1
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Jain S, Lamba BY, Dubey SK. Recent advancements in the sensors for food analysis to detect gluten: A mini-review [2019-2023]. Food Chem 2024; 449:139204. [PMID: 38613992 DOI: 10.1016/j.foodchem.2024.139204] [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: 11/03/2023] [Revised: 03/24/2024] [Accepted: 03/29/2024] [Indexed: 04/15/2024]
Abstract
People with celiac disease or gluten sensitivity may experience an immune reaction to the protein called gluten, which is present in wheat, barley, and rye. A strict gluten-free diet is the sole cure for these ailments. There are chances of food fraud about the claim of being gluten-free food items. As a result, there is a rising need for trustworthy and precise ways to identify gluten. There are many methods to detect gluten in food samples viz., enzyme-linked immunosorbent assay 1 Surface plasmon resonance (SPR), Electrochemical sensors, Fluorescence-based sensors, etc. The use of sensors is one of the most promising methods for gluten detection. For detecting gluten, a variety of sensors, including optical, electrochemical, and biosensors, have been developed with different limits of detection and sensitivity. The present review reports the recent advancements (2019-2023) in the development of sensors for gluten detection in food. We may conclude that sensitivity and limit of detection are not related to the type of sensor used (aptamer or antibody-based), however, there are advancements, with the year, on the simplicity of the material used like paper-based sensors and paradigm shift to reagent free sensors by the spectral analysis. Also, recent work shows the potential of IoT-based studies for gluten detection.
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Affiliation(s)
- Sapna Jain
- Applied Science Cluster (Chemistry), School of Advanced Engineering, UPES, Dehradun 248007, India.
| | - Bhawna Yadav Lamba
- Applied Science Cluster (Chemistry), School of Advanced Engineering, UPES, Dehradun 248007, India
| | - Sanjeev Kumar Dubey
- Applied Science Cluster (Chemistry), School of Advanced Engineering, UPES, Dehradun 248007, India
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2
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Wall E, Semrad CE. Celiac Disease, Gluten Sensitivity, and Diet Management. Curr Gastroenterol Rep 2024; 26:191-199. [PMID: 38865028 DOI: 10.1007/s11894-024-00931-x] [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] [Accepted: 04/02/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW Celiac disease is a common chronic inflammatory condition of the small bowel triggered by gluten in wheat, rye and barley in the diet. Non-celiac gluten sensitivity presents with symptoms similar to celiac disease with the ingestion of gluten or other components of wheat. In this article, we review challenges presented by a gluten free diet for the treatment of both disorders. RECENT FINDINGS Wheat is ubiquitous in the diet and medications/products. A registered dietitian is mandatory for patient education on the gluten free diet. Naturally gluten free foods provide a healthy diet for those with celiac disease. Whole grains labelled gluten free, including oats, are encouraged in the diet as refined grains may be deficient in fiber, protein, and micronutrients, particularly folate. Gluten contamination is the most common cause of persistent symptoms in celiac disease though shared equipment of food preparation may not be as large a problem as suspected. Most with celiac disease on a gluten free diet will fully recover and gain weight that poses a problem for those overweight to start. The gluten free diet may have a negative impact on quality of life for both celiac patients and their families. Those with hypervigilance of the gluten free diet and avoidance of dining out have the lowest quality of life. The gluten free diet is currently the only effective treatment for celiac disease. A registered dietitian is needed to educate patients on the complexity of the gluten free diet with a goal of healthy eating, maintaining a healthy weight, and avoiding disordered eating or diet hypervigilance; key to a good quality of life.
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Affiliation(s)
- Elizabeth Wall
- Clinical Nutrition, University of Chicago Medicine, Chicago, IL, USA
| | - Carol E Semrad
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA.
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3
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Pinto-Sanchez MI, Blom JJ, Gibson PR, Armstrong D. Nutrition Assessment and Management in Celiac Disease. Gastroenterology 2024; 167:116-131.e1. [PMID: 38593924 DOI: 10.1053/j.gastro.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
Celiac disease (CeD) is the most common immune condition affecting the gastrointestinal tract; it is triggered by gluten and the only available treatment is a strict gluten-free diet (GFD). Therefore, for patients with CeD, adopting a GFD is not a lifestyle choice. The major problem is that a GFD is restrictive and, like all restrictive diets, it has the potential for adverse nutritional outcomes, especially if adopted for a long term. It is well known that GFD can be nutritionally inadequate and is frequently associated with vitamin and mineral deficiencies; it is also associated with excessive sugar and fat intake, particularly when gluten-free substitutes are consumed. Consequently, people with CeD are affected by higher rates of overweight and obesity and metabolic complications, such as fatty liver and cardiovascular disease. Therefore, assessment of nutritional status and diet quality at diagnosis and while on a long-term GFD is key in the management of CeD. This narrative review addresses nutritional considerations in CeD and management of common challenges associated with a GFD.
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Affiliation(s)
- M Ines Pinto-Sanchez
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jedid-Jah Blom
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Peter R Gibson
- Central Clinical School, Department of Gastroenterology, Monash University, Clayton, Victoria, Australia
| | - David Armstrong
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
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Verma AK, Quattrini S, Serin Y, Monachesi C, Catassi GN, Gatti S, Makharia GK, Lionetti E, Catassi C. Unauthentic Information About Celiac Disease on Social Networking Pages: Is It a Matter of Concern in Celiac Disease Management? Dig Dis Sci 2024:10.1007/s10620-024-08486-7. [PMID: 38816597 DOI: 10.1007/s10620-024-08486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/07/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Facebook (FB) is the most popular online networking platform. Many celiac disease Facebook (CD-FB) pages spread awareness about celiac disease (CD). To get the latest information, patients with CD frequently follow such pages. However, little is known about whether such pages provide authentic and reliable information. AIMS This study aims to investigate whether CD-FB pages spread misleading information to patients with CD. METHODS On the Facebook social networking platform, CD-FB pages created in three celiac-prevalent countries (Italy, the USA, and India) were explored using different combinations of keywords. The type/category of the CD-FB page, country of origin, purpose, page web link, and number of followers/members were documented in a Microsoft spreadsheet. All posts distributed on selected CD-FB pages in the last 3 years were thoroughly screened. RESULTS From August 2022 to March 2023, a total of 200 CD-FB pages from Italy, the USA, and India were explored. Out of these 200 pages, 155 CD-FB (Italy 70; the USA 46; India 39) were found eligible. Of them, 20 (13%) CD-FB pages (Italy 4; the USA 5; India 11) shared misleading information about CD. Surprisingly, 11 (8%) of these 20 pages (Italy 0; the USA 2; India 9) supported alternative treatment options for CD. CONCLUSIONS CD-FB pages are useful for disseminating celiac-disease-related information. While most such pages provide useful information, 13% of CD-FB pages allow misleading information. Patients with CD should consult their treating unit before following any uncertain information posted on CD-FB pages.
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Affiliation(s)
- Anil K Verma
- Department of Medicine Farncombe, Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
- Celiac Disease Research Laboratory, Polytechnic University of Marche, Ancona, Italy.
| | - Sara Quattrini
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Yeliz Serin
- Department of Nutrition and Dietetics, Faculty of Health Science, Çukurova University, Adana, Turkey
| | - Chiara Monachesi
- Department of Medicine Farncombe, Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Giulia N Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Simona Gatti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Elena Lionetti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, Ancona, Italy
- Center for Celiac Research and Treatment, Mass General Hospital for Children, Boston, USA
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Luque V, Crespo-Escobar P, Hård Af Segerstad EM, Koltai T, Norsa L, Roman E, Vreugdenhil A, Fueyo-Díaz R, Ribes-Koninckx C. Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. J Pediatr Gastroenterol Nutr 2024; 78:973-995. [PMID: 38291739 DOI: 10.1002/jpn3.12079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/10/2023] [Accepted: 08/20/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Coeliac disease is a chronic, immune-mediated disorder for which the only treatment consists of lifelong strict adherence to gluten-free diet (GFD). However, there is a lack of evidence-based guidelines on the GFD dietary management of coeliac disease. This position paper, led by the Special Interest Group in coeliac disease of the European Society of Pediatric, Gastroenterology Hepatology, and Nutrition, supported by the Nutrition Committee and the Allied Health Professionals Committee, aims to present evidence-based recommendations on the GFD as well as how to support dietary adherence. METHODS A wide literature search was performed using the MeSH Terms: "diet, gluten free," "gluten-free diet," "diets, gluten-free," "gluten free diet," and "coeliac disease" in Pubmed until November 8th, 2022. RESULTS The manuscript provides an overview of the definition of the GFD, regulations as basis to define the term "gluten-free," which foods are naturally gluten-free and gluten-containing. Moreover, it provides recommendations and educational tips and infographics on suitable food substitutes, the importance of reading food labels, risk of gluten cross-contact at home and in public settings, nutritional considerations as well as factors associated to dietary adherence based on available evidence, or otherwise clinical expertise. CONCLUSIONS This position paper provides guidance and recommendations to support children with coeliac disease to safely adhere to a GFD.
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Affiliation(s)
- Veronica Luque
- Serra Húnter, Universitat Rovira i Virgili, Reus, Spain
- Paediatric Nutrition and Development Research Unit, IISPV, Reus, Spain
| | - Paula Crespo-Escobar
- Health Sciences Department, ADVISE Research Group, Miguel de Cervantes European University, Valladolid, Spain
- Nutrition and Dietetics Unit, Hospital Recoletas Campo Grande, Valladolid, Spain
| | - Elin M Hård Af Segerstad
- Paediatric Department, Skane University Hospital, Malmoe, Sweden
- Department of Clinical Sciences, Celiac Disease and Diabetes Unit, Faculty of Medicine, Lund University, Malmoe, Sweden
| | - Tunde Koltai
- Direction Board, Association of European Coeliac Societies, Brussels, Belgium
| | - Lorenzo Norsa
- Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Enriqueta Roman
- Paediatric Gastroenterology and Nutrition, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Anita Vreugdenhil
- Department of Pediatrics, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ricardo Fueyo-Díaz
- Department of Psychology and Sociology, Aragonese Primary Care Research Group (GAIAP, B21_20R), University of Zaragoza, Zaragoza, Spain
| | - Carmen Ribes-Koninckx
- Paediatric Gastroenterology, Hepatology and Nutrition, La Fe University Hospital & La Fe Research Institute, Valencia, Spain
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Mazzola AM, Zammarchi I, Valerii MC, Spisni E, Saracino IM, Lanzarotto F, Ricci C. Gluten-Free Diet and Other Celiac Disease Therapies: Current Understanding and Emerging Strategies. Nutrients 2024; 16:1006. [PMID: 38613039 PMCID: PMC11013189 DOI: 10.3390/nu16071006] [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: 02/05/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
A lifelong gluten-free diet (GFD) is the only treatment for celiac disease and other gluten-related disorders. Nevertheless, strict adherence to the GFD is often challenging due to concerns about social isolation, risk of gluten contaminations, high cost, poor quality and the taste of gluten-free products. Moreover, although the GFD is effective in achieving mucosal healing, it may lead to dietary imbalances due to nutrient deficiencies over a long period of time. To overcome these issues, several gluten-free wheat flours have been developed to create products that closely resemble their gluten-containing counterparts. Furthermore, given the critical importance of adhering to the GFD, it becomes essential to promote adherence and monitor possible voluntary or involuntary transgressions. Various methods, including clinical assessment, questionnaires, serology for celiac disease, duodenal biopsies and the detection of Gluten Immunogenic Peptides (GIPs) are employed for this purpose, but none are considered entirely satisfactory. Since adherence to the GFD poses challenges, alternative therapies should be implemented in the coming years to improve treatment efficacy and the quality of life of patients with celiac disease. The aim of this narrative review is to explore current knowledge of the GFD and investigate its future perspectives, focusing on technology advancements, follow-up strategies and insights into a rapidly changing future.
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Affiliation(s)
- Anna Maria Mazzola
- Gastroenterology Unit, Spedali Civili Hospital, 25123 Brescia, Italy; (A.M.M.); (I.Z.); (F.L.)
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Irene Zammarchi
- Gastroenterology Unit, Spedali Civili Hospital, 25123 Brescia, Italy; (A.M.M.); (I.Z.); (F.L.)
| | - Maria Chiara Valerii
- Unit of Translational Physiology and Nutrition, Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (M.C.V.); (E.S.)
| | - Enzo Spisni
- Unit of Translational Physiology and Nutrition, Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (M.C.V.); (E.S.)
| | - Ilaria Maria Saracino
- Microbiology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
| | - Francesco Lanzarotto
- Gastroenterology Unit, Spedali Civili Hospital, 25123 Brescia, Italy; (A.M.M.); (I.Z.); (F.L.)
| | - Chiara Ricci
- Gastroenterology Unit, Spedali Civili Hospital, 25123 Brescia, Italy; (A.M.M.); (I.Z.); (F.L.)
- Department of Experimental and Clinical Science, University of Brescia, 25123 Brescia, Italy
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Day M, Kuzin J, Spencer M, Hilliard T, Phillips P, Moore A. Food intolerances. Nursing 2024; 54:27-31. [PMID: 38271126 DOI: 10.1097/01.nurse.0000997984.19998.cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT Food intolerances are prevalent and often confused with food allergies. This article reviews the complex landscape of adverse reactions to food, distinguishing between immune-mediated responses (food allergies) and nonimmune reactions (food intolerances). It also explores specific food intolerances such as lactose intolerance, nonceliac gluten sensitivity, fructose intolerance, and salicylate sensitivity.
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Affiliation(s)
- Mercedes Day
- At the Texas Tech University Health Sciences Center, Mercedes Day, Julia Kuzin, and Priscila Reid are assistant professors, Tara Hilliard is an associate professor, Amy Moore is a professor, and Michelle Spencer is an instructor and clinical site coordinator
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8
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Liu YY, Ye RL, Meng M. Specificity Enhancement of Glutenase Bga1903 toward Celiac Disease-Eliciting Pro-Immunogenic Peptides via Active-Site Modification. Int J Mol Sci 2023; 25:505. [PMID: 38203677 PMCID: PMC10779176 DOI: 10.3390/ijms25010505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Celiac disease is an autoimmune disease triggered by oral ingestion of gluten, with certain gluten residues resistant to digestive tract enzymes. Within the duodenum, the remaining peptides incite immunogenic responses, including the generation of autoantibodies and inflammation, leading to irreversible damage. Our previous exploration unveiled a glutenase called Bga1903 derived from the Gram-negative bacterium Burkholderia gladioli. The cleavage pattern of Bga1903 indicates its moderate ability to mitigate the toxicity of pro-immunogenic peptides. The crystal structure of Bga1903, along with the identification of subsites within its active site, was determined. To improve its substrate specificity toward prevalent motifs like QPQ within gluten peptides, the active site of Bga1903 underwent site-directed mutagenesis according to structural insights and enzymatic kinetics. Among the double-site mutants, E380Q/S387L exhibits an approximately 34-fold increase in its specificity constant toward the QPQ sequence, favoring glutamines at the P1 and P3 positions compared to the wild type. The increased specificity of E380Q/S387L not only enhances its ability to break down pro-immunogenic peptides but also positions this enzyme variant as a promising candidate for oral therapy for celiac disease.
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Affiliation(s)
| | | | - Menghsiao Meng
- Graduate Institute of Biotechnology, National Chung Hsing University, 250 Kuo-Kuang Rd., Taichung 40227, Taiwan; (Y.-Y.L.); (R.-L.Y.)
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Syage J, Ramos A, Loskutov V, Norum A, Bledsoe A, Choung RS, Dickason M, Sealey-Voyksner J, Murray J. Dynamics of Serologic Change to Gluten in Celiac Disease Patients. Nutrients 2023; 15:5083. [PMID: 38140342 PMCID: PMC10746107 DOI: 10.3390/nu15245083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/25/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Serologic measures of tissue transglutaminase (tTG) immunoglobulin A (IgA) and deamidated gliadin peptide (DGP) IgA and immunoglobulin G (IgG) are hallmark tests utilized when diagnosing individuals for celiac disease (CeD) and for monitoring adherence to a gluten-free diet (GFD), currently the only available treatment for CeD. We address two issues in this study: (i) the relapse to seropositivity for CeD patients who resume a gluten containing diet and (ii) the correlation between two different tTG-IgA assays near the upper limit of normal (ULN) designated thresholds. Regarding the first issue, often a suspected CeD individual is put back on a gluten diet to return to their serologic levels. However, we show it requires a substantial amount of gluten for serology to return to a positive level. For example, in one study of 22 patients treated with placebo and taking 84 g of gluten over 6 weeks, only two converted from seronegative to seropositive for tTG-IgA. Regarding the second topic, we compare the relationship for different serologic assays, namely tTG-IgA AB (recombinant, ULN = 4 units/mL) vs. tTG-IgA (non-recombinant, ULN = 20 units). There is a strong correlation between both measurements as evidenced by a Pearson coefficient of R = 0.8584; however, we observed that the cross-correlation in terms of sensitivity and specificity improved substantially by using an ULN value of three instead of four for the tTG-IgA AB (recombinant) assay. This result suggests that assay thresholds used for initial diagnosis in patients who have not yet started a GFD may need to be adjusted for monitoring and in the setting of a diagnostic gluten challenge.
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Affiliation(s)
- Jack Syage
- ImmunogenX, Inc., 1600 Dove Street, Suite 330, Newport Beach, CA 92660, USA; (A.R.); (V.L.); (M.D.)
| | - Ana Ramos
- ImmunogenX, Inc., 1600 Dove Street, Suite 330, Newport Beach, CA 92660, USA; (A.R.); (V.L.); (M.D.)
| | - Vasiliy Loskutov
- ImmunogenX, Inc., 1600 Dove Street, Suite 330, Newport Beach, CA 92660, USA; (A.R.); (V.L.); (M.D.)
| | - Anna Norum
- ImmunogenX, Inc., 1600 Dove Street, Suite 330, Newport Beach, CA 92660, USA; (A.R.); (V.L.); (M.D.)
| | - Adam Bledsoe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rok Seon Choung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew Dickason
- ImmunogenX, Inc., 1600 Dove Street, Suite 330, Newport Beach, CA 92660, USA; (A.R.); (V.L.); (M.D.)
| | - Jennifer Sealey-Voyksner
- ImmunogenX, Inc., 1600 Dove Street, Suite 330, Newport Beach, CA 92660, USA; (A.R.); (V.L.); (M.D.)
| | - Joseph Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
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Garcia-Calvo E, García-García A, Rodríguez S, Takkinen K, Martín R, García T. Production and Characterization of Novel Fabs Generated from Different Phage Display Libraries as Probes for Immunoassays for Gluten Detection in Food. Foods 2023; 12:3274. [PMID: 37685207 PMCID: PMC10486584 DOI: 10.3390/foods12173274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
Gluten is the main fraction of wheat proteins. It is widely used in the food industry because of the properties that are generated in the dough, but it is also able to trigger diseases like allergies, autoimmunity processes (such as celiac disease), and intolerances in sensitized persons. The most effective therapy for these diseases is the total avoidance of gluten in the diet because it not only prevents damage but also enhances tissue healing. To ensure the absence of gluten in food products labeled as gluten-free, accurate detection systems, like immunoassays, are required. In this work, four recombinant Fab antibody fragments, selected by phage display technology, were produced and tested for specificity and accuracy against gluten in experimental flour mixtures and commercial food products. A high-affinity probe (Fab-C) was identified and characterized. An indirect ELISA test was developed based on Fab-C that complied with the legal detection limits and could be applied in the assessment of gluten-free diets.
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Affiliation(s)
- Eduardo Garcia-Calvo
- Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.G.-C.); (S.R.); (R.M.); (T.G.)
| | - Aina García-García
- Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.G.-C.); (S.R.); (R.M.); (T.G.)
| | - Santiago Rodríguez
- Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.G.-C.); (S.R.); (R.M.); (T.G.)
| | - Kristiina Takkinen
- Biosensors Team, VTT Technical Research Center of Finland Ltd., P.O. Box 1000, FI-02044 Espoo, Finland;
| | - Rosario Martín
- Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.G.-C.); (S.R.); (R.M.); (T.G.)
| | - Teresa García
- Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Veterinaria, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.G.-C.); (S.R.); (R.M.); (T.G.)
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11
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Rostami A, Hogg-Kollars S. Deep-Dive Directions for Dietitians (DDDDs): a roadmap for the nutritional management of poorly responsive coeliac disease patients. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2023; 16:136-144. [PMID: 37554752 PMCID: PMC10404826 DOI: 10.22037/ghfbb.v16i2.2807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/14/2023] [Indexed: 08/10/2023]
Abstract
A substantial number of coeliac disease patients fail to respond to treatment with a gluten-free diet. Non-responsiveness might be multifactorial and the spectrum ranges from intentional or inadvertent gluten contamination as the main aetiology, to sensitivity to other nutrients (in addition to additives and preservatives). If the diagnosis of coeliac disease is correctly made and cross contamination and other factors have been excluded, then the aetiology behind the symptoms of a small group of coeliac patients might be refractory coeliac disease. The journey to ensure gluten contamination is not behind the persistent symptoms, is very challenging and requires in-depth training and skills. We therefore present potential guidance for the healthcare professional, in particular dietitians, on how to navigate these challenges on this journey.
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Affiliation(s)
- Adele Rostami
- Digestive Health Clinic, Palmerston North New Zealand
| | - Sabine Hogg-Kollars
- Department of Nutrition, University College of Teacher Education, Vienna, Austria
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12
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Murray JA, Syage JA, Wu TT, Dickason MA, Ramos AG, Van Dyke C, Horwath I, Lavin PT, Mäki M, Hujoel I, Papadakis KA, Bledsoe AC, Khosla C, Sealey-Voyksner JA. Latiglutenase Protects the Mucosa and Attenuates Symptom Severity in Patients With Celiac Disease Exposed to a Gluten Challenge. Gastroenterology 2022; 163:1510-1521.e6. [PMID: 35931103 PMCID: PMC9707643 DOI: 10.1053/j.gastro.2022.07.071] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND & AIMS Gluten ingestion in patients with celiac disease can lead to gastrointestinal symptoms and small intestinal mucosal injury. METHODS This gluten challenge phase 2 trial was double blind and placebo controlled, and it assessed the efficacy and safety of a 1200-mg dose of IMGX003 in patients with celiac disease exposed to 2 g of gluten per day for 6 weeks. The change in the ratio of villus height to crypt depth was the primary endpoint. Secondary endpoints included density of intraepithelial lymphocytes and symptom severity. These endpoints were evaluated by analysis of covariance. Additional endpoints included serology and gluten-immunogenic peptides in urine. RESULTS Fifty patients were randomized, and 43 patients completed the study (IMGX003, n = 21; placebo, n = 22). The mean change in the ratio of villus height to crypt depth (primary endpoint) for IMGX003 vs placebo was -0.04 vs -0.35 (P = .057). The mean change in the density of intraepithelial lymphocytes (secondary endpoint) for IMGX003 vs placebo was 9.8 vs 24.8 cells/mm epithelium (P = .018). The mean change (worsening) in symptom severity in relative units (secondary endpoint) for IMGX003 vs placebo was 0.22 vs 1.63 (abdominal pain, P = .231), 0.96 vs 3.29 (bloating, P = .204), and 0.02 vs 3.20 (tiredness, P = .113). The 3 × 2-week trend line significance values for these symptoms, respectively, were P = .014, .030, and .002. CONCLUSIONS IMGX003 reduced gluten-induced intestinal mucosal damage and symptom severity. (ClinicalTrials.gov, Number: NCT03585478).
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Affiliation(s)
- Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
| | | | - Tsung-Teh Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Carol Van Dyke
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Irina Horwath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Philip T Lavin
- Boston Biostatistics Research Foundation, Framingham, Massachusetts
| | - Markku Mäki
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Isabel Hujoel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Adam C Bledsoe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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13
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Aspasia S, Emmanuela-Kalliopi K, Nikolaos T, Eirini S, Ioannis S, Anastasia M. The gluten-free diet challenge in adults with coeliac disease: the Hellenic survey. PEC INNOVATION 2022; 1:100037. [PMID: 37213748 PMCID: PMC10194373 DOI: 10.1016/j.pecinn.2022.100037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 05/23/2023]
Abstract
Objective The only available treatment for coeliac disease (CD) is a lifelong strict gluten-free diet (GFD), which can be extremely challenging. Τhe aim of the present study was to gain an insight into patients' perceptions regarding the GFD, in relation to difficulties experienced, disease-specific symptoms, adherence level, and information sources used. Methods Two hundred ninety CD patients (247 women and 43 men) aged 18-74 years, completed a self-administered questionnaire. Results Self-rated dietary adherence was high in 65.5%, moderate in 27.5% and poor in 6.9% of the patients. The main difficulties encountered were the high cost and limited availability of GF foods and meals in markets and restaurants. The main source of information concerning CD and GFD was the internet, and the most useful source was the Coeliac Society. Dietary adherence correlated positively with Coeliac Society membership and awareness of the monthly CD allowance. Conclusion Α substantial proportion of patients did not adhere to a strict GFD. Patients were not adequately followed-up. Innovation A self-administered questionnaire was used to explore the practical challenges of a GFD in an understudied population, Greek adult coeliac patients. The results highlighted the need for dietitians with expertise on CD.
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Affiliation(s)
- Spyridaki Aspasia
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University (HMU), Trypitos area, 723 00 Sitia, Greece
| | - Kotsoni Emmanuela-Kalliopi
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University (HMU), Trypitos area, 723 00 Sitia, Greece
| | - Thalassinos Nikolaos
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University (HMU), Trypitos area, 723 00 Sitia, Greece
| | - Sfakianaki Eirini
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University (HMU), Trypitos area, 723 00 Sitia, Greece
| | - Sfendourakis Ioannis
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University (HMU), Trypitos area, 723 00 Sitia, Greece
| | - Markaki Anastasia
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University (HMU), Trypitos area, 723 00 Sitia, Greece
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14
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Liu YY, Lin IC, Chen PC, Lee CC, Meng M. Crystal structure of a Burkholderia peptidase and modification of the substrate-binding site for enhanced hydrolytic activity toward gluten-derived pro-immunogenic peptides. Int J Biol Macromol 2022; 222:2258-2269. [DOI: 10.1016/j.ijbiomac.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/19/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
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15
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Lee AR. Review article: Dietary management of coeliac disease. Aliment Pharmacol Ther 2022; 56 Suppl 1:S38-S48. [PMID: 35815831 DOI: 10.1111/apt.16974] [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] [Received: 12/05/2021] [Revised: 12/23/2021] [Accepted: 05/03/2022] [Indexed: 12/09/2022]
Abstract
As the gluten-free diet is currently the only treatment for coeliac disease and one that needs to applied in the long term, this review aims to explore the various issues confronting an individual and discuss the importance of ongoing dietary management. The process of dietary counselling has shifted from one that focuses on just foods to avoid to one that evaluates the multiple life factors (social, cultural, environmental, biological) that affect the individual's food choices and dietary behaviour. The nutritional quality of a gluten-free diet continues to affect vitamin, mineral and weight status of individuals with coeliac disease. There are many barriers to dietary adherence including increased cost and limited availability of gluten-free products, as well as the negative impact on an individual's social domain of quality of life. Therefore, assessment, education and counselling by a coeliac specialist dietitian should be the cornerstone of dietary management.
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Affiliation(s)
- Anne R Lee
- Celiac Disease Center, Columbia University Irving Medical Center, New York City, New York, USA
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16
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Gluten contamination in labelled gluten-free, naturally gluten-free and meals in food services in low-, middle- and high-income countries: a systematic review and meta-analysis. Br J Nutr 2022; 127:1528-1542. [PMID: 34753529 DOI: 10.1017/s0007114521002488] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The gluten-free diet is based on the consumption of foods without gluten, which aims to manage celiac disease. The concern of celiac patients is that these foods should be safe. However, gluten contamination can affect these foods. The objectives of this review and meta-analysis were first, to identify articles that detected gluten contamination in gluten-free foods using validated methods. Second, to quantify the overall prevalence of gluten contamination of naturally gluten-free foods, labelled gluten-free products, and meals prepared in food services. Third, to highlight the influence of the country's income and the period of study on this prevalence. The studies were identified in Scopus, Science Direct, Web of Science, PubMed, and Google Scholar. Forty articles were included according to PRISMA guidelines. The statistical meta-analysis was performed using MedCalc 19 software. The results show that in the gluten-free foods analysed, the overall prevalence of gluten contamination was estimated at 15.12% (95% CI: 9.56%-21.70%), with more than 20 mg/kg of gluten. Naturally gluten-free foods were significantly more contaminated than labelled gluten-free products and than meals in food services (28.32%; 9.52%; 4.66% respectively; p < 0.001). Moreover, it was noticed that oats were the most contaminated food. In addition, the prevalence of gluten contamination has significantly decreased over time. The majority of the studies were carried out in upper-middle-income and high-income countries, while only one study was conducted in lower-middle income countries. Therefore, it is necessary to implement preventive actions to reduce gluten contamination, ensuring safe gluten-free foods for celiac patients, including low-income countries.
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17
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The global burden of coeliac disease: opportunities and challenges. Nat Rev Gastroenterol Hepatol 2022; 19:313-327. [PMID: 34980921 DOI: 10.1038/s41575-021-00552-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 02/06/2023]
Abstract
Coeliac disease is a systemic disorder characterized by immune-mediated enteropathy, which is caused by gluten ingestion in genetically susceptible individuals. The clinical presentation of coeliac disease is highly variable and ranges from malabsorption through solely extra-intestinal manifestations to asymptomatic. As a result, the majority of patients with coeliac disease remain undiagnosed, misdiagnosed or experience a substantial delay in diagnosis. Coeliac disease is diagnosed by a combination of serological findings of disease-related antibodies and histological evidence of villous abnormalities in duodenal biopsy samples. However, variability in histological grading and in the diagnostic performance of some commercially available serological tests remains unacceptably high and confirmatory assays are not readily available in many parts of the world. Currently, the only effective treatment for coeliac disease is a lifelong, strict, gluten-free diet. However, many barriers impede patients' adherence to this diet, including lack of widespread availability, high cost, cross-contamination and its overall restrictive nature. Routine follow-up is necessary to ensure adherence to a gluten-free diet but considerable variation is evident in follow-up protocols and the optimal disease management strategy is not clear. However, these challenges in the diagnosis and management of coeliac disease suggest opportunities for future research.
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18
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Lebovits J, Lee AR, Ciaccio EJ, Wolf RL, Davies RH, Cerino C, Lebwohl B, Green PHR. Impact of Celiac Disease on Dating. Dig Dis Sci 2022; 67:5158-5167. [PMID: 35635630 PMCID: PMC9150385 DOI: 10.1007/s10620-022-07548-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/30/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND/AIMS When seeking a romantic partner, individuals with celiac disease (CD) must navigate challenging social situations. We aimed to investigate dating-related behaviors in adults with CD. METHODS A total of 11,884 affiliates of the Celiac Disease Center at Columbia University were invited to participate in an online survey. Adults (≥ 18 years) with biopsy-diagnosed CD were included. Among the 5,249 who opened the email, 538 fully completed the survey (10.2%). The survey included a CD-specific dating attitudes/behaviors questionnaire, a Social Anxiety Questionnaire (SAQ), a CD-specific quality of life instrument (CD-QOL), and a CD Food Attitudes and Behaviors scale (CD-FAB). RESULTS Respondents were primarily female (86.8%) and the plurality (24.4%) was in the 23-35 year age range. 44.3% had dated with CD, and among them, 68.4% reported that CD had a major/moderate impact on their dating life. A major/moderate impact was more commonly reported among females (69.3%, p < 0.001), 23-35-year-olds (77.7%, p = 0.015), those with a household income < $50 K (81.7%, p = 0.019), and those with a lower CD-QOL score (50.5 vs. 73.4, p = 0.002). While on dates, 39.3% were uncomfortable explaining precautions to waiters, 28.2% engaged in riskier eating behaviors, and 7.5% intentionally consumed gluten. 39.0% of all participants were hesitant to kiss their partner because of CD; females more so than males (41.1% vs. 22.7%, p = 0.005). CONCLUSIONS The majority of participants felt that CD had a major/moderate impact on their dating life. This impact may result in hesitation toward dating and kissing, decreased QOL, greater social anxiety, and less adaptive eating attitudes and behaviors. CD and the need to adhere to a gluten free diet have a major impact on dating and intimacy.
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Affiliation(s)
- Jessica Lebovits
- grid.239585.00000 0001 2285 2675The Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Anne R. Lee
- grid.239585.00000 0001 2285 2675The Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Edward J. Ciaccio
- grid.239585.00000 0001 2285 2675The Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Randi L. Wolf
- grid.21729.3f0000000419368729Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY 10027 USA
| | - Rebecca H. Davies
- grid.21729.3f0000000419368729Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY 10027 USA
| | - Chloe Cerino
- grid.21729.3f0000000419368729Program in Nutrition, Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY 10027 USA
| | - Benjamin Lebwohl
- grid.239585.00000 0001 2285 2675The Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Peter H. R. Green
- grid.239585.00000 0001 2285 2675The Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
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Korth N, Taylor SL, Clarke JL, Downs ML. Gluten Cross-Contact in Restaurant-Scale Pasta Cooking. J Food Prot 2021; 84:2159-2162. [PMID: 34324674 DOI: 10.4315/jfp-21-230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/25/2021] [Indexed: 11/11/2022]
Abstract
ABSTRACT Celiac disease and nonceliac gluten sensitivity are provoked by the consumption of gluten from wheat, barley, rye, and related grains. Affected individuals are advised to adhere to gluten-free diets. Recently, gluten-free foods have become a marketing trend with gluten-free options both in packaged foods and in restaurants and food service establishments. Pasta is one of the primary gluten-containing foods in diets in North America and Europe. Gluten-free pasta formulations are commercially available. In restaurants, multiple pasta dishes are often prepared simultaneously in large pots with multiple compartments and shared cooking water. The objective of this study was to determine whether gluten transfer occurs between traditional and gluten-free pasta when cooked simultaneously in the same water. Pasta was boiled in a commercial, four-compartment, 20-qt (18.9-L) cooking pot containing three batches of traditional penne pasta and one batch of gluten-free penne pasta. The amount of pasta (dry weight) was either 52 g (recommended serving size) or 140 g (typical restaurant portion). Five consecutive batches of pasta were boiled, and cooking water and gluten-free pasta were sampled at completion of cooking. Water and gluten-free pasta samples were tested for gluten with the Neogen Veratox for Gliadin enzyme-linked immunosorbent assay kit. Gluten concentrations were low (<20 ppm) in both water and gluten-free pasta samples through five 52-g batches. Gluten concentrations in the 52-g gluten-free pasta samples slowly increased through five batches but were never >20 ppm. During cooking of the 140-g gluten-free pasta samples, the gluten concentrations in the cooking water increased with each batch to >50 and >80 ppm after the fourth and fifth batches, respectively. The gluten concentrations in the 140-g gluten-free pasta samples approached 20 ppm by the fourth batch and reached nearly 40 ppm after the fifth batch. Although gluten transfer does not occur at a high rate, gluten-free pasta should be prepared in a separate cooking vessel in restaurant and food service establishments. HIGHLIGHTS
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Affiliation(s)
- Nate Korth
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, 1901 North 21st Street, 283 Food Innovation Center, Lincoln, Nebraska 68588
| | - Steve L Taylor
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, 1901 North 21st Street, 283 Food Innovation Center, Lincoln, Nebraska 68588
| | - Jennifer L Clarke
- Department of Food Science and Technology, University of Nebraska-Lincoln, 340 Hardin Hall North Wing, Lincoln, Nebraska 68583, USA.,Department of Statistics, University of Nebraska-Lincoln, 340 Hardin Hall North Wing, Lincoln, Nebraska 68583, USA
| | - Melanie L Downs
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, 1901 North 21st Street, 283 Food Innovation Center, Lincoln, Nebraska 68588
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20
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The Gluten-Free Diet for Celiac Disease and Beyond. Nutrients 2021; 13:nu13113993. [PMID: 34836247 PMCID: PMC8625243 DOI: 10.3390/nu13113993] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/20/2022] Open
Abstract
The gluten-free diet (GFD) has gained popularity beyond its main medical indication as the treatment for gluten-induced immune-mediated disorders such as celiac disease (CD), dermatitis herpetiformis, gluten ataxia, wheat allergy, and non-celiac gluten sensitivity. However, the diet carries some disadvantages such as elevated costs, nutritional deficiencies, and social and psychological barriers. The present work aims to review indications, proven benefits, and adverse events of a gluten-free diet. Close follow-up with patients following the diet is recommended. More data is needed to assess the effectiveness of the diet in managing mental and cognitive disorders and to establish a connection between the brain and gluten.
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21
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Coto L, Sousa C, Cebolla A. Dynamics and Considerations in the Determination of the Excretion of Gluten Immunogenic Peptides in Urine: Individual Variability at Low Gluten Intake. Nutrients 2021; 13:2624. [PMID: 34444783 PMCID: PMC8398346 DOI: 10.3390/nu13082624] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A lifelong strict gluten-free diet is the only available treatment for celiac disease, but total exclusion of gluten is difficult to achieve. The aim of this study was to determine the range of time and the amount of gluten immunogenic peptides (GIP) excreted in urine after specific gluten ingestions. METHODS 20 healthy participants followed the same diet for 12 days in which 50 mg and 2 g of gluten were ingested and all the urinations were collected. GIP were analyzed by lateral flow immunoassay (LFIA) tests and quantified using an LFIA reader. RESULTS GIP were detected in 15% and 95% of participants after 50 mg and 2 g gluten intakes, respectively. The higher frequency and concentration of GIP was found between 6 and 9 h after both gluten ingestions. The ranges of detection were 3-12 h (50 mg) and 0-15 h (2 g). CONCLUSIONS An increase in the frequency of urine tests may be a suitable approach to avoid false negative results. The use of the LFIA test in three urine samples collected at different times may show a sensitivity of 19.6% for a gluten ingestion like 50 mg, increasing to 93% after 2 g consumption.
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Affiliation(s)
- Laura Coto
- Biomedal S.L., 41900 Seville, Spain;
- Human Nutrition and Food Science Doctoral Program, University of Granada, 18011 Granada, Spain
| | - Carolina Sousa
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, 41012 Seville, Spain;
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22
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Mandracchia F, Llauradó E, Valls RM, Tarro L, Solà R. Evaluating Mediterranean Diet-Adherent, Healthy and Allergen-Free Meals Offered in Tarragona Province Restaurants (Catalonia, Spain): A Cross-Sectional Study. Nutrients 2021; 13:nu13072464. [PMID: 34371970 PMCID: PMC8308532 DOI: 10.3390/nu13072464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/21/2022] Open
Abstract
Restaurant meal consumption has increased substantially, but the ability of restaurants to adhere to guidelines for the Mediterranean diet, healthiness and food allergen management is a challenge. This cross-sectional study aims to assess the Mediterranean diet adherence, healthiness, nutritional quality and food allergen management of meals at restaurants in the Tarragona province (Catalonia, Spain). Primary outcomes included adherence to criteria for the Mediterranean diet (AMed) and gluten management (SMAP), nutritional quality of dishes indicated by a green traffic light rating, meal nutrient content and allergen-free options. Secondary outcomes included restaurant staff knowledge about the Mediterranean diet and food allergens. Forty-four restaurants and 297 dishes were analysed. The restaurants fulfilled an average (mean ± SD) of 5.1 ± 1.6 of 9 compulsory AMed criteria and 12.9 ± 2.8 of 18 SMAP criteria. Dishes were mainly rated green for sugar (n = 178/297; 59.9%) but not for energy (n = 23/297; 7.7%) or total fat (n = 18/297; 6.1%). Waiters and cooks received passing scores for food allergen knowledge (5.8 ± 1.7 and 5.5 ± 1.5 out of 10 points, respectively). Restaurants partially met the AMed and SMAP criteria. Increasing fibre and decreasing saturated fat content are necessary to improve consumers’ adherence to healthy diets. For restaurant staff, training courses should be considered to improve their food allergen management.
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Affiliation(s)
- Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
| | - Rosa Maria Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
- Correspondence: ; Tel.: +34-977-758-920
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
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Food Safety and Cross-Contamination of Gluten-Free Products: A Narrative Review. Nutrients 2021; 13:nu13072244. [PMID: 34210037 PMCID: PMC8308338 DOI: 10.3390/nu13072244] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 02/06/2023] Open
Abstract
A gluten-free diet (GFD) is currently the only effective treatment for celiac disease (CD); an individual’s daily intake of gluten should not exceed 10 mg. However, it is difficult to maintain a strict oral diet for life and at least one-third of patients with CD are exposed to gluten, despite their best efforts at dietary modifications. It has been demonstrated that both natural and certified gluten-free foods can be heavily contaminated with gluten well above the commonly accepted threshold of 20 mg/kg. Moreover, meals from food services such as restaurants, workplaces, and schools remain a significant risk for inadvertent gluten exposure. Other possible sources of gluten are non-certified oat products, numerous composite foods, medications, and cosmetics that unexpectedly contain “hidden” vital gluten, a proteinaceous by-product of wheat starch production. A number of immunochemical assays are commercially available worldwide to detect gluten. Each method has specific features, such as format, sample extraction buffers, extraction time and temperature, characteristics of the antibodies, recognition epitope, and the reference material used for calibration. Due to these differences and a lack of official reference material, the results of gluten quantitation may deviate systematically. In conclusion, incorrect gluten quantitation, improper product labeling, and poor consumer awareness, which results in the inadvertent intake of relatively high amounts of gluten, can be factors that compromise the health of patients with CD.
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Rej A, Sanders DS. An update on coeliac disease from the NHS England National Centre for Refractory Coeliac Disease. Clin Med (Lond) 2021; 21:127-130. [PMID: 33762372 DOI: 10.7861/clinmed.2021-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Coeliac disease (CD) is a common autoimmune-mediated gluten sensitive enteropathy, with a prevalence of around 1%. While the incidence of CD has increased over the last 2 decades, many cases still remain undiagnosed. The presentation of CD is variable and can be subtle, with it being important to explore both gastrointestinal and extra-intestinal features. The cornerstone of management is adherence to a strict gluten free diet, which requires support and education from an expert gastrointestinal dietitian. Persisting symptoms in individuals requires re-evaluation, with repeat duodenal biopsies sometimes required. Refractory CD affects a small subset of individuals with CD, requiring specialist input.
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Affiliation(s)
- Anupam Rej
- Royal Hallamshire Hospital, Sheffield, UK;
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25
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Kivelä L, Caminero A, Leffler DA, Pinto-Sanchez MI, Tye-Din JA, Lindfors K. Current and emerging therapies for coeliac disease. Nat Rev Gastroenterol Hepatol 2021; 18:181-195. [PMID: 33219355 DOI: 10.1038/s41575-020-00378-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/12/2022]
Abstract
Coeliac disease is a common enteropathy that occurs in genetically susceptible individuals in response to the ingestion of gluten proteins present in wheat, rye and barley. Currently, the only available treatment for the condition is a strict, life-long gluten-free diet that, despite being safe and often effective, is associated with several challenges. Due to the high cost, particularly restrictive nature and perception of decreased quality of life associated with the diet, some patients are continuously exposed to gluten, which prevents an adequate disease control. Moreover, a subgroup of patients does not respond to the diet adequately, and healing of the small-bowel mucosa can be incomplete. Thus, there is a need for alternative treatment forms. The increasingly understood pathogenetic process of coeliac disease has enabled the identification of various targets for future therapies. Multiple investigational therapies ranging from tolerogenic to immunological approaches are in the pipeline, and several drug candidates have entered phase II/III clinical trials. This Review gives a broad overview of the different investigative treatment modalities for coeliac disease and summarizes the latest advances in this field.
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Affiliation(s)
- Laura Kivelä
- Tampere Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland.,Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alberto Caminero
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Daniel A Leffler
- Harvard Celiac Disease Research Program, Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Takeda Pharmaceuticals, Cambridge, MA, USA
| | - Maria Ines Pinto-Sanchez
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Jason A Tye-Din
- Immunology Division, The Walter and Eliza Hall Institute, Parkville, and Gastroenterology Department, The Royal Melbourne Hospital, Parkville, Australia
| | - Katri Lindfors
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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Abstract
Gluten is a common dietary component with a complex protein structure. It forms incomplete products of digestion, which have the potential to mount an immune response in genetically predisposed individuals, resulting in celiac disease. It also has been linked with nonceliac gluten sensitivity and irritable bowel syndrome due to wheat allergy. A gluten-free diet is an effective treatment of these conditions; however, it can lead to micronutrient and mineral deficiencies and a macronutrient imbalance with higher sugar and lipid intake. Recent popularity has led to greater availability, but increasing cost, of commercially available gluten-free products.
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Affiliation(s)
- Naueen A Chaudhry
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, 1329 Southwest 16th Street, Suite 5251, Gainesville, FL 32608, USA
| | - Chelsea Jacobs
- Department of Medicine, University of Florida, 1329 Southwest 16th Street, Suite 5251, Gainesville, FL 32608, USA
| | - Peter H R Green
- Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, New York, NY 10032, USA
| | - S Devi Rampertab
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, 1329 Southwest 16th Street, Suite 5251, Gainesville, FL 32608, USA.
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27
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Kurki A, Kemppainen E, Laurikka P, Kaukinen K, Lindfors K. The use of peripheral blood mononuclear cells in celiac disease diagnosis and treatment. Expert Rev Gastroenterol Hepatol 2021; 15:305-316. [PMID: 33176106 DOI: 10.1080/17474124.2021.1850262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Celiac disease is characterized by an abnormal immune activation driven by the ingestion of gluten from wheat, barley, and rye. Gluten-specific CD4+ T cells play an important role in disease pathogenesis and are detectable among peripheral blood mononuclear cells (PBMCs). Areas covered: This review summarizes the use of celiac disease patient PBMCs in clinical applications focusing on their exploitation in the development of diagnostic approaches and novel drugs to replace or complement gluten-free diet. Expert opinion: The most used PBMC-based methods applied in celiac disease research include ELISpot and HLA-DQ:gluten tetramer technology. ELISpot has been utilized particularly in research aiming to develop a celiac disease vaccine and in studies addressing the toxicity of different grains in celiac disease. HLA-DQ:gluten tetramer technology on the other hand initially focused on improving current diagnostics but in combination with additional markers it is also a useful outcome measure in clinical trials to monitor the efficacy of drug candidates. In addition, the technology serves well in the more detailed characterization of celiac disease-specific T cells, thereby possibly revealing novel therapeutic targets. Future studies may also reveal clinical applications for PBMC microRNAs and/or dendritic cells or monocytes present among PBMCs.
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Affiliation(s)
- Alma Kurki
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland
| | - Esko Kemppainen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland
| | - Pilvi Laurikka
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital , Tampere, Finland
| | - Katri Lindfors
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland
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28
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Goyal H, Gajendran M, Boregowda U, Perisetti A, Aziz M, Bansal P, Inamdar S, Tharian B. Current and future implications of COVID-19 on gastroenterology training and clinical practice. Int J Clin Pract 2020; 74:e13717. [PMID: 32955773 PMCID: PMC7537026 DOI: 10.1111/ijcp.13717] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/27/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has affected almost every country on the globe, affecting 185 countries with more than 2.6 million cases and 182,000 deaths as of April 22, 2020. The United States (US) has seen an exponential surge in the COVID-19 patients and has become the epicentre with more than 845,000 confirmed cases and 46,000 deaths. The governments and healthcare providers all over the world are racing with time to reduce the rate of increase in active cases by social distancing to flatten the curve of this pandemic. Practicing gastroenterologists are facing multiple challenges in the safe practice of medicine because of patient's inability to visit physicians' offices, endoscopy centers and the threat of potential virus spread through gastrointestinal secretions by endoscopies in emergent cases. The gastroenterological associations from Europe and North America have made position statements to guide gastroenterologists to navigate through the clinical practice during the COVID-19 pandemic. Gastroenterology fellows are on the frontlines during the COVID-19 pandemic, experiencing personal, physical and economic stresses. They had to balance the programmatic changes to meet the demands of the patient care with the additional pressure to meet training requirements. Given the imperatives for social and physical distancing, training programmes have to implement innovative educational methods to substitute traditional teaching. Healthcare organisations must synchronise institutional workforce needs with trainee safety, education and well-being. In this perspective, we have discussed the challenges that can be anticipated and implementing strategies to support fellows during the times of the COVID-19 pandemic.
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Affiliation(s)
- Hemant Goyal
- The Wright Center for Graduate Medical EducationScrantonPAUSA
| | - Mahesh Gajendran
- Department of Internal MedicinePaul L Foster School of MedicineTexas Tech UniversityEl PasoTXUSA
| | | | - Abhilash Perisetti
- Department of Gastroenterology and HepatologyUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Muhammad Aziz
- Department of Internal MedicineThe University of ToledoToledoOHUSA
| | - Pardeep Bansal
- Division of GastroenterologyMoses Taylor Hospital and Reginal Hospital of ScrantonScrantonPAUSA
| | - Sumant Inamdar
- Department of Gastroenterology and HepatologyUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Benjamin Tharian
- Department of Gastroenterology and HepatologyUniversity of Arkansas for Medical SciencesLittle RockARUSA
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29
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Monzani A, Lionetti E, Felici E, Fransos L, Azzolina D, Rabbone I, Catassi C. Adherence to the Gluten-Free Diet during the Lockdown for COVID-19 Pandemic: A Web-Based Survey of Italian Subjects with Celiac Disease. Nutrients 2020; 12:nu12113467. [PMID: 33198212 PMCID: PMC7698218 DOI: 10.3390/nu12113467] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022] Open
Abstract
We aimed to assess the perceived impact of the lockdown, imposed to control the spreading of COVID-19, on the adherence of Italian celiac disease (CD) subjects to the gluten-free diet by a web-based survey. A total of 1983 responses were analyzed, 1614 (81.4%) by CD adults and 369 (18.6%) by parents/caregivers of CD children/adolescents. The compliance with the GFD was unchanged for 69% of the adults and 70% of the children, and improved for 29% of both. The factors increasing the probability to report stricter compliance were the presence of CD symptoms in the last year before the lockdown (odds ratio (OR) 1.98, 95% confidence interval (CI) 1.46–2.26), a partial usual adherence to gluten-free diet (GFD) (OR 1.91, 95% CI 1.2–3.06), and having tried recipes with naturally gluten-free ingredients more than usual (OR 1.58, 95% CI 1.28–1.96) for adults; the presence of CD symptoms in the last year (OR 2.05, 95% CI 1.21–3.47), still positive CD antibodies (OR 1.89, 95% CI 1.14–3.13), and other family members with CD (OR 2.24, 95% CI 1.3–3.85) for children/adolescents. Therefore, the lockdown led to a reported improved adherence to the GFD in one-third of the respondents, in particular in those with previous worse disease control, offering the opportunity to avoid sources of contamination/transgression and increase the use of naturally gluten-free products.
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Affiliation(s)
- Alice Monzani
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy;
- Correspondence: ; Tel.: +39-03213733868; Fax: +39-03213733598
| | - Elena Lionetti
- Department of Pediatrics, Marche Polytechnic University, 60020 Ancona, Italy; (E.L.); (C.C.)
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children Hospital, 15121 Alessandria, Italy;
| | - Lucia Fransos
- Piedmont Section, Italian Celiac Association, 10136 Turin, Italy;
| | - Danila Azzolina
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Carlo Catassi
- Department of Pediatrics, Marche Polytechnic University, 60020 Ancona, Italy; (E.L.); (C.C.)
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30
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Rej A, Aziz I, Sanders DS. Coeliac disease and noncoeliac wheat or gluten sensitivity. J Intern Med 2020; 288:537-549. [PMID: 32573000 DOI: 10.1111/joim.13120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
Abstract
Coeliac disease (CD) and noncoeliac wheat or gluten sensitivity (NCWS/NCGS) are common gluten-related disorders. Both conditions can present with gastrointestinal and extraintestinal manifestations, which can be a challenge for physicians to discern between. Whilst coeliac serology and histological assessment are required for the diagnosis of CD, there are no clear biomarkers for the diagnosis of NCGS. The management of both conditions is with a gluten-free diet (GFD), although the duration, as well as strictness of adherence to a GFD in NCGS, is unclear. Adherence to a GFD in CD can also be challenging, with recent developments of noninvasive assessments, although histological assessment via duodenal biopsies remains the gold standard. The management of refractory coeliac disease remains particularly challenging, often requiring specialist input. Whilst wheat is noted to be a trigger for symptom generation in NCGS, it is unclear which components of wheat are responsible for symptom generation in this group, with further research required to elucidate the pathophysiology.
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Affiliation(s)
- A Rej
- From the, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - I Aziz
- From the, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK
| | - D S Sanders
- From the, Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK
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31
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Wolf RL, Vipperman-Cohen A, Green PHR, Lee AR, Reilly NR, Zybert P, Lebwohl B. Portable gluten sensors: qualitative assessments by adults and adolescents with coeliac disease. J Hum Nutr Diet 2020; 33:876-880. [PMID: 32975829 DOI: 10.1111/jhn.12810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Portable gluten sensors are now commercially available to the public, although there is genuine uncertainty within the medical community over whether they should be used for coeliac disease management. The present study described qualitatively the experience of using a portable gluten sensor for 15 adults and 15 adolescents with coeliac disease participating in a 3-month pilot clinical trial. METHODS Participants were 30 individuals, aged 13-70 years, with biopsy-confirmed coeliac disease on a gluten-free diet. All received a portable gluten sensor and were randomised to low, medium, and high numbers of single-use capsules. Open-ended questions addressed likes and dislikes using the portable gluten sensor after 3 months. Major themes were identified and described. RESULTS Participants liked that the portable gluten sensor provided extra assurance to check foods presented as gluten-free, the convenient size and portability, the added sense of control, and overall peace-of-mind. Participants disliked having attention drawn to them when using the sensor and feeling as if they were deterring others from eating. Participants also disliked the physical difficulty associated with using the capsules, questionable accuracy and the inability to test fermented foods. Adults were more enthusiastic about the sensor than adolescents. CONCLUSIONS Positive and negative experiences may be expected when using commercially available portable gluten sensors to help manage coeliac disease. As future versions of this and other gluten sensors become available, it will be important to investigate the relationship between users' experience with the sensors and long-term outcomes such as mucosal healing and quality of life.
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Affiliation(s)
- R L Wolf
- Department of Health & Behavior Studies, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - A Vipperman-Cohen
- Department of Health & Behavior Studies, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - P H R Green
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, Harkness Pavilion, New York, NY, USA
| | - A R Lee
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, Harkness Pavilion, New York, NY, USA
| | - N R Reilly
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, Harkness Pavilion, New York, NY, USA
| | - P Zybert
- Department of Health & Behavior Studies, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - B Lebwohl
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, Harkness Pavilion, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
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32
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Shah R, Satyavada S, Ismail M, Kurin M, Smith ZL, Cooper GS, Chak A. COVID-19 pandemic through the lens of a gastroenterology fellow: looking for the silver lining. Gastrointest Endosc 2020; 92:394-398. [PMID: 32247755 PMCID: PMC7130320 DOI: 10.1016/j.gie.2020.03.3852] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Raj Shah
- Reprint requests: Raj Shah, MD, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Wearn Bldg, Ste 242, Cleveland, OH 44106
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Bajaj JS, Brenner DM, Cai Q, Cash BD, Crowell M, DiBaise J, Gallegos-Orozco JF, Gardner TB, Gyawali CP, Ha C, Holtmann G, Jamil LH, Kaplan GG, Karsan HA, Kinoshita Y, Lebwohl B, Leontiadis GI, Lichtenstein GR, Longstreth GF, Muthusamy VR, Oxentenko AS, Pimentel M, Pisegna JR, Rubenstein JH, Russo MW, Saini SD, Samadder NJ, Shaukat A, Simren M, Stevens T, Valdovinos M, Vargas H, Spiegel B, Lacy BE. Major Trends in Gastroenterology and Hepatology Between 2010 and 2019: An Overview of Advances From the Past Decade Selected by the Editorial Board of The American Journal of Gastroenterology. Am J Gastroenterol 2020; 115:1007-1018. [PMID: 32618649 DOI: 10.14309/ajg.0000000000000709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J S Bajaj
- Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA
| | - D M Brenner
- Northwestern University, Chicago Illinois, USA
| | - Q Cai
- Emory University, Atlanta, Georgia, USA
| | - B D Cash
- McGovern Medical School, Houston, Texas, USA
| | - M Crowell
- Mayo Clinic, Scottsdale, Arizona, USA
| | - J DiBaise
- Mayo Clinic, Scottsdale, Arizona, USA
| | | | - T B Gardner
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - C P Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C Ha
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - G Holtmann
- University of Queensland, Brisbane, Australia, USA
| | - L H Jamil
- Beaumont Health-Royal Oak, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - G G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - H A Karsan
- Atlanta Gastroenterology Associates and Emory University, Atlanta, Georgia, USA
| | - Y Kinoshita
- Steel Memorial Hirohata Hospital and Himeji Brain and Heart Center, Himeji, Japan
| | - B Lebwohl
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - G F Longstreth
- Kaiser Permanente Southern California, San Diego, California, USA
| | - V R Muthusamy
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - M Pimentel
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - J R Pisegna
- Department of Veterans Affairs, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA Los Angeles, California, USA
| | - J H Rubenstein
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - M W Russo
- Carolinas Medical Center-Atrium Health, Charlotte, North Carolina, USA
| | - S D Saini
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - A Shaukat
- Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - M Simren
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - T Stevens
- Cleveland Clinic, Cleveland, Ohio, USA
| | - M Valdovinos
- Instituto Nacional de Ciencias Médicas y Nutricion S.Z., Mexico City, Mexico
| | - H Vargas
- Mayo Clinic, Scottsdale, Arizona, USA
| | - B Spiegel
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - B E Lacy
- Mayo Clinic, Jacksonville, Florida, USA
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Mullin G, Chey W, Crowe SE. The 2019 James W. Freston Conference: Food at the Intersection of Gut Health and Disease. Gastroenterology 2020; 159:20-25. [PMID: 32224128 PMCID: PMC7707161 DOI: 10.1053/j.gastro.2020.03.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/01/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Freston Conference Faculty AnanthakrishanAshwinMBBS, MPH4Garcia-BailoBibianaMSc, PhD5DellonEvanMD, MPH, AGAF6DiBaiseJohnMD7FasanoAlessioMD8HallerEmilyMS, RDN2HamiltonMatthew J.MD9KleinSamMD10LebwohlBenjaminMD, AGAF11LeungJohnMD1213LewisJamesMD, MSCE, AGAF14NguyenLindaMD, AGAF15PandolfinoJohnMD, AGAF16ParrishCarol ReesMS, RDN17ScarlataKateRDN18TackJanMD PhD19FryeJeanettaMD17HarerKimberelyMD20ZevallosVictorPhD21SrinivasanSachinMD22VermaSandeepMD23Jansson-KnodellClaireMD24DiaVermontPhD25RifkinSamaraMD20PaceLauraMD, PhD26
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35
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Penny HA, Baggus EMR, Rej A, Snowden JA, Sanders DS. Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease. Nutrients 2020; 12:E216. [PMID: 31947666 PMCID: PMC7019917 DOI: 10.3390/nu12010216] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 02/06/2023] Open
Abstract
Coeliac disease is a common small intestinal enteropathy which manifests following ingestion of gluten in genetically susceptible individuals. Since gluten was identified as the driving factor in coeliac disease, the gluten-free diet (GFD) has remained the mainstay of treatment. While most individuals will display improvement in symptoms and signs of coeliac disease following institution of the GFD, up to 30% will continue to experience symptoms and/or have persisting intestinal inflammation. These individuals can be classified as having non-responsive coeliac disease (NRCD), which may be associated with dietary indiscretion, slow healing, refractory coeliac disease, and/or an alternative condition. The purpose of this review is to provide an overview of the causes of NRCD in adults, highlight a systematic approach to investigate these patients, and appraise the latest management aspects of this subset of coeliac disease.
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Affiliation(s)
- Hugo A. Penny
- Academic Unit of Gastroenterology, University of Sheffield, Sheffield S10 2TN, UK; (H.A.P.); (E.M.R.B.); (A.R.)
- Lydia Becker Institute of Inflammation and Immunology, University of Manchester, Manchester M13 9PL, UK
| | - Elisabeth M. R. Baggus
- Academic Unit of Gastroenterology, University of Sheffield, Sheffield S10 2TN, UK; (H.A.P.); (E.M.R.B.); (A.R.)
| | - Anupam Rej
- Academic Unit of Gastroenterology, University of Sheffield, Sheffield S10 2TN, UK; (H.A.P.); (E.M.R.B.); (A.R.)
| | - John A. Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK;
| | - David S. Sanders
- Academic Unit of Gastroenterology, University of Sheffield, Sheffield S10 2TN, UK; (H.A.P.); (E.M.R.B.); (A.R.)
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36
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McDonald BD, Kupfer SS. Can We Cross Off Common Kitchen Practices as Causes of Gluten Cross-Contact? Gastroenterology 2020; 158:51-53. [PMID: 31730765 DOI: 10.1053/j.gastro.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/07/2019] [Indexed: 12/02/2022]
Affiliation(s)
| | - Sonia S Kupfer
- University of Chicago Celiac Disease Center, Chicago, Illinois.
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37
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Ramedani N, Sharifan A, Gholam-Mostafaei FS, Rostami-Nejad M, Yadegar A, Ehsani-Ardakani MJ. The potentials of probiotics on gluten hydrolysis; a review study. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2020; 13:S1-S7. [PMID: 33584998 PMCID: PMC7881392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Celiac disease (CD) is an autoimmune disorder of the small intestinal mucosa in genetically susceptible subjects consuming gluten. Gluten in wheat, rye and barley is harmful for some individuals and leads to various symptoms. Research has shown that treatment with probiotics in CD patients could improve the symptoms by the gluten hydrolysis. For this purpose, different databases such as Medline, PubMed, Scopus, and Google Scholar were searched using the following keywords: Celiac disease, Wheat flour, Gluten, glutamine, Probiotic, Bifidobacterium, Lactobacillus, Enzymes, Wheat allergy, Immune system, T cells, HLA-DQ2, HLA-DQ8, Gluten-free diet, Proteolysis, α2-gliadin fragment, Gliadin, 33-mer peptide, and Zonulin. The search aimed to retrieve the articles published during 2000-2019. Today, a gluten-free diet (GFD) is the only celiac disease treatment. Biotechnological strategy based on probiotic treatment could degrade gluten. Research has shown that combination of the probiotic enzyme is more effective than single probiotic on gluten hydrolysis. The result of different studies showed that probiotic mixture has the capacity to hydrolyze a considerable concentration of the 33-mer of gliadin completely. The present study was aimed to investigate associations between the capacities of probiotics on gluten hydrolysis.
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Affiliation(s)
- Najmeh Ramedani
- Department of Food Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Anousheh Sharifan
- Department of Food Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Fahimeh Sadat Gholam-Mostafaei
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Ehsani-Ardakani
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Syage JA, Green PHR, Khosla C, Adelman DC, Sealey-Voyksner JA, Murray JA. Latiglutenase Treatment for Celiac Disease: Symptom and Quality of Life Improvement for Seropositive Patients on a Gluten-Free Diet. ACTA ACUST UNITED AC 2019; 1:293-301. [PMID: 32313451 DOI: 10.1002/ygh2.371] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Celiac disease (CD) is a widespread autoimmune disease triggered by dietary gluten that can lead to severe gastrointestinal symptoms. Because there is no available treatment other than a lifelong gluten-free diet, many patients continue to experience chronic symptoms. Aim In this analysis we report on the efficacy of latiglutenase, an orally administered enzyme treatment, for improving multiple gluten-induced symptoms and consequent quality of life (QOL) due to inadvertent gluten consumption. Methods This analysis is based on data from the CeliAction study of symptomatic patients (ALV003-1221; NCT01917630). Patients were treated with latiglutenase or placebo for 12 weeks and instructed to respond to a symptom diary daily and to multiple QOL questionnaires at weeks 0, 6, and 12 of the treatment periods as secondary endpoints. The results were stratified by serostatus. Results 398 patients completed the 12-week CDSD study. In seropositive, but not seronegative, CD patients a statistically significant and dose-dependent improvement was seen in the severity and frequency of abdominal pain, bloating, tiredness, and constipation. In subjects receiving 900 mg latiglutenase, improvements (p-values) in the severity of these symptoms for week 12 were 58% (0.038), 44% (0.023), 21% (0.164), and 104% (0.049) respectively, relative to placebo-dosed subjects. The reduction in symptoms trended higher for more symptomatic patients. Similar results were observed for the QOL outcome measures. Conclusions Although this study was not powered to definitively establish the benefit of latiglutenase in seropositive CD patients, such patients appear to show symptomatic and QOL benefit from using latiglutenase with meals.
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Affiliation(s)
| | - Peter H R Green
- Celiac Disease Center, Columbia University, New York, NY, United States
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Improving the Treatment of Celiac Disease. Am J Gastroenterol 2019; 114:1355-1356. [PMID: 31205132 DOI: 10.14309/ajg.0000000000000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Response to Forbes. Am J Gastroenterol 2019; 114:1356. [PMID: 31232833 DOI: 10.14309/ajg.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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