Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease

2001 ◽  
Vol 100 (4) ◽  
pp. 379-386 ◽  
Author(s):  
Adrian G. CUMMINS ◽  
Fiona M. THOMPSON ◽  
Ross N. BUTLER ◽  
John C. CASSIDY ◽  
David GILLIS ◽  
...  
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Prospective Study ◽  
Coeliac Disease ◽  
Intestinal Permeability ◽  
Early Stage ◽  
Mitotic Count ◽  
Intestinal Biopsy ◽  
Gluten Free ◽  
Intestinal Morphometry

It is often difficult to assess small bowel recovery in adults with coeliac disease on a gluten-free diet (GFD). This prospective study compares changes in intestinal permeability with changes in intestinal biopsy at various intervals after commencing a GFD. Intestinal permeability was measured by lactulose/rhamnose absorption from 1 week to 24 months after commencing a GFD. Intestinal morphometry was measured by villus area, crypt length and mitotic count per crypt at diagnosis and after commencing a GFD. Median intestinal permeability values decreased from 0.47 (n = 35) at diagnosis to 0.25 (n = 17) after 1 week and to 0.16 (n = 18) after 2 months of a GFD. Rhamnose absorption improved significantly at an early stage, from 6.6% (untreated) to 15.4% at 3 months of a GFD, whereas the decrease in lactulose permeation took longer: from 3.4% (untreated) to 0.8% after 12 months of a GFD. Mean villus area (n = 29) was reduced to 16% of control values at diagnosis, and improved to a maximum of 48% after 6 months on a GFD, but did not change thereafter. Mean crypt length and mitotic count per crypt were increased by 222% and 356% respectively at diagnosis, and these parameters remained elevated at 172% and 216% above control values after 6 months of a GFD. We conclude that intestinal permeability improves within 2 months after starting a GFD, but that measurable intestinal biopsy improvement requires ingestion of a GFD for at least 3–6 months, and even then remains incomplete.

scholarly journals Wait-and-See Approach or Gluten-Free Diet Administration—The Rational Management of Potential Coeliac Disease

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 947
Author(s):  
Anna Szaflarska-Popławska
Keyword(s):  
Small Intestine ◽  
Celiac Disease ◽  
Prognostic Factors ◽  
Coeliac Disease ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Individual Basis ◽  
Therapeutic Decisions ◽  
Rational Management ◽  
Wait And See

Potential celiac disease (PCD) is a heterogeneous disease; only some patients develop full celiac disease (CD), characterised by advanced atrophic changes in the small intestine. Few accurate prognostic factors exist for the progression of PCD; therefore, therapeutic decisions should be made on an individual basis in each case. Patients with clinical gastroenterological or parenteral symptoms often benefit from a gluten-free diet, and those left on a diet containing gluten should receive clinical, serological and histopathological supervision.

scholarly journals Effect of gluten-free diet on the growth and nutritional status of children with coeliac disease

2009 ◽  
Vol 137 (11-12) ◽  
pp. 632-637 ◽  
Author(s):  
Nedeljko Radlovic ◽  
Marija Mladenovic ◽  
Zoran Lekovic ◽  
Dragana Zivanovic ◽  
Radivoj Brdar ◽  
...  
Keyword(s):  
Growth Rate ◽  
Small Bowel ◽  
Nutritional Status ◽  
Coeliac Disease ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Small Bowel Mucosa ◽  
And Gender ◽  
Nutritional Status Of Children ◽  
Bowel Mucosa

Introduction. Gluten-free diet (GFD) presents the basis of coeliac disease (CD) treatment. If strictly applied, the disorders of the small bowel mucosa and other disease signs rapidly resolve. Objective. The goal of the study was to evaluate the effect of GFD on the growth and nutritional status of children with the classical form of CD. In addition, we analyzed the differences between these parameters with the duration and the patients' compliance with GFD. Methods. The study goals were achieved on a sample of 90 children, 56 female and 34 male, aged 0.5-7.5 (1.53?1.05) years, with the classic CD diagnosed on the basis of typical pathohistological findings of the small bowel mucosa and clinical recovery of patients on GFD. The duration of the patients' follow-up was 1.08-8.75 (3.03?1.14) years, i.e. until the age of 2.5-15 (4.59?1.78) years. The initial and control values of body height (BH) in relation to matched values for age and gender were expressed in percentiles, while the deviation in body weight (BW) for the matched values of height and gender was expressed in percentages. The referent haemoglobin (Hb) rate in blood, as a laboratory indicator of nutritional status in children aged up to 5 years was ?110 g/L, and for those aged above 5 years it was ?115 g/L. Compliance with GFD was based on the pathohistological findings of the small bowel mucosa or determination of tissue transglutaminase. Results. Over the studied period, the effect of GFD was highly significant, both on the increase of BH percentiles (37.62?26.26 vs. 57.22?25.29; p<0.001), and on the decrease of BW deficit 11.58?10.80 vs. 0.89?8.194; p<0.001). After the treatment period, none of the children showed slowed growth rate or BW deficit above 20%, while BW deviation ranging between 10-20% in relation to the referent values was registered in 17 (18.19%) and the excess of over 20% in 2 patients. In 86 (95.56%) patients, control Hb values in blood were normal, while mild anaemia was registered in 4 patients, all compliant with GFD. The difference between the compliant and non-compliant patients with GFD was not detected either in BH percentiles (p=0.586) or in BW percentage deviation as compared to standard values (p=0.516) or in blood Hb values (p=0.445). In addition, differences between the children on GFD lasting over and below 3 years were not detected either in BH percentiles (p=0.915) or in BW deviation percentages in relation to the ideal rate (p=0.476). Conclusion. GFD applied for 1-3 years has a highly significant effect on the growth rate and nutritional status of children with the classical form of CD. Significant differences in these parameters of the disease were not detected between strictly compliant and non-compliant patients on GFD.

scholarly journals Molecular Biomarkers for Celiac Disease: Past, Present and Future

2020 ◽  
Vol 21 (22) ◽  
pp. 8528
Author(s):  
Aarón D. Ramírez-Sánchez ◽  
Ineke L. Tan ◽  
B.C. Gonera-de Jong ◽  
Marijn C. Visschedijk ◽  
Iris Jonkers ◽  
...  
Keyword(s):  
Small Intestine ◽  
Celiac Disease ◽  
Early Stage ◽  
Villous Atrophy ◽  
Upper Endoscopy ◽  
Gluten Free ◽  
Non Invasive ◽  
Immune Mediated ◽  
Gastrointestinal Complaints ◽  
Small Intestinal

Celiac disease (CeD) is a complex immune-mediated disorder that is triggered by dietary gluten in genetically predisposed individuals. CeD is characterized by inflammation and villous atrophy of the small intestine, which can lead to gastrointestinal complaints, malnutrition, and malignancies. Currently, diagnosis of CeD relies on serology (antibodies against transglutaminase and endomysium) and small-intestinal biopsies. Since small-intestinal biopsies require invasive upper-endoscopy, and serology cannot predict CeD in an early stage or be used for monitoring disease after initiation of a gluten-free diet, the search for non-invasive biomarkers is ongoing. Here, we summarize current and up-and-coming non-invasive biomarkers that may be able to predict, diagnose, and monitor the progression of CeD. We further discuss how current and emerging techniques, such as (single-cell) transcriptomics and genomics, can be used to uncover the pathophysiology of CeD and identify non-invasive biomarkers.

scholarly journals Coeliac disease: a diverse clinical syndrome caused by intolerance of wheat, barley and rye

2005 ◽  
Vol 64 (4) ◽  
pp. 434-450 ◽  
Author(s):  
Norma McGough ◽  
John H. Cummings
Keyword(s):  
Coeliac Disease ◽  
Bone Fractures ◽  
Tissue Transglutaminase ◽  
Clinical Syndrome ◽  
Gluten Free Diet ◽  
Autoimmune Response ◽  
Intestinal Biopsy ◽  
Bowel Habit ◽  
Jejunal Mucosa ◽  
Gluten Free

Coeliac disease is a lifelong intolerance to the gluten found in wheat, barley and rye, and some patients are also sensitive to oats. The disease is genetically determined, with 10% of the first-degree relatives affected and 75% of monozygotic twins being concordant. Of the patients with coeliac disease 95% are human leucocyte antigen (HLA)-DQ2 or HLA-DQ8 positive. Characteristically, the jejunal mucosa becomes damaged by a T-cell-mediated autoimmune response that is thought to be initiated by a 33-mer peptide fragment in A2 gliadin, and patients with this disorder have raised levels of anti-endomysium and tissue transglutaminase antibodies in their blood. Coeliac disease is the major diagnosable food intolerance and, with the advent of a simple blood test for case finding, prevalence rates are thought to be approximately 1:100. Classically, the condition presented with malabsorption and failure to thrive in infancy, but this picture has now been overtaken by the much more common presentation in adults, usually with non-specific symptoms such as tiredness and anaemia, disturbance in bowel habit or following low-impact bone fractures. Small intestinal biopsy is necessary for diagnosis and shows a characteristically flat appearance with crypt hypoplasia and infiltration of the epithelium with lymphocytes. Diet is the key to management and a gluten-free diet effectively cures the condition. However, this commitment is lifelong and many aisles in the supermarket are effectively closed to individuals with coeliac disease. Compliance can be monitored by measuring antibodies in blood, which revert to negative after 6–9 months. Patients with minor symptoms, who are found incidentally to have coeliac disease, often ask whether it is necessary to adhere to the diet. Current advice is that dietary adherence is necessary to avoid the long-term complications, which are, principally, osteoporosis and small bowel lymphoma. However, risk of these complications diminishes very considerably in patients who are on a gluten-free diet.

scholarly journals PRESENT DATA IN THE DIAGNOSIS AND TREATMENT OF COELIAC DISEASE (2)

2017 ◽  
Vol 64 (1) ◽  
pp. 25-33
Author(s):  
Dan Olteanu ◽  
◽  
Alexandru Diaconescu ◽  
Radu Voiosu ◽  
Andrei Voiosu ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Coeliac Disease ◽  
Disease Incidence ◽  
Diagnostic Value ◽  
Gluten Free Diet ◽  
Intestinal Biopsy ◽  
Gluten Free ◽  
Refractory Celiac Disease ◽  
Small Intestinal Biopsy ◽  
Small Intestinal

Coeliac disease incidence rised during the last 50 years and represents a concern by diagnostic problems and costs. The recent data regarding etiology, pathogeny, comparative diagnostic value of serology and small intestinal biopsy are summarised. The new data about refractory celiac disease to gluten free diet and therapeutic perspectives are also presented (glutenases, larazotide acetate, genetic alteration of cereals, tissulary transglutaminase inhibitors etc).

scholarly journals A Young, Immunocompetent Woman with Small Bowel and Hepatic Mucormycosis Successfully Treated with Aggressive Surgical Debridements and Antifungal Therapy

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Daniel Vikum ◽  
Ingvild Nordøy ◽  
Cecilie Torp Andersen ◽  
Børre Fevang ◽  
Pål Dag Line ◽  
...  
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Coeliac Disease ◽  
Amphotericin B ◽  
Antifungal Therapy ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
Extensive Involvement

A 24-year-old woman with coeliac disease and transient neutropenia developed mucormycosis with extensive involvement of the liver and small intestine. She was successfully treated with aggressive surgical debridements and long-term antifungal therapy with liposomal amphotericin B and posaconazole.

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