rye, gluten is a very complex mixture of grain storage proteins, which may affect the health of sensitive consumers like celiac patients. Since gluten proteins are suitable targets for plant proteases, the knowledge of the proteases involved in storage protein mobilization could be employed to manipulate the amount of gluten in the grain. Some proteases have been previously found to exhibit promising properties for their application in the degradation of known toxic peptides from gluten. To explore the variability in gluten-degrading capacities, we have now analyzed the degradation of gluten from different wheat cultivars using several cysteine proteases from barley. The wide variability showed highlights the possibility to select the protease with the highest potential to alter grain composition reducing the gluten content. Consequently, new avenues could be explored combining genetic manipulation of proteolytic processes with silencing techniques to be used as biotechnological tools against gluten-related disorders.
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Affiliation(s)
- Manuel Martinez
- Centro de Biotecnologia y Genomica de Plantas, Instituto Nacional de Investigacion y Tecnologia Agraria y Alimentaria (INIA), Universidad Politécnica de Madrid (UPM), Campus Montegancedo UPM, Madrid, Spain
- Departamento de Biotecnologia-Biologia Vegetal, Escuela Tecnica Superior de Ingenieria Agronomica, Alimentaria y de Biosistemas, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Sara Gómez-Cabellos
- Centro de Biotecnologia y Genomica de Plantas, Instituto Nacional de Investigacion y Tecnologia Agraria y Alimentaria (INIA), Universidad Politécnica de Madrid (UPM), Campus Montegancedo UPM, Madrid, Spain
| | - María José Giménez
- Departamento de Mejora Genética Vegetal, Instituto de Agricultura Sostenible (IAS-CSIC), Córdoba, Spain
| | - Francisco Barro
- Departamento de Mejora Genética Vegetal, Instituto de Agricultura Sostenible (IAS-CSIC), Córdoba, Spain
| | - Isabel Diaz
- Centro de Biotecnologia y Genomica de Plantas, Instituto Nacional de Investigacion y Tecnologia Agraria y Alimentaria (INIA), Universidad Politécnica de Madrid (UPM), Campus Montegancedo UPM, Madrid, Spain
- Departamento de Biotecnologia-Biologia Vegetal, Escuela Tecnica Superior de Ingenieria Agronomica, Alimentaria y de Biosistemas, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Mercedes Diaz-Mendoza
- Centro de Biotecnologia y Genomica de Plantas, Instituto Nacional de Investigacion y Tecnologia Agraria y Alimentaria (INIA), Universidad Politécnica de Madrid (UPM), Campus Montegancedo UPM, Madrid, Spain
- *Correspondence: Mercedes Diaz-Mendoza,
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Sulieman AA, Zhu KX, Peng W, Hassan HA, Obadi M, Siddeeg A, Zhou HM. Rheological and quality characteristics of composite gluten-free dough and biscuits supplemented with fermented and unfermented Agaricus bisporus polysaccharide flour. Food Chem 2019; 271:193-203. [DOI: 10.1016/j.foodchem.2018.07.189] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
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Abstract
Celiac disease represents a problem in our society, not only because of its interest in terms of healthcare, but also because of its increasing prevalence in recent years and the impact it has on sufferers and their families. This integrative review investigated current knowledge about the experience of living with a gluten-free diet, as well as social support and the role played by nurses and/or associations in the process. A total of 18 articles were selected. Results revealed greater family support is needed to deal with the day-to-day issues of a gluten-free diet. Furthermore, women diagnosed with celiac disease have more psychological distress than men according to some studies. Sufferers of celiac disease report that more information is needed at all levels (hotel and catering, healthcare, social), which would help generate coping strategies. The few studies retrieved that talk about this topic show that following a gluten-free diet affects the personal, family, emotional, social, and financial dimensions of sufferers of celiac disease. The nurse tends to be the person whom those coping with the illness go to for support, although celiac disease associations are also a fundamental pillar in this support. Policy makers need to adapt health services to the needs of individuals with celiac disease.
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Spagnoli C, Pisani F, Di Mario F, Leandro G, Gaiani F, De' Angelis GL, Fusco C. Peripheral neuropathy and gastroenterologic disorders: an overview on an underrecognized association. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:22-32. [PMID: 30561392 PMCID: PMC6502186 DOI: 10.23750/abm.v89i9-s.7956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Although peripheral neuropathies in children are often of genetic origin, acquired causes should be carefully looked for and ruled out also in the pediatric age. Gastroenterological disorders can be complicated by peripheral neuropathy as a result of micronutrients deficiency, drug toxicity or because of shared pathophysiological mechanisms. METHODS In this descriptive review we sought to give an overview on the most relevant clinical conditions in which peripheral neuropathies are associated with gastro-intestinal disorders or symptoms. RESULTS We describe the clinical, demographic, and electrophysiological features of peripheral neuropathy in three main clinical scenarios: in the context of common gastroenterological disorders (inflammatory bowel and celiac disease), in the context of micronutrients deficiencies arising from malabsorption irrespective of etiology, and in a rare degenerative mitochondrial disorder, mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) disorder. CONCLUSIONS The association between gastrointestinal and peripheral nervous system symptoms is probably still underrecognized but has to be actively sought, in order to provide prompt diagnosis resulting in optimal care and long-term management with the aim to improve quality of life and, at least in some conditions, try to impact on prognosis.
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Affiliation(s)
- Carlotta Spagnoli
- Child Neurology Unit, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy.
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Tumgor G, Agin M, Doran F, Cetiner S. Frequency of Celiac Disease in Children with Peptic Ulcers. Dig Dis Sci 2018; 63:2681-2686. [PMID: 29946872 DOI: 10.1007/s10620-018-5174-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 06/19/2018] [Indexed: 12/29/2022]
Abstract
AIM The aim of the present study is to investigate the frequency of celiac disease in children with peptic ulcers and to compare it with that of non-celiac peptic ulcers in terms of clinical and laboratory values. METHODS Upper gastrointestinal endoscopy was performed in 1769 patients at the Department of Pediatric Gastroenterology, The Faculty of Medicine, Cukurova University, Turkey, between January 2012 and January 2017. These cases consisted of subjects presenting with various GIS symptoms and indicated for endoscopy (with chronic diarrhea, delayed growth and development, abdominal pains, GIS bleeding, etc.). The levels of immunoglobulin A (IgA) serum anti-tissue transglutaminase antibodies, IgA anti-endomysial antibodies (EMA), and IgA serum were estimated in the patients with peptic ulcers. RESULTS Celiac disease was diagnosed with serology, endoscopy, and histopathology in 250 (14%) of all cases undergoing endoscopy. Peptic ulcers were diagnosed in 74 patients (4.2%) of all cases undergoing endoscopy. tTGA and EMA (+) levels were determined in 22 (29%) of the 74 patients with peptic ulcers, and then the presence of peptic ulcers was investigated in the upper gastrointestinal system using gastrointestinal endoscopy, followed by histopathological confirmation of celiac disease. HP infection was present in 14 (63%) of the patients with celiac disease and in 23 (44%) of non-celiac peptic ulcers; the difference was not statistically significant (p = 0.12). In the total ulcer group, 10.8% (8/74) of patients with celiac peptic ulcers were negative for HP infection, whereas 21% (8/37) of HP-negative patients with ulcers had celiac disease. CONCLUSION There exists a high risk of celiac disease in children with peptic ulcers. We thus recommend celiac disease to be investigated, particularly in HP-negative patients with peptic ulcers but with no history of NSAID use.
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Affiliation(s)
- Gokhan Tumgor
- Department of Pediatric Gastroenterology, Medical Faculty, Çukurova University, Adana, Turkey.
| | - Mehmet Agin
- Department of Pediatric Gastroenterology, Medical Faculty, Çukurova University, Adana, Turkey
| | - Figen Doran
- Department of Pathology, Medical Faculty, Çukurova University, Adana, Turkey
| | - Salih Cetiner
- Department of Medical Microbiology, Medical Faculty, Çukurova University, Adana, Turkey
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Sood A, Midha V, Makharia G, Thelma BK, Halli SS, Mehta V, Mahajan R, Narang V, Sood K, Kaur K. A simple phenotypic classification for celiac disease. Intest Res 2018; 16:288-292. [PMID: 29743842 PMCID: PMC5934602 DOI: 10.5217/ir.2018.16.2.288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/01/2018] [Accepted: 01/03/2018] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Celiac disease is a global health problem. The presentation of celiac disease has unfolded over years and it is now known that it can manifest at different ages, has varied presentations, and is prone to develop complications, if not managed properly. Although the Oslo definitions provide consensus on the various terminologies used in literature, there is no phenotypic classification providing a composite diagnosis for the disease. Methods Various variables identified for phenotypic classification included age at diagnosis, age at onset of symptoms, clinical presentation, family history and complications. These were applied to the existing registry of 1,664 patients at Dayanand Medical College and Hospital, Ludhiana, India. In addition, age was evaluated as below 15 and below 18 years. Cross tabulations were used for the verification of the classification using the existing data. Expert opinion was sought from both international and national experts of varying fields. Results After empirical verification, age at diagnosis was considered appropriate in between A1 (<18) and A2 (≥18). The disease presentation has been classified into 3 types–P1 (classical), P2 (non-classical) and P3 (asymptomatic). Complications were considered as absent (C0) or present (C1). A single phenotypic classification based on these 3 characteristics, namely age at the diagnosis, clinical presentation, and intestinal complications (APC classification) was derived. Conclusions APC classification (age at diagnosis, presentation, complications) is a simple disease explanatory classification for patients with celiac disease aimed at providing a composite diagnosis.
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Affiliation(s)
- Ajit Sood
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College, Ludhiana, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - B K Thelma
- Department of Genetics, University of Delhi South Campus, New Delhi, India
| | - Shivalingappa S Halli
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College, Ludhiana, India
| | - Kriti Sood
- Department of Pathology, Dayanand Medical College, Ludhiana, India
| | - Kirandeep Kaur
- Department of Pharmacology, Dayanand Medical College, Ludhiana, India
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Abstract
Over the last decade, there have been significant advances in the identification, characterization, and treatment of autoimmune neurologic disorders in children. Many of these diseases include a typical movement disorder that can be a powerful aid to diagnosis. Frequently, movement disorders in autoimmune conditions are the sole or among a few presenting symptoms, allowing for earlier diagnosis of an underlying malignancy or systemic autoimmune disease. Given that early detection and treatment with immunotherapy may confer improved outcomes, recognizing these patterns of abnormal movements is essential for child neurologists. The purpose of this review is to summarize the clinical characteristics, diagnosis, and treatment of movement disorders that occur in pediatric autoimmune disorders.
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Kozhakhmetova A, Wyatt RC, Caygill C, Williams C, Long AE, Chandler K, Aitken RJ, Wenzlau JM, Davidson HW, Gillespie KM, Williams AJK. A quarter of patients with type 1 diabetes have co-existing non-islet autoimmunity: the findings of a UK population-based family study. Clin Exp Immunol 2018; 192:251-258. [PMID: 29431870 DOI: 10.1111/cei.13115] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 12/28/2022] Open
Abstract
Individuals with type 1 diabetes (T1D) are at increased risk of coeliac disease (CD), autoimmune thyroiditis and autoimmune gastritis, but the absolute risks are unclear. The aim of this study was to investigate the prevalence of autoantibodies to tissue transglutaminase (TGA), thyroid peroxidase (TPOA) and gastric H+ /K+ -ATPase (ATPA) and their genetic associations in a well-characterized population-based cohort of individuals with T1D from the Bart's-Oxford family study for whom islet autoantibody prevalence data were already available. Autoantibodies in sera from 1072 patients (males/females 604/468; median age 11·8 years, median T1D duration 2·7 months) were measured by radioimmunoassays; HLA class II risk genotype was analysed in 973 (91%) using polymerase chain reaction with sequence specific primers (PCR-SSP). The prevalence of TGA (and/or history of CD), TPOA and ATPA in patients was 9·0, 9·6 and 8·2%, respectively; 3·1% had two or more autoantibodies. Females were at higher risk of multiple autoimmunity; TGA/CD were associated with younger age and TPOA with older age. ATPA were uncommon in patients under 5 years, and more common in older patients. Anti-glutamate decarboxylase autoantibodies were predictive of co-existing TPOA/ATPA. TGA/CD were associated with human leucocyte antigen (HLA) DR3-DQ2, with the DR3-DQ2/DR3-DQ2 genotype conferring the highest risk, followed by DR4-DQ8/DR4-DQ8. ATPA were associated with DR3-DQ2, DRB1*0404 (in males) and the DR3-DQ2/DR4-DQ8 genotype. TPOA were associated with the DR3-DQ2/DR3-DQ2 genotype. Almost one-quarter of patients diagnosed with T1D aged under 21 years have at least one other organ-specific autoantibody. HLA class II genetic profiling may be useful in identifying those at risk of multiple autoimmunity.
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Affiliation(s)
- A Kozhakhmetova
- Diabetes and Metabolism, Translational Health Sciences, University of Bristol, Bristol, UK
| | - R C Wyatt
- Diabetes and Metabolism, Translational Health Sciences, University of Bristol, Bristol, UK
| | - C Caygill
- Diabetes and Metabolism, Translational Health Sciences, University of Bristol, Bristol, UK
| | - C Williams
- Diabetes and Metabolism, Translational Health Sciences, University of Bristol, Bristol, UK
| | - A E Long
- Diabetes and Metabolism, Translational Health Sciences, University of Bristol, Bristol, UK
| | - K Chandler
- Diabetes and Metabolism, Translational Health Sciences, University of Bristol, Bristol, UK
| | - R J Aitken
- Diabetes and Metabolism, Translational Health Sciences, University of Bristol, Bristol, UK
| | - J M Wenzlau
- The Barbara Davis Center for Diabetes, University of Colorado, Denver, CO, USA
| | - H W Davidson
- The Barbara Davis Center for Diabetes, University of Colorado, Denver, CO, USA
| | - K M Gillespie
- Diabetes and Metabolism, Translational Health Sciences, University of Bristol, Bristol, UK
| | - A J K Williams
- Diabetes and Metabolism, Translational Health Sciences, University of Bristol, Bristol, UK
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Kárpáti S, Sárdy M, Németh K, Mayer B, Smyth N, Paulsson M, Traupe H. Transglutaminases in autoimmune and inherited skin diseases: The phenomena of epitope spreading and functional compensation. Exp Dermatol 2018; 27:807-814. [PMID: 28940785 DOI: 10.1111/exd.13449] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 02/06/2023]
Abstract
Transglutaminases (TGs) are structurally and functionally related enzymes that modify the post-translational structure and activity of proteins or peptides, and thus are able to turn on or switch off their function. Depending on location and activities, TGs are able to modify the signalling, the function and the fate of cells and extracellular connective tissues. Besides mouse models, human diseases enable us to appreciate the function of various TGs. In this study, skin diseases induced by genetic damages or autoimmune targeting of these enzymes will be discussed. TG1, TG3 and TG5 contribute to the cutaneous barrier and thus to the integrity and function of epidermis. TGM1 mutations related to autosomal recessive ichthyosis subtypes, TGM5 mutations to a mild epidermolysis bullosa phenotype and as novelty TGM3 mutation to uncombable hair syndrome will be discussed. Autoimmunity to TG2, TG3 and TG6 may develop in a few of those genetically determined individuals who lost tolerance to gluten, and manifest as coeliac disease, dermatitis herpetiformis or gluten-dependent neurological symptoms, respectively. These gluten responder diseases commonly occur in combination. In autoimmune diseases, the epitope spreading is remarkable, while in some inherited pathologies, a unique compensation of the lost enzyme function is noted.
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Affiliation(s)
- Sarolta Kárpáti
- Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Miklós Sárdy
- Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Krisztián Németh
- Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Balázs Mayer
- Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Neil Smyth
- Biological Sciences, University of Southampton, Southampton, UK
| | - Mats Paulsson
- Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Heiko Traupe
- Department of Dermatology, University of Münster, Münster, Germany
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Fukunaga M, Ishimura N, Fukuyama C, Izumi D, Ishikawa N, Araki A, Oka A, Mishiro T, Ishihara S, Maruyama R, Adachi K, Kinoshita Y. Celiac disease in non-clinical populations of Japan. J Gastroenterol 2018; 53:208-214. [PMID: 28389733 DOI: 10.1007/s00535-017-1339-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/28/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Celiac disease is a chronic autoimmune enteropathy caused by gluten ingestion. While its prevalence in Western countries is reported to be as high as 1%, the prevalence has not been evaluated in a large-scale study of a Japanese population. The aim of our study was to clarify the possible presence of celiac disease in a Japanese non-clinical population as well as in patients showing symptoms suggestive of the disease. METHODS Serum samples were collected from 2008 non-clinical adults and 47 patients with chronic unexplained abdominal symptoms between April 2014 and June 2016. The anti-tissue transglutaminase (TTG) immunoglobulin A antibody titer was determined as a screening test for celiac disease in all subjects, and individuals with a value of >2 U/mL subsequently underwent testing for the presence of serum endomysial IgA antibody (EMA) as confirmation. Those testing positive for EMA or with a high concentration (>10 U/mL) of TTG were further investigated by histopathological examinations of duodenal mucosal biopsy specimens and HLA typing tests. RESULTS Of the 2008 non-clinical adults from whom serum samples were collected, 161 tested positive for TTG, and all tested negative for EMA. Four subjects who had a high TTG titer were invited to undergo confirmatory testing, and the histopathological results confirmed the presence of celiac disease in only a single case (0.05%). Of the 47 symptomatic patients, one (2.1%) was found to have a high TTG titer and was diagnosed with celiac disease based on duodenal histopathological findings. CONCLUSION The presence of celiac disease in a non-clinical Japanese population was low at 0.05% and was rarely found in patients with unexplained chronic abdominal symptoms.
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Affiliation(s)
- Mai Fukunaga
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
| | - Chika Fukuyama
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Daisuke Izumi
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Nahoko Ishikawa
- Department of Pathology, Shimane University School of Medicine, Izumo, Japan
| | - Asuka Araki
- Department of Pathology, Shimane University School of Medicine, Izumo, Japan
| | - Akihiko Oka
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Tomoko Mishiro
- Health Center, Shimane Environment and Health Public Corporation, Matsue, Japan
| | - Shunji Ishihara
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Riruke Maruyama
- Department of Pathology, Shimane University School of Medicine, Izumo, Japan
| | - Kyoichi Adachi
- Health Center, Shimane Environment and Health Public Corporation, Matsue, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
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Spinell T, DeMayo F, Cato M, Thai A, Helmerhorst EJ, Green PHR, Lebwohl B, Demmer RT. The association between coeliac disease and periodontitis: Results from NHANES 2009-2012. J Clin Periodontol 2018; 45:303-310. [PMID: 29243293 DOI: 10.1111/jcpe.12856] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2017] [Indexed: 12/26/2022]
Abstract
AIM To investigate whether coeliac disease (CD) was associated with periodontitis among a nationally representative sample of US adults. MATERIALS AND METHODS The National Health and Nutrition Examination Survey (NHANES) 2009-2012 enrolled 6,661 subjects with full-mouth periodontal examination and serological testing for antitissue transglutaminase (tTg) and antiendomysial (EMA) antibodies. CD was defined as (i) self-reported physician diagnosis while on a gluten-free diet; or (ii) tTg levels >10.0 U/ml and positive EMA results. Positive serology without self-reported diagnosis was defined as undiagnosed CD (UdxCD). Periodontitis was defined according to the CDC/AAP definition. Multivariable linear and logistic models were used to regress the mean probing depth (PD) or attachment loss (AL) outcomes across CD categories (none, diagnosed and undiagnosed). RESULTS The prevalence of moderate/severe periodontitis and diagnosed/undiagnosed CD was 40% and 0.74%, respectively. Mean AL was lower among those with CD although results were not statistically significant (p = .67). The odds of periodontitis among individuals with diagnosed and undiagnosed CD were: 0.5(0.22, 1.16) and 0.62(0.1, 3.75), respectively. Mean PD levels among those without CD or with diagnosed or undiagnosed CD were 1.49 ± 0.02, 1.36 ± 0.11 and 1.31 ± 0.11 (p = .03). CONCLUSION CD is associated with modestly lower levels of mean PD but was not associated with mean AL or periodontitis. Larger studies are necessary to enhance precision and strengthen conclusions.
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Affiliation(s)
- Thomas Spinell
- Department of Operative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Francesco DeMayo
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Matthew Cato
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ashley Thai
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Eva J Helmerhorst
- Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Peter H R Green
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ryan T Demmer
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minnesota, MN, USA
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Prevalence, incidence, and autoimmune comorbidities of celiac disease: a nation-wide, population-based study in Denmark from 1977 to 2016. Eur J Gastroenterol Hepatol 2018; 30:83-91. [PMID: 29076940 DOI: 10.1097/meg.0000000000000992] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to describe and identify potential trends with respect to prevalence, incidence, age, sex, and autoimmune comorbidity of celiac disease (CD). PATIENTS AND METHODS A Danish nationwide cohort study of CD using data from The National Patient Register. Patients with a primary or secondary diagnosis code of CD during the period 1977 to 2016 were identified. Information on sex, date of birth, death, or immigration was obtained from the Danish Civil Registration System, and autoimmune comorbidities were identified in the Danish National Patient Register. The CD cohort was compared with the general Danish population using a control cohort and aggregated data obtained from Statistics Denmark. RESULTS The CD cohort consisted of 11 802 (65% women) patients. The median age at diagnosis of CD varied between 30 years in 1980-1984 and 45 years in 1995-1999 and 27 years in 2015-2016. The prevalence of CD in 1986 and 2016 was 14 and 180 per 100 000 persons, respectively, with a female/male ratio changing from 1.3 to 2.0. Incidence rates (per 100 000 person-years) changed from 1.6 in 1980-1984 to 15.2 in 2015-2016, with the largest increase among females aged 0-9 years. In 2016, prevalence of autoimmune comorbidities was 16.4% among the CD patients compared with 5.3% in the general population. CONCLUSION The prevalence of diagnosed CD has doubled every decade in Denmark from 1986 to 2016, and in the same period the female/male ratio has increased and the median age at diagnosis has decreased. The prevalence of autoimmune comorbidity in 2016 was three times higher among CD patients compared with the general Danish population.
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Werkstetter KJ, Korponay-Szabó IR, Popp A, Villanacci V, Salemme M, Heilig G, Lillevang ST, Mearin ML, Ribes-Koninckx C, Thomas A, Troncone R, Filipiak B, Mäki M, Gyimesi J, Najafi M, Dolinšek J, Dydensborg Sander S, Auricchio R, Papadopoulou A, Vécsei A, Szitanyi P, Donat E, Nenna R, Alliet P, Penagini F, Garnier-Lengliné H, Castillejo G, Kurppa K, Shamir R, Hauer AC, Smets F, Corujeira S, van Winckel M, Buderus S, Chong S, Husby S, Koletzko S. Accuracy in Diagnosis of Celiac Disease Without Biopsies in Clinical Practice. Gastroenterology 2017. [PMID: 28624578 DOI: 10.1053/j.gastro.2017.06.002] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The guidelines of the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition allow for diagnosis of celiac disease without biopsies in children with symptoms and levels of immunoglobulin A against tissue-transglutaminase (TGA-IgA) 10-fold or more the upper limit of normal (ULN), confirmed by detection of endomysium antibodies (EMA) and positivity for HLA-DQ2/DQ8. We performed a large, international prospective study to validate this approach. METHODS We collected data from consecutive pediatric patients (18 years or younger) on a gluten-containing diet who tested positive for TGA-IgA from November 2011 through May 2014, seen at 33 pediatric gastroenterology units in 21 countries. Local centers recorded symptoms; measurements of total IgA, TGA, and EMA; and histopathology findings from duodenal biopsies. Children were considered to have malabsorption if they had chronic diarrhea, weight loss (or insufficient gain), growth failure, or anemia. We directly compared central findings from 16 antibody tests (8 for TGA-IgA, 1 for TGA-IgG, 6 for IgG against deamidated gliadin peptides, and 1 for EMA, from 5 different manufacturers), 2 HLA-DQ2/DQ8 tests from 2 manufacturers, and histopathology findings from the reference pathologist. Final diagnoses were based on local and central results. If all local and central results were concordant for celiac disease, cases were classified as proven celiac disease. Patients with only a low level of TGA-IgA (threefold or less the ULN) but no other results indicating celiac disease were classified as no celiac disease. Central histo-morphometry analyses were performed on all other biopsies and cases were carefully reviewed in a blinded manner. Inconclusive cases were regarded as not having celiac disease for calculation of diagnostic accuracy. The primary aim was to determine whether the nonbiopsy approach identifies children with celiac disease with a positive predictive value (PPV) above 99% in clinical practice. Secondary aims included comparing performance of different serological tests and to determine whether the suggested criteria can be simplified. RESULTS Of 803 children recruited for the study, 96 were excluded due to incomplete data, low level of IgA, or poor-quality biopsies. In the remaining 707 children (65.1% girls; median age, 6.2 years), 645 were diagnosed with celiac disease, 46 were found not to have celiac disease, and 16 had inconclusive results. Findings from local laboratories of TGA-IgA 10-fold or more the ULN, a positive result from the test for EMA, and any symptom identified children with celiac disease (n = 399) with a PPV of 99.75 (95% confidence interval [CI], 98.61-99.99); the PPV was 100.00 (95% CI, 98.68-100.00) when only malabsorption symptoms were used instead of any symptom (n = 278). Inclusion of HLA analyses did not increase accuracy. Findings from central laboratories differed greatly for patients with lower levels of antibodies, but when levels of TGA-IgA were 10-fold or more the ULN, PPVs ranged from 99.63 (95% CI, 98.67-99.96) to 100.00 (95% CI, 99.23-100.00). CONCLUSIONS Children can be accurately diagnosed with celiac disease without biopsy analysis. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide. HLA analysis is not required for accurate diagnosis. Clinical Trial Registration no: DRKS00003555.
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Affiliation(s)
- Katharina Julia Werkstetter
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany
| | - Ilma Rita Korponay-Szabó
- Celiac Disease Center Heim Pál Children's Hospital, Budapest and Department of Pediatrics, University of Debrecen, Debrecen, Hungary; Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Alina Popp
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland; University of Medicine and Pharmacy "Carol Davila" and National Institute for Mother and Child Health "Alessandrescu-Rusescu," Bucharest, Romania
| | | | | | - Gabriele Heilig
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany
| | | | - Maria Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Carmen Ribes-Koninckx
- Department of Pediatric Gastroenterology and Hepatology, La Fe University Hospital, Valencia, Spain
| | - Adrian Thomas
- Department of Pediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Riccardo Troncone
- Department of Translational Medical Sciences & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
| | - Birgit Filipiak
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany
| | - Markku Mäki
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Judit Gyimesi
- Celiac Disease Center Heim Pál Children's Hospital, Budapest and Department of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - Mehri Najafi
- Department of Pediatric Gastroenterology & Hepatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jernej Dolinšek
- Department of Pediatrics, University Medical Center (UMC), Maribor, Slovenia
| | | | - Renata Auricchio
- Department of Translational Medical Sciences & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy
| | - Alexandra Papadopoulou
- Division of Gastroenterology, Hepatology and Nutrition, First Department of Pediatrics, Children's Hospitals "Agia Sophia," University of Athens, Athens, Greece
| | - Andreas Vécsei
- Gastroenterology Outpatient Clinic, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Peter Szitanyi
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Ester Donat
- Department of Pediatric Gastroenterology and Hepatology, La Fe University Hospital, Valencia, Spain
| | - Rafaella Nenna
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | | | - Francesca Penagini
- Department of Pediatric Gastroenterology, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Hélène Garnier-Lengliné
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hôpital Necker-Enfants Malades, Paris, France
| | - Gemma Castillejo
- Department of Pediatric Gastroenterology and Nutrition, Hospital Universitari Sant Joan, Reus, Spain
| | - Kalle Kurppa
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Françoise Smets
- Université Catholique de Louvain, IREC, PEDI, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Susana Corujeira
- Department of Pediatric Gastroenterology, Hospital S. João, Porto, Portugal
| | - Myriam van Winckel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ghent University Hospital, Ghent, Belgium
| | - Stefan Buderus
- Department of Pediatrics, St. Marien Hospital, Bonn, Germany
| | - Sonny Chong
- Queen Mary's Hospital for Children, Carshalton, United Kingdom
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Sibylle Koletzko
- Dr. von Hauner Children's Hospital, Department of Pediatrics, University Hospital, LMU Munich, Munich, Germany.
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Dubois B, Bertin P, Muhovski Y, Escarnot E, Mingeot D. Development of TaqMan probes targeting the four major celiac disease epitopes found in α-gliadin sequences of spelt ( Triticum aestivum ssp. spelta) and bread wheat ( Triticum aestivum ssp. aestivum). PLANT METHODS 2017; 13:72. [PMID: 28912827 PMCID: PMC5588674 DOI: 10.1186/s13007-017-0222-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/31/2017] [Indexed: 06/01/2023]
Abstract
BACKGROUND Celiac disease (CD) is caused by specific sequences of gluten proteins found in cereals such as bread wheat (Triticum aestivum ssp. aestivum) and spelt (T. aestivum ssp. spelta). Among them, the α-gliadins display the highest immunogenicity, with four T-cell stimulatory epitopes. The toxicity of each epitope sequence can be reduced or even suppressed according to the allelic form of each sequence. One way to address the CD problem would be to make use of this allelic variability in breeding programs to develop safe varieties, but tools to track the presence of toxic epitopes are required. The objective of this study was to develop a tool to accurately detect and quantify the immunogenic content of expressed α-gliadins of spelt and bread wheat. RESULTS Four TaqMan probes that only hybridize to the canonical-i.e. toxic-form of each of the four epitopes were developed and their specificity was demonstrated. Six TaqMan probes targeting stable reference genes were also developed and constitute a tool to normalize qPCR data. The probes were used to measure the epitope expression levels of 11 contrasted spelt accessions and three ancestral diploid accessions of bread wheat and spelt. A high expression variability was highlighted among epitopes and among accessions, especially in Asian spelts, which showed lower epitope expression levels than the other spelts. Some discrepancies were identified between the canonical epitope expression level and the global amount of expressed α-gliadins, which makes the designed TaqMan probes a useful tool to quantify the immunogenic potential independently of the global amount of expressed α-gliadins. CONCLUSIONS The results obtained in this study provide useful tools to study the immunogenic potential of expressed α-gliadin sequences from Triticeae accessions such as spelt and bread wheat. The application of the designed probes to contrasted spelt accessions revealed a high variability and interesting low canonical epitope expression levels in the Asian spelt accessions studied.
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Affiliation(s)
- Benjamin Dubois
- Département Sciences du vivant, Centre wallon de Recherches agronomiques (CRA-W), Chaussée de Charleroi, 234, 5030 Gembloux, Belgium
- Earth and Life Institute – Agronomy, Université catholique de Louvain (UCL), Croix du Sud, 2 bte L7.05.11, 1348 Louvain-la-Neuve, Belgium
| | - Pierre Bertin
- Earth and Life Institute – Agronomy, Université catholique de Louvain (UCL), Croix du Sud, 2 bte L7.05.11, 1348 Louvain-la-Neuve, Belgium
| | - Yordan Muhovski
- Département Sciences du vivant, Centre wallon de Recherches agronomiques (CRA-W), Chaussée de Charleroi, 234, 5030 Gembloux, Belgium
| | - Emmanuelle Escarnot
- Département Sciences du vivant, Centre wallon de Recherches agronomiques (CRA-W), Rue de Liroux, 4, 5030 Gembloux, Belgium
| | - Dominique Mingeot
- Département Sciences du vivant, Centre wallon de Recherches agronomiques (CRA-W), Chaussée de Charleroi, 234, 5030 Gembloux, Belgium
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Neurological manifestations of atypical celiac disease in childhood. Acta Neurol Belg 2017; 117:719-727. [PMID: 28434139 DOI: 10.1007/s13760-017-0781-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/10/2017] [Indexed: 01/03/2023]
Abstract
Various typical and atypical neurological manifestations can be seen as the initial symptoms of celiac disease (CD). We suggest that gluten toxicity is the most suspicious triggering risk factor for probable pathophysiological pathways of neurological involvement in atypical CD. The medical charts of 117 patients diagnosed with atypical CD were retrieved from a tertiary center in Ankara, Turkey. Eight patients reported as having neurologic manifestations as initiating symptoms were evaluated in detail. The initial neurological manifestations of CD in our study included atypical absence, which was reported first in this study, generalized tonic-clonic seizures, complex partial seizures, severe axial hypotonia and down phenotype, multifocal leukoencephalopathy, mild optic neuritis, attention deficit hyperactivity disorder, and short duration headaches. Seizures mostly emphasizing atypical absence could be the initial presentation manifestation of CD, first described in this literature. Gluten toxicity could be one of the most powerful triggering factors for developing epilepsy in CD. Learning disorders such as attention deficit hyperactivity disorder, short duration headaches, mild optic neuritis, encephalopathy, and DS could also be the initial neurological manifestations of atypical CD. A gluten-restricted diet may improve neurological complaints, epileptic discharges, and neuropsychiatric symptoms. All we found may be a small part of the full range of neurological disorders of unknown origin related to CD. Clinical suspicion should be the rule for accurate diagnosis of the disease.
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González DA, de Armas LG, Rodríguez IM, Almeida AA, García MG, Gannar F, de León AC. Strategies to improve the efficiency of celiac disease diagnosis in the laboratory. J Immunol Methods 2017; 449:62-67. [PMID: 28733214 DOI: 10.1016/j.jim.2017.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/16/2017] [Accepted: 07/18/2017] [Indexed: 01/30/2023]
Abstract
The demand for testing to detect celiac disease (CD) autoantibodies has increased, together with the cost per case diagnosed, resulting in the adoption of measures to restrict laboratory testing. We designed this study to determine whether opportunistic screening to detect CD-associated autoantibodies had advantages compared to efforts to restrict testing, and to identify the most cost-effective diagnostic strategy. We compared a group of 1678 patients in which autoantibody testing was restricted to cases in which the test referral was considered appropriate (G1) to a group of 2140 patients in which test referrals were not reviewed or restricted (G2). Two algorithms A (quantifying IgA and Tissue transglutaminase IgA [TG-IgA] in all patients), and B (quantifying only TG-IgA in all patients) were used in each group, and the cost-effectiveness of each strategy was calculated. TG-IgA autoantibodies were positive in 62 G1 patients and 69 G2 patients. Among those positive for tissue transglutaminase IgA and endomysial IgA autoantibodies, the proportion of patients with de novo autoantibodies was lower (p=0.028) in G1 (11/62) than in G2 (24/69). Algorithm B required fewer determinations than algorithm A in both G1 (2310 vs 3493; p<0.001) and G2 (2196 vs 4435; p<0.001). With algorithm B the proportion of patients in whom IgA was tested was lower (p<0.001) in G2 (29/2140) than in G1 (617/1678). The lowest cost per case diagnosed (4.63 euros/patient) was found with algorithm B in G2. We conclude that opportunistic screening has advantages compared to efforts in the laboratory to restrict CD diagnostic testing. The most cost-effective strategy was based on the use of an appropriate algorithm.
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Affiliation(s)
- Delia Almeida González
- Immunology Unit, NS Candelaria University Hospital, Santa Cruz de Tenerife, Spain; Research Unit, NS Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Laura García de Armas
- Gynecology Section, NS Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | | | | | - Miriam García García
- Rheumatology Section, NS Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Fadoua Gannar
- Research Unit, NS Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Antonio Cabrera de León
- Research Unit, NS Candelaria University Hospital, Santa Cruz de Tenerife, Spain; Universidad de La Laguna, La Laguna, Spain.
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Pavlovic M, Berenji K, Bukurov M. Screening of celiac disease in Down syndrome - Old and new dilemmas. World J Clin Cases 2017; 5:264-269. [PMID: 28798921 PMCID: PMC5535317 DOI: 10.12998/wjcc.v5.i7.264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/28/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is a common and well defined autoimmune disorder caused by gliadin and related proteins of wheat, rye, and barley. Epidemiologic studies confirmed that CD is highly associated with other autoimmune diseases and with Down syndrome (DS). The symptomatic form of CD in patients with DS is more frequent than asymptomatic forms. However, growth impairment, anemia, intermittent diarrhea, and constipation are symptoms and signs typically of children with DS without CD. Late identification of the disease can lead to various complications, sometimes even very severe. Therefore, systematic screening for CD is essential in the management of children and adolescents with DS. Many medical organizations recommend screening in this group of patients. However, current policy statements vary in their recommendations for screening and there is still a need for establishing uniform diagnostic criteria.
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Chan J, Mack DR, Manuel DG, Mojaverian N, de Nanassy J, Benchimol EI. Validation of an algorithm to identify children with biopsy-proven celiac disease from within health administrative data: An assessment of health services utilization patterns in Ontario, Canada. PLoS One 2017; 12:e0180338. [PMID: 28662204 PMCID: PMC5491178 DOI: 10.1371/journal.pone.0180338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 06/14/2017] [Indexed: 12/27/2022] Open
Abstract
Importance Celiac disease (CD) is a common pediatric illness, and awareness of gluten-related disorders including CD is growing. Health administrative data represents a unique opportunity to conduct population-based surveillance of this chronic condition and assess the impact of caring for children with CD on the health system. Objective The objective of the study was to validate an algorithm based on health administrative data diagnostic codes to accurately identify children with biopsy-proven CD. We also evaluated trends over time in the use of health services related to CD by children in Ontario, Canada. Study design and setting We conducted a retrospective cohort study and validation study of population-based health administrative data in Ontario, Canada. All cases of biopsy-proven CD diagnosed 2005–2011 in Ottawa were identified through chart review from a large pediatric health care center, and linked to the Ontario health administrative data to serve as positive reference standard. All other children living within Ottawa served as the negative reference standard. Case-identifying algorithms based on outpatient physician visits with associated ICD-9 code for CD plus endoscopy billing code were constructed and tested. Sensitivity, specificity, PPV and NPV were tested for each algorithm (with 95% CI). Poisson regression, adjusting for sex and age at diagnosis, was used to explore the trend in outpatient visits associated with a CD diagnostic code from 1995–2011. Results The best algorithm to identify CD consisted of an endoscopy billing claim follow by 1 or more adult or pediatric gastroenterologist encounters after the endoscopic procedure. The sensitivity, specificity, PPV, and NPV for the algorithm were: 70.4% (95% CI 61.1–78.4%), >99.9% (95% CI >99.9->99.9%), 53.3% (95% CI 45.1–61.4%) and >99.9% (95% CI >99.9->99.9%) respectively. It identified 1289 suspected CD cases from Ontario-wide administrative data. There was a 9% annual increase in the use of this combination of CD-associated diagnostic codes in physician billing data (RR 1.09, 95% CI 1.07–1.10, P<0.001). Conclusions With its current structure and variables Ontario health administrative data is not suitable in identifying incident pediatric CD cases. The tested algorithms suffer from poor sensitivity and/or poor PPV, which increase the risk of case misclassification that could lead to biased estimation of CD incidence rate. This study reinforced the importance of validating the codes used to identify cohorts or outcomes when conducting research using health administrative data.
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Affiliation(s)
- Jason Chan
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David R. Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas G. Manuel
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nassim Mojaverian
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Joseph de Nanassy
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Eric I. Benchimol
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Narang M, Puri AS, Sachdeva S, Singh J, Kumar A, Saran RK. Celiac disease and Helicobacter pylori infection in children: Is there any Association? J Gastroenterol Hepatol 2017; 32:1178-1182. [PMID: 27862319 DOI: 10.1111/jgh.13654] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/21/2016] [Accepted: 11/09/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Helicobacter pylori (HP) infection can influence the inflammatory and immune responses in the gut and may therefore play a role in the development of gluten-related enteropathy in genetically susceptible individuals. Our objective was to assess the relationship between celiac disease and HP infection in children. METHODS Children (1-18 years) diagnosed as celiac disease (CD) (n = 324) with submission of gastric and duodenal biopsies and duodenal histology having Marsh grade III features were eligible for the study. Non-celiac patients referred for endoscopy were selected as controls. We studied proportion of HP prevalence in children with confirmed CD as compared with HP prevalence in reference group comprising non-celiac children referred for endoscopy. We also evaluated predictors of HP infection in children with celiac disease. RESULTS Of the 324 participants with CD, gastric HP was seen in 37 (11.4%) patients. The prevalence of HP in patients without CD (50%, P < 0.001) was significantly higher. Among patients with CD, HP infection was most frequent in patients with Marsh IIIa. In the stepwise regression analysis for risk factors of HP infection in CD patients: presence of gastritis, hemoglobin, and absence of scalloping were found to be independent predictors in a multivariate setup. CONCLUSION Celiac disease and gastric HP infection have inverse relationship that raises the question whether development of HP infection confers protection against CD.
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Affiliation(s)
- Manish Narang
- Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Amarender Singh Puri
- Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Jatinderpal Singh
- Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Ravindra K Saran
- Department of Pathology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
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Abstract
Gluten-related disorders include celiac disease (CD), wheat allergy, and nonceliac gluten sensitivity. CD is an autoimmune enteropathy caused by damage to small intestinal mucosa when gluten is ingested in genetically susceptible individuals. Currently, the only available treatment of CD is gluten-free diet. Several potential treatments are being researched. Wheat allergy is a hypersensitivity reaction caused by IgE-mediated and/or non-IgE-mediated immune response, and can involve the gastrointestinal tract, skin, or respiratory tract. Nonceliac gluten sensitivity is one of a variety of immunologic, morphologic, or symptomatic manifestations precipitated by ingestion of gluten in individuals in whom CD and wheat allergy are excluded.
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Affiliation(s)
- Runa D Watkins
- Pediatric Gastroenterology & Nutrition, University of Maryland, 22 South Greene Street, N5W68, Baltimore, MD 21201, USA.
| | - Shamila Zawahir
- Pediatric Gastroenterology & Nutrition, University of Maryland, 22 South Greene Street, N5W68, Baltimore, MD 21201, USA
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Mohan Kumar BV, Prasada Rao UJS, Prabhasankar P. Immunogenicity characterization of hexaploid and tetraploid wheat varieties related to celiac disease and wheat allergy. FOOD AGR IMMUNOL 2017. [DOI: 10.1080/09540105.2017.1319342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- B. V. Mohan Kumar
- Flour Milling Baking and Confectionery Technology Department, CSIR-Central Food Technological Research Institute, Mysore, India
- Academy of Scientific & Innovative Research (AcSIR), CSIR-Central Food Technological Research Institute, Mysore, India
| | - U. J. S. Prasada Rao
- Department Biochemistry, CSIR-Central Food Technological Research Institute, Mysore, India
| | - P. Prabhasankar
- Flour Milling Baking and Confectionery Technology Department, CSIR-Central Food Technological Research Institute, Mysore, India
- Academy of Scientific & Innovative Research (AcSIR), CSIR-Central Food Technological Research Institute, Mysore, India
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Clinical Characteristics and the Dietary Response in Celiac Disease Patients Presenting With or Without Anemia. J Clin Gastroenterol 2017; 51:412-416. [PMID: 27306936 DOI: 10.1097/mcg.0000000000000556] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS It remains unclear as to what are the clinical characteristics associated with the presence of anemia at celiac disease diagnosis, and how these are affected by a gluten-free diet. We investigated these issues in a prospective study. METHODS Clinical and demographic data, small-bowel mucosal histology, serology, and laboratory parameters, body mass index (BMI), and bone mineral density (BMD) both at diagnosis and after 1 year on a gluten-free diet were investigated in 163 adults with celiac disease. Gastrointestinal symptoms and psychological well-being were evaluated by validated Gastrointestinal Symptom Rating Scale and Psychological General Well-Being questionnaires. All study variables were compared between participants with and without anemia at celiac disease diagnosis. RESULTS Altogether, 23% of the patients had anemia at diagnosis. Anemic patients were more often women (P=0.001) and had more gastrointestinal symptoms (P=0.004) and were less often screen detected (P=0.009). Further, they had higher celiac antibody values (P=0.007) and a lower total iron (P<0.001), BMI (P=0.003), and density of mucosal γδ+ intraepithelial lymphocytes (P=0.033). After 1 year on a gluten-free diet, the anemia group had a lower mucosal villous height-crypt depth ratio (P=0.008) and BMI (P=0.050), and higher antibody values (P=0.012) and densities of CD3 (P=0.008) and αβ+ intraepithelial lymphocytes (P=0.022). There was no significant difference between the groups in their bone mineral density, Gastrointestinal Symptom Rating Scale and Psychological General Well-Being. CONCLUSIONS Celiac patients with anemia had more severe disease than nonanemic patients in terms of the serology and a lower BMI. Further, they evinced a slower histologic response to the dietary treatment. An early diagnosis and careful follow-up are important in these patients.
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