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Wieser H, Ciacci C, Gizzi C, Santonicola A. Otorhinolaryngological Manifestations and Esophageal Disorders in Celiac Disease: A Narrative Review. J Clin Med 2023; 12:7036. [PMID: 38002650 PMCID: PMC10672081 DOI: 10.3390/jcm12227036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Celiac disease (CeD) is a chronic gluten-sensitive immune-mediated enteropathy characterized by numerous intestinal and extra-intestinal signs and symptoms. Among extra-intestinal manifestations, otorhinolaryngological (ORL) complaints in CeD are relatively rare and their relation to CeD is frequently overlooked by physicians. Recent studies underlined that the prevalence of recurrent aphthous stomatitis, aphthous ulcers, geographic tongue, and xerostomia was significantly increased in CeD patients compared with healthy individuals. However, data about the other oral manifestations of CeD, such as atrophic glossitis, glossodynia, angular cheilitis, and salivary abnormalities, are scanty. Further ORL conditions associated with CeD include sensorineural hearing loss, nasal abnormalities, and obstructive sleep apnea. Moreover, several esophageal disorders such as gastroesophageal reflux disease and eosinophilic esophagitis have been associated with CeD. The pathophysiological link between both ORL and esophageal manifestations and CeD might be further investigated. In addition, also the role of gluten-free diet in improving these conditions is largely unclear. Certainly, otorhinolaryngologists can play an important role in identifying people with unrecognized CeD and may help prevent its long-term complications. The aim of this narrative review is to analyze the latest evidence on the association between CeD and ORL and esophageal manifestations.
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Affiliation(s)
- Herbert Wieser
- Hamburg School of Food Science, Institute of Food Chemistry, University of Hamburg, 20146 Hamburg, Germany;
| | - Carolina Ciacci
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.G.); (A.S.)
| | - Carolina Gizzi
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.G.); (A.S.)
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.G.); (A.S.)
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Vats V, Makineni P, Hemaida S, Haider A, Subramani S, Kaur N, Butt AN, Scott-Emuakpor R, Zahir M, Mathew M, Iqbal J. Gluten Intolerance and Its Association With Skin Disorders: A Narrative Review. Cureus 2023; 15:e44549. [PMID: 37790051 PMCID: PMC10544948 DOI: 10.7759/cureus.44549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Gluten sensitivity is defined as a chronic intolerance to gluten ingestion in genetically predisposed individuals. The etiology is thought to be immune-mediated and has a variable dermatologic presentation. Celiac disease (CD) is one of the most common forms of gluten intolerance and encompasses a wide range of extra-intestinal pathology, including cutaneous, endocrine, nervous, and hematologic systems. Psoriasis, another long-term inflammatory skin condition, has been linked to significant symptomatic improvement with a gluten-free diet (GFD). Palmoplantar pustulosis (PP), a variant of psoriasis, and aphthous stomatitis, which causes recurrent oral ulcers, have also exhibited beneficial results after the dietary elimination of gluten. In addition to this, dermatitis herpetiformis (DH), another immune-mediated skin disorder, is genetically similar to CD and has, therefore, shown tremendous improvement with a GFD. Another highly prevalent long-term skin condition called atopic dermatitis (AD), however, has revealed inconsistent results with gluten elimination and would require further research in the future to yield concrete results. Hereditary angioedema (HA) has shown an association with gluten intolerance in some patients who had symptomatic benefits with a GFD. Similarly, vitiligo and linear IgA bullous dermatosis have also shown some clinical evidence of reversal with a GFD. On the contrary, rosacea enhances the risk of developing CD. This narrative review emphasizes the potential impact of gluten intolerance on different cutaneous conditions and the potential therapeutic effect of a GFD on various symptomatic manifestations. There is a need for additional clinical and observational trials to further expand on the underlying pathophysiology and provide conclusive and comprehensive recommendations for possible dietary interventions.
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Affiliation(s)
- Vaibhav Vats
- Internal Medicine, Smt. Kashibai Navale Medical College and General Hospital, Mumbai, IND
| | - Pallavi Makineni
- Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | | | - Anum Haider
- Internal Medicine, Bahria University Medical & Dental College, Karachi, PAK
| | | | - Navjot Kaur
- Medicine, Government Medical College, Amritsar, Amritsar, IND
| | - Amna Naveed Butt
- Medicine/Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Mohammad Zahir
- Medicine, Ayub Medical College, Abottabad, Abottabad, PAK
| | - Midhun Mathew
- Internal Medicine, Pennsylvania Hospital, Philadelphia, USA
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Miceli Sopo S, Mastellone F, Bersani G, Di Noi S, Gelsomino M. Biopsy-sparing celiac disease diagnosis in children. Dig Liver Dis 2023; 55:1153-1155. [PMID: 37308395 DOI: 10.1016/j.dld.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Stefano Miceli Sopo
- Pediatric Allergy Unit, Pediatrics Section, Department of Life Sciences and Public Health, Policlinico Gemelli University Foundation IRCCS, Catholic University of Sacre Hearth, Rome 00168, Italy.
| | - Francesco Mastellone
- Post-Graduate School of Pediatrics, Department of Life Sciences and Public Health, Policlinico Gemelli University Foundation IRCCS, Catholic University of Sacre Hearth, Rome 00168, Italy.
| | - Giulia Bersani
- Pediatric Allergy Unit, Pediatrics Section, Department of Life Sciences and Public Health, Policlinico Gemelli University Foundation IRCCS, Catholic University of Sacre Hearth, Rome 00168, Italy
| | - Silvia Di Noi
- Post-Graduate School of Pediatrics, Department of Life Sciences and Public Health, Policlinico Gemelli University Foundation IRCCS, Catholic University of Sacre Hearth, Rome 00168, Italy
| | - Mariannita Gelsomino
- Post-Graduate School of Pediatrics, Department of Life Sciences and Public Health, Policlinico Gemelli University Foundation IRCCS, Catholic University of Sacre Hearth, Rome 00168, Italy
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Bulut M, Tokuc M, Aydin MN, Ayyildiz Civan H, Polat E, Dogan G, Altuntas C, Bayrak NA, Beser OF. Nutrition and oral health in children with recently and previously diagnosed celiac disease. Clin Oral Investig 2023:10.1007/s00784-023-04971-x. [PMID: 36961593 DOI: 10.1007/s00784-023-04971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/19/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVES To evaluate the nutritional and oral health status of children with previously diagnosed celiac disease (CD) who follow a gluten-free diet and recently diagnosed CD patients. MATERIALS AND METHODS Previously and recently diagnosed groups were formed from children with CD, aged 4 to 15 years. A questionnaire was completed about the children's dental history and nutritional and oral hygiene habits. All the children underwent an oral examination, and dmft-DMFT indices were determined. Dental plaque status, periodontal health, and dental enamel defects were recorded. Oral soft tissues were examined for the presence of lesions. Unstimulated salivary flow rate and pH value were evaluated. RESULTS A statistically significant difference was determined between the previously and recently diagnosed patients in terms of toothpaste preference (p=0.003), frequency of going to the dentist (p=0.039), and the types of dental treatment they had received (p=0.001). A statistically significant difference was determined between the previously and recently diagnosed patient groups in terms of dmft values (p=0.005). CONCLUSIONS Children with CD should be directed to a pediatric dentist to improve oral and dental health, relieve the symptoms of oral mucosal lesions, be informed about enamel defects, and be encouraged to use gluten-free oral care products. CLINICAL RELEVANCE The collaboration of pediatric gastroenterologists and pediatric dentists can prevent the progression of oral symptoms in children with CD and eliminate long-term complications in terms of both oral health and multisystemic problems.
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Affiliation(s)
- M Bulut
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Okan University, Istanbul, Türkiye.
| | - M Tokuc
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Okan University, Istanbul, Türkiye
| | - M N Aydin
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Okan University, Istanbul, Türkiye
| | - H Ayyildiz Civan
- Pediatric Gastroenterology, Hepatology and Nutrition, I.A.U. VM Medical Park Hospital Florya, Istanbul, Türkiye
| | - E Polat
- Pediatric Gastroenterology, Hepatology and Nutrition, Sancaktepe Sehit Prof Dr Ilhan Varank Training & Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - G Dogan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmialem Vakif University Faculty of Medicine, Istanbul, Türkiye
| | - C Altuntas
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istinye University Faculty of Medicine, Istanbul, Türkiye
| | - N A Bayrak
- Pediatric Gastroenterology, Hepatology and Nutrition, Zeynep Kamil Women & Children's Training & Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - O F Beser
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Türkiye
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5
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Xu K, Zhou C, Huang F, Duan N, Wang Y, Zheng L, Wang X, Wang W. Relationship between dietary factors and recurrent aphthous stomatitis in China: a cross-sectional study. J Int Med Res 2021; 49:3000605211017724. [PMID: 34057842 PMCID: PMC8753793 DOI: 10.1177/03000605211017724] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective Recurrent aphthous stomatitis (RAS), a common oral mucosal disorder characterized by chronic, inflammatory, and ovoid ulcers, has a complex etiology. The purpose of the study was to investigate the specific dietary factors influencing the prevalence of RAS. Methods A total of 754 participants aged 18 to 59 years were enrolled in this descriptive cross-sectional study. An anonymous questionnaire was adopted to investigate the distribution of RAS, dietary factors, self-reported trigger factors, and therapeutic methods. Results Among all participants, the prevalence rate of RAS was 21.4%. Univariable analysis showed that fruit, dairy products, vegetables, and water, but not fried foods, fermented foods, spicy foods, and eggs, were preventive factors against RAS. After adjusting for age and sex, multivariable regression analysis suggested that fruit (adjusted odds ratio [aOR] = 0.430, 95% confidence interval [CI] = 0.218–0.847) and water (aOR = 0.294, 95% CI = 0.119–0.726) were protective factors against RAS. Conclusion This study found that the consumption of fruit and water was negatively associated with RAS. These results imply a potential adjunctive and complementary role of food in RAS treatment and some feasible means of RAS prevention.
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Affiliation(s)
- Kaiyuan Xu
- Department of Oral Medicine, 144984Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chongchong Zhou
- Department of Oral Medicine, 144984Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fan Huang
- Department of Oral Medicine, 144984Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ning Duan
- Department of Oral Medicine, 144984Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yanyi Wang
- Department of Oral Medicine, 144984Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lichun Zheng
- Department of Oral Medicine, 144984Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiang Wang
- Department of Oral Medicine, 144984Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenmei Wang
- Department of Oral Medicine, 144984Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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Wang Z, Cao H, Xiong J, Lu Y, Deng Y, Nan H, Zheng S, Ye H, Cao Z. Recent advances in the aetiology of recurrent aphthous stomatitis (RAS). Postgrad Med J 2021; 98:57-66. [PMID: 33574180 DOI: 10.1136/postgradmedj-2020-139421] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 11/04/2022]
Abstract
Recurrent aphthous stomatitis (RAS) is the most common disease of oral mucosa, which almost attacks each individual once in their lifespan. Although plenty of factors have been suggested to play a role in the pathogenesis of RAS, the aetiology of RAS is still controversial, which might lead to limited clinical therapies in accordance with each RAS patient. This review mainly illustrates recent advances in potential causes associated with RAS in detail. Deeper comprehension of the aetiology of RAS will support doctors and researchers to make a better management of RAS patients and to discover new treatments. The aetiology of RAS is complicated, hence we should take a comprehensive view into its aetiology, with multiple potential factors being considered. Sample collection of RAS patients have greatly limited the progress in the aetiology of RAS. A research model of multiagency cooperation can help achieve perfect sample collection of year-round and multiposition.
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Affiliation(s)
- Zihan Wang
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Haibo Cao
- Clinical Medicine School, Hebei University of Engineering, Handan, China
| | - Jianqi Xiong
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Yilong Lu
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Yixiao Deng
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Han Nan
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Shutian Zheng
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Hui Ye
- Department of Biochemistry, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Zhensheng Cao
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
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7
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Morgado de Abreu LF, Morgado de Abreu MAM, Sdepanian VL, Hirata CHW, Pimentel DRN, Braz JCM, Costa A. Serological screening for celiac disease using IgA-tissue transglutaminase antibody in patients with recurrent aphthous stomatitis. Int J Dermatol 2020; 60:e49-e51. [PMID: 33107591 DOI: 10.1111/ijd.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/06/2020] [Accepted: 09/29/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Luiz F Morgado de Abreu
- Postgraduate Program in Health Science, Instituto de Assistência Médica ao Servidor Público Estadual, São Paulo, SP, Brazil
| | - Marilda A M Morgado de Abreu
- Department of Dermatology, Hospital Regional de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
| | - Vera L Sdepanian
- Division of Pediatric Gastroenterology, Department of Pediatrics, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Cleonice H W Hirata
- Department of Otorhinolaryngology, Head and Neck Surgery, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Dalva R N Pimentel
- Department of Dermatology, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Janáina C M Braz
- Department of Dermatology, Hospital Regional de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
| | - Adilson Costa
- Postgraduate Program in Health Science, Instituto de Assistência Médica ao Servidor Público Estadual, São Paulo, SP, Brazil
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Muddasani S, Rusk AM, Baquerizo Nole KL. Gluten and skin disease beyond dermatitis herpetiformis: a review. Int J Dermatol 2020; 60:281-288. [PMID: 32810304 DOI: 10.1111/ijd.15098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/21/2020] [Accepted: 07/14/2020] [Indexed: 01/15/2023]
Abstract
Gluten, a protein found in wheat, rye, and barley, is known to cause an immune reaction in patients with celiac disease (CD) resulting in small bowel villous atrophy and impaired nutrient absorption and cutaneous manifestations in patients with dermatitis herpetiformis (DH). It is common that patients associate skin conditions with their diet, and the advantages of a gluten-free diet (GFD) are brought up frequently. Indeed, there is evidence that certain dermatologic conditions can respond to a GFD, especially for those with concomitant CD and DH. In the last decade, new data have become available on the significance of gluten in skin disease. Herein, we review the role of gluten and a GFD on various cutaneous diseases beyond DH.
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Affiliation(s)
- Suraj Muddasani
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Amanda M Rusk
- Department of Dermatology, University of Cincinnati, Cincinnati, OH, USA
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Yılmaz S, Tuna Kırsaçlıoğlu C, Şaylı TR. Celiac disease and hematological abnormalities in children with recurrent aphthous stomatitis. Pediatr Int 2020; 62:705-710. [PMID: 31957941 DOI: 10.1111/ped.14155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/12/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recurrent aphthous stomatitis (RAS) is one of the most common diseases of the oral mucosa and may be related to vitamin deficiencies or systemic diseases such as celiac disease (CD). The aim of this study was to investigate the frequency of hematinic deficiency and CD in children with RAS. METHODS The medical records of patients diagnosed with RAS were reviewed for the presence of hematinic deficiencies (hemoglobin, mean corpuscular volume, ferritin, vitamin B12 , folic acid), and CD. The study group included 108 children with RAS and 57 healthy children who were evaluated for hematological abnormalities in routine evaluation. RESULTS The frequency of a family history of RAS was significantly higher in the RAS group compared to the control group (34.2% vs 7%, respectively; P < 0.001). A hematological abnormality was detected in 32.4% of the RAS group and 10.5% of the control group (P = 0.02). The prevalence of iron deficiency anemia was significantly higher in the RAS group (P = 0.037). Three (2.7%) patients with RAS were diagnosed with CD, which is a significantly higher frequency than that observed in healthy children in Turkey (P < 0.01; OR 6.03, 95% CI [2.37, 4.56]). These children had mild malnutrition, iron deficiency, and iron deficiency anemia. CONCLUSIONS Children with RAS should be evaluated for nutritional status and hematological indices, and in the case of hematological abnormalities and malnutrition screening for CD should be considered.
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Affiliation(s)
- Songül Yılmaz
- Department of Pediatrics, Turkish Republic Health Ministry, Ankara Child Health Diseases, Hematology and Oncology Training and Research Hospital, Ankara, Turkey
| | - Ceyda Tuna Kırsaçlıoğlu
- Department of Pediatric Gastroenterology, Turkish Republic Health Ministry, Ankara Child Health Diseases, Hematology and Oncology Training and Research Hospital, Ankara, Turkey
| | - Tülin Revide Şaylı
- Department of Pediatrics, Turkish Republic Health Ministry, Ankara Child Health Diseases, Hematology and Oncology Training and Research Hospital, Ankara, Turkey
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Isasi C, Stadnitsky A, Casco F, Tejerina E, Royuela A, Esteban B, Puga NF. Non-celiac gluten sensitivity and chronic refractory low back pain with spondyloarthritis features. Med Hypotheses 2020; 140:109646. [PMID: 32145444 DOI: 10.1016/j.mehy.2020.109646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To propose the hypothesis that non-celiac gluten sensitivity is associated with chronic low-back pain related to spondyloarthritis, and a gluten free diet has a therapeutic benefit in a subgroup of patients. Gut involvement is a well-known association of spondyloarthritis but limited to a few disorders such as inflammatory bowel disease. Currently the therapeutic implication of this association is pharmacologic treatment for inflammation with immunosupresive drugs for both diseases. Here is a case series of patients with chronic low-back pain, spondyloarthritis related features, and response to gluten free diet despite celiac disease being ruled out. METHODS Retrospective case report of 110 patients from a tertiary hospital rheumatology clinic specialized in chronic pain and gluten sensitivity. These are patients with refractory low-back pain and spondyloarthritis features who followed a gluten free diet despite celiac disease being ruled out. Demanding improvement was defined based on the achievement of at least one of the following objectives: asymptomatic status, remission of chronic low-back pain, returning to normal life, returning to work, changing from confinement to bed/wheelchair to being able to walk, returning to self-sufficiency for hygiene and personal care, discontinuation of opioids. RESULTS Average age at low-back onset pain was 30. Average disease duration was 15 years. 87 (79%) of the patients experienced improvement. 69 (62%) of the patients achieved demanding improvement. Average duration of gluten-free diet in patients with demanding improvement was 60 months. 56 out of 69 patients with demanding improvement ingested gluten. Of these 56 patients, 54 experienced clinical worsening and were considered as having non-celiac gluten sensitivity. Oral aphthae and having a relative with celiac disease were associated with demanding improvement. Out of 28 patients retrospectively classified as having axial spondyloarthritis, 23 had demanding improvement. Out of 16 patients with uveitis, 13 had demanding improvement. Out of 83 patients with fibromyalgia, 48 had demanding improvement. CONCLUSION These observational data support the proposed hypothesis and offer information regarding possible clinical predictors of response to diet.
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Affiliation(s)
- Carlos Isasi
- Rheumatology Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Alexander Stadnitsky
- Family Medicine at Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Fernando Casco
- Pathological Anatomy Department of Unilabs, Madrid, Spain
| | - Eva Tejerina
- Pathological Anatomy Department of Hospital Universitario Puerta de Hierro, Majadahonda Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain
| | - Blanca Esteban
- Asociación de celíacos y sensibles al gluten de Madrid (Association of Celiacs and Gluten-Sensitives of Madrid, Spain
| | - Natalia Fernandez Puga
- Digestive Medicine Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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11
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European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J Pediatr Gastroenterol Nutr 2020; 70:141-156. [PMID: 31568151 DOI: 10.1097/mpg.0000000000002497] [Citation(s) in RCA: 515] [Impact Index Per Article: 128.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented. METHODS Literature databases and other sources of information were searched for studies that could inform on 10 formulated questions on symptoms, serology, HLA genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations. RESULTS Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable, an IgG-based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10× ULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. HLA DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10× ULN at least 4 biopsies from the distal duodenum and at least 1 from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely. CONCLUSIONS CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.
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Bijelić B, Matić IZ, Besu I, Janković L, Juranić Z, Marušić S, Andrejević S. Celiac disease-specific and inflammatory bowel disease-related antibodies in patients with recurrent aphthous stomatitis. Immunobiology 2019; 224:75-79. [DOI: 10.1016/j.imbio.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
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Nieri M, Tofani E, Defraia E, Giuntini V, Franchi L. Enamel defects and aphthous stomatitis in celiac and healthy subjects: Systematic review and meta-analysis of controlled studies. J Dent 2017; 65:1-10. [DOI: 10.1016/j.jdent.2017.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/22/2017] [Accepted: 07/01/2017] [Indexed: 12/14/2022] Open
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Besu I, Srdic-Rajic T, Matić I, Jankovic L, Besu V, Konic-Ristic A, Juranic Z. The absence of immunoreactivity to donkey’s milk in patients with recurrent aphthous ulcers and immunoreactivity to cow’s milk. FOOD AGR IMMUNOL 2017. [DOI: 10.1080/09540105.2017.1293017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Irina Besu
- Department of Experimental Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Tatjana Srdic-Rajic
- Department of Experimental Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ivana Matić
- Department of Experimental Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ljiljana Jankovic
- Clinic for Periodontology and Oral medicine, Faculty of Stomatology, University of Belgrade, Belgrade, Serbia
| | - Valeri Besu
- Dental Ordination ‘Dr Besu’, Zrenjanin, Serbia
| | - Aleksandra Konic-Ristic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Zorica Juranic
- Department of Experimental Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
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Abstract
Recurrent aphthous stomatitis (RAS) is the most common acute oral ulcerative condition in North America. RAS is divided into a mild, common form, simple aphthosis, and a severe, less common form, complex aphthosis. Aphthosis is a reactive condition. The lesions of RAS can represent the mucosal manifestation of a variety of conditions. These include conditions with oral and genital aphthae such as ulcus vulvae acutum, reactive nonsexually related acute genital ulcers, and Behçet disease. The mouth is the beginning of the gastrointestinal (GI) tract, and the lesions of RAS can be a manifestation of GI diseases such as gluten-sensitive enteropathy, ulcerative colitis, and Crohn disease. Complex aphthosis may also have correctable causes. The clinician should seek these in a careful evaluation. Successful management of both simple and complex aphthosis depends on accurate diagnosis, proper classification, recognition of provocative factors, and the identification of associated diseases. The outlook for patients with both simple and complex aphthosis is positive.
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Affiliation(s)
- Ricky Z Cui
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Alison J Bruce
- Department of Dermatology, Mayo Clinic, Jacksonville, FL.
| | - Roy S Rogers
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ
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Rahmati A, Shakeri R, Sohrabi M, Alipour A, Boghratian A, Setareh M, Zamani F. Correlation of tissue transglutaminase antibody with duodenal histologic marsh grading. Middle East J Dig Dis 2014; 6:131-6. [PMID: 25093060 PMCID: PMC4119669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/23/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent guidelines have proposed that there is a correlation between tissue transglutaminase (tTG) antibody titers and degrees of duodenal biopsy, and that duodenal biopsy can be omitted in some patients with high levels of tTG antibody. Using data of registered patients in a gastrointestinal clinic we aimed to assess the correlation between tissue transglutaminase antibody with duodenal histologic Marsh grading in Iranian patients with celiac disease. METHODS We retrospectively reviewed hospital files of registered patients in the gastrointestinal clinic of Firoozgar Hospital, Tehran, Iran. Demographic, laboratory, and histology data of those who had tTG titer and pathology reports of duodenal biopsy based on the modified Marsh classification were extracted and used for the study. RESULTS 159 patients with available tTG titer and pathology reports were enrolled in our study. Mean ±SD of the patients was 35.6±15.2 and 100 (62.9%) of them were women. 133 out of 153 patients had villous atrophy (Marsh IIIa-IIIc). Anemia was the most common sign and bloating, abdominal pain, and diarrhea were the first three common symptoms in these patients. Mean tTG titers was significantly higher in patients graded as Marsh III (p for trend=0.003). Our results showed that tTG titer more than 9 folds higher than the kit's cut-off value was about 97.2% sensitive for Marsh II and more duodenal damage. CONCLUSION There was a correlation between tTG titers and degrees of duodenal damage in patients with celiac disease. Duodenal biopsy is not always necessary for diagnosing celiac disease and when tTG level is more than 9 folds higher than the manufacture's recommended cut-off value it can be avoided. Meanwhile small intestinal biopsy should always be considered in case of high clinical suspicion, regardless of the results of serologic testing.
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Affiliation(s)
- Atieh Rahmati
- 1 Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Shakeri
- 1 Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,2 Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran
| | - Masoudreza Sohrabi
- 2 Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran
| | - Abbass Alipour
- 3 Department of Community Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirhossein Boghratian
- 2 Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran
| | - Massomeh Setareh
- 2 Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- 2 Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran
,Corresponding Author: Farhad Zamani, MD Gastrointestinal and Liver Disease Research of Medical Sciences, Tehran, Iran Tel: + 98 21 82141633 Fax:+ 98 21 88940489
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Sahin I, Eminbeyli L, Andic S, Tuncer I, Koz S. Screening for Celiac Disease among Patients with Chronic Kidney Disease. Ren Fail 2012; 34:545-9. [DOI: 10.3109/0886022x.2012.669299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Acar S, Yetkıner AA, Ersın N, Oncag O, Aydogdu S, Arıkan C. Oral findings and salivary parameters in children with celiac disease: a preliminary study. Med Princ Pract 2012; 21:129-33. [PMID: 22024774 DOI: 10.1159/000331794] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 06/28/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of dental enamel defects, recurrent aphthous stomatitis (RAS) and caries experience and to measure salivary flow rate, buffer capacity, saliva and plaque pH and salivary cariogenic microflora in patients with celiac disease (CD) compared to healthy subjects. SUBJECTS AND METHODS Thirty-five patients, aged 6-19 years, with a diagnosis of CD and 35 healthy children of the same age participated in the study. Enamel defects were diagnosed and classified using Aine's classification. The patients with RAS and dental caries were recorded using WHO criteria. The parents were interviewed about various oral health-related factors. Saliva samples were collected to measure the stimulated salivary flow rate, buffer capacity and pH values of saliva and plaque. Salivary mutans streptococci and lactobacilli were counted. RESULTS The enamel defects and RAS prevalence were statistically higher (40 and 37.1%, respectively) in the CD group, and the prevalence of salivary mutans streptococci (48 and 14%) and lactobacilli (51 and 34%) colonization was statistically lower (p = 0.012, p = 0.010) in the CD group; the DMFS and dfs values were similar in both groups. CONCLUSION CD appeared to be associated with a significantly higher prevalence of developing enamel defects and RAS, but a lower prevalence of salivary mutans streptococci and lactobacilli colonization, and the diagnosis of these oral manifestations might be helpful for an early diagnosis of CD.
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Affiliation(s)
- Sibel Acar
- Department of Pediatric Dentistry, Hepatology and Nutrition, Ege University, Izmir, Turkey.
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Abstract
Recurrent aphthous ulcers are common painful mucosal conditions affecting the oral cavity. Despite their high prevalence, etiopathogenesis remains unclear. This review article summarizes the clinical presentation, diagnostic criteria, and recent trends in the management of recurrent apthous stomatitis.
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Affiliation(s)
- L Preeti
- Department of Oral Pathology, SRM Dental College, Ramapuram, India
| | - KT Magesh
- Department of Oral Pathology, SRM Dental College and Hospital, Kattankulathur, India
| | - K Rajkumar
- Department of Oral Pathology, SRM Dental College, Ramapuram, India
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Epidemiology of celiac disease in iran: a review. Middle East J Dig Dis 2011; 3:5-12. [PMID: 25197526 PMCID: PMC4154929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 01/29/2011] [Indexed: 11/04/2022] Open
Abstract
Celiac disease (CD) was traditionally believed to be a chronic enteropathy, almost exclusively affecting people of European origin. Celiac disease is the permanent intolerance to dietary gluten, the major protein component of wheat. The availability of new, simple, very sensitive and specific serological tests has shown that CD is as common in Middle Eastern countries as in Europe, Australia and New Zealand where the major dietary staple is wheat. A high prevalence of CD has been found in Iran, in both the general population and the at-risk groups, i.e. patients with type 1 diabetes or irritable bowel syndrome (IBS). In developing countries, serological testing in at risk groups is necessary for early identification of celiac patients. Clinical studies show that presentation with non-specific symptoms or a lack of symptoms is as common in the Middle East as in Europe. Wheat is a major component of the Iranian diet and exposure to wheat proteins induces some degree of immune tolerance, leading to milder symptoms that may be mistaken with other GI disorders. The implementation of gluten free diet (GFD) is a major challenge for both patients and clinicians in Iran, especially since commercial gluten-free products are not available in this area.
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Abstract
Celiac disease is one of the most common chronic diseases encountered in the Western world with a serological prevalence of approximately 1%. Since it is so common, much comorbidity will occur either as associations or simply by chance, or as complications of the disorder. Many of the published studies purporting to establish the frequency of these occurrences have been limited by factors such as the source and number of patients considered, choice of control groups and ascertainment bias. Recent epidemiological studies have attempted to minimize these sources of error and provide more reliable information. Autoimmune diseases constitute clinically important associations, of which Type 1 diabetes mellitus and thyroid disorders are the most important. Several liver disorders, including primary biliary cirrhosis and primary sclerosing cholangitis, are also associated. The frequency of malignant complications of celiac disease is much lower than earlier studies have indicated, with lymphoma increased by approximately fivefold and the absolute number of tumors is small. The increase in fracture risk in celiac disease is only modest. Although neurological and psychiatric conditions affect celiac patients, no disorder specifically associated with celiac disease has been identified. Reproductive problems have been overexaggerated. It is important that these co-morbidities are recognized because if not, symptoms will be falsely attributed to deliberate or inadvertent ingestion of gluten, rather than prompt a search for a second diagnosis. Furthermore, in a patient with an established diagnosis that is considered falsely to account for the whole clinical picture, celiac disease is likely to remain undetected.
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Affiliation(s)
- Nina R Lewis
- Division of Epidemiology and Public Health, University of Nottingham, UK
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