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.

Gluten-related immunogenic peptides in stool as means to monitor compliance with gluten-free diet in children with newly dia gnosed coeliac disease

2021 ◽  
Vol 75 (6) ◽  
pp. 519-523
Author(s):  
Radim Vyhnánek ◽  
Ziad Khaznadar ◽  
Roman Vyhnánek ◽  
Milan Paulík
Keyword(s):  
Coeliac Disease ◽  
Blood Sample ◽  
Stool Sample ◽  
Tissue Transglutaminase ◽  
Sandwich Elisa ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Newly Diagnosed ◽  
Strict Adherence ◽  
Immunogenic Peptides

Objectives and study: To compare the values of gluten-related immunogenic peptides (GIP) in stool and anti-tissue transglutaminase IgA antibodies (anti-tTG IgA) in blood in children newly diagnosed with coeliac disease (CD). Methods: All children (2–15 y) newly diagnosed with CD between May 2018 and May 2020 at our clinic who complied with the inclusion criteria were invited to join the prospective study. During workup for CD, a stool sample to measure GIP was taken together with a blood sample to measure anti-tTG IgA. All newly diagnosed children were invited 4 months later for a check-up. Children and their caregivers were asked about known non-compliance with the gluten-free diet (GFD), a blood sample was taken to measure the anti-tTG IgA, and a stool sample was collected to measure GIP. Blood was evaluated for anti-tTG IgA by ELISA, and the stool was tested by quantitative Sandwich ELISA designed to detect and quantify GIP using the G12 antibody. Values of GIP and anti-tTG IgA were compared in terms of their relation to the upper limit of normal (ULN) of the particular method. Results: 29 children (18 girls) were enrolled in the study. The values of GIP in stool at the time of diagnosis were above the ULN (0.15 µg/g) in all children. Average 4.21, median 3.29, standard deviation (SD) 3.7. After the four months, all but three (89.7%) had values of GIP in the reference range. Average 0.29, median 0.12, SD 0.73. Similarly, anti-tTG IgA values were above the ULN (9.9 U/mL) at the time of diagnosis in all children. Average 164, median 195, SD 49. Although the anti-tTG IgA levels were lower at check-up in all but one child, only 10 (34.5%) showed values within the normal range, with an average of 27.9, median 12.0, and SD 38.9. All children declared strict adherence to GFD. Discussion: Using the GIP concentration in stool, adherence to GFD in our cohort of children is very good, better than that described in literature. Conclusion: Measuring GIP in stool could prove a more sensitive indicator of adherence to GFD in the early months after the diagnosis of CD when anti-tTG IgA are still elevated above the ULN due to their well-described gradual decrease after GFD initiation.

scholarly journals Measuring the response of the jejunal mucosa in adult coeliac disease to treatment with a gluten-free diet

Gut ◽  
1974 ◽  
Vol 15 (11) ◽  
pp. 870-874 ◽  
Author(s):  
B. L. Chapman ◽  
K. Henry ◽  
F. Paice ◽  
N. F. Coghill ◽  
J. S. Stewart
Keyword(s):  
Coeliac Disease ◽  
Gluten Free Diet ◽  
Jejunal Mucosa ◽  
Gluten Free

Digestion of Gluten Peptides by Normal Human Jejunal Mucosa and by Mucosa from Patients with Adult Coeliac Disease

1970 ◽  
Vol 38 (1) ◽  
pp. 11-25 ◽  
Author(s):  
A. P. Douglas ◽  
C. C. Booth
Keyword(s):  
Amino Acids ◽  
Coeliac Disease ◽  
Intestinal Mucosa ◽  
Gluten Free Diet ◽  
Jejunal Mucosa ◽  
Gluten Free ◽  
Control Subjects ◽  
Gluten Peptides ◽  
Significant Difference ◽  
Secondary Phenomenon

1. The ability of homogenates of jejunal mucosa to liberate amino acids from a peptic-tryptic digest of gluten was assessed. Mucosal specimens were obtained from thirty-two control subjects without malabsorptive disease, from twenty-six patients with untreated adult coeliac disease and from nine patients with adult coeliac disease in whom the intestinal mucosa was histologically normal as a consequence of treatment with a gluten-free diet. In addition nine of the untreated patients were restudied after institution of a gluten-free diet. 2. The ability of the jejunal mucosa from the patients with untreated adult coeliac disease to liberate amino acids from the gluten peptides was significantly less than that of the mucosa from control subjects. 3. No significant difference from normal was found when jejunal mucosa from patients with treated adult coeliac disease was studied irrespective of whether or not the mucosa was histologically normal. 4. These results indicate that the impairment of jejunal mucosal digestion of gluten in untreated adult coeliac disease is a secondary phenomenon and do not support the hypothesis that coeliac disease is due to the absence from the intestinal mucosa of an enzyme normally concerned in the digestion of gluten.

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 Coeliac disease as the cause of resistant sideropenic anaemia in children with Down's syndrome: Case report

2010 ◽  
Vol 138 (1-2) ◽  
pp. 91-94 ◽  
Author(s):  
Momcilo Pavlovic ◽  
Nedeljko Radlovic ◽  
Zoran Lekovic ◽  
Karolina Berenji ◽  
Zorica Stojsic ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Oral Therapy ◽  
Tissue Transglutaminase ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Duodenal Mucosa ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Atrioventricular Canal ◽  
Related Proteins

Introduction. Coeliac disease (CD) is a permanent intolerance of gluten, i.e. of gliadin and related proteins found in the endosperm of wheat, rye and barley. It is characterized by polygenic predisposition, autoimmune nature, predominantly asymptomatic or atypical clinical course, as well as by high prevalence in patients with Down's syndrome (DS) and some other diseases. Outline of Cases. We are presenting a girl and two boys, aged 6-7 (X=6.33) years with DS and CD recognized under the feature of sideropenic anaemia resistant to oral therapy with iron. Beside mental retardation, low stature and the morphological features characteristic of DS, two patients had a congenital heart disease; one ventricular septal defect and the other atrioventricular canal. In two patients, trisomy on the 21st chromosome pair (trisomy 21) was disclosed in all cells, while one had a mosaic karyotype. All three patients had classical laboratory parameters of sideropenic anaemia: blood Hb 77-89 g/l (X=81.67), HCT 0.26-0.29% (X=0.28), MCV 69-80 fl (X=73), MCH 24.3-30 pg (X=26.77) and serum iron 2-5 ?mol/L (X=4.0). Beside anaemia and in one patient a mild isolated hypertransaminasemia (AST 67 U/l, ALT 62 U/l), other indicators of CD were not registered in any of the children. In addition, in all three patients, we also detected an increased level of antibodies to tissue transglutaminase (atTG) of IgA class (45-88 U/l) so that we performed endoscopic enterobiopsy in order to reliably confirm the diagnosis of CD. In all three patients, the pathohistological finding of the duodenal mucosa specimen showed mild to moderate destructive enteropathy associated with high intraepithelial lymphocyte infiltration, cryptic hyperplasia and lympho-plasmocytic infiltration of the stroma. In all three patients, the treatment with a strict gluten-free diet and iron therapy applied orally for 3-4 months resulted in blood count normalization and the correction of sideropenia. Serum level of the atTG-IgA, repeated after a 12-month diet, was also normal. Conclusion. CD should be taken into consideration in all cases of sideropenic anaemia resistant to iron oral therapy in children with DS. The diagnosis of CD implicates corresponding pathohistological confirmation, while the treatment of sideropenic anaemia and its complications, beside iron preparations, also requires compliance with a gluten-free diet.

scholarly journals Present data in the diagnosis and treatment of coeliac disease (Part I)

2016 ◽  
Vol 63 (4) ◽  
pp. 272-279
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 raised 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. 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).

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