1
|
Haimi M, Lerner A. Utilizing Telemedicine Applications in Celiac Disease and Other Gluten-Free-Diet-Dependent Conditions: Insights from the COVID-19 Pandemic. Healthcare (Basel) 2024; 12:1132. [PMID: 38891207 PMCID: PMC11171739 DOI: 10.3390/healthcare12111132] [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: 05/04/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Globally, approximately 1.4% of people have celiac disease (CD), induced by gluten sensitivity. If left untreated, it causes small intestinal inflammation and villous atrophy, which can result in failure to thrive, anemia, osteoporosis, malabsorption, and even malignancy. The only treatment option available is a gluten-free diet (GFD). Few studies have looked at the role and perception of telehealth in relation to CD and selective nutrition both before and after the COVID-19 pandemic. AIM Our goal was to screen and investigate the research conducted both before and after the COVID-19 pandemic concerning the utilization of telehealth applications and solutions in CD and other GFD-dependent circumstances. METHODS We employed a narrative review approach to explore articles that were published in scholarly journals or organizations between the years 2000 and 2024. Only English-language publications were included. PubMed and Google Scholar searches were mainly conducted using the following keywords: telemedicine, telehealth, telecare, eHealth, m-health, COVID-19, SARS-CoV-2, celiac disease, and gluten-free diet (GFD). Manual searches of the references in the acquired literature were also carried out, along with the authors' own personal contributions of their knowledge and proficiency in this field. RESULTS Only a few studies conducted prior to the COVID-19 outbreak examined the viewpoints and experiences of adult patients with CD with relation to in-person clinic visits, as well as other options such as telehealth. The majority of patients believed that phone consultations were appropriate and beneficial. Video conferencing and telemedicine became more popular during the COVID-19 pandemic, demonstrating the effectiveness of using these technologies for CD on a global basis. In recent years, urine assays for gluten identification have become accessible for use at home. These tests could be helpful for CD monitoring with telemedicine assistance. CONCLUSIONS The extended knowledge gathered from the COVID-19 pandemic is expected to complement pre-COVID-19 data supporting the usefulness of telemedicine even after the emergent pandemic, encouraging its wider adoption in standard clinical practice. The monitoring and follow-up of CD patients and other GFD-dependent conditions can greatly benefit from telemedicine.
Collapse
Affiliation(s)
- Motti Haimi
- Health Systems Management Department, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Aaron Lerner
- Chaim Sheba Medical Center, The Zabludowicz Research Center for Autoimmune Diseases, Ramat Gan 5266202, Israel;
- Research Department, Ariel University, Ariel 407000, Israel
| |
Collapse
|
2
|
Sabooniha F. Psoriasis, bone and bowel: a comprehensive review and new insights. EXPLORATION OF MUSCULOSKELETAL DISEASES 2024; 2:1-19. [DOI: https:/doi.org/10.37349/emd.2024.00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/01/2023] [Indexed: 01/25/2024]
Abstract
Psoriasis is a chronic immune-mediated disorder affecting about 2% of the population worldwide which is associated with significant morbidity. The disease usually presents as raised, well-demarcated erythematous plaques with adherent silvery scales. Psoriasis can appear at any age but it has two peaks occurring at 15–20 and 55–60 years of age. It affects males and females equally. Despite the multitude of investigations about psoriasis and even development of drugs with satisfactory results, its pathogenesis is not fully understood yet and its course is unpredictable. Various environmental triggers, e.g., obesity, stress and drugs may induce disease in genetically susceptible patients. Although psoriasis was considered primarily as a disease of the skin, more investigations have been revealed its systemic nature. Psoriatic arthritis (PsA) may complicate up to one-third of cases of psoriasis vulgaris (PV). Also, the association between psoriasis and a variety of other immune-mediated disorders such as inflammatory bowel disease (IBD) and celiac disease (CD) has been confirmed in various studies. Moreover, a growing body of evidences indicates that psoriasis shares some common histological and phenotypical properties with the spectrum of osteoimmunological diseases such as Paget’s disease of bone (PDB). Thus, exploring the common molecular and genetic mechanisms underlying psoriasis and related disorders is of paramount importance for better elucidating disease pathogenesis and designing more targeted treatments.
Collapse
|
3
|
Sernicola A, Mazzetto R, Tartaglia J, Ciolfi C, Miceli P, Alaibac M. Role of Human Leukocyte Antigen Class II in Antibody-Mediated Skin Disorders. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1950. [PMID: 38003999 PMCID: PMC10673328 DOI: 10.3390/medicina59111950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
HLA class II molecules are key factors determining susceptibility to autoimmune disorders, and their role in immune-mediated skin conditions such as psoriasis has been extensively investigated. However, there is currently little understanding of their role in antibody-mediated skin diseases such as autoimmune blistering disorders. We researched the available literature using PubMed to narratively review the current knowledge on HLA associations in antibody-mediated blistering skin pathologies. Our results summarized the risk alleles that are identified in the literature, together with certain known protective alleles: in the pemphigus group, alleles HLA-DQB1*0503 and HLA-DRB1*0402 are most commonly associated with disease; in the pemphigoid group, the most studied allele is HLA-DQB1*0301; in epidermolysis bullosa acquisita, few genetic studies are available; in dermatitis herpetiformis, the association with haplotypes HLA-DQ2 and HLA-DQ8 is strongly established; finally, in linear IgA bullous disease, specific HLA alleles may be responsible for pediatric presentations. Our current pathogenic understanding of this group of disorders assigns a key role to predisposing HLA class II alleles that are able to bind disease autoantigens and therefore stimulate antigen-specific autoreactive T cells. The latter engage B lymphocytes that will produce pathogenic autoantibodies. The distribution of HLA alleles and their disease associations are variable across demographics, and an in-depth pathogenetic understanding is needed to support associations between HLA alleles and disease phenotypes. Additionally, in a personalized medicine approach, the identification of HLA alleles associated with the risk of disease may become clinically relevant in identifying susceptible subjects that should avoid exposure to known triggers, such as medication, when possible.
Collapse
|
4
|
Khani S, Soheili A, Vahabi SM, Dara N, Sayyari A, Nilipour Y, Parvizi M, Hosseini A. Co-occurrence of celiac disease and glycogen storage disease in a five-year-old patient with diabetes mellitus; a case report. Clin Case Rep 2023; 11:e7804. [PMID: 37614289 PMCID: PMC10442470 DOI: 10.1002/ccr3.7804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/05/2023] [Accepted: 07/08/2023] [Indexed: 08/25/2023] Open
Abstract
A patient presented with edema, ascites and jaundice. Histologic report was consistent with Celiac Disease. Liver biopsy commensurate with Glycogen storage disease III, which was confirmed by genetic testing. A gluten-free diet was initiated. After 2 months, ascites was relieved, hepatic function was improved, and hepatic size reduced.
Collapse
Affiliation(s)
- Sina Khani
- Medical Student Research Committee, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Amirali Soheili
- Medical Student Research Committee, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | | | - Naghi Dara
- Pediatric Gastroentrology, Hepatology and Nutrition Research Center Research Institute for Children's HealthShahid Beheshti University of Medical sciencesTehranIran
| | - Aliakbar Sayyari
- Pediatric Gastroentrology, Hepatology and Nutrition Research Center Research Institute for Children's HealthShahid Beheshti University of Medical sciencesTehranIran
| | - Yalda Nilipour
- Pediatric Pathology Research Center, Research Institute for children's HealthShahid Beheshti University of Medical SciencesTehranIran
| | - Maryam Parvizi
- Pediatric Pathology Research Center, Research Institute for children's HealthShahid Beheshti University of Medical SciencesTehranIran
| | - Amirhossein Hosseini
- Pediatric Gastroentrology, Hepatology and Nutrition Research Center Research Institute for Children's HealthShahid Beheshti University of Medical sciencesTehranIran
| |
Collapse
|
5
|
Gluten proteins: Enzymatic modification, functional and therapeutic properties. J Proteomics 2022; 251:104395. [PMID: 34673267 DOI: 10.1016/j.jprot.2021.104395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/13/2021] [Accepted: 09/27/2021] [Indexed: 01/28/2023]
Abstract
Glutens are potential proteins with multifunctional therapeutic effects. Their covalence network structures with and without protease inhibitors are expected to enhance or to serve further properties and further technological points such as increased bioactive surfaces, gelatinization, gelation and pasting properties. The depletion of the allergic peptide sequences of gluten proteins comprising sometimes protease inhibitors are valid via the enzymatic ingestion using proteolytic enzymes that might enhance these functional and technological processes by producing active peptides having osmoregulation and regular glass transitions, surface activity for coating and encapsulation properties. In addition to further therapeutic functions such as immunoregulatory, antithrombin and opioidal activities, particularly in eradicating most of the free radicals, suppressing diabetes Mellitus II complications and inhibiting angiotensin converting enzyme cardiovascular growth diseases.
Collapse
|
6
|
Vitale S, Maglio M, Picascia S, Mottola I, Miele E, Troncone R, Auricchio R, Gianfrani C. Intestinal Cellular Biomarkers of Mucosal Lesion Progression in Pediatric Celiac Disease. Pharmaceutics 2021; 13:pharmaceutics13111971. [PMID: 34834386 PMCID: PMC8623763 DOI: 10.3390/pharmaceutics13111971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
Celiac disease (CD) is a chronic intestinal inflammation caused by gluten ingestion in genetically predisposed individuals. Overt-CD and potential-CD are the two main forms of gluten intolerance in pediatric patients with different grades of intestinal mucosa lesion and clinical management. For overt-CD patients the gluten-free diet is mandatory, while for potential-CD the dietary therapy is recommended only for those subjects becoming clinically symptomatic overtime. To date, specific early biomarkers of evolution to villous atrophy in potential-CD are lacking. We recently observed an expansion of TCRγδ+ T cells and a concomitant disappearance of IL4-producing T cells in the intestinal mucosa of overt-CD patients compared to potential-CD children, suggesting the involvement of these two cells subsets in the transition from potential-CD to overt-CD. In this study, we demonstrated that the intestinal densities of IL4+ T cells inversely correlated with TCRγδ+ T cell expansion (p < 0.005) and with the serum levels of anti-tissue transglutaminase antibodies (p < 0.01). The changes of these two cell subsets strongly correlated with mucosal lesions, according to the histological Marsh classification, as the transition from M0 to M3 lesions was associated with a significant reduction of IL4+ T cells (M0 vs. M1 p < 0.04, M0 vs. M3 p < 0.007) and an increase of TCRγδ+ T cells (M0 vs. M1 p < 0.05, M0 vs. M3 p < 0.0006). These findings strongly suggest that the detection of TCRγδ+ and IL4+ T cells could serve as cellular biomarkers of mucosal lesion and targets of novel immunomodulatory therapies for CD.
Collapse
Affiliation(s)
- Serena Vitale
- Institute of Biochemistry and Cell Biology-CNR, 80131 Naples, Italy; (S.V.); (S.P.); (I.M.); (C.G.)
| | - Mariantonia Maglio
- Department of Translational Medicine & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.M.); (E.M.); (R.T.)
| | - Stefania Picascia
- Institute of Biochemistry and Cell Biology-CNR, 80131 Naples, Italy; (S.V.); (S.P.); (I.M.); (C.G.)
| | - Ilaria Mottola
- Institute of Biochemistry and Cell Biology-CNR, 80131 Naples, Italy; (S.V.); (S.P.); (I.M.); (C.G.)
| | - Erasmo Miele
- Department of Translational Medicine & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.M.); (E.M.); (R.T.)
| | - Riccardo Troncone
- Department of Translational Medicine & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.M.); (E.M.); (R.T.)
| | - Renata Auricchio
- Department of Translational Medicine & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.M.); (E.M.); (R.T.)
- Correspondence:
| | - Carmen Gianfrani
- Institute of Biochemistry and Cell Biology-CNR, 80131 Naples, Italy; (S.V.); (S.P.); (I.M.); (C.G.)
- Department of Translational Medicine & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.M.); (E.M.); (R.T.)
| |
Collapse
|
7
|
Gomez-Casado C, Sanchez-Solares J, Izquierdo E, Díaz-Perales A, Barber D, Escribese MM. Oral Mucosa as a Potential Site for Diagnosis and Treatment of Allergic and Autoimmune Diseases. Foods 2021; 10:970. [PMID: 33925074 PMCID: PMC8146604 DOI: 10.3390/foods10050970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
Most prevalent food allergies during early childhood are caused by foods with a high allergenic protein content, such as milk, egg, nuts, or fish. In older subjects, some respiratory allergies progressively lead to food-induced allergic reactions, which can be severe, such as urticaria or asthma. Oral mucosa remodeling has been recently proven to be a feature of severe allergic phenotypes and autoimmune diseases. This remodeling process includes epithelial barrier disruption and the release of inflammatory signals. Although little is known about the immune processes taking place in the oral mucosa, there are a few reports describing the oral mucosa-associated immune system. In this review, we will provide an overview of the recent knowledge about the role of the oral mucosa in food-induced allergic reactions, as well as in severe respiratory allergies or food-induced autoimmune diseases, such as celiac disease.
Collapse
Affiliation(s)
- Cristina Gomez-Casado
- Institute of Applied Molecular Medicine, Department of Basic Medical Sciences, Faculty of Medicine, San Pablo CEU University, 28003 Madrid, Spain; (J.S.-S.); (E.I.); (D.B.); (M.M.E.)
| | - Javier Sanchez-Solares
- Institute of Applied Molecular Medicine, Department of Basic Medical Sciences, Faculty of Medicine, San Pablo CEU University, 28003 Madrid, Spain; (J.S.-S.); (E.I.); (D.B.); (M.M.E.)
| | - Elena Izquierdo
- Institute of Applied Molecular Medicine, Department of Basic Medical Sciences, Faculty of Medicine, San Pablo CEU University, 28003 Madrid, Spain; (J.S.-S.); (E.I.); (D.B.); (M.M.E.)
| | - Araceli Díaz-Perales
- Center of Plant Biotechnology and Genomics, Technical University of Madrid, 28040 Madrid, Spain;
| | - Domingo Barber
- Institute of Applied Molecular Medicine, Department of Basic Medical Sciences, Faculty of Medicine, San Pablo CEU University, 28003 Madrid, Spain; (J.S.-S.); (E.I.); (D.B.); (M.M.E.)
| | - María M. Escribese
- Institute of Applied Molecular Medicine, Department of Basic Medical Sciences, Faculty of Medicine, San Pablo CEU University, 28003 Madrid, Spain; (J.S.-S.); (E.I.); (D.B.); (M.M.E.)
| |
Collapse
|
8
|
Iron Absorption in Celiac Disease and Nutraceutical Effect of 7-Hydroxymatairesinol. Mini-Review. Molecules 2020; 25:molecules25092041. [PMID: 32349426 PMCID: PMC7249079 DOI: 10.3390/molecules25092041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 12/23/2022] Open
Abstract
Anemia is the main extra-gastrointestinal symptom in inflammatory bowel diseases (IBDs). Interleukin-6 (IL-6) and other cytokines are secreted and act in the microenvironment of the small intestine mucous membrane of IBD patients. Iron is essential for multiple cell functions and its homeostasis is regulated by the hepcidin–ferroportin axis. Hepcidin (HEPC) is mainly produced by the liver in response to iron needs but is also an acute phase protein. During inflammation, hepcidin is upregulated by IL-6 and is responsible for iron compartmentalization within cells, in turn causing anemia of inflammation. Tissues other than liver can produce hepcidin in response to inflammatory stimuli, in order to decrease iron efflux at a local level, then acting in an autocrine–paracrine manner. In IBDs and, in particular, in celiac disease (CeD), IL-6 might trigger the expression, upregulation and secretion of hepcidin in the small intestine, reducing iron efflux and exacerbating defective iron absorption. 7-Hydroxymatairesinol (7-HMR) belongs to the family of lignans, polyphenolic compounds produced by plants, and has nutraceutical antioxidant, anti-inflammatory and estrogenic properties. In this mini-review we revise the role of inflammation in IBDs and in particular in CeD, focusing our attention on the close link among inflammation, anemia and iron metabolism. We also briefly describe the anti-inflammatory and estrogenic activity of 7-HMR contained in foods that are often consumed by CeD patients. Finally, considering that HEPC expression is regulated by iron needs, inflammation and estrogens, we explored the hypothesis that 7-HMR consumption could ameliorate anemia in CeD using Caco-2 cells as bowel model. Further studies are needed to verify the regulation pathway through which 7-HMR may interfere with the local production of HEPC in bowel.
Collapse
|
9
|
Isasi C, Stadnitsky A, Casco F, Tejerina E, Royuela A, Esteban B, Puga NF. Non-celiac gluten sensitivity and chronic refractory low back pain with spondyloarthritis features. Med Hypotheses 2020; 140:109646. [PMID: 32145444 DOI: 10.1016/j.mehy.2020.109646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To propose the hypothesis that non-celiac gluten sensitivity is associated with chronic low-back pain related to spondyloarthritis, and a gluten free diet has a therapeutic benefit in a subgroup of patients. Gut involvement is a well-known association of spondyloarthritis but limited to a few disorders such as inflammatory bowel disease. Currently the therapeutic implication of this association is pharmacologic treatment for inflammation with immunosupresive drugs for both diseases. Here is a case series of patients with chronic low-back pain, spondyloarthritis related features, and response to gluten free diet despite celiac disease being ruled out. METHODS Retrospective case report of 110 patients from a tertiary hospital rheumatology clinic specialized in chronic pain and gluten sensitivity. These are patients with refractory low-back pain and spondyloarthritis features who followed a gluten free diet despite celiac disease being ruled out. Demanding improvement was defined based on the achievement of at least one of the following objectives: asymptomatic status, remission of chronic low-back pain, returning to normal life, returning to work, changing from confinement to bed/wheelchair to being able to walk, returning to self-sufficiency for hygiene and personal care, discontinuation of opioids. RESULTS Average age at low-back onset pain was 30. Average disease duration was 15 years. 87 (79%) of the patients experienced improvement. 69 (62%) of the patients achieved demanding improvement. Average duration of gluten-free diet in patients with demanding improvement was 60 months. 56 out of 69 patients with demanding improvement ingested gluten. Of these 56 patients, 54 experienced clinical worsening and were considered as having non-celiac gluten sensitivity. Oral aphthae and having a relative with celiac disease were associated with demanding improvement. Out of 28 patients retrospectively classified as having axial spondyloarthritis, 23 had demanding improvement. Out of 16 patients with uveitis, 13 had demanding improvement. Out of 83 patients with fibromyalgia, 48 had demanding improvement. CONCLUSION These observational data support the proposed hypothesis and offer information regarding possible clinical predictors of response to diet.
Collapse
Affiliation(s)
- Carlos Isasi
- Rheumatology Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Alexander Stadnitsky
- Family Medicine at Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Fernando Casco
- Pathological Anatomy Department of Unilabs, Madrid, Spain
| | - Eva Tejerina
- Pathological Anatomy Department of Hospital Universitario Puerta de Hierro, Majadahonda Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain
| | - Blanca Esteban
- Asociación de celíacos y sensibles al gluten de Madrid (Association of Celiacs and Gluten-Sensitives of Madrid, Spain
| | - Natalia Fernandez Puga
- Digestive Medicine Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| |
Collapse
|
10
|
Sharma N, Bhatia S, Chunduri V, Kaur S, Sharma S, Kapoor P, Kumari A, Garg M. Pathogenesis of Celiac Disease and Other Gluten Related Disorders in Wheat and Strategies for Mitigating Them. Front Nutr 2020; 7:6. [PMID: 32118025 PMCID: PMC7020197 DOI: 10.3389/fnut.2020.00006] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/20/2020] [Indexed: 12/12/2022] Open
Abstract
Wheat is a major cereal crop providing energy and nutrients to the billions of people around the world. Gluten is a structural protein in wheat, that is necessary for its dough making properties, but it is responsible for imparting certain intolerances among some individuals, which are part of this review. Most important among these intolerances is celiac disease, that is gluten triggered T-cell mediated autoimmune enteropathy and results in villous atrophy, inflammation and damage to intestinal lining in genetically liable individuals containing human leukocyte antigen DQ2/DQ8 molecules on antigen presenting cells. Celiac disease occurs due to presence of celiac disease eliciting epitopes in gluten, particularly highly immunogenic alpha-gliadins. Another gluten related disorder is non-celiac gluten-sensitivity in which innate immune-response occurs in patients along with gastrointestinal and non-gastrointestinal symptoms, that disappear upon removal of gluten from the diet. In wheat allergy, either IgE or non-IgE mediated immune response occurs in individuals after inhalation or ingestion of wheat. Following a life-long gluten-free diet by celiac disease and non-celiac gluten-sensitivity patients is very challenging as none of wheat cultivar or related species stands safe for consumption. Hence, different molecular biology, genetic engineering, breeding, microbial, enzymatic, and chemical strategies have been worked upon to reduce the celiac disease epitopes and the gluten content in wheat. Currently, only 8.4% of total population is affected by wheat-related issues, while rest of population remains safe and should not remove wheat from the diet, based on false media coverage.
Collapse
Affiliation(s)
- Natasha Sharma
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Simran Bhatia
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Venkatesh Chunduri
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Satveer Kaur
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Saloni Sharma
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Payal Kapoor
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Anita Kumari
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Monika Garg
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| |
Collapse
|
11
|
Abstract
Celiac disease is a common inflammatory disease triggered by dietary gluten in genetically susceptible individuals. The strongest and best-characterized genetic susceptibilities in celiac disease are class II human leukocyte antigen (HLA) genes known as HLA-DQ2 and DQ8. HLA genetic testing is available through a number of commercial and academic laboratories and is used in the evaluation of celiac disease and to identify at-risk family members. Importantly, HLA genetic testing has a high negative predictive value for celiac disease, but a low positive predictive value. Therefore, for a practicing clinician, it is important to understand when to order HLA genetic testing, what test to order, and how to interpret the result. This review provides a practical primer on HLA genetics in celiac disease.
Collapse
|
12
|
Bascuñán KA, Roncoroni L, Branchi F, Doneda L, Scricciolo A, Ferretti F, Araya M, Elli L. The 5 Ws of a gluten challenge for gluten-related disorders. Nutr Rev 2019; 76:79-87. [PMID: 29325090 DOI: 10.1093/nutrit/nux068] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Gluten-related disorders (GRDs) are gradually emerging as epidemiologically relevant diseases, with a global prevalence estimated to be approximately 5% in the population. Conditions related to gluten ingestion include celiac disease (CD), wheat allergy (WA), and nonceliac gluten sensitivity (NCGS). Although mediated by different pathogenic pathways, these 3 conditions share similar clinical manifestations and can present a difficult differential diagnosis. The gluten challenge (GC) is an important diagnostic tool for GRDs, but there is great variability in regards to deciding which patients should be challenged, what amount of gluten should be used, what the GC duration should be, when and where the GC should occur, and, sometimes, why to conduct a GC. This review summarizes the current knowledge about the desirable characteristics of GCs in the 3 main GRDs following a 5 Ws approach-that is, the 5 main journalistic questions: who, what, when, where, why. The answers will help to determine the correct use of the GC in diagnosing GRDs.
Collapse
Affiliation(s)
- Karla A Bascuñán
- Department of Nutrition, School of Medicine, University of Chile, Santiago, Chile
| | - Leda Roncoroni
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy
| | - Federica Branchi
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Luisa Doneda
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy
| | - Alice Scricciolo
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Francesca Ferretti
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Magdalena Araya
- Institute of Nutrition and Food Technology, INTA, University of Chile, Santiago, Chile
| | - Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
13
|
Long-Term Outcome of Potential Celiac Disease in Genetically at-Risk Children: The Prospective CELIPREV Cohort Study. J Clin Med 2019; 8:jcm8020186. [PMID: 30764503 PMCID: PMC6406363 DOI: 10.3390/jcm8020186] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The long-term outcome of potential celiac disease (CD) is still a debated issue. We aimed to evaluate the progression of potential CD versus overt CD after 10-years of follow-up in a cohort of children genetically predisposed to CD. METHODS The CELIPREV study is prospectively following from birth 553 children with CD-predisposing HLA genes. Children with a diagnosis of potential CD continued to receive a normal diet and repeated the serological screening for CD every year. An intestinal biopsy was taken in presence of persistent positive serology. RESULTS Overall, 26 (4.7%) children received a diagnosis of potential CD (50% females, median age 24 months). All children were symptom-free. Twenty-three children continued a gluten-containing diet; at 10 years from the first biopsy, three children developed overt CD (13%), 19 (83%) became antibodies negative at 1 year from the first biopsy and remained negative up to 10 years of follow-up and one subject (4%) had fluctuating antibody course with transiently negative values and persistently negative biopsy. CONCLUSIONS In children genetically predisposed to CD with a diagnosis of potential CD the risk of progression to overt CD while on a gluten-containing diet is very low in the long-term.
Collapse
|
14
|
Xu Y, Wan Q, Feng J, Du L, Li K, Zhou Y. Whole grain diet reduces systemic inflammation: A meta-analysis of 9 randomized trials. Medicine (Baltimore) 2018; 97:e12995. [PMID: 30412134 PMCID: PMC6221555 DOI: 10.1097/md.0000000000012995] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUNDS Observational studies had suggested an inverse association between whole grain consumption and concentration of inflammatory markers, but evidence from interventional studies was inconsistent. Therefore, we conducted a meta-analysis of randomized trials to have a better understanding of this issue. METHODS This study has been registered in PROSPERO (ID: CRD42018096533). We searched PubMed, Web of Science, Embase, Medline, and Cochrane Library for articles focusing on the topic from inception to 1 January, 2018. Summary standardized mean difference (SMD) and 95% confidence interval (CI) were calculated by using either random effect model or fixed effect model according to the heterogeneity of included studies. Subgroup analysis was also performed. RESULTS Totally 9 randomized trials included 838 participants were identified. In a pooled analysis of all studies, consumption of whole grains had an inverse association with inflammatory markers (SMD 0.16, 95% CI, 0.02-0.30), including C-reactive protein (CRP), Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α), Interleukin-1β (IL-1β). Specific analyses for CRP and IL-6 yielded that whole grain diet was related with a significant decrease in the concentration of CRP (SMD 0.29, 95% CI, 0.08-0.50) and IL-6 (SMD 0.19, 95% CI, 0.03-0.36). CONCLUSIONS The evidence suggested that citizens could benefit from increased whole grain intake for reducing systemic inflammation. Further well-designed studies are required to investigate the mechanism under the appearance.
Collapse
Affiliation(s)
- Yujie Xu
- West China School of Nursing and Department of Nursing
| | | | - Jinhua Feng
- Department of Biliary Surgery, West China Hospital, Sichuan University
| | - Liang Du
- Chinese Evidence-Based Medicine/Cochrane Center
| | - Ka Li
- Department of nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zhou
- Department of Gastrointestinal Surgery
| |
Collapse
|
15
|
Yu XB, Uhde M, Green PH, Alaedini A. Autoantibodies in the Extraintestinal Manifestations of Celiac Disease. Nutrients 2018; 10:E1123. [PMID: 30127251 PMCID: PMC6115844 DOI: 10.3390/nu10081123] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/15/2018] [Accepted: 08/17/2018] [Indexed: 02/07/2023] Open
Abstract
Increased antibody reactivity towards self-antigens is often indicative of a disruption of homeostatic immune pathways in the body. In celiac disease, an autoimmune enteropathy triggered by the ingestion of gluten from wheat and related cereals in genetically predisposed individuals, autoantibody reactivity to transglutaminase 2 is reflective of the pathogenic role of the enzyme in driving the associated inflammatory immune response. Autoantibody reactivity to transglutaminase 2 closely corresponds with the gluten intake and clinical presentation in affected patients, serving as a highly useful biomarker in the diagnosis of celiac disease. In addition to gastrointestinal symptoms, celiac disease is associated with a number of extraintestinal manifestations, including those affecting skin, bones, and the nervous system. Investigations of these manifestations in celiac disease have identified a number of associated immune abnormalities, including B cell reactivity towards various autoantigens, such as transglutaminase 3, transglutaminase 6, synapsin I, gangliosides, and collagen. Clinical relevance, pathogenic potential, mechanism of development, and diagnostic and prognostic value of the various identified autoantibody reactivities continue to be subjects of investigation and will be reviewed here.
Collapse
Affiliation(s)
- Xuechen B Yu
- Department of Medicine, Columbia University Medical Center, 1130 Saint Nicholas Ave., New York, NY 10032, USA.
- Celiac Disease Center, Columbia University, New York, NY 10032, USA.
- Institute of Human Nutrition, Columbia University, New York, NY 10032, USA.
| | - Melanie Uhde
- Department of Medicine, Columbia University Medical Center, 1130 Saint Nicholas Ave., New York, NY 10032, USA.
- Celiac Disease Center, Columbia University, New York, NY 10032, USA.
| | - Peter H Green
- Department of Medicine, Columbia University Medical Center, 1130 Saint Nicholas Ave., New York, NY 10032, USA.
- Celiac Disease Center, Columbia University, New York, NY 10032, USA.
| | - Armin Alaedini
- Department of Medicine, Columbia University Medical Center, 1130 Saint Nicholas Ave., New York, NY 10032, USA.
- Celiac Disease Center, Columbia University, New York, NY 10032, USA.
- Institute of Human Nutrition, Columbia University, New York, NY 10032, USA.
| |
Collapse
|
16
|
Pinto-Sanchez MI, Verdu EF. Non-celiac gluten or wheat sensitivity: It's complicated! Neurogastroenterol Motil 2018; 30:e13392. [PMID: 30854780 DOI: 10.1111/nmo.13392] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022]
Abstract
In the last 30 years, non-celiac gluten sensitivity (NCGS) has emerged as an intriguing and controversial topic in gastroenterology. The diagnosis of NCGS/NCWS requires a symptomatic reaction to gluten, or wheat-containing food, and remission of symptoms with gluten or wheat challenge, in patients in whom celiac disease and wheat allergy have been excluded. There have been several randomized clinical trials (RCT) addressing this issue which have produced controversial results. In this issue of Neurogastroenterology and Motility, a double-blind placebo-controlled randomized trial in patients with suspected NCGS on GFD, did not reproduce symptoms after gluten intake compared to placebo. This mini-review addresses outstanding issues related to the diagnosis of NCGS/NCWS as well as areas of interest for future studies that could explain, in part, the controversy in this area.
Collapse
Affiliation(s)
- Maria I Pinto-Sanchez
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Elena F Verdu
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
17
|
Nutritional constituents of pseudo cereals and their potential use in food systems: A review. Trends Food Sci Technol 2018. [DOI: 10.1016/j.tifs.2018.03.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
18
|
The incidence of HLA-DQ2/DQ8 in Turkish children with celiac disease and a comparison of the geographical distribution of HLA-DQ. GASTROENTEROLOGY REVIEW 2017; 12:256-261. [PMID: 29358994 PMCID: PMC5771449 DOI: 10.5114/pg.2017.72099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/20/2016] [Indexed: 12/31/2022]
Abstract
Introduction Celiac disease (CD) is an auto-immune enteropathy that occurs in genetically pre-disposed people as a result of the consumption of gluten-containing foods. Aim To identify the incidence of HLA-DQ2 and HLA-DQ8 observed in children with CD. Material and methods In this study, we focused on children ranging in age from 2 to 18 years and diagnosed with celiac disease. In our patients diagnosed with CD, in addition to tissue transglutaminase antibodies (anti-tTG), we also evaluated HLA-DQ2 B1 and HLA-DQ8 B1 alleles using the method of polymerase chain reaction (PCR)/sequence-specific oligonucleotide probes (Luminex®). The detection of 0201/0202 for HLA-DQ2 allele and 0302 for HLA-DQ8 allele was accepted as a positive result. Results The mean age of our patients with celiac disease was 7.42 ±3.18 years, and the female/male ratio was 1.5/1. Seventy-six percent of our patients were HLA-DQ2 and/or HLA-DQ8 positive, 67% were HLA-DQ2 positive, and 25% were HLA-DQ8 positive. Nevertheless, 24% of them were HLA-DQ2 and HLA-DQ8 negative. The incidence of HLA-DQ2 in the control group was 18.8% with a significant difference compared to the HLA-DQ2 incidence in the patient group (67%) (p < 0.05). Similarly the HLA-DQ8 incidence in the control group (5.7%) was significantly lower than the incidence in the patient group (25%) (p < 0.05). Conclusions The incidence of the patients diagnosed with CD, who are HLA-DQ2 and HLA-DQ8 negative, varies among different populations.
Collapse
|
19
|
Intestinal Production of Anti-Tissue Transglutaminase 2 Antibodies in Patients with Diagnosis Other Than Celiac Disease. Nutrients 2017; 9:nu9101050. [PMID: 28934109 PMCID: PMC5691667 DOI: 10.3390/nu9101050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/06/2017] [Accepted: 09/14/2017] [Indexed: 12/21/2022] Open
Abstract
It has been hypothesized that gluten-dependent production of anti-tissue-transglutaminase 2 (anti-TG2) antibodies may occur only at an intestinal level. We have investigated intestinal production of anti-TG2 antibodies in 136 patients with normal serum levels of anti-TG2 antibodies and normal duodenal mucosa. Intestinal deposits of anti-TG2 antibodies were evaluated by immunofluorescence and anti-TG2 antibodies released in organ culture supernatants measured by ELISA. Intestinal antibody libraries were obtained from 10 subjects. Immunohistochemistry for CD25⁺, CD3⁺, and TCR-γδ⁺ was assessed in subjects with positive (n = 32) and negative (n = 31) intestinal anti-TG2 antibodies. Globally 33/136 (24%) seronegative patients produced anti-TG2 autoantibodies at an intestinal level. Antibody libraries analysis confirmed the anti-TG2 antibodies mucosal production in all (n = 8) positive subjects. Lamina propria CD25⁺ cell count was significantly (p < 0.05) higher in patients with intestinal anti-TG2. Moreover, 13/32 (41%) of them showed high TCR-γδ⁺/CD3⁺ ratios. Intestinal anti-TG2 antibody production does not show absolute specificity for CD. It is seen more often in association with inflamed mucosa. Further investigations are necessary to prove the possible role of dietary gluten.
Collapse
|
20
|
Parzanese I, Qehajaj D, Patrinicola F, Aralica M, Chiriva-Internati M, Stifter S, Elli L, Grizzi F. Celiac disease: From pathophysiology to treatment. World J Gastrointest Pathophysiol 2017; 8:27-38. [PMID: 28573065 PMCID: PMC5437500 DOI: 10.4291/wjgp.v8.i2.27] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 03/08/2017] [Accepted: 03/23/2017] [Indexed: 02/06/2023] Open
Abstract
Celiac disease, also known as "celiac sprue", is a chronic inflammatory disorder of the small intestine, produced by the ingestion of dietary gluten products in susceptible people. It is a multifactorial disease, including genetic and environmental factors. Environmental trigger is represented by gluten while the genetic predisposition has been identified in the major histocompatibility complex region. Celiac disease is not a rare disorder like previously thought, with a global prevalence around 1%. The reason of its under-recognition is mainly referable to the fact that about half of affected people do not have the classic gastrointestinal symptoms, but they present nonspecific manifestations of nutritional deficiency or have no symptoms at all. Here we review the most recent data concerning epidemiology, pathogenesis, clinical presentation, available diagnostic tests and therapeutic management of celiac disease.
Collapse
|
21
|
Intestinal, Systemic, and Oral Gluten-related Alterations in Patients With Nonceliac Gluten Sensitivity. J Clin Gastroenterol 2016; 50:849-858. [PMID: 26974761 DOI: 10.1097/mcg.0000000000000515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nonceliac gluten sensitivity (NCGS) is an emergent condition, the framework of which is yet unclear, whereas the diagnosis is suggested only by gluten-dependent symptoms after excluding wheat allergy and celiac disease (CD). Our goal was to highlight intestinal, systemic, and oral alterations to clarify the NCGS pathogenesis and identify new diagnostic tools. STUDY A total of 60 NCGS patients, 20 untreated CD, 20 treated CD, and 20 healthy volunteers were recruited. The differential diagnosis among gluten-related disorders was performed by serological, allergy, and histologic tools. NCGS patients were also subjected to antigliadin antibody (AGA) detection and HLA typing. All participants underwent an oral mucosa patch test for gluten (GOMPT), whereas an oral provocation test (OPT) for gluten was performed in 26 NCGS patients. RESULTS About 6/60 (10%) NCGS patients showed IgG AGA-positive results, whereas 45/60 (75%) patients carried HLA-DQ2 and/or HLA-DQ8 genes. GOMPT showed positive results in 45/60 (75%) NCGS patients, 3/20 (15%) untreated CD patients, 5/20 (25%) treated CD patients, and in no healthy volunteers. No significant difference was found between the severity of symptoms reported by NCGS patients subjected to OPT with gluten-containing croissants and those who underwent OPT with gluten-free croissants. CONCLUSIONS GOMPT seems to be a specific tool for NCGS diagnosis, although further investigations are needed to overcome limits due to the small population studied and to contextualize GOMPT false-positive results.
Collapse
|
22
|
Stefanucci A, Mollica A, Macedonio G, Zengin G, Ahmed AA, Novellino E. Exogenous opioid peptides derived from food proteins and their possible uses as dietary supplements: A critical review. FOOD REVIEWS INTERNATIONAL 2016. [DOI: 10.1080/87559129.2016.1225220] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Azzurra Stefanucci
- Dipartimento di Farmacia, Università di Chieti-Pescara “G. d’Annunzio”, Chieti, Italy
| | - Adriano Mollica
- Dipartimento di Farmacia, Università di Chieti-Pescara “G. d’Annunzio”, Chieti, Italy
| | - Giorgia Macedonio
- Dipartimento di Farmacia, Università di Chieti-Pescara “G. d’Annunzio”, Chieti, Italy
| | - Gokhan Zengin
- Department of Biology, Science Faculty, Selcuk University, Konya, Turkey
| | - Abdelkareem A. Ahmed
- Department of Physiology and Biochemistry, Faculty of Veterinary Science, University of Nyala, Nyala, Sudan
| | - Ettore Novellino
- Dipartimento di Farmacia, Università di Napoli “Federico II”, Naples, Italy
| |
Collapse
|
23
|
Agarwal S, Kovilam O, Zach TL, Agrawal DK. Immunopathogenesis and therapeutic approaches in pediatric celiac disease. Expert Rev Clin Immunol 2016; 12:857-69. [PMID: 26999328 PMCID: PMC4975578 DOI: 10.1586/1744666x.2016.1168294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/16/2016] [Indexed: 01/06/2023]
Abstract
Celiac Disease is an autoimmune enteropathy with increasing incidence worldwide in both adults and children. It occurs as an inflammatory condition with destruction of the normal architecture of villi on consumption of gluten and related protein products found in wheat, barley and rye. However, the exact pathogenesis is not yet fully understood. A gluten-free diet remains the main modality of therapy to date. While some patients continue to have symptoms even on a gluten-free diet, adherence to this diet is also difficult, especially for the children. Hence, there is continued interest in novel methods of therapy and the current research focus is on the promising novel non-dietary modalities of treatment. Here, we critically reviewed the existing literature regarding the pathogenesis of celiac disease in children including the role of in-utero exposure leading to neonatal and infant sensitization and its application for the development of new therapeutic approaches for these patients.
Collapse
Affiliation(s)
- Shreya Agarwal
- Department of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA
| | - Oormila Kovilam
- Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, NE, USA
| | - Terence L. Zach
- Department of Pediatrics, Creighton University School of Medicine, Omaha, NE, USA
| | - Devendra K. Agrawal
- Department of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA
| |
Collapse
|
24
|
Infantino M, Manfredi M, Meacci F, Grossi V, Severino M, Benucci M, Bellio E, Bellio V, Nucci A, Zolfanelli F, Ugolini S, Catani S, Macchia D. Diagnostic accuracy of anti-gliadin antibodies in Non-Celiac Gluten Sensitivity (NCGS) patients. Clin Chim Acta 2015; 451:135-41. [DOI: 10.1016/j.cca.2015.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/08/2015] [Accepted: 09/17/2015] [Indexed: 12/12/2022]
|
25
|
Pruimboom L, de Punder K. The opioid effects of gluten exorphins: asymptomatic celiac disease. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2015; 33:24. [PMID: 26825414 PMCID: PMC5025969 DOI: 10.1186/s41043-015-0032-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 11/08/2015] [Indexed: 06/05/2023]
Abstract
Gluten-containing cereals are a main food staple present in the daily human diet, including wheat, barley, and rye. Gluten intake is associated with the development of celiac disease (CD) and related disorders such as diabetes mellitus type I, depression, and schizophrenia. However, until now, there is no consent about the possible deleterious effects of gluten intake because of often failing symptoms even in persons with proven CD. Asymptomatic CD (ACD) is present in the majority of affected patients and is characterized by the absence of classical gluten-intolerance signs, such as diarrhea, bloating, and abdominal pain. Nevertheless, these individuals very often develop diseases that can be related with gluten intake. Gluten can be degraded into several morphine-like substances, named gluten exorphins. These compounds have proven opioid effects and could mask the deleterious effects of gluten protein on gastrointestinal lining and function. Here we describe a putative mechanism, explaining how gluten could "mask" its own toxicity by exorphins that are produced through gluten protein digestion.
Collapse
Affiliation(s)
- Leo Pruimboom
- Natura Foundation, Edisonstraat 66, 3281 NC, Numansdorp, Netherlands.
- Department of Laboratory Medicine, University Medical Center Groningen (UMCG), University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, Netherlands.
| | - Karin de Punder
- Natura Foundation, Edisonstraat 66, 3281 NC, Numansdorp, Netherlands.
- Institute of Medical Psychology, Charité University Medicine Berlin, Hufelandweg 14, 10117, Berlin, Germany.
| |
Collapse
|
26
|
Ohata C, Ishii N, Niizeki H, Shimomura Y, Furumura M, Inoko H, Mitsunaga S, Saiki M, Shigeta M, Fujiwara S, Yamakawa K, Kobayashi S, Kamata M, Inaba M, Ito T, Uhara H, Watanabe R, Ohtoshi S, Ohashi T, Tanaka T, Suzuki M, Sitaru C, Kárpáti S, Zone J, Hashimoto T. Unique characteristics in Japanese dermatitis herpetiformis. Br J Dermatol 2015; 174:180-3. [DOI: 10.1111/bjd.13965] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C. Ohata
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0001 Japan
| | - N. Ishii
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0001 Japan
| | - H. Niizeki
- Department of Dermatology National Center for Child Health and Development Tokyo Japan
| | - Y. Shimomura
- Laboratory of Genetic Skin Diseases Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - M. Furumura
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0001 Japan
| | - H. Inoko
- GenoDive Pharma Inc. Kanagawa Japan
| | - S. Mitsunaga
- Department of Molecular Life Science Tokai University School of Medicine Kanagawa Japan
| | - M. Saiki
- Department of Dermatology Nagano Municipal Hospital Nagano Japan
| | | | - S. Fujiwara
- Department of Dermatology Faculty of Medicine Oita University Oita Japan
| | | | - S. Kobayashi
- Division of Dermatology Seibo International Catholic Hospital Tokyo Japan
| | - M. Kamata
- Department of Dermatology Faculty of Medicine University of Tokyo Tokyo Japan
| | - M. Inaba
- Department of Dermatology Nippon Medical School Hospital Tokyo Japan
| | - T. Ito
- Department of Dermatology Hamamatsu University School of Medicine Shizuoka Japan
| | - H. Uhara
- Department of Dermatology Shinshu University School of Medicine Nagano Japan
| | - R. Watanabe
- Department of Dermatology Faculty of Medicine University of Tokyo Tokyo Japan
| | - S. Ohtoshi
- Department of Dermatology Showa University Fujigaoka Hospital Kanagawa Japan
| | - T. Ohashi
- Department of Dermatology Fukushima Medical University Fukushima Japan
| | - T. Tanaka
- Department of Dermatology Shiga University of Medical Science Shiga Japan
| | - M. Suzuki
- Department of Dermatology Jichi Medical University Tochigi Japan
| | - C. Sitaru
- Department of Dermatology University of Freiburg Freiburg Germany
| | - S. Kárpáti
- Department of Dermatology, Venereology and Dermatooncology Semmelweis University Budapest Hungary
| | - J.J. Zone
- Department of Dermatology University of Utah School of Medicine Salt Lake City UT USA
| | - T. Hashimoto
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology 67 Asahimachi Kurume Fukuoka 830‐0001 Japan
| |
Collapse
|
27
|
Speciani AF, Piuri G. Measuring Biomarkers for an Innovative Personal Food Profile. J Am Coll Nutr 2015; 34 Suppl 1:34-8. [PMID: 26400432 DOI: 10.1080/07315724.2015.1080109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Measuring the level of inflammation with an innovative approach (with blood analyses to evaluate the action of cytokines such as B-cell activating factor [BAFF], platelet activating factor [PAF], interleukin-6 [IL-6], sirtuin) allows you to better understand the body's language. The body recognizes foods and food antigens through a mapping performed by means of immunoglobulin G (IgG). Recent studies have shown that high levels of IgG in a nutrient express the personal excess of that food in the daily nutrition. Food is the most important source of hidden inflammation but is also the main tool for regaining wellness. Europeans have reactions to milk, yeast, and gluten, whereas the Japanese have reactions to rice and soybeans. Scientific knowledge of inflammatory mediators allows the discovery of new drugs, new supplements, and new plant compounds (Resveratrol, Maqui, oil of Perilla) that are able to reduce inflammation and support well-being. The interaction between the environment, nutrition, and knowledge of inflammation is an evolution and at the same time a revolution to gain and maintain health.
Collapse
|
28
|
Opri R, Veneri D, Mengoli C, Zanoni G. Immune response to Hepatitis B vaccine in patients with celiac disease: A systematic review and meta-analysis. Hum Vaccin Immunother 2015; 11:2800-5. [PMID: 26378476 DOI: 10.1080/21645515.2015.1069448] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
It is debated whether patients with celiac disease (CD) have non-protective antibody responses to HBV vaccination more frequently than non-affected subjects. To perform a literature review and meta-analysis on protective response to HBV vaccination in CD patients. RCTs and observational controlled studies were eligible. Outcome of interest was an anti-HBs (HBsAb) titer ≥ 10 IU/L after last vaccine dose. Comparative index was rate ratio (RR). Heterogeneity between studies was addressed and funnel plots were analyzed. Meta-regression models were applied to investigate effect size due to study-specific variables. Twelve retrospective studies on a total of 1,447 participants and 4 prospective studies on 184 subjects were selected. The RR was 0.732 (95% C.I.: 0.664-0.808) and 0.777 (95% C.I.: 0.629-0.960) in the prospective and retrospective studies, respectively. The I(2), indicating heterogeneity, was 51.1% in retrospective, 39.8% in prospective studies. Non-protective antibody responses occurred more frequently in patients than controls. Due to limitations in the available studies, additional trials to evaluate post-vaccination HBsAb titer in CD patients are needed.
Collapse
Affiliation(s)
- R Opri
- a Department of Pathology and Diagnostics ; Section of Immunology; University of Verona ; Verona , Italy
| | - D Veneri
- b Department of Medicine ; Section of Hematology; University of Verona ; Verona , Italy
| | - C Mengoli
- c Infectious Diseases; University of Padua ; Padua , Italy
| | - G Zanoni
- a Department of Pathology and Diagnostics ; Section of Immunology; University of Verona ; Verona , Italy
| |
Collapse
|
29
|
Setty M, Discepolo V, Abadie V, Kamhawi S, Mayassi T, Kent A, Ciszewski C, Maglio M, Kistner E, Bhagat G, Semrad C, Kupfer SS, Green PH, Guandalini S, Troncone R, Murray JA, Turner JR, Jabri B. Distinct and Synergistic Contributions of Epithelial Stress and Adaptive Immunity to Functions of Intraepithelial Killer Cells and Active Celiac Disease. Gastroenterology 2015; 149:681-91.e10. [PMID: 26001928 PMCID: PMC4550536 DOI: 10.1053/j.gastro.2015.05.013] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 04/27/2015] [Accepted: 05/12/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The mechanisms of tissue destruction during progression of celiac disease are poorly defined. It is not clear how tissue stress and adaptive immunity contribute to the activation of intraepithelial cytotoxic T cells and the development of villous atrophy. We analyzed epithelial cells and intraepithelial cytotoxic T cells in family members of patients with celiac disease, who were without any signs of adaptive antigluten immunity, and in potential celiac disease patients, who have antibodies against tissue transglutaminase 2 in the absence of villous atrophy. METHODS We collected blood and intestinal biopsy specimens from 268 patients at tertiary medical centers in the United States and Italy from 2004 to 2012. All subjects had normal small intestinal histology. Study groups included healthy individuals with no family history of celiac disease or antibodies against tissue transglutaminase 2 (controls), healthy family members of patients with celiac disease, and potential celiac disease patients. Intraepithelial cytotoxic T cells were isolated and levels of inhibitory and activating natural killer (NK) cells were measured by flow cytometry. Levels of heat shock protein (HSP) and interleukin 15 were measured by immunohistochemistry, and ultrastructural alterations in intestinal epithelial cells (IECs) were assessed by electron microscopy. RESULTS IECs from subjects with a family history of celiac disease, but not from subjects who already had immunity to gluten, expressed higher levels of HS27, HSP70, and interleukin-15 than controls; their IECs also had ultrastructural alterations. Intraepithelial cytotoxic T cells from relatives of patients with celiac disease expressed higher levels of activating NK receptors than cells from controls, although at lower levels than patients with active celiac disease, and without loss of inhibitory receptors for NK cells. Intraepithelial cytotoxic T cells from potential celiac disease patients failed to up-regulate activating NK receptors. CONCLUSIONS A significant subset of healthy family members of patients with celiac disease with normal intestinal architecture had epithelial alterations, detectable by immunohistochemistry and electron microscopy. The adaptive immune response to gluten appears to act in synergy with epithelial stress to allow intraepithelial cytotoxic T cells to kill epithelial cells and induce villous atrophy in patients with active celiac disease.
Collapse
Affiliation(s)
- Mala Setty
- Section of Gastroenterology, Department of Pediatrics and University of Chicago Celiac Disease Center, University of Chicago, Chicago (IL), USA
| | - Valentina Discepolo
- Section of Gastroenterology, Department of Pediatrics and University of Chicago Celiac Disease Center, University of Chicago, Chicago (IL), USA,European Laboratory for the Investigation of Food-Induced Disorders (ELFID), Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II. Naples, Italy,Section of Gastroenterology, Department of Medicine and University of Chicago Celiac Disease Center, University of Chicago, Chicago (IL), USA,CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145 Naples, Italy
| | - Valérie Abadie
- Sainte-Justine Hospital Research Center, Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Sarah Kamhawi
- Section of Gastroenterology, Department of Medicine and University of Chicago Celiac Disease Center, University of Chicago, Chicago (IL), USA
| | - Toufic Mayassi
- Section of Gastroenterology, Department of Medicine and University of Chicago Celiac Disease Center, University of Chicago, Chicago (IL), USA
| | - Andrew Kent
- Section of Gastroenterology, Department of Medicine and University of Chicago Celiac Disease Center, University of Chicago, Chicago (IL), USA
| | - Cezary Ciszewski
- Section of Gastroenterology, Department of Medicine and University of Chicago Celiac Disease Center, University of Chicago, Chicago (IL), USA
| | - Maria Maglio
- European Laboratory for the Investigation of Food-Induced Disorders (ELFID), Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II. Naples, Italy
| | - Emily Kistner
- Department of Health Studies, University of Chicago, Chicago (IL), USA
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Carol Semrad
- Section of Gastroenterology, Department of Medicine and University of Chicago Celiac Disease Center, University of Chicago, Chicago (IL), USA
| | - Sonia S Kupfer
- Section of Gastroenterology, Department of Medicine and University of Chicago Celiac Disease Center, University of Chicago, Chicago (IL), USA
| | - Peter H Green
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA
| | - Stefano Guandalini
- Section of Gastroenterology, Department of Pediatrics and University of Chicago Celiac Disease Center, University of Chicago, Chicago (IL), USA
| | - Riccardo Troncone
- European Laboratory for the Investigation of Food-Induced Disorders (ELFID), Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II. Naples, Italy
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jerrold R Turner
- Department of Medicine, University of Chicago, Chicago, Illinois; Department of Pathology, University of Chicago, Chicago, Illinois.
| | - Bana Jabri
- Department of Pediatrics, University of Chicago, Chicago, Illinois; Department of Medicine, University of Chicago, Chicago, Illinois.
| |
Collapse
|
30
|
Celiac disease. J Allergy Clin Immunol 2015; 135:1099-106; quiz 1107. [PMID: 25956012 DOI: 10.1016/j.jaci.2015.01.044] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/03/2015] [Accepted: 01/07/2015] [Indexed: 02/07/2023]
Abstract
This review will focus on the pathogenesis, clinical manifestations, diagnosis, and management of celiac disease (CD). Given an increasing awareness of gluten-related disorders, medical professionals of all varieties are encountering patients with a diagnosis of CD or who are thought to have food intolerance to gluten. The prevalence of CD among the general population is estimated to be 1% in Western nations, and there is growing evidence for underdiagnosis of the disease, especially in non-Western nations that were traditionally believed to be unaffected. The development of serologic markers specific to CD has revolutionized the ability both to diagnose and monitor patients with the disease. Additionally, understanding of the clinical presentations of CD has undergone a major shift over the past half century. Although it is well understood that CD develops in genetically predisposed subjects exposed to gluten, the extent of other environmental factors in the pathogenesis of the disease is an area of continued research. Currently, the main therapeutic intervention for CD is a gluten-free diet; however, novel nondietary agents are under active investigation. Future areas of research should also help us understand the relationship of CD to other gluten-related disorders.
Collapse
|
31
|
Shahbazkhani B, Sadeghi A, Malekzadeh R, Khatavi F, Etemadi M, Kalantri E, Rostami-Nejad M, Rostami K. Non-Celiac Gluten Sensitivity Has Narrowed the Spectrum of Irritable Bowel Syndrome: A Double-Blind Randomized Placebo-Controlled Trial. Nutrients 2015; 7:4542-54. [PMID: 26056920 PMCID: PMC4488801 DOI: 10.3390/nu7064542] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 12/13/2022] Open
Abstract
Several studies have shown that a large number of patients who are fulfilling the criteria for irritable bowel syndrome (IBS) are sensitive to gluten. The aim of this study was to evaluate the effect of a gluten-free diet on gastrointestinal symptoms in patients with IBS. In this double-blind randomized, placebo-controlled trial, 148 IBS patients fulfilling the Rome III criteria were enrolled between 2011 and 2013. However, only 72 out of the 148 commenced on a gluten-free diet for up to six weeks and completed the study; clinical symptoms were recorded biweekly using a standard visual analogue scale (VAS). In the second stage after six weeks, patients whose symptoms improved to an acceptable level were randomly divided into two groups; patients either received packages containing powdered gluten (35 cases) or patients received placebo (gluten free powder) (37 cases). Overall, the symptomatic improvement was statistically different in the gluten-containing group compared with placebo group in 9 (25.7%), and 31 (83.8%) patients respectively (p < 0.001). A large number of patients labelled as irritable bowel syndrome are sensitive to gluten. Using the term of IBS can therefore be misleading and may deviate and postpone the application of an effective and well-targeted treatment strategy in gluten sensitive patients.
Collapse
Affiliation(s)
- Bijan Shahbazkhani
- Gastroenterology Unit, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 5715915199, Iran.
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran 1599666615, Iran.
- Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Clinic, Tehran 14117-13135, Iran.
| | - Amirsaeid Sadeghi
- Gastroenterology Unit, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 5715915199, Iran.
| | - Reza Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran 1599666615, Iran.
- Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Clinic, Tehran 14117-13135, Iran.
| | - Fatima Khatavi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran 1449614535, Iran.
| | - Mehrnoosh Etemadi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran 1449614535, Iran.
| | | | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985714711, Iran.
| | - Kamran Rostami
- Department of Gastroenterology, Alexandra Hospital, Worcestershire B98 7UB, UK.
| |
Collapse
|
32
|
Isasi C, Tejerina E, Morán LM. Non-celiac gluten sensitivity and rheumatic diseases. ACTA ACUST UNITED AC 2015; 12:4-10. [PMID: 25956352 DOI: 10.1016/j.reuma.2015.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 02/07/2023]
Abstract
Celiac disease is an autoimmune systemic disease having among its clinical manifestations frequent symptoms common to rheumatologic diseases such as musculoskeletal pain, asthenia, and cognitive fatigue. It is associated with other autoimmune diseases like Sjögren disease. It is a well-characterized disease with specific diagnostic tests. Non-celiac gluten sensitivity is an emerging entity with symptoms similar to celiac disease, but without specific diagnostic tests. The concept of non-celiac gluten sensitivity and its diagnostic problems are reviewed, and the hypothesis of its association with fibromyalgia, spondyloarthritis, and autoimmune conditions is proposed. Clinical observations supporting the hypothesis are described, highlighting the benefit of treating non-celiac gluten sensitivity.
Collapse
Affiliation(s)
- Carlos Isasi
- Servicio de Reumatología, Hospital Puerta de Hierro Majadahonda, Majadahonda, Madrid, España.
| | - Eva Tejerina
- Servicio de Anatomía Patológica, Hospital Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
| | - Luz M Morán
- Servicio de Radiodiagnóstico, Hospital Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
| |
Collapse
|
33
|
Dieta sin gluten y sin caseína en los trastornos del espectro autista; perspectivas diferentes. An Pediatr (Barc) 2015; 82:373. [DOI: 10.1016/j.anpedi.2014.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 11/23/2022] Open
|
34
|
Assessing of Celiac Disease and Nonceliac Gluten Sensitivity. Gastroenterol Res Pract 2015; 2015:723954. [PMID: 26064097 PMCID: PMC4429206 DOI: 10.1155/2015/723954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/15/2015] [Indexed: 12/17/2022] Open
Abstract
The publication of papers on the topic of gluten related disorders has substantially increased over the last few years. This has motivated healthcare professionals to pay attention not only to celiac disease and wheat allergy but also to a condition termed nonceliac gluten sensitivity (NCGS). Until now this condition has been diagnosed clinically on the basis of exclusion criteria and clinical response to gluten withdrawal. In addition, recent research in this field has shown that other food components distinct from gluten are implicated in NCGS cases, thereby changing our general understanding of NCGS diagnosis in either individuals on gluten containing diets or those already following a gluten-free diet with no proper diagnostic work-up of celiac disease. With this in mind, the assessment of NCGS will require extensive knowledge of celiac disease manifestations and the laboratory tests commonly performed during diagnosis of celiac disease.
Collapse
|
35
|
Guandalini S, Polanco I. Nonceliac gluten sensitivity or wheat intolerance syndrome? J Pediatr 2015; 166:805-11. [PMID: 25662287 DOI: 10.1016/j.jpeds.2014.12.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 11/24/2014] [Accepted: 12/16/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Stefano Guandalini
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL.
| | - Isabel Polanco
- Autonomous University, La Paz Children's University Hospital, Madrid, Spain
| |
Collapse
|
36
|
Tovoli F, Masi C, Guidetti E, Negrini G, Paterini P, Bolondi L. Clinical and diagnostic aspects of gluten related disorders. World J Clin Cases 2015; 3:275-284. [PMID: 25789300 PMCID: PMC4360499 DOI: 10.12998/wjcc.v3.i3.275] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/28/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
Gluten is one of the most abundant and widely distributed components of food in many areas. It can be included in wheat, barley, rye, and grains such as oats, barley, spelt, kamut, and triticale. Gluten-containing grains are widely consumed; in particular, wheat is one of the world’s primary sources of food, providing up to 50% of the caloric intake in both industrialized and developing countries. Until two decades ago, celiac disease (CD) and other gluten-related disorders were believed to be exceedingly rare outside of Europe and were relatively ignored by health professionals and the global media. In recent years, however, the discovery of important diagnostic and pathogenic milestones led CD from obscurity to global prominence. In addition, interestingly, people feeding themselves with gluten-free products greatly outnumber patients affected by CD, fuelling a global consumption of gluten-free foods with approximately $2.5 billion in United States sales each year. The acknowledgment of other medical conditions related to gluten that has arisen as health problems, providing a wide spectrum of gluten-related disorders. In February 2011, a new nomenclature for gluten-related disorders was created at a consensus conference in London. In this review, we analyse innovations in the field of research that emerged after the creation of the new classification, with particular attention to the new European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for CD and the most recent research about non-celiac gluten sensitivity.
Collapse
|
37
|
The effects of reduced gluten barley diet on humoral and cell-mediated systemic immune responses of gluten-sensitive rhesus macaques. Nutrients 2015; 7:1657-71. [PMID: 25756783 PMCID: PMC4377872 DOI: 10.3390/nu7031657] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/11/2015] [Accepted: 02/27/2015] [Indexed: 12/20/2022] Open
Abstract
Celiac disease (CD) affects approximately 1% of the general population while an estimated additional 6% suffers from a recently characterized, rapidly emerging, similar disease, referred to as non-celiac gluten sensitivity (NCGS). The only effective treatment of CD and NCGS requires removal of gluten sources from the diet. Since required adherence to a gluten-free diet (GFD) is difficult to accomplish, efforts to develop alternative treatments have been intensifying in recent years. In this study, the non-human primate model of CD/NCGS, e.g., gluten-sensitive rhesus macaque, was utilized with the objective to evaluate the treatment potential of reduced gluten cereals using a reduced gluten (RG; 1% of normal gluten) barley mutant as a model. Conventional and RG barleys were used for the formulation of experimental chows and fed to gluten-sensitive (GS) and control macaques to determine if RG barley causes a remission of dietary gluten-induced clinical and immune responses in GS macaques. The impacts of the RG barley diet were compared with the impacts of the conventional barley-containing chow and the GFD. Although remission of the anti-gliadin antibody (AGA) serum responses and an improvement of clinical diarrhea were noted after switching the conventional to the RG barley diet, production of inflammatory cytokines, e.g., interferon-gamma (IFN-γ), tumor necrosis factor (TNF) and interleukin-8 (IL-8) by peripheral CD4+ T helper lymphocytes, persisted during the RG chow treatment and were partially abolished only upon re-administration of the GFD. It was concluded that the RG barley diet might be used for the partial improvement of gluten-induced disease but its therapeutic value still requires upgrading—by co-administration of additional treatments.
Collapse
|
38
|
Rasgos clínicos sugestivos de trastorno del espectro autista como manifestación de sensibilidad al gluten no celíaca. An Pediatr (Barc) 2014; 81:409-11. [DOI: 10.1016/j.anpedi.2014.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/09/2014] [Accepted: 02/17/2014] [Indexed: 11/17/2022] Open
|
39
|
Tavío Hernández E, Cano Ruiz A. Sensibilidad al gluten no celíaca: ¿una verdadera entidad o solo una quimera? Med Clin (Barc) 2014; 143:446-7. [DOI: 10.1016/j.medcli.2014.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/26/2014] [Accepted: 07/07/2014] [Indexed: 02/08/2023]
|
40
|
Mansueto P, Seidita A, D'Alcamo A, Carroccio A. Non-celiac gluten sensitivity: literature review. J Am Coll Nutr 2014; 33:39-54. [PMID: 24533607 DOI: 10.1080/07315724.2014.869996] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A significant percentage of the general population report problems caused by wheat and/or gluten ingestion, even though they do not have celiac disease (CD) or wheat allergy (WA), because they test negative both for CD-specific serology and histopathology and for immunoglobulin E (IgE)-mediated assays. Most patients report both gastrointestinal and nongastrointestinal symptoms, and all report improvement of symptoms on a gluten-free diet. This clinical condition has been named non-celiac gluten sensitivity (NCGS). AIM We attempt to define the current pathogenic, clinical, and diagnostic criteria of this "new" disease, to provide a practical view that might be useful to evaluate, diagnose, and manage NCGS patients. METHODS We reviewed the international literature through PubMed and Medline, using the search terms "wheat (hyper)sensitivity," "wheat allergy," "wheat intolerance," "gluten (hyper)sensitivity," and "gluten intolerance," and we discuss current knowledge about NCGS. RESULTS It has been demonstrated that patients suffering from NCGS are a heterogeneous group, composed of several subgroups, each characterized by different pathogenesis, clinical history, and, probably, clinical course. NCGS diagnosis can be reached only by excluding CD and WA. Recent evidence shows that a personal history of food allergy in infancy, coexistent atopy, positive for immunoglobulin G (IgG) antigliadin antibodies and flow cytometric basophil activation test, with wheat and duodenal and/or ileum-colon intraepithelial and lamina propria eosinophil counts, could be useful to identify NCGS patients. CONCLUSIONS Future research should aim to identify reliable biomarkers for NCGS diagnosis and to better define the different NCGS subgroups. Key teaching points: • Most patients report both gastrointestinal and nongastrointestinal symptoms, and all agree that there is an improvement of symptoms on a gluten-free diet. • NCGS diagnosis can be reached only by excluding celiac disease and wheat allergy. • Patients suffering from NCGS are a heterogeneous group, composed of several subgroups, each characterized by different pathogenesis, clinical history, and, probably, clinical course. • A personal history of food allergy in infancy, coexistent atopy, positive IgG antigliadin antibodies (AGA) and flow cytometric basophil activation test, with wheat and duodenal and/or ileum-colon intraepithelial and lamina propria eosinophil counts, could be useful to identify NCGS patients. • Future research should aim to identify reliable biomarkers for NCGS diagnosis and to better define the different NCGS subgroup.
Collapse
Affiliation(s)
- Pasquale Mansueto
- a Internal Medicine, University Hospital of Palermo , Palermo , ITALY
| | | | | | | |
Collapse
|
41
|
Paoloni M, Tavernese E, Ioppolo F, Fini M, Santilli V. Complete remission of plantar fasciitis with a gluten-free diet: relationship or just coincidence? Foot (Edinb) 2014; 24:140-2. [PMID: 25063015 DOI: 10.1016/j.foot.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/18/2014] [Indexed: 02/04/2023]
Abstract
We report the case of a 46-year-old woman with no known history for gluten sensitivity who presented severe heel pain, and was successfully managed with a gluten-free diet. Previously she had been unsuccessfully treated with several conservative remedies. The presence of musculoskeletal problems in patients with gluten sensitivity is not rare. To the best of our knowledge, however, this is the first case report mentioning the successful management of plantar fasciitis with a gluten-free diet. The case report highlights the importance of considering gluten sensitivity among other possible differential diagnosis for musculoskeletal pain insensitive to traditional therapies.
Collapse
Affiliation(s)
- Marco Paoloni
- Board of Physical Medicine and Rehabilitation, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, "Sapienza" University, Rome, Italy.
| | - Emanuela Tavernese
- Pediatric Neuro-Rehabilitation Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Ioppolo
- Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy
| | | | - Valter Santilli
- Board of Physical Medicine and Rehabilitation, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, "Sapienza" University, Rome, Italy; Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy
| |
Collapse
|
42
|
Czaja-Bulsa G. Non coeliac gluten sensitivity - A new disease with gluten intolerance. Clin Nutr 2014; 34:189-94. [PMID: 25245857 DOI: 10.1016/j.clnu.2014.08.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 08/11/2014] [Accepted: 08/22/2014] [Indexed: 12/18/2022]
Abstract
Until recently gluten intolerance has been believed to be typical of celiac disease (CD) and wheat allergy (WA). In the last few years, however, several study results have been published that have proved that gluten intolerance can also affect people who do not suffer from any of the above mentioned diseases. The new syndrome has been named non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS). It has been included in the new list of gluten-related disorders published in 2012. Researchers believe that NCGS is the most common syndrome of gluten intolerance. This review discusses many aspects of NCGS epidemiology, pathophysiology, clinical spectrum, and treatment and current tools to identify patients suffering from CD, WA, and NCGS.
Collapse
Affiliation(s)
- Grażyna Czaja-Bulsa
- Paediatric and Paediatric Nursery Unit of The Pomeranian Medical University in Szczecin, Poland; Division of Paediatrics, Gastroenterology and Rheumatology of The "Zdroje" Hospital in Szczecin, Poland.
| |
Collapse
|
43
|
Isasi C, Tejerina E, Fernandez-Puga N, Serrano-Vela JI. Fibromyalgia and chronic fatigue syndrome caused by non-celiac gluten sensitivity. ACTA ACUST UNITED AC 2014; 11:56-7. [PMID: 25047419 DOI: 10.1016/j.reuma.2014.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/15/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Carlos Isasi
- Servicio de Reumatología, Hospital Puerta de Hierro, Majadahonda, Madrid, España.
| | - Eva Tejerina
- Servicio de Anatomía Patológica, Hospital Puerta de Hierro, Majadahonda, Madrid, España
| | | | | |
Collapse
|
44
|
Zanini B, Lanzarotto F, Villanacci V, Carabellese N, Ricci C, Lanzini A. Clinical expression of lymphocytic duodenosis in "mild enteropathy" celiac disease and in functional gastrointestinal syndromes. Scand J Gastroenterol 2014; 49:794-800. [PMID: 24941349 DOI: 10.3109/00365521.2014.919017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Abnormally high number of duodenal intraepithelial lymphocytes is frequently found in many conditions including mild enteropathy celiac disease (CD) and functional gastrointestinal syndromes, but is unclear whether lymphocytosis affects the clinical phenotype particularly in functional syndromes. MATERIALS AND METHODS We compared clinical characteristics of celiac patients with lymphocytic duodenosis and normal villous structure with those of patients with functional gastrointestinal syndromes with and without lymphocytic duodenosis. We retrospectively identified 3 cohorts among patients referred for suspected CD: (1) "CoelD", 135 patients (age 36 ± 14 years) with mild enteropathy CD; (2) "LymD", 245 patients (38 ± 12 years) with functional gastrointestinal syndromes and lymphocytic duodenosis; and (3) "NorD", 147 patients (37 ± 15 years) with functional syndromes and normal duodenal histology. RESULTS Prevalence of gastrointestinal symptoms was similar in the three cohorts, but prevalence of extra-intestinal manifestations (42% vs. 27% vs. 18%, p < 0.003) and of associated diseases (35% vs. 15% vs. 14%, p < 0.0001) was higher in "CoelD" than in "LymD" and "NorD", respectively. Prevalence of Helicobacter pylori infection was similar in the three cohorts. The proportion of patients with final diagnosis of irritable bowel syndrome-diarrhea (38% vs. 37%), dyspepsia (31% vs. 27%), functional pain (14% vs. 19%), and functional diarrhoea (14% vs. 11%) was virtually the same in the cohorts with (LymD) and without (NorD) lymphocytic duodenosis. CONCLUSIONS Lymphocytic duodenosis has different clinical presentation in patients with mild enteropathy CD than those with functional gastrointestinal syndromes, and is not specific for any particular functional syndrome.
Collapse
Affiliation(s)
- Barbara Zanini
- Gastroenterology Unit, University and Spedali Civili , Brescia , Italy
| | | | | | | | | | | |
Collapse
|
45
|
Characteristics of patients who avoid wheat and/or gluten in the absence of Celiac disease. Dig Dis Sci 2014; 59:1255-61. [PMID: 24374645 DOI: 10.1007/s10620-013-2981-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/28/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gastrointestinal symptoms that respond to the removal of wheat and/or gluten are becoming more common. Patients who avoid wheat and/or gluten (PWAWG) are a heterogeneous group and predominantly self-diagnosed prior to presenting for clinical evaluation. SPECIFIC AIM We characterized PWAWGs seen at a tertiary care referral center and compared them to patients with celiac disease (CD) and subjects in the National Health and Nutrition examination survey (NHANES). METHODS This was a cross-sectional study evaluating patients seen by four gastroenterologists at a CD referral center. Baseline characteristics, laboratory values, and medical comorbidities were compared to CD patients who presented at the same center and subjects enrolled in NHANES. RESULTS Eighty-four PWAWGs were identified and compared to 585 CD patients and 2,686 NHANES patients. Thirty-two alternative diagnoses were made in 25 (30%) PWAWGs, including small intestinal bacterial overgrowth and fructose/lactose intolerance. When compared to patients with CD, PWAWGs had similar body mass index (BMI, 23.1 vs. 23.5, p = 0.54) and mean hemoglobin value (13.4 vs. 13.3, p = 0.6). When compared to male and female patients in NHANES, BMI, folate, and mean hemoglobin values were lower in PWAWGs. Both male and female PWAWGs had a lower prevalence of hypertension. CONCLUSION While there are similarities between CD and PWAWGs that could possibly be due to shared HLA haplotypes or an effect of the gluten-free diet, alternative diagnoses are common in these patients. PWAWGs have a similar cardiovascular profile as CD patients in terms of lower BMI and lower prevalence of hypertension.
Collapse
|
46
|
Alonso Canal L, Viada Bris J, Acuña Quirós M, Serrano Vela J, Martínez Gómez M. Del intestino al cerebro…, pasando por el torrente sanguíneo. An Pediatr (Barc) 2014; 80:335-7. [DOI: 10.1016/j.anpedi.2013.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/04/2013] [Indexed: 11/30/2022] Open
|
47
|
Isasi C, Colmenero I, Casco F, Tejerina E, Fernandez N, Serrano-Vela JI, Castro MJ, Villa LF. Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. Rheumatol Int 2014; 34:1607-12. [PMID: 24728027 PMCID: PMC4209093 DOI: 10.1007/s00296-014-2990-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/10/2014] [Indexed: 02/06/2023]
Abstract
Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available. Gluten sensitivity that does not fulfill the diagnostic criteria for celiac disease (CD) is increasingly recognized as a frequent and treatable condition with a wide spectrum of manifestations that overlap with the manifestations of FM, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome. The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy. All patients had intraepithelial lymphocytosis without villous atrophy. Clinical response was defined as achieving at least one of the following scenarios: remission of FM pain criteria, return to work, return to normal life, or the discontinuation of opioids. The mean follow-up period was 16 months (range 5–31). This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome.
Collapse
|
48
|
Modern diagnosis of celiac disease and relevant differential diagnoses in the case of cereal intolerance. ACTA ACUST UNITED AC 2014; 23:67-77. [PMID: 26120517 PMCID: PMC4479435 DOI: 10.1007/s40629-014-0006-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 05/19/2013] [Indexed: 12/12/2022]
Abstract
At an incidence of 1:500, celiac disease (formerly sprue) is an important differential diagnosis in patients with malabsorption, abdominal discomfort, diarrhea and food intolerances. Celiac disease can induce a broad spectrum of both gastrointestinal and extraintestinal symptoms, e.g. dermatitis herpetiformis (Duhring's disease). A variety of oligo- and asymptomatic courses (e.g. anemia, osteoporosis, depression) through to refractory collagenic celiac disease are seen. In HLA-DQ2 and -8 predisposed individuals, celiac disease is provoked by contact with wheat gliadin fractions through a predominantly Th1 immune response and an accompanying Th2 response, which can eventually lead to villous atrophy. Using appropriate serological tests (IgA antibodies against tissue-transglutaminase, endomysium and deamidated gliadin peptides) under sufficient gluten ingestion, the diagnosis can be made more reliably today than previously. The same IgG-based serological tests should be used in the case of IgA deficiency. Diagnosis can either be made in children and adolescents with anti-transglutaminase titers exceeding ten times the standard for two of the above-mentioned serological markers and HLA conformity or it is made by endoscopy and histological Marsh classification in adults and in cases of inconclusive serology. If clinically tolerated, gluten challenges are indicated in patients that already have reduced gluten intake, in borderline serological results, discordance between serological and histological results or in suspected food allergy. The diagnosis of celiac disease needs to be definitive and robust before establishing a gluten-free diet, since lifelong abstention from gluten (gliadin < 20 mg/kg foodstuffs), cereal products (wheat, rye, barley and spelt) as well as from preparations and beverages containing gluten, is necessary. With effective elimination of gluten, the prognosis regarding complete resolution of small bowel inflammation is good. Refractory courses are seen only in rare cases, accompanied by enteropathy-associated T-cell lymphoma.
Collapse
|
49
|
Moderne Diagnostik der Zöliakie und relevante Differenzialdiagnosen bei Getreideunverträglichkeiten. ALLERGO JOURNAL 2014. [DOI: 10.1007/s15007-014-0504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
50
|
Abstract
BACKGROUND Although the incidence of inflammatory bowel diseases (IBD) in Japan has increased, the prevalence of celiac disease is considered very low with the lowest genetic disposition. IBD is reported as the most common comorbidity because of the high positive rate of serological celiac markers. The aim of this study was to examine the current incidence of celiac disease, especially in IBD patients in Japan, where both wheat consumption and incidence of IBD have increased. METHODS A total of 172 patients with IBD and 190 controls in Japan were screened for serum antibody of tissue transglutaminase and deaminated gliadin peptide. In sero-positive patients, HLA testing and upper gastrointestinal endoscopy with duodenal biopsy was performed. Some of the sero-positive patients started a gluten-restricted or unrestricted diet, and serological change was determined. RESULTS The positivity of both serum antibodies was significantly higher in IBD and correlated with disease activity. However, no biopsy-defined or HLA-defined true celiac disease was found. A decrease in serum antibody titers was observed with a gluten-restricted diet. CONCLUSIONS Despite the increased incidence of IBD and high positivity for serum celiac antibody in Japanese IBD patients, no true-positive celiac disease was noted, suggesting the presence of gluten intolerance in these populations.
Collapse
|