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Fucà E, Costanzo F, Galassi P, Celestini L, Valentini D, Vicari S. Celiac disease in children and adolescents with Down syndrome: behavioural, adaptive and sleep profiles. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:932-940. [PMID: 38509762 DOI: 10.1111/jir.13135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Individuals with Down syndrome (DS) exhibit higher risk for celiac disease (CD) than general population. Although literature suggests CD could be associated with behavioural problems in both paediatric and adult age, such association has been poorly explored in children and adolescents DS. Therefore, the current study aimed to investigate differences in emotional/behavioural difficulties, adaptive skills and sleep problems between children with DS with and without CD. METHODS Data were retrospectively collected from a database including data from 381 individuals with DS (3-18 years). The final sample included 65 participants, 27 with co-occurring CD and 38 age, IQ, sex and body mass index-matched controls without CD. Emotional/behavioural difficulties, adaptive skills and sleep problems were assessed through parent report questionnaires. RESULTS No group differences emerged in emotional/behavioural difficulties, whereas participants in the CD group showed better adaptive skills in the practical domain than control group. Weak differences emerged in sleep problems. CONCLUSIONS Youth with DS and co-occurring CD do not exhibit more emotional and behavioural problems than youth with DS without co-occurring CD but exhibit better adaptive skills in the practical domain.
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Affiliation(s)
- E Fucà
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F Costanzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P Galassi
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - L Celestini
- Pediatric Unit, Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - D Valentini
- Pediatric Unit, Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Life Science and Public Health, Catholic University of the Sacred Heart, Rome, Italy
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Renga G, Pariano M, D'Onofrio F, Pieraccini G, Di Serio C, Villella VR, Abbate C, Puccetti M, Giovagnoli S, Stincardini C, Bellet MM, Ricci M, Costantini C, Oikonomou V, Romani L. The immune and microbial homeostasis determines the Candida-mast cells cross-talk in celiac disease. Life Sci Alliance 2024; 7:e202302441. [PMID: 38719750 PMCID: PMC11079604 DOI: 10.26508/lsa.202302441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
Celiac disease (CD) is an autoimmune enteropathy resulting from an interaction between diet, genome, and immunity. Although many patients respond to a gluten-free diet, in a substantive number of individuals, the intestinal injury persists. Thus, other factors might amplify the ongoing inflammation. Candida albicans is a commensal fungus that is well adapted to the intestinal life. However, specific conditions increase Candida pathogenicity. The hypothesis that Candida may be a trigger in CD has been proposed after the observation of similarity between a fungal wall component and two CD-related gliadin T-cell epitopes. However, despite being implicated in intestinal disorders, Candida may also protect against immune pathologies highlighting a more intriguing role in the gut. Herein, we postulated that a state of chronic inflammation associated with microbial dysbiosis and leaky gut are favorable conditions that promote C. albicans pathogenicity eventually contributing to CD pathology via a mast cells (MC)-IL-9 axis. However, the restoration of immune and microbial homeostasis promotes a beneficial C. albicans-MC cross-talk favoring the attenuation of CD pathology to alleviate CD pathology and symptoms.
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Affiliation(s)
- Giorgia Renga
- https://ror.org/00x27da85 Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marilena Pariano
- https://ror.org/00x27da85 Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fiorella D'Onofrio
- https://ror.org/00x27da85 Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Claudia Di Serio
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Valeria Rachela Villella
- European Institute for Research in Cystic Fibrosis (IERFC-Onlus), San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Abbate
- European Institute for Research in Cystic Fibrosis (IERFC-Onlus), San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Puccetti
- https://ror.org/00x27da85 Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Stefano Giovagnoli
- https://ror.org/00x27da85 Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Claudia Stincardini
- https://ror.org/00x27da85 Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marina Maria Bellet
- https://ror.org/00x27da85 Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maurizio Ricci
- https://ror.org/00x27da85 Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Claudio Costantini
- https://ror.org/00x27da85 Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Vasileios Oikonomou
- https://ror.org/00x27da85 Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luigina Romani
- https://ror.org/00x27da85 Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Mikulska J, Pietrzak D, Rękawek P, Siudaj K, Walczak-Nowicka ŁJ, Herbet M. Celiac disease and depressive disorders as nutritional implications related to common factors - A comprehensive review. Behav Brain Res 2024; 462:114886. [PMID: 38309373 DOI: 10.1016/j.bbr.2024.114886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
Celiac disease (CD) is an immune-mediated disease affecting the small intestine. The only treatment strategy for CD is the gluten-free diet (GFD). One of the more common mental disorders in CD patients is major depressive disorder (MDD). The influence of GFD on the occurrence of MDD symptoms in patients with CD will be evaluated. This diet often reduces nutritional deficiencies in these patients and also helps to reduce depressive symptoms. Both disease entities are often dominated by the same deficiencies of nutrients such as iron, zinc, selenium, iodine, or B and D vitamins. Deficiencies of particular components in CD can favor MDD and vice versa. Gluten can adversely affect the mental state of patients without CD. Also, intestinal microbiota may play an important role in the described process. This work aims to comprehensively assess the common factors involved in the pathomechanisms of MDD and CD, with particular emphasis on nutrient imbalances. Given the complexity of both disease entities, and the many common links, more research related to improving mental health in these patients and the implementation of a GFD would need to be conducted, but it appears to be a viable pathway to improving the quality of life and health of people struggling with CD and MDD. Therefore, probiotics, micronutrients, macronutrients, and vitamin supplements are recommended to reduce the risk of MDD, given that they may alleviate the symptoms of both these disease entities. In turn, in patients with MDD, it is worth considering testing for CD.
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Affiliation(s)
- Joanna Mikulska
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Diana Pietrzak
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Paweł Rękawek
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Krystian Siudaj
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Łucja Justyna Walczak-Nowicka
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland.
| | - Mariola Herbet
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
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Haj Ali S, Alqurneh R, Abu Sneineh A, Ghazal B, Agraib L, Abbasi L, Rifaei S, Mazzawi T. The Prevalence of Anxiety and Depressive Symptoms Among Patients With Celiac Disease in Jordan. Cureus 2023; 15:e39842. [PMID: 37397686 PMCID: PMC10314801 DOI: 10.7759/cureus.39842] [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: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Background Celiac disease is an immune-mediated intestinal disorder with a global prevalence of 1% that results from gluten sensitivity in a genetically susceptible person. It presents with gastrointestinal symptoms, consequences of malabsorption, and/or extraintestinal manifestations that include neuropsychiatric symptoms. Aim The aim of this study was to measure the frequency of anxiety and depressive symptoms in Jordanian patients with celiac disease. Methods This was a cross-sectional study. A questionnaire was sent electronically to celiac disease patients who were members of the Friends of Celiac Disease Patients Association through WhatsApp using Google Forms (Google, Mountain View, California). The questionnaire contained demographic and disease-related questions, in addition to questions that assessed anxiety and depressive symptoms using validated Arabic versions of the Generalized Anxiety Disorder-7 score and Patient Health Questionnaire-9, respectively. Results A total of 133 patients answered the questionnaires. Of the respondents, 82.7% were females, and the mean age was 33.9 +/- 11.22 years; 31.6% of patients were non-compliant with a gluten-free diet, and 56.4% were symptomatic at the time of the questionnaire. The prevalence of anxiety and depressive symptoms were 85% and 82.7%, respectively. There was no correlation between any of the variables and the presence of anxiety or depressive symptoms. Conclusion A significant proportion of celiac disease patients in Jordan have evidence of anxiety and depressive symptoms. Given this high prevalence and the possible impact on the quality of life, physicians need to screen patients for the presence of psychiatric comorbidities and refer those who have symptoms for further evaluation.
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Affiliation(s)
- Sara Haj Ali
- Medicine, Al-Balqa Applied University, Al-Salt, JOR
| | | | - Awni Abu Sneineh
- Gastroenterology and Hepatology, University of Jordan, Amman, JOR
| | | | - Lana Agraib
- Food Science and Nutrition, Jerash University, Jerash, JOR
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Abstract
OBJECTIVE There are no definitive results about either the presence of exact comorbidity between celiac disease (CD) and attention-deficit/hyperactivity disorders (ADHD) or etiology. We intend to screen ADHD-related cognitive and behavioral traits in children with biopsy-proven CD and investigate the possible association of these traits with certain vitamin levels, body-mass index, and gluten-free diet (GFD) compliance. METHOD A total of 85 children with biopsy-proven CD (the ages of 8-18 years) were compared with age and sex-matched 72 healthy controls in terms of demographics, psychiatric symptoms, certain vitamin levels, and anthropometric measurements. RESULTS ADHD-like cognitive issues, such as inattention and learning difficulties, as well as psychosomatic symptoms and poor prosocial behavior, were all associated with GFD noncompliance in childhood CD. CONCLUSION Untreated CD may predispose to ADHD-resembling symptoms. Physicians should be aware of the probability of ADHD misdiagnosing due to ADHD-resembling cognitive and behavioral traits in untreated CD.
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Affiliation(s)
- Ayşegül Efe
- University of Health Sciences, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ayşegül Tok
- University of Health Sciences, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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de Sousa Franckilin LR, Dos Santos ACPM, Freitas FEDA, Vieira IG, de Freitas Jorge CE, Neri DG, de Abreu MVC, Fonseca JK, Loffi RG, Foureaux G. Gluten: do only celiac patients benefit from its removal from the diet? FOOD REVIEWS INTERNATIONAL 2022. [DOI: 10.1080/87559129.2021.2024566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Renato Guimarães Loffi
- Departamento de Ciência, Tecnologia e Inovação, Treini Biotecnologia Ltda, Belo Horizonte, Brazil
| | - Giselle Foureaux
- Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Nutrição, Angiogold: Medicina Integrativa, Belo Horizonte, Brazil
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Lerner A, Freire de Carvalho J, Kotrova A, Shoenfeld Y. Gluten-free diet can ameliorate the symptoms of non-celiac autoimmune diseases. Nutr Rev 2021; 80:525-543. [PMID: 34338776 DOI: 10.1093/nutrit/nuab039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/05/2021] [Accepted: 05/12/2021] [Indexed: 11/12/2022] Open
Abstract
CONTEXT A gluten-free diet (GFD) is the recommended treatment for gluten-dependent disease. In addition, gluten withdrawal is popular and occasionally is suggested as a treatment for other autoimmune diseases (ADs). OBJECTIVE The current systematic review summarizes those entities and discusses the logic behind using a GFD in classical non-gluten-dependentADs. DATA SOURCES A search for medical articles in PubMed/MEDLINE, Web of Sciences, LILACS, and Scielo published between 1960 and 2020 was conducted, using the key words for various ADs and GFDs. DATA EXXTRACTION Eight-three articles were included in the systematic review (using PRISMA guidelines). DATA ANALYSIS Reduction in symptoms of ADs after observance of a GFD was observed in 911 out of 1408 patients (64.7%) and in 66 out of the 83 selected studies (79.5%). The age of the patients ranged from 9 months to 69 years. The duration of the GFD varied from 1 month to 9 years. A GFD can suppress several harmful intraluminal intestinal events. Potential mechanisms and pathways for the action of GFD in the gut - remote organs' axis have been suggested. CONCLUSION A GFD might represent a novel nutritional therapeutic strategy for classical non-gluten-dependent autoimmune conditions.
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Affiliation(s)
- Aaron Lerner
- A. Lerner and Y. Shoenfeld are with the The Zabludowicz Research Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel. J. Freire de Carvalho is with the Department of Rheumatology, Institute for Health Sciences of the Federal University of Bahia, Salvador, Bahia, Brazil. A. Kotrova and Y. Shoenfeld are with the Department of Autoimmune research, Saint Petersburg State University, St. Petersburg, Russia. Y. Shoenfeld is with the Department of Administration, Ariel University, Israel. Y. Shoenfeld is with the Department of Autoimmune research, I.M Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Jozélio Freire de Carvalho
- A. Lerner and Y. Shoenfeld are with the The Zabludowicz Research Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel. J. Freire de Carvalho is with the Department of Rheumatology, Institute for Health Sciences of the Federal University of Bahia, Salvador, Bahia, Brazil. A. Kotrova and Y. Shoenfeld are with the Department of Autoimmune research, Saint Petersburg State University, St. Petersburg, Russia. Y. Shoenfeld is with the Department of Administration, Ariel University, Israel. Y. Shoenfeld is with the Department of Autoimmune research, I.M Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Anna Kotrova
- A. Lerner and Y. Shoenfeld are with the The Zabludowicz Research Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel. J. Freire de Carvalho is with the Department of Rheumatology, Institute for Health Sciences of the Federal University of Bahia, Salvador, Bahia, Brazil. A. Kotrova and Y. Shoenfeld are with the Department of Autoimmune research, Saint Petersburg State University, St. Petersburg, Russia. Y. Shoenfeld is with the Department of Administration, Ariel University, Israel. Y. Shoenfeld is with the Department of Autoimmune research, I.M Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Yehuda Shoenfeld
- A. Lerner and Y. Shoenfeld are with the The Zabludowicz Research Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel. J. Freire de Carvalho is with the Department of Rheumatology, Institute for Health Sciences of the Federal University of Bahia, Salvador, Bahia, Brazil. A. Kotrova and Y. Shoenfeld are with the Department of Autoimmune research, Saint Petersburg State University, St. Petersburg, Russia. Y. Shoenfeld is with the Department of Administration, Ariel University, Israel. Y. Shoenfeld is with the Department of Autoimmune research, I.M Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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Jericho H, Khan N, Cordova J, Sansotta N, Guandalini S, Keenan K. Call for Action: High Rates of Depression in the Pediatric Celiac Disease Population Impacts Quality of Life. JPGN REPORTS 2021; 2:e074. [PMID: 37205970 PMCID: PMC10191553 DOI: 10.1097/pg9.0000000000000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/29/2021] [Indexed: 05/21/2023]
Abstract
To test the impact of celiac disease (CD) and depression symptoms on quality of life in adolescent patients. Methods We conducted a prospective survey of 12- to 18-year-old celiac patients and their caregivers between January 2015 and November 2016. Enrolled parents and youth completed standard measures of adjustment to celiac disease, depression, and quality of life. Results We enrolled 105 patients with CD and their parents. Both parents and youth reported high levels of depression symptoms. There were no associations between age, duration of CD, or following a gluten-free diet (GFD) and quality of life. No significant associations were found between adolescent perception of CD state and quality of life; parental report of adolescent's adjustment to CD; and youth report of quality of life were modestly associated (r = 0.19, P ≤ 0.05). Moderate associations were observed between adolescent reports of depression and quality of life (r = 0.59, P < 0.01) and between parental reports of adolescent depression and quality of life (r = 0.41, P = 0.01). Only depressive symptoms by youth and parent report, however, and not adjustment to celiac, explained unique variance in quality of life. Conclusion Adolescents with CD report levels of depression comparable to those reported by adolescents seeking mental health services. Length of time living with CD, or on GFD, age at diagnosis and perception of disease state do not appear to contribute to depression. High rates of depression may impact CD prognosis, therefore, screening for depression in adolescents with CD appears critical. Identification and intervention of depression may lead to improved adherence to the GFD during emerging adulthood.
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Affiliation(s)
- Hilary Jericho
- From the Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Celiac Disease Center, University of Chicago Medicine, Comer Children’s Hospital, Chicago, IL
| | - Narmeen Khan
- From the Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Celiac Disease Center, University of Chicago Medicine, Comer Children’s Hospital, Chicago, IL
| | - Jonathan Cordova
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL
| | - Naire Sansotta
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Guandalini
- From the Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Celiac Disease Center, University of Chicago Medicine, Comer Children’s Hospital, Chicago, IL
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago, IL
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Lerner A, Benzvi C. "Let Food Be Thy Medicine": Gluten and Potential Role in Neurodegeneration. Cells 2021; 10:756. [PMID: 33808124 PMCID: PMC8065505 DOI: 10.3390/cells10040756] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Wheat is a most favored staple food worldwide and its major protein is gluten. It is involved in several gluten dependent diseases and lately was suggested to play a role in non-celiac autoimmune diseases. Its involvement in neurodegenerative conditions was recently suggested but no cause-and-effect relationship were established. The present narrative review expands on various aspects of the gluten-gut-brain axes events, mechanisms and pathways that connect wheat and gluten consumption to neurodegenerative disease. Gluten induced dysbiosis, increased intestinal permeabillity, enteric and systemic side effects, cross-reactive antibodies, and the sequence of homologies between brain antigens and gluten are highlighted. This combination may suggest molecular mimicry, alluding to some autoimmune aspects between gluten and neurodegenerative disease. The proverb of Hippocrates coined in 400 BC, "let food be thy medicine," is critically discussed in the frame of gluten and potential neurodegeneration evolvement.
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Affiliation(s)
- Aaron Lerner
- Chaim Sheba Medical Center, The Zabludowicz Research Center for Autoimmune Diseases, Tel Hashomer 5262000, Israel;
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Child and Parent Mental Health Problems in Pediatric Celiac Disease: A Prospective Study. J Pediatr Gastroenterol Nutr 2020; 71:315-320. [PMID: 32404753 DOI: 10.1097/mpg.0000000000002769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of our study was to estimate the levels of mental health problems in children with celiac disease (CD) along with their parents' mental health status, to compare these levels with those of healthy controls and to investigate how these problems are affected by a gluten-free diet (GFD). METHODS Our study constituted 50 patients with CD at diagnosis before the initiation of a GFD (age 8.6 ± 3.7 years, group A), 39 patients with CD on a GFD for at least 12 months (age 10.4 ± 3.4 years, group B) and 38 healthy controls (age 7.7 ± 3.8 years, group C), as well as their parents. One of the parents of each child completed the Child Behaviour Checklist (CBCL) and the Symptom Checklist 90 (SCL-90-R) to evaluate the children's and parents' mental health problems, respectively. Twenty patients in group A were reevaluated at least 12 months after initiation of a GFD (group D). RESULTS At diagnosis, CD patients had higher scores in the CBCL for internalizing problems than healthy controls (55.7 ± 10.3 vs 47.9 ± 15.4, P = 0.007) and their parents demonstrated increased severity of mental health problems, including anxiety and depression, than the parents of healthy controls (0.72 ± 0.49 vs 0.54 ± 0.58, P = 0.013). CONCLUSIONS CD patients at diagnosis and their parents, had more mental health problems, including anxiety and depression, than healthy controls.
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Ertürk E, Wouters S, Imeraj L, Lampo A. Association of ADHD and Celiac Disease: What Is the Evidence? A Systematic Review of the Literature. J Atten Disord 2020; 24:1371-1376. [PMID: 26825336 DOI: 10.1177/1087054715611493] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: This article tries to answer the question whether or not there is evidence for a relationship between celiac disease (CD) and ADHD. A review of the current literature on this topic is provided. Method: PUBMED/MEDLINE, Web of Science, and Google scholar were searched to include all published trials on ADHD and CD (no date limitation, both noncontrolled and controlled trials). In addition, the reference list of included studies was screened to find other relevant articles. Results: Eight studies report a possible association between CD and ADHD; however, the results are inconsistent. Only three out of eight studies report a positive correlation between ADHD and CD. Conclusion: Up till now, there is no conclusive evidence for a relationship between ADHD and CD. Therefore, it is not advised to perform routine screening of CD when assessing ADHD (and vice versa) or to implement gluten-free diet as a standard treatment in ADHD.
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Aaron L, Torsten M. Candida albicans in celiac disease: A wolf in sheep's clothing. Autoimmun Rev 2020; 19:102621. [PMID: 32693029 DOI: 10.1016/j.autrev.2020.102621] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022]
Abstract
Candida albicans is a commensal fungus with a potential pathogenicity and celiac disease is an autoimmune condition. Both share multiple pathophysiological junctions, including serological markers against cell-wall proteins of Candida, anti-gliadin antibodies are positive in both entities, gluten and a candidal virulence factor share sequence similarity and the autoantigen of celiac disease, the tissue transglutaminase, is pivotal in Candida albicans commensalism and hostile behavior and its covalently cross linked products are stable and resistant to breakdown in the two entities. Those autoimmune/infectious cross roads are the basis for the hypothesis that Candida albicans is an additional environmental factor for celiac disease autoimmunogenesis.
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Di Liberto D, D’Anneo A, Carlisi D, Emanuele S, De Blasio A, Calvaruso G, Giuliano M, Lauricella M. Brain Opioid Activity and Oxidative Injury: Different Molecular Scenarios Connecting Celiac Disease and Autistic Spectrum Disorder. Brain Sci 2020; 10:E437. [PMID: 32659996 PMCID: PMC7407635 DOI: 10.3390/brainsci10070437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/11/2022] Open
Abstract
Celiac Disease (CD) is an immune-mediated disease triggered by the ingestion of wheat gliadin and related prolamins from other cereals, such as barley and rye. Immunity against these cereal-derived proteins is mediated by pro-inflammatory cytokines produced by both innate and adaptive system response in individuals unable to adequately digest them. Peptides generated in this condition are absorbed across the gut barrier, which in these patients is characterized by the deregulation of its permeability. Here, we discuss a possible correlation between CD and Autistic Spectrum Disorder (ASD) pathogenesis. ASD can be induced by an excessive and inappropriate brain opioid activity during the neonatal period. Cereal-derived peptides produced in celiac patients cross the blood-brain barrier and bind to endogenous opioid receptors interfering with neurotransmission and generating deleterious effects on brain maturation, learning and social relations. Moreover, an increase in oxidative stress and a decrease in the antioxidant capacity, as well as an extended mitochondrial impairment in the brain, could represent a possible connection between ASD and CD. Therefore, we critically discuss the proposed relationship between ASD and CD and the possible usefulness of a gluten-free diet in ASD patients.
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Affiliation(s)
- Diana Di Liberto
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), University of Palermo, 90127 Palermo, Italy;
| | - Antonella D’Anneo
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), Laboratory of Biochemistry, University of Palermo, 90127 Palermo, Italy; (A.D.B.); (G.C.); (M.G.)
| | - Daniela Carlisi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy; (D.C.); (S.E.)
| | - Sonia Emanuele
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy; (D.C.); (S.E.)
| | - Anna De Blasio
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), Laboratory of Biochemistry, University of Palermo, 90127 Palermo, Italy; (A.D.B.); (G.C.); (M.G.)
| | - Giuseppe Calvaruso
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), Laboratory of Biochemistry, University of Palermo, 90127 Palermo, Italy; (A.D.B.); (G.C.); (M.G.)
| | - Michela Giuliano
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), Laboratory of Biochemistry, University of Palermo, 90127 Palermo, Italy; (A.D.B.); (G.C.); (M.G.)
| | - Marianna Lauricella
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy; (D.C.); (S.E.)
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14
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Aucoin M, Bhardwaj S. Major Depressive Disorder and Food Hypersensitivity: A Case Report. Neuropsychobiology 2020; 78:249-255. [PMID: 31600757 DOI: 10.1159/000502963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/24/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Major depressive disorder (MDD) is a common chronic mental health condition and not all patients respond to pharmacotherapy. Increasing evidence suggests that dietary choices play a role in the pathogenesis of mental illness and serve as modifiable factors with utility in the treatment of these disorders. Although many mechanisms are being explored, one area of study is the role of food hypersensitivity reactions in mental health conditions. CASE PRESENTATION This article reports on a 34-year-old female patient with MDD whose symptoms improved in response to a dietary intervention involving the elimination of common food allergens. Reintroduction of the foods on several occasions was associated with a worsening of mood symptoms. Serum IgG testing reported results consistent with the reintroduction challenge. DISCUSSION AND CONCLUSIONS Hypothesized mechanisms underlying the potential relationship between food hypersensitivity and MDD are presented. Further research in this area is warranted.
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Affiliation(s)
- Monique Aucoin
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada,
| | - Sukriti Bhardwaj
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
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15
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Rostami-Nejad M, Taraghikhah N, Ciacci C, Pourhoseingholi MA, Barzegar F, Rezaei-Tavirani M, Aldulaimi D, Zali MR. Anxiety Symptoms in Adult Celiac Patients and the Effect of a Gluten-Free Diet: An Iranian Nationwide Study. Inflamm Intest Dis 2020; 5:42-47. [PMID: 32232054 DOI: 10.1159/000505657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/31/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction Psychiatric disorders, especially anxiety, are considered extraintestinal manifestations of celiac disease (CD). Objective This study aims to evaluate the level of anxiety in treated patients with CD in Iran. Methods A total of 283 CD patients (190 female, 93 male) were enrolled in a study during 2016-2018 from 9 centers in Iran. The Zung Self-Rating Anxiety Scale questionnaire was completed. The anxiety index was calculated. Also, demographic data and the duration of treatment with a gluten-free diet (GFD) were recorded. Data were analyzed by SPSS version 20. Results Anxiety symptoms were reported in 67.8% of patients. Female patients had a higher anxiety index than male patients. Duration of treatment with a GFD did not influence the anxiety index (17.3% were on a GFD for <1 year, 33.6% for 1-2 years, and 49.1% had GFD for >2 years; p = 0.86). Conclusions These results suggest that anxiety symptoms are common among patients, especially females, with CD in Iran and GFD duration has no effect on their improvement.
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Affiliation(s)
- Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Taraghikhah
- Student Research Committee, Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Carolina Ciacci
- Coeliac Center at Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Mohamad Amin Pourhoseingholi
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnoush Barzegar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - David Aldulaimi
- Consultant Gastroenterologist, South Warwickshire Foundation Trust, Warwick, United Kingdom
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Psychiatric Manifestations of Coeliac Disease, a Systematic Review and Meta-Analysis. Nutrients 2020; 12:nu12010142. [PMID: 31947912 PMCID: PMC7019223 DOI: 10.3390/nu12010142] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Coeliac disease (CD) is increasingly prevalent and is associated with both gastrointestinal (GI) and extra-intestinal manifestations. Psychiatric disorders are amongst extra-intestinal manifestations proposed. The relationship between CD and such psychiatric disorders is not well recognised or understood. Aim: The aim of this systematic review and meta-analysis was to provide a greater understanding of the existing evidence and theories surrounding psychiatric manifestations of CD. Methodology: An online literature search using PubMed was conducted, the prevalence data for both CD and psychiatric disorders was extracted from eligible articles. Meta analyses on odds ratios were also performed. Results: A total of 37 articles were included in this review. A significant increase in risk was detected for autistic spectrum disorder (OR 1.53, 95% CI 1.24–1.88, p < 0.0001), attention deficit hyperactivity disorder (OR 1.39, 95% CI 1.18–1.63, p < 0.0001), depression (OR 2.17, 95% CI 2.17–11.15, p < 0.0001), anxiety (OR 6.03, 95% CI 2.22–16.35, p < 0.0001), and eating disorders (OR 1.62, 95% CI 1.37–1.91, p < 0.00001) amongst the CD population compared to healthy controls. No significant differences were found for bipolar disorder (OR 2.35, 95% CI 2.29–19.21, p = 0.43) or schizophrenia (OR 0.46, 95% CI 0.02–10.18, p = 0.62). Conclusion: CD is associated with an increased risk of depression, anxiety, eating disorders as well as ASD and ADHD. More research is required to investigate specific biological explanations as well as any effect of gluten free diet.
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17
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Renga G, Bellet MM, Stincardini C, Pariano M, Oikonomou V, Villella VR, Brancorsini S, Clerici C, Romani L, Costantini C. To Be or Not to Be a Pathogen: Candida albicans and Celiac Disease. Front Immunol 2019; 10:2844. [PMID: 31867008 PMCID: PMC6906151 DOI: 10.3389/fimmu.2019.02844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/19/2019] [Indexed: 12/20/2022] Open
Abstract
Celiac disease (CD) is an immune-mediated disorder triggered by the ingestion of gluten and characterized by reversible small-bowel mucosal atrophy in genetically predisposed subjects. Although the prevalence of CD has increased, many aspects of this pathology are still unrecognized. Candida albicans, a commensal of the human gastrointestinal tract, has been linked to CD for a long time based, among others, upon the observation of similarity between the fungal wall component, hyphal wall protein 1, and CD-related gliadin T-cell epitopes. We have recently demonstrated that Candida may switch from commensal to pathogen contingent upon several players, including mast cells, key sentinels of the immune system at the interface between the environment and the host, and the pleiotropic cytokine IL-9. However, other factors are likely to play a role by altering the balance between inflammation and tolerance. In this regard, tryptophan and its metabolites are increasingly being recognized in promoting mucosal homeostasis by balancing the immune response to external cues. Based on these premises, we will discuss how the output of Candida colonization in the gut is highly contextual, being determined at the intersection of many immunological (IL-9/mast cells) and metabolic (tryptophan) pathways that ultimately dictate the Candida commensalism vs. pathogenicity in CD, thus paving the way for novel therapeutic opportunities in CD.
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Affiliation(s)
- Giorgia Renga
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Marina M Bellet
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Marilena Pariano
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Vasilis Oikonomou
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Valeria R Villella
- Division of Genetics and Cell Biology, European Institute for Research in Cystic Fibrosis, San Raffaele Scientific Institute, Milan, Italy
| | | | - Carlo Clerici
- Gastroenterology Unit, Santa Maria della Misericordia Hospital of Perugia, Perugia, Italy
| | - Luigina Romani
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Claudio Costantini
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
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18
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Leviter J, Constantine E. More Than Just Teenage Angst? CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.100730] [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]
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19
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Smith LB, Kurppa K, Agardh D. Further Support for Psychological Symptoms in Pediatric Celiac Disease. Pediatrics 2019; 144:peds.2019-1683. [PMID: 31492764 DOI: 10.1542/peds.2019-1683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Laura B Smith
- University of South Florida Diabetes Center, Health Informatics Institute, and Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida;
| | - Kalle Kurppa
- Department of Paediatrics, Center for Child Health Research, Tampere University Hospital, Tampere, Finland; and
| | - Daniel Agardh
- Unit of Diabetes and Celiac Disease, Malmö University, Malmö, Sweden
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20
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Abstract
OBJECTIVES Mental health disorders comorbid to chronic illness are associated with higher medical care utilization and costs for adults and children. Celiac disease (CD) has a substantial perceived treatment burden and is associated with higher rates of psychopathology in adults. However, establishing the risk for psychological comorbidities in children with CD is still needed. This study aimed to review existing research on mental health concerns in pediatric CD and propose an initial psychosocial research and clinical agenda. METHODS Databases, including Scopus and PubMed. Additional publications were accessed and reviewed from the references provided by initially identified publications. Two investigators screened studies using predetermined criteria (peer-reviewed, published in English, electronically available, inclusive of child participants, and examining CD). One investigator initially extracted data, with subsequent review by the second investigator. RESULTS Twenty-six publications met criteria for the current review (16 case-control, 9 observational, and 1 clinical trial). Publications were heterogeneous in symptoms examined, methodology, and population characteristics. Several studies found elevated risk for psychological comorbidities and poorer quality of life in children with CD. However, many studies were limited by small sample sizes and inconsistent or nonvalidated approaches to measuring psychological symptoms. CONCLUSIONS Many existing studies have found increased prevalence of comorbid CD and psychological symptoms or diagnoses. Therefore, screening for psychological symptoms in CD and also screening for CD in psychological clinic populations is needed. We have identified the importance for further study of mechanisms and risk, and identify preliminary priorities for psychosocial research and clinical care in pediatric CD.
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21
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Martínez-Martinez MI, Alegre-Martínez A, García-Ibánez J, Cauli O. Quality of Life in People with Coeliac Disease: Psychological and Socio- Economic Aspects. Endocr Metab Immune Disord Drug Targets 2019; 19:116-120. [PMID: 30033882 DOI: 10.2174/1871530318666180723100003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Coeliac disease (CD) is a chronic autoimmune intestinal disorder characterized by intolerance to gluten, a protein contained in certain cereals. The main physiopathological basis of CD is the progressive destruction of intestinal villi caused by gluten ingestion by genetically-susceptible individuals. Patients who receive a diagnosis of CD must make significant changes to their daily habits and this can affect their quality of life. The objective of this review is to summarize the evidence regarding the economic, physical and social limitations which can affect the quality of life in patients with CD. RESULTS Different factors such as physical changes, psychological effects, interpersonal relationships, emotions and economic difficulties can affect the quality of life of these patients. Observations suggest that, in general, women with CD experience a greater deterioration in their quality of life than men. Lastly, complications in daily life are also associated with the reduced availability of gluten-free products which also usually cost more than standard products. CONCLUSIONS Continuous health education and care regarding socio-economic issues should be continuously developed and provided to people with CD.
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Affiliation(s)
- Maria Isabel Martínez-Martinez
- Departamento de Enfermeria. Facultad de Enfermeria y Podologia, Universidad de Valencia. C/ Jaume Roig, s/n, 46001 Valencia, Spain
| | - Antoni Alegre-Martínez
- Departamento de Ciencias Biomédicas, Universidad Cardenal Herrera CEU. Avenida Seminario, s/n, 46113 Montcada, Valencia, Spain
| | - Jessica García-Ibánez
- Departamento de Enfermeria. Facultad de Enfermeria y Podologia, Universidad de Valencia. C/ Jaume Roig, s/n, 46001 Valencia, Spain
| | - Omar Cauli
- Departamento de Enfermeria. Facultad de Enfermeria y Podologia, Universidad de Valencia. C/ Jaume Roig, s/n, 46001 Valencia, Spain
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22
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Jericho H, Guandalini S. Extra-Intestinal Manifestation of Celiac Disease in Children. Nutrients 2018; 10:nu10060755. [PMID: 29895731 PMCID: PMC6024684 DOI: 10.3390/nu10060755] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 12/11/2022] Open
Abstract
The aim of this literature review is to discuss the extra-intestinal manifestations of celiac disease within the pediatric celiac population.
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Affiliation(s)
- Hilary Jericho
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Celiac Disease Center-Comer Children's Hospital, Chicago, IL 60637, USA.
| | - Stefano Guandalini
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Celiac Disease Center-Comer Children's Hospital, Chicago, IL 60637, USA.
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23
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Holbein CE, Carmody JK, Hommel KA. Topical Review: Adherence Interventions for Youth on Gluten-Free Diets. J Pediatr Psychol 2018; 43:392-401. [PMID: 29096013 PMCID: PMC6658851 DOI: 10.1093/jpepsy/jsx138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 02/07/2023] Open
Abstract
Objective To summarize gluten-free diet (GFD) nonadherence risk factors, nonadherence rates, and current intervention research within an integrative framework and to develop a research agenda for the development and implementation of evidence-based GFD adherence interventions. Methods Topical review of literature published since 2008 investigating GFD adherence in pediatric samples. Results Reviews of pediatric studies indicate GFD nonadherence rates ranging from 19 to 56%. There are few evidence-based, published pediatric GFD adherence interventions. Novel assessments of GFD adherence are promising but require further study. Nonmodifiable and modifiable factors within individual, family, community, and health systems domains must be considered when developing future interventions. Clinical implications are discussed. Conclusions Avenues for future research include development and refinement of adherence assessment tools and development of evidence-based GFD adherence interventions. Novel technologies (e.g., GFD mobile applications) require empirical study but present exciting opportunities for adherence intervention.
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Affiliation(s)
- Christina E Holbein
- Division of Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center
| | - Julia K Carmody
- Division of Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center
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24
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OLIVEIRA GN, MOHAN R, FAGBEMI A. REVIEW OF CELIAC DISEASE PRESENTATION IN A PEDIATRIC TERTIARY CENTRE. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55:86-93. [DOI: 10.1590/s0004-2803.201800000-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/09/2017] [Indexed: 12/11/2022]
Abstract
ABSTRACT BACKGROUND: Celiac disease is an immune-mediated disorder with a multiform presentation and therefore a challenging diagnosis. OBJECTIVE: Our purpose is to identify the epidemiological, clinical, laboratory and histologic characteristics of children with celiac disease at diagnosis and on follow-up. METHODS: Children with previously established or newly diagnosed celiac disease, admitted in a tertiary centre in a two-year period (2014-2016) were recruited. Data was collected retrospectively from electronic medical records and clinical notes, and subsequently analysed with SPSS version 20.0. RESULTS: A total of 159 patients, out of 312, were included. Age ranged from 1 to 17 years (mean ± SD: 8.5±4.5 years, 69% girls). Disease presentation was classical in 60%, non-classical in 25%, subclinical in 10% and 5% classified as potential celiac disease. Non-classical and subclinical profiles had a higher mean age at presentation but not statistically significant (P-value 0.24). The most frequent gastrointestinal features at presentation were abdominal pain (58%), diarrhea (43%) and bloating (27%). A positive family history for celiac disease was present in 24% (n=35). We found anaemia in 23%, low ferritin in 63% and a moderate to severe deficiency of 25-hydroxyvitamin D in 62%. celiac disease -specific serologic testing and esophagogastroduodenoscopy were performed in 99%. Histology revealed modified Marsh 2 or 3 enteropathy in 94%, the remaining had normal histology but positive human leukocyte antigen typing. Clinical improvement at 12 months of gluten-free diet was complete in 51% and partial in 49%. IgA tTG normalized after 12-30 months of gluten-free diet in 45%. On growth assessment at diagnosis and after 12-28 months of gluten-free diet, 100% had height increase (mean ±SD: 7.11±4.43 cm) and 96% weight gain (mean ±SD: 5.60±4.91 kg). CONCLUSION: Our findings outline the diverse clinical presentations of pediatric celiac disease that should be considered irrespective of age. Increased clinician’s awareness will enable an early diagnosis and treatment, with subsequent symptom and nutritional status improvement.
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Affiliation(s)
| | - Rajiv MOHAN
- Royal Manchester Children’s Hospital, United Kingdom
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25
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Ludlow AK, Rogers SL. Understanding the impact of diet and nutrition on symptoms of Tourette syndrome: A scoping review. J Child Health Care 2018; 22:68-83. [PMID: 29268618 DOI: 10.1177/1367493517748373] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Anecdotal reports frequently suggest some dietary involvement in the maintenance of tics in children with Tourette syndrome (TS). This scoping review aimed to (1) understand the possible influence of diet as a trigger of tics and (2) map out the existing studies documenting dietary interventions in children with TS. Current evidence suggests no single diet to benefit individuals with TS. However, reports from parents of children with TS suggest that certain allergens in food may exacerbate tic-related symptoms. For example, an increase in tics has been related to the consumption of caffeine and refined sugar. Moreover, oligoantigenic diets and sugar-free diets have been identified as significantly reducing tics. More research is urgently needed to develop more accurate guidance for parents and children with TS, as many have reported using dietary and nutritional supplements, despite the lack of evidence detailing any benefits, side effects and recommended doses.
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Affiliation(s)
- Amanda K Ludlow
- 1 Department of Psychology and Sport Sciences, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, UK
| | - Samantha L Rogers
- 2 Centre for Research in Primary and Community Care, School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, UK
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26
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Cossu G, Carta MG, Contu F, Mela Q, Demelia L, Elli L, Dell'Osso B. Coeliac disease and psychiatric comorbidity: epidemiology, pathophysiological mechanisms, quality-of-life, and gluten-free diet effects. Int Rev Psychiatry 2017; 29:489-503. [PMID: 28681625 DOI: 10.1080/09540261.2017.1314952] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Coeliac Disease (CD) is an autoimmune disease in which an environmental factor, gluten, triggers a pathological reaction. It results in intra- and entra-intestinal manifestations of disease, including, most frequently, diarrhoea, weight loss, and anaemia. CD occurs in ∼1% of the western population, being one of the most common autoimmune lifelong disorders, and may present with a variety of psychiatric comorbidities. Psychiatric comorbidity in CD often complicates the diagnosis, reduces the quality-of-life, and worsens the prognosis of affected patients. This review summarizes the epidemiological studies that underline this connection, and focuses on the potential mechanisms related to this comorbility, such as nutritional deficiencies, immune responses, interference in brain processes, and dysfunctions in the gut-brain axis. Factors that play a central role on patients' quality of life, psychological well-being and adherence are presented. Finally, evidence of regression in psychiatric symptoms following the introduction of a gluten-free diet is underlined as well.
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Affiliation(s)
- Giulia Cossu
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Mauro Giovanni Carta
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Federico Contu
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Quirico Mela
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Luigi Demelia
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Luca Elli
- b Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - Bernardo Dell'Osso
- c Department of Pathophysiology and Transplantation , University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy.,d Department of Psychiatry and Behavioral Sciences , Bipolar Disorders Clinic, Stanford University , CA , USA
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27
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Brietzke E, Cerqueira RO, Mansur RB, McIntyre RS. Gluten related illnesses and severe mental disorders: a comprehensive review. Neurosci Biobehav Rev 2017; 84:368-375. [PMID: 28830676 DOI: 10.1016/j.neubiorev.2017.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/02/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022]
Abstract
The putative role of gluten in the pathophysiology of severe mental illnesses remains uncertain and there is doubt about the possible benefit of gluten-free diets for individuals affected by psychosis and mood disorders. The objective of this review was to summarize the findings linking gluten related conditions to pathophysiological substrates implicated in schizophrenia and mood disorders and review the evidences of potential benefits of glute-free diets in these populations. A literature search was conducted within PubMed and Scielo databases including references from inception until March 1st 2017. The strategy search was to use the key words "gluten", "celiac disease", "wheat", "bipolar disorder", "mood disorders", "psychosis", "schizophrenia", "depression". In the review about the potential efficacy of gluten-free diets in severe mental illnesses, we included only studies with original data, including cross sectional and longitudinal studies and clinical trials. Book chapters, review articles and meta-analysis and republished data were excluded. Although the current available evidences suggest that people with celiac disease or gluten allergy could have a slightly higher risk of schizophrenia and mood disorders compared to the general population, the literature review reveals significant inaccuracies in the data. There is insufficient evidence to recommend gluten-free diets for populations with psychosis and mood disorders.
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Affiliation(s)
- Elisa Brietzke
- Research Group in Molecular and Behavioral Neuroscience of Bipolar Disorder, Federal University of São Paulo (Unifesp), São Paulo, Brazil; Mood Disorders Psychpharmachology Unit (MDPU), Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Canada.
| | - Raphael O Cerqueira
- Research Group in Molecular and Behavioral Neuroscience of Bipolar Disorder, Federal University of São Paulo (Unifesp), São Paulo, Brazil
| | - Rodrigo B Mansur
- Mood Disorders Psychpharmachology Unit (MDPU), Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychpharmachology Unit (MDPU), Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada
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Psychopathology, quality of life, and related factors in children with celiac disease. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2016.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Sevinç E, Çetin FH, Coşkun BD. Psychopathology, quality of life, and related factors in children with celiac disease. J Pediatr (Rio J) 2017; 93:267-273. [PMID: 27886806 DOI: 10.1016/j.jped.2016.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE This study aimed to survey children with celiac disease (CD) for psychiatric disorders, determine the possible factors that predict psychopathology, and analyze health-related quality of life and possible factors that could affect the quality of life. METHODS In this study, all children completed the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime Version - Turkish Version (K-SADS-PL-T), as well as the Pediatric Quality of Life Inventory (PedsQL) for the 8-12 age group, and a sentence completion test. A face-to-face interview was performed with the parents of the participants to inform them about the study. RESULTS This study included 52 children with celiac disease in the age range of 8-12 years, and 40 healthy children. The mean age of the study group was 10.36±0.36 years, and 31 (59%) of them were females. The mean age of the control group was 10.35±0.46 years and 24 (60%) of them were females. The mean subscale scores of the Pediatric Quality of Life Inventory were significantly lower in children with celiac disease when compared to the control group (p<0.05). There was at least one psychiatric disorder in the 26 (50%) children with celiac disease. CONCLUSIONS This study has shown once more that celiac disease is associated with some psychiatric signs/diagnoses, and that it decreased quality of life. Further studies are needed to determine the factors that could reduce the psychiatric signs. It is apparent that those studies would contribute new approaches to improve diagnosis, treatment, and quality of life.
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Affiliation(s)
- Eylem Sevinç
- Emel Mehmet Tarman Children's Hospital, Department of Pediatric Gastroenterology, Kayseri, Turkey.
| | - Fatih Hilmi Çetin
- Emel Mehmet Tarman Children's Hospital, Department of Child and Adolescent Psychiatry, Kayseri, Turkey
| | - Banu Demet Coşkun
- Kayseri Training and Research Hospital, Department of Gastroenterology, Kayseri, Turkey
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Abstract
Dietary exclusion of gluten-containing products has become increasingly popular in the general population, and currently ∼30% of people in the United States are limiting gluten ingestion. Although celiac disease (CD), wheat allergy (WA), and nonceliac gluten sensitivity (NCGS) constitute a spectrum of gluten-related disorders that require exclusion of gluten from the diet, together these account for a relatively small percentage of those following a gluten-free diet, and the vast majority has no medical necessity for doing so. Differentiating between CD, WA, and NCGS has important prognostic and therapeutic implications. Because of the protean manifestations of gluten-related disorders, it is not possible to differentiate between them on clinical grounds alone. This clinical report will compare and contrast the manifestations of gluten-related disorders, emphasize the importance of differentiating between these conditions, discuss initial and subsequent tests needed to confirm the diagnosis, and provide recommendations on treatment and follow-up for each condition.
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Karakuła-Juchnowicz H, Szachta P, Opolska A, Morylowska-Topolska J, Gałęcka M, Juchnowicz D, Krukow P, Lasik Z. The role of IgG hypersensitivity in the pathogenesis and therapy of depressive disorders. Nutr Neurosci 2016; 20:110-118. [PMID: 25268936 DOI: 10.1179/1476830514y.0000000158] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depressive episodes are associated not only with changes in neurotransmission in the central nervous system, but also may lead to structural changes in the brain through neuroendocrine, inflammatory, and immunological mechanisms. The aim of this article is to present a new hypothesis connecting the inflammatory theory of depression with IgG food hypersensitivity and leaky gut syndrome. This new potential pathway that may mediate the pathogenesis of depression implies the existence of subsequent developmental stages. Overproduction of zonulin triggered, for example, by gliadin through activation of the epidermal growth factor receptor and protease-activated receptor causes loosening of the tight junction barrier and an increase in permeability of the gut wall ('leaky gut'). This results in a process allowing larger molecules that would normally stay in the gut to cross into the bloodstream and in the induction of IgG-dependent food sensitivity. This condition causes an increased immune response and consequently induces the release of proinflammatory cytokines, which in turn may lead to the development of depressive symptoms. It seems advisable to assess the intestinal permeability using as a marker, for example, zonulin and specific IgG concentrations against selected nutritional components in patients with depression. In the case of increased IgG concentrations, the implementation of an elimination-rotation diet may prove to be an effective method of reducing inflammation. This new paradigm in the pathogenesis of depressive disorders linking leaky gut, IgG-dependent food sensitivity, inflammation, and depression is promising, but still needs further studies to confirm this theory.
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Affiliation(s)
| | | | - Aneta Opolska
- c Department of Dietetics Higher School of Social Sciences , Lublin , Poland
| | | | | | | | - Paweł Krukow
- a Department of Clinical Neuropsychiatry Medical University , Lublin , Poland
| | - Zofia Lasik
- b Institute for Microecology , Poznań , Poland
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Effects of Gluten-Free Diet on Quality of Life and Depression in Children With Celiac Disease. J Pediatr Gastroenterol Nutr 2015; 61:303-6. [PMID: 26322559 DOI: 10.1097/mpg.0000000000000799] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the level of depression and quality of life in children with celiac disease (CD). In addition, it aimed to examine the relations of depression level and life quality with adherence to a gluten-free diet (GFD). METHODS Twenty-five children with CD and 25 healthy controls were included. The Depression Scale for Children and the General Purpose Health-Related Quality of Life Scale for Children were performed on patients before and after receiving recommendations to follow a GFD. RESULTS No significant differences were found in the depression scores between the patients and the control subjects (P > 0.05). In contrast, total scores and scores of the emotional well-being subscale of the measure of Quality of Life Scale for Children were significantly lower in patients with CD compared with the control group (P < 0.05). No significant improvements were observed in depression or life quality scores of the total subsample of celiac patients, all of whom received a recommendation to follow a GFD (P > 0.05). Significant decrease was observed in the depression scores, however, of celiac patients who were able to actually adhere to the GFD compared with nonadherent patients. CONCLUSIONS CD negatively affected quality of life in children. Adherence to GFD was associated with reduction in depression symptoms. Improving the adherence of celiac patients to a GFD may have a favorable effect on their depression symptoms.
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van Hees NJM, Giltay EJ, Tielemans SMAJ, Geleijnse JM, Puvill T, Janssen N, van der Does W. Essential amino acids in the gluten-free diet and serum in relation to depression in patients with celiac disease. PLoS One 2015; 10:e0122619. [PMID: 25884227 PMCID: PMC4401736 DOI: 10.1371/journal.pone.0122619] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/23/2015] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Celiac disease (CD) is associated with an increased risk of major depressive disorder, possibly due to deficiencies in micronutrients in the gluten-free diet. We aimed to investigate whether essential amino acids (i.e., the precursors of serotonin, dopamine and other neurotransmitters) are depleted in the diet and serum of CD patients with major depressive disorder. METHODS In a cross-sectional study we assessed dietary intake of amino acids and serum levels of amino acids, in 77 CD patients on a gluten-free diet and in 33 healthy controls. Major depressive disorder was assessed with structured interviews (using the Mini International Neuropsychiatric Interview Plus). Dietary intake was assessed using a 203-item food frequency questionnaire. RESULTS Participants had a mean age of 55 years and 74% were women. The intake of vegetable protein was significantly lower in CD patients than in healthy controls (mean difference of 7.8 g/d; 95% CI: 4.7-10.8), as were serum concentrations of tyrosine, phenylalanine and tryptophan (all p < 0.005). However, within the CD patient group, the presence of major depressive disorder (n = 42) was not associated with intake or serum levels of essential amino acids. CONCLUSIONS Patients with CD on a long-term gluten-free diet, with good adherence, consume significantly less vegetable protein than controls, and their serum levels of several essential amino acids were also lower. Despite its potential adverse effect, intake and serum levels of essential amino acids were not related to major depression.
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Affiliation(s)
| | - Erik J. Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Thomas Puvill
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
| | - Nadine Janssen
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Willem van der Does
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Agardh D, Lee HS, Kurppa K, Simell V, Aronsson CA, Jörneus O, Hummel M, Liu E, Koletzko S. Clinical features of celiac disease: a prospective birth cohort. Pediatrics 2015; 135:627-34. [PMID: 25733751 PMCID: PMC4379464 DOI: 10.1542/peds.2014-3675] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To investigate clinical features of celiac disease (CD) and their association with risk factors for CD in a genetic risk birth cohort. METHODS Children from 6 clinical centers in 4 countries positive for HLA-DR3-DQ2 or DR4-DQ8 were annually screened for tissue transglutaminase antibodies (tTGA) and assessed for symptoms by questionnaires. Associations of symptoms with anthropometrics, known risk factors for CD, tTGA levels, and mucosal lesions in those biopsied were examined. RESULTS Of 6706 screened children, 914 developed persistent positive tTGA, 406 underwent biopsies, and 340 had CD. Compared with age-matched tTGA-negative children, those with persistent tTGA were more likely to have symptoms at 2 (34% vs 19%, P < .001) and 3 years of age (28% vs 19%, P = .009) but not at 4 years (27% vs 21%, NS). Z-scores for height, weight, and BMI did not differ between groups. In children with persistent tTGA, having ≥ 1 symptom was associated with family history of CD (odds ratio = 2.59, 95% confidence interval, 1.21-5.57) but not with age, gender, or HLA-DR3-DQ2 homozygosity. At seroconversion, tTGA levels were higher in symptomatic than asymptomatic children (P < .001), in those from CD families (P < .001), and in US participants (P < .001) but not associated with age, gender, or HLA genotype. tTGA levels correlated with severity of mucosal lesions both in symptomatic (r = 0.53, P < .001) and asymptomatic children (r = 0.22, P = .01). CONCLUSIONS A majority of children detected with persistent tTGA in screenings are asymptomatic and have normal growth by age 4 years. tTGA levels correlate more strongly with severity of mucosal lesions in symptomatic as compared with asymptomatic children.
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Affiliation(s)
- Daniel Agardh
- The Diabetes and Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmo, Sweden; Pediatric Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida;
| | - Hye-Seung Lee
- Pediatric Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Kalle Kurppa
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Ville Simell
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Carin Andrén Aronsson
- The Diabetes and Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmo, Sweden
| | - Ola Jörneus
- The Diabetes and Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmo, Sweden
| | - Michael Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Klinikum Rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Edwin Liu
- Digestive Health Institute, University of Colorado, Children's Hospital Colorado, Denver, Colorado; and
| | - Sibylle Koletzko
- Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
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Levy SE, Hyman SL. Complementary and alternative medicine treatments for children with autism spectrum disorders. Child Adolesc Psychiatr Clin N Am 2015; 24:117-43. [PMID: 25455579 DOI: 10.1016/j.chc.2014.09.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There are many treatments in current use for core and associated symptoms of autism spectrum disorders (ASD). This review discusses the complementary and alternative medical (CAM) treatments commonly added to conventional interventions for children with ASD, including natural products, mind and body practices, and other biomedical treatments. The article focuses on factors associated with use of CAM, the empirical evidence for the most frequently used treatments, and how clinicians work with families who choose CAM treatments. Some treatments have been ineffective, some have unacceptable potential side effects, and others require more study in depth.
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Affiliation(s)
- Susan E Levy
- Division of Developmental & Behavioral Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| | - Susan L Hyman
- Neurodevelopmental and Behavioral Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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Peters SL, Biesiekierski JR, Yelland GW, Muir JG, Gibson PR. Editorial: Noncoeliac gluten sensitivity--a disease of the mind or gut? Authors' reply. Aliment Pharmacol Ther 2014; 40:114-5. [PMID: 24903429 DOI: 10.1111/apt.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 12/27/2022]
Affiliation(s)
- S L Peters
- Department of Gastroenterology, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, Vic, Australia.
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Abstract
BACKGROUND Neuropsychiatric symptoms may represent an atypical manifestation of celiac disease that occur before a gastroenterological diagnosis is made. Some studies suggest that a gluten-free diet is effective in treating the depression, anxiety, and neurological complications associated with celiac disease. METHOD The article describes the case of a patient suffering from chronic, treatment-resistant symptoms of depression and anxiety. The diagnosis of celiac disease and introduction of an elimination diet caused a significant improvement in mental state and everyday functioning in the presenting patient. CONCLUSION The presence of persistent anxiety and depressive symptoms, with a poor reaction to pharmacological treatment, indicates a need to identify somatic reasons for the underlying condition. It is important to remember that celiac disease can occur at any age, not only in childhood. The presence of this somatic cause of persistent depressive and anxiety symptoms should be considered in the diagnostic process in adults.
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Affiliation(s)
| | - Janusz OEmigielski
- Department of Geriatric Medicine Medical University of ŁódŸ, ŁódŸ, Poland
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Marchese A, Klersy C, Biagi F, Balduzzi D, Bianchi PI, Trotta L, Vattiato C, Zilli A, Rademacher J, Andrealli A, Astegiano M, Michelini I, Häuser W, Corazza GR. Quality of life in coeliac patients: Italian validation of a coeliac questionnaire. Eur J Intern Med 2013; 24:87-91. [PMID: 23102568 DOI: 10.1016/j.ejim.2012.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 09/28/2012] [Accepted: 09/29/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Coeliac disease (CD) is a chronic condition requiring a gluten-free diet, which is a very demanding diet to maintain on a life-long basis. For this reason it is a condition that can have serious repercussions on the quality of life (QOL). Therefore the need to elaborate a questionnaire on QOL specifically for patients with CD (CDQ): its original language is German, and the translation/validation process represents a considerable challenge involving not only a translation into Italian but also an adaptation to the country's specific cultural differences. METHODS The questionnaire has been translated according to a "German → Italian → Italian → German" algorithm with reconciliation of the differences. Scores for CDQ are computed overall and over four areas of four items each: emotion, gastrointestinal symptoms, gastrointestinal worries, social problems. RESULTS CDQ was administered to 171 coeliacs (F 132, mean age 38 yrs ± 14). Completeness was optimal. Item internal consistency was satisfied for 100% and 97% of patients for the specific and generic part, respectively. Cronbach's α coefficient was 0.7 for all scales. The general CDQ was higher in patients reporting subjective well-being (discriminant validity). CONCLUSIONS The Italian translation of CDQ sounds natural, is easy to understand and reduces possible cultural biases to a minimum. A field test gave results comparable to the original validation, supporting the use of CDQ in cross-national surveys.
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Affiliation(s)
- Alessandra Marchese
- Coeliac Centre/First Dept of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
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Ruuskanen A, Kaukinen K, Collin P, Krekelä I, Patrikainen H, Tillonen J, Nyrke T, Laurila K, Haimila K, Partanen J, Valve R, Mäki M, Luostarinen L. Gliadin antibodies in older population and neurological and psychiatric disorders. Acta Neurol Scand 2013; 127:19-25. [PMID: 22494246 DOI: 10.1111/j.1600-0404.2012.01668.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVES A variety of neurological and psychiatric disorders have recently been linked to coeliac disease and gluten sensitivity. We here explored whether persistently positive gliadin antibodies (AGA) and coeliac-type HLA increase the risk of gluten sensitivity-related neurological and psychiatric manifestations. The study was carried out in an older population who had consumed gluten for decades but who had no previous coeliac disease diagnosis. MATERIALS AND METHODS The original study population comprised 4272 randomly selected older individuals, of whom 2089 had AGA and transglutaminase 2 antibodies (antiTG2) measured twice within a 3-year interval. Forty-nine persistently AGA-positive but antiTG2-negative subjects with coeliac-type HLA and 52 randomly selected persistently AGA- and antiTG2-negative age- and sex-matched controls were clinically examined for neurological disorders. The Psychological General Well-Being (PGWB) questionnaire, the SF-36 health survey questionnaire and the Depression Scale (DEPS) were employed to evaluate psychological well-being. The medical files of all the study subjects were analysed for previous illnesses. RESULTS Persistently AGA-positive but antiTG2-negative older subjects carrying coeliac disease-type HLA did not evince significantly more neurological symptoms or diseases than AGA-negative control subjects (P = 0.682, P = 0.233). There were no statistically significant differences between AGA-positive and AGA-negative groups in psychological well-being and quality of life when measured by PGWB (P = 0.426), SF-36 questionnaires (P = 0.120) and DEPS (P = 0.683). CONCLUSIONS At population level, persistent AGA positivity did not indicate gluten sensitivity-related neurological and psychiatric disorders.
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Affiliation(s)
- A. Ruuskanen
- Department of Neurology; Päijät-Häme Central Hospital in Lahti; Lahti; Finland
| | - K. Kaukinen
- Department of Gastroenterology and Alimentary Tract Surgery; Tampere University Hospital and Medical School, University of Tampere; Tampere; Finland
| | - P. Collin
- Department of Gastroenterology and Alimentary Tract Surgery; Tampere University Hospital and Medical School, University of Tampere; Tampere; Finland
| | - I. Krekelä
- Department of Gastroenterology; Päijat-Häme Central Hospital in Lahti; Lahti; Finland
| | - H. Patrikainen
- Department of Gastroenterology; Päijat-Häme Central Hospital in Lahti; Lahti; Finland
| | - J. Tillonen
- Department of Gastroenterology; Päijat-Häme Central Hospital in Lahti; Lahti; Finland
| | - T. Nyrke
- Department of Neurophysiology; Päijät-Häme Central Hospital in Lahti; Lahti; Finland
| | - K. Laurila
- Pediatric Research Center, University of Tampere and Tampere University Hospital; Tampere; Finland
| | - K. Haimila
- Finnish Red Cross Blood Service; Helsinki; Finland
| | - J. Partanen
- Finnish Red Cross Blood Service; Helsinki; Finland
| | - R. Valve
- Department of Education and Development in Lahti; University of Helsinki; Helsinki; Finland
| | - M. Mäki
- Pediatric Research Center, University of Tampere and Tampere University Hospital; Tampere; Finland
| | - L. Luostarinen
- Department of Neurology; Päijät-Häme Central Hospital in Lahti; Lahti; Finland
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Severance EG, Alaedini A, Yang S, Halling M, Gressitt KL, Stallings CR, Origoni AE, Vaughan C, Khushalani S, Leweke FM, Dickerson FB, Yolken RH. Gastrointestinal inflammation and associated immune activation in schizophrenia. Schizophr Res 2012; 138:48-53. [PMID: 22446142 PMCID: PMC4244845 DOI: 10.1016/j.schres.2012.02.025] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 02/08/2023]
Abstract
Immune factors are implicated in normal brain development and in brain disorder pathogenesis. Pathogen infection and food antigen penetration across gastrointestinal barriers are means by which environmental factors might affect immune-related neurodevelopment. Here, we test if gastrointestinal inflammation is associated with schizophrenia and therefore, might contribute to bloodstream entry of potentially neurotropic milk and gluten exorphins and/or immune activation by food antigens. IgG antibodies to Saccharomyces cerevisiae (ASCA, a marker of intestinal inflammation), bovine milk casein, wheat-derived gluten, and 6 infectious agents were assayed. Cohort 1 included 193 with non-recent onset schizophrenia, 67 with recent onset schizophrenia and 207 non-psychiatric controls. Cohort 2 included 103 with first episode schizophrenia, 40 of whom were antipsychotic-naïve. ASCA markers were significantly elevated and correlated with food antigen antibodies in recent onset and non-recent onset schizophrenia compared to controls (p≤0.00001-0.004) and in unmedicated individuals with first episode schizophrenia compared to those receiving antipsychotics (p≤0.05-0.01). Elevated ASCA levels were especially evident in non-recent onset females (p≤0.009), recent onset males (p≤0.01) and in antipsychotic-naïve males (p≤0.03). Anti-food antigen antibodies were correlated to antibodies against Toxoplasma gondii, an intestinally-infectious pathogen, particularly in males with recent onset schizophrenia (p≤0.002). In conclusion, gastrointestinal inflammation is a relevant pathology in schizophrenia, appears to occur in the absence of but may be modified by antipsychotics, and may link food antigen sensitivity and microbial infection as sources of immune activation in mental illness.
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Affiliation(s)
- Emily G Severance
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 1105, Baltimore, MD 21287-4933, USA.
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Abstract
OBJECTIVE We used meta-analysis to test hypotheses concerning whether adult celiac disease is reliably linked with anxiety and/or depression. METHOD We examined published reports on anxiety and depression in adult celiac disease. RESULTS Eighteen studies on depression and eleven studies on anxiety in adult celiac disease met selection criteria. They show that depression is reliably more common and/or more severe in adults with celiac disease than in healthy adults (overall meta-analysis effect size: 0.97). The fail-safe margin of unpublished reports that would be required to negate the finding exceeds 8000. Adults with celiac disease do not, however, differ reliably in terms of depression from adults with other physical illnesses, nor do they differ reliably from healthy adults or adults with other physical illnesses in terms of anxiety. CONCLUSION Depression is common in adult celiac disease and resembles the condition in other physical illnesses. We view the findings as support for the notion that non-specific mechanisms mediate emotional disorders in adult celiac disease.
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Affiliation(s)
- D F Smith
- Center for Psychiatric Research, Psychiatric Hospital of Aarhus University, Risskov, Denmark.
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42
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Jackson JR, Eaton WW, Cascella NG, Fasano A, Kelly DL. Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity. Psychiatr Q 2012; 83:91-102. [PMID: 21877216 PMCID: PMC3641836 DOI: 10.1007/s11126-011-9186-y] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Celiac Disease (CD) is an immune-mediated disease dependent on gluten (a protein present in wheat, rye or barley) that occurs in about 1% of the population and is generally characterized by gastrointestinal complaints. More recently the understanding and knowledge of gluten sensitivity (GS), has emerged as an illness distinct from celiac disease with an estimated prevalence 6 times that of CD. Gluten sensitive people do not have villous atrophy or antibodies that are present in celiac disease, but rather they can test positive for antibodies to gliadin. Both CD and GS may present with a variety of neurologic and psychiatric co-morbidities, however, extraintestinal symptoms may be the prime presentation in those with GS. However, gluten sensitivity remains undertreated and underrecognized as a contributing factor to psychiatric and neurologic manifestations. This review focuses on neurologic and psychiatric manifestations implicated with gluten sensitivity, reviews the emergence of gluten sensitivity distinct from celiac disease, and summarizes the potential mechanisms related to this immune reaction.
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Affiliation(s)
- Jessica R Jackson
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228, USA
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Increased suicide risk in coeliac disease--a Swedish nationwide cohort study. Dig Liver Dis 2011; 43:616-22. [PMID: 21419726 DOI: 10.1016/j.dld.2011.02.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 01/17/2011] [Accepted: 02/04/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Individuals with coeliac disease have increased risk of depression and death from external causes, but conclusive studies on death from suicide are missing. We examined the risk of suicide in coeliac disease and amongst individuals where the small intestinal biopsy showed no villous atrophy. METHODS We collected biopsy data from all 28 clinical pathology departments in Sweden for individuals diagnosed during 1969-2007 with coeliac disease (Marsh 3: villous atrophy; n=29,083 unique individuals), inflammation without villous atrophy (Marsh 1-2; n=13,263) or positive coeliac disease serology but normal mucosa (Marsh 0, n=3719). Through Cox regression we calculated Hazard ratios for suicide as recorded in the Swedish Cause of Death Register. RESULTS The risk for suicide was higher in patients with coeliac disease compared to general population controls (HR=1.55; 95%CI=1.15-2.10; based on 54 completed suicides). Whilst suicide was also more common amongst individuals with inflammation (HR=1.96; 95%CI=1.39-2.77), no such increase was seen amongst individuals with a normal mucosa but positive coeliac disease serology (HR=1.06; 95%CI=0.37-3.02). CONCLUSIONS We found a moderately increased risk of suicide amongst patients with coeliac disease. This merits increased attention amongst physicians treating these patients.
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Högberg L, Webb C, Fälth-Magnusson K, Forslund T, Magnusson KE, Danielsson L, Ivarsson A, Sandström O, Sundqvist T. Children with screening-detected coeliac disease show increased levels of nitric oxide products in urine. Acta Paediatr 2011; 100:1023-7. [PMID: 21284717 DOI: 10.1111/j.1651-2227.2011.02186.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM Increased concentration of nitric oxide (NO) metabolites, nitrite and nitrate, in the urine is a strong indication of ongoing small intestinal inflammation, which is a hallmark of the enteropathy of coeliac disease (CD). It has previously been shown that children with symptomatic, untreated CD have increased levels of NO oxidation products in their urine. The aim of this study was to investigate whether screening-detected, asymptomatic coeliac children display the same urinary nitrite/nitrate pattern. METHODS In a multicenter screening study, serum samples were collected from 7208 12-year-old children without previously diagnosed CD. Sera were analysed for anti-human tissue transglutaminase (tTG) of isotype IgA. Small bowel biopsy was performed in antibody-positive children, yielding 153 new cases of CD. In the screening-detected individuals, the sum of nitrite and nitrate concentrations in the urine was analysed and used as an indicator of NO production. For comparison, 73 children with untreated, symptomatic CD were studied. RESULTS The nitrite/nitrate levels in children with screening-detected CD and those with untreated symptomatic CD did not differ significantly. Both groups had significantly increased urinary nitrite/nitrate concentrations compared to the children with normal small bowel biopsy (p < 0.001). CONCLUSION Children with screening-detected CD have increased production of NO just as children with untreated symptomatic CD. High NO metabolite levels in the urine may indicate a pathogenetic feature of CD and be a marker of major clinical importance.
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Affiliation(s)
- L Högberg
- Pediatric Clinic, Norrköping Hospital, Norrköping, Sweden.
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Mazzone L, Reale L, Spina M, Guarnera M, Lionetti E, Martorana S, Mazzone D. Compliant gluten-free children with celiac disease: an evaluation of psychological distress. BMC Pediatr 2011; 11:46. [PMID: 21619651 PMCID: PMC3149570 DOI: 10.1186/1471-2431-11-46] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 05/27/2011] [Indexed: 11/10/2022] Open
Abstract
Background Children with chronic illnesses are known to have increased risks for emotional and behavioral problems. In the present study, children and adolescent suffering from celiac disease (CD) were compared with healthy controls to assess differences in the psychological profile. Methods A total of 100 well-treated and compliant CD patients (65 females/35 males; age mean ± SD: 10.38 ± 2.71) were compared to 100 normal controls (58 females/42 males; age mean ± SD: 11.47 ± 2.61). Emotional and behavioral problems were assessed by the Child Behavior Checklist (CBCL), the Children's Depression Inventory (CDI) and the Multidimensional Anxiety Scale for Children (MASC). Results Subjects with CD self-reported an increased rate of anxiety and depression symptoms and showed higher scores in "harm avoidance" and "somatic complaints", in the CBCL parent-report questionnaire, as compared to healthy control subjects. Furthermore, gender differences could be observed in the group of CD patients, with males displaying significantly higher CBCL externalizing scores, in social, thought and attention problems, as compared to female, who in turns showed more prominent internalizing symptoms such as depression. Conclusions The increased rate of emotional and behavioral problems in children and adolescent with CD emphasizes the importance of an early detection of mental health problems in these children.
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Affiliation(s)
- Luigi Mazzone
- Department of Paediatrics, Division of Child Neurology and Psychiatry, University of Catania, Catania, Italy.
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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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Long-term deterioration of quality of life in adult patients with celiac disease is associated with treatment noncompliance. Dig Liver Dis 2010; 42:685-91. [PMID: 20399159 DOI: 10.1016/j.dld.2010.03.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 03/01/2010] [Accepted: 03/08/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Deterioration of quality of life in the long term has been suggested for celiac disease patients on a gluten-free diet. AIMS To determine long-term quality of life of celiac disease patients and to assess the benefits of gluten-free diet compliance. PATIENTS We prospectively evaluated 53 newly diagnosed adult celiac disease patients. METHODS The Short Form 36 Health Survey, the Gastrointestinal Symptoms Rating Scale and the Beck Depression Inventory were employed at the time of diagnosis, 1 year, and beyond 4 years (median: 53 months) on treatment. RESULTS At 1 year, a significant improvement from baseline in quality of life indicators was observed (p<0.001 to p<0.0001) with comparable scores to healthy subjects. At 4 years, the Short Form 36 Health Survey scores (p<0.002 to p<0.0002) and Beck Depression Inventory score (p<0.002) show significant deterioration compare with 1 year. Most scores remained significantly better than those at diagnosis (p<0.03 to p<0.0005). No changes were detected in the Gastrointestinal Symptoms Rating Scale scores. The long-term impairment of quality of life was attributable to the deterioration of most dimensions in patients who were not strictly compliant with the gluten-free diet (p<0.05 to p<0.001). CONCLUSIONS Long-term deterioration of quality of life outcomes after the first year of gluten-free diet was associated with the lack of strict compliance with the diet.
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Ruuskanen A, Kaukinen K, Collin P, Huhtala H, Valve R, Mäki M, Luostarinen L. Positive serum antigliadin antibodies without celiac disease in the elderly population: does it matter? Scand J Gastroenterol 2010; 45:1197-202. [PMID: 20545470 DOI: 10.3109/00365521.2010.496491] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Antigliadin antibodies (AGA) show good sensitivity but low specificity for celiac disease and can also be found in healthy individuals. However, data suggest that AGA positivity might be related to distinct disease entities such as allergy and gluten ataxia. Our aim here is to explore the clinical relevance of positive AGA in the elderly population. MATERIAL AND METHODS Serum IgA- and IgG-class AGA and IgA-class tissue transglutaminase antibodies (tTGA) were determined in 2815 individuals aged 52-74 years. Equal numbers of AGA- and tTGA-negative participants of similar age and gender, but without known celiac disease, were randomly selected as controls. Information on clinical history was obtained from hospital records in all groups. RESULTS Altogether 381 persons were positive for IgA/IgG-class AGA; 38 (14%) of them were also positive for tTGA. Out of the biopsied subjects, 34 (100%) in the AGA+ tTGA+ group and five (9%) in AGA+ tTGA- group had celiac disease. Rheumatoid arthritis and depression were found significantly more often in AGA-positives than controls. The significance remained even when tTGA-positive and known celiac disease cases were excluded. No statistical differences were found in the occurrence of neurological diseases, diabetes, allergic and cardiovascular diseases or malignancies. CONCLUSIONS Although AGA positivity is of clinical relevance only in a subset of elderly people, it seems to be related to rheumatoid arthritis and depression, both conditions linked to celiac disease. Further studies are needed to reveal the mechanisms underlying this. The poor specificity of AGA for celiac disease was here once more in evidence.
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Affiliation(s)
- Anitta Ruuskanen
- Department of Neurology, Päijät-Häme Central Hospital in Lahti, Finland
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Gautam S. Fourth revolution in psychiatry - Addressing comorbidity with chronic physical disorders. Indian J Psychiatry 2010; 52:213-9. [PMID: 21180405 PMCID: PMC2990820 DOI: 10.4103/0019-5545.70973] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The moral treatment of mental patients, Electro Convulsive therapy (ECT), and Psychotropic medications constitute the first, second, and third revolution in psychiatry, respectively. Addressing comorbidities of mental illnesses with chronic physical illnesses will be the fourth revolution in psychiatry. Mind and body are inseparable; there is a bidirectional relationship between psyche and soma, each influencing the other. Plausible biochemical explanations are appearing at an astonishing rate. Psychiatric comorbidity with many chronic physical disorders has remained neglected. Such comorbidity with cardiac, respiratory, Gastrointestinal, endocrinal, and neurological disorders, trauma, and other conditions like HIV and so on, needs to be addressed too. Evidence base of prevalence and causal relationship of psychiatric comorbidities in these disorders has been highlighted and strategies to meet the challenge of comorbidity have been indicated.
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Affiliation(s)
- Shiv Gautam
- Department of Psychiatry and Superintendent, Psychiatric Center, Jaipur, India
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Haines ML, Anderson RP, Gibson PR. Systematic review: The evidence base for long-term management of coeliac disease. Aliment Pharmacol Ther 2008; 28:1042-66. [PMID: 18671779 DOI: 10.1111/j.1365-2036.2008.03820.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND While gluten-free diet is an effective treatment for coeliac disease, the need for and goals of long-term management of patients are poorly defined. AIM To review systematically the complications and associations of coeliac disease, to identify potential risk factors, to define ways of assessing risk factors and to provide a strategy for management. METHODS Review of medical literature from 1975. RESULTS There is an increasing list of potential complications and/or conditions associated with coeliac disease, in particular, autoimmune disease, malignancy and bone disease. Risk factors that may predict or influence long-term outcomes include genetic susceptibility, environmental factors predominantly gluten ingestion, persistent small intestinal inflammation/injury and nutritional deficiencies. Genotyping of patients is yet to have an established clinical role in long-term management. Assessment of adherence to the gluten-free diet largely relies upon skilled dietary history, but the ultimate test is duodenal histopathology, which is the only currently established means of assessing healing. Symptoms, serology or other non-invasive means are poor predictors of healing and the likelihood of complications. CONCLUSION Evidence (albeit limited) that adherence to a gluten-free diet and mucosal healing prevent and/or ameliorate complications indicates that a planned long-term strategy for follow-up is essential.
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Affiliation(s)
- M L Haines
- Department of Gastroenterology, Monash University Department of Medicine, Box Hill Hospital, Box Hill, and Walter and Eliza Hall Institute, Parkville, Vic., Australia
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