Is a gluten-free diet necessary in Marsh I intestinal lesions in patients with HLADQ2, DQ8 genotype and without gastrointestinal symptoms?

Celiac disease (CD) is an autoimmune disorder characterized by an immune response to gluten peptides in wheat, barley, and rye. The diagnosis of celiac disease is confirmed by three important characteristics: consistent symptoms, positive celiac-specific serology, and small intestinal biopsy findings of inflammation, crypt hyperplasia, and villous atrophy. CD may present with overt gastrointestinal symptoms, including diarrhea (or constipation), weight loss, and abdominal bloating and discomfort, or covertly with micronutrient deficiencies such as iron deficiency with anemia. A gluten-free diet (GFD) remains the mainstay of treatment. The aim of this review is to highlight the pathogenesis of CD, concepts and challenges associated with a GFD, and nutritional management of CD applicable in clinical practice to internists, gastroenterologists, and dietitians. Patients should be referred to an expert celiac dietitian for education on adherence to a GFD to address gluten contamination in the diet, the psychosocial implications of following a GFD, and macro- and micronutrient disequilibria arising from celiac disease and the GFD. Several novel therapeutics are on the horizon in various stages of development, including glutenases, antigliadin antibodies, tight junction regulators, modulation of the immune response to gliadin, and efforts to engineer less toxic gluten-containing foodstuffs. This review contains 3 figures, 5 tables, and 61 references. Key words: celiac disease, genetic engineering, food engineering, gluten, glutenases, gluten-free diet, oats, IgY, nutrition, tight junction regulators, wheat

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Nutritional Management of Celiac Disease

10.2310/im.9036 ◽

2017 ◽

Author(s):

Ciarán P Kelly ◽

Satya Kurada ◽

Mariana Urquiaga

Keyword(s):

Immune Response ◽

Celiac Disease ◽

Tight Junction ◽

Villous Atrophy ◽

Gastrointestinal Symptoms ◽

Gluten Free Diet ◽

Intestinal Biopsy ◽

Nutritional Management ◽

Gluten Free ◽

Antigliadin Antibodies

Celiac disease (CD) is an autoimmune disorder characterized by an immune response to gluten peptides in wheat, barley, and rye. The diagnosis of celiac disease is confirmed by three important characteristics: consistent symptoms, positive celiac-specific serology, and small intestinal biopsy findings of inflammation, crypt hyperplasia, and villous atrophy. CD may present with overt gastrointestinal symptoms, including diarrhea (or constipation), weight loss, and abdominal bloating and discomfort, or covertly with micronutrient deficiencies such as iron deficiency with anemia. A gluten-free diet (GFD) remains the mainstay of treatment. The aim of this review is to highlight the pathogenesis of CD, concepts and challenges associated with a GFD, and nutritional management of CD applicable in clinical practice to internists, gastroenterologists, and dietitians. Patients should be referred to an expert celiac dietitian for education on adherence to a GFD to address gluten contamination in the diet, the psychosocial implications of following a GFD, and macro- and micronutrient disequilibria arising from celiac disease and the GFD. Several novel therapeutics are on the horizon in various stages of development, including glutenases, antigliadin antibodies, tight junction regulators, modulation of the immune response to gliadin, and efforts to engineer less toxic gluten-containing foodstuffs. This review contains 3 figures, 5 tables, and 61 references. Key words: celiac disease, genetic engineering, food engineering, gluten, glutenases, gluten-free diet, oats, IgY, nutrition, tight junction regulators, wheat

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Probiotics in Celiac Disease

Nutrients ◽

10.3390/nu10121824 ◽

2018 ◽

Vol 10 (12) ◽

pp. 1824 ◽

Cited By ~ 13

Author(s):

Fernanda Cristofori ◽

Flavia Indrio ◽

Vito Miniello ◽

Maria De Angelis ◽

Ruggiero Francavilla

Keyword(s):

Celiac Disease ◽

Gut Microbiota ◽

Intestinal Microbiota ◽

Gastrointestinal Symptoms ◽

Human Microbiome ◽

Gluten Free Diet ◽

Gluten Free ◽

Microbial Composition ◽

Close Link ◽

Host Protection

Recently, the interest in the human microbiome and its interplay with the host has exploded and provided new insights on its role in conferring host protection and regulating host physiology, including the correct development of immunity. However, in the presence of microbial imbalance and particular genetic settings, the microbiome may contribute to the dysfunction of host metabolism and physiology, leading to pathogenesis and/or the progression of several diseases. Celiac disease (CD) is a chronic autoimmune enteropathy triggered by dietary gluten exposure in genetically predisposed individuals. Despite ascertaining that gluten is the trigger in CD, evidence has indicated that intestinal microbiota is somehow involved in the pathogenesis, progression, and clinical presentation of CD. Indeed, several studies have reported imbalances in the intestinal microbiota of patients with CD that are mainly characterized by an increased abundance of Bacteroides spp. and a decrease in Bifidobacterium spp. The evidence that some of these microbial imbalances still persist in spite of a strict gluten-free diet and that celiac patients suffering from persistent gastrointestinal symptoms have a desert gut microbiota composition further support its close link with CD. All of this evidence gives rise to the hypothesis that probiotics might play a role in this condition. In this review, we describe the recent scientific evidences linking the gut microbiota in CD, starting from the possible role of microbes in CD pathogenesis, the attempt to define a microbial signature of disease, the effect of a gluten-free diet and host genetic assets regarding microbial composition to end in the exploration of the proof of concept of probiotic use in animal models to the most recent clinical application of selected probiotic strains.

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Dermatomyositis Associated with Celiac Disease: Response to a Gluten-Free Diet

Canadian Journal of Gastroenterology ◽

10.1155/2006/574074 ◽

2006 ◽

Vol 20 (6) ◽

pp. 433-435 ◽

Cited By ~ 20

Author(s):

Min Soo Song ◽

David Farber ◽

Alain Bitton ◽

Jeremy Jass ◽

Michael Singer ◽

...

Keyword(s):

Celiac Disease ◽

Adult Population ◽

Gastrointestinal Symptoms ◽

Human Leukocyte ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Deficiency Anemia ◽

Gluten Free ◽

Disease Response ◽

Vitamin Deficiencies

The association between dermatomyositis and celiac disease in children has been well documented. In the adult population, however, the association has not been clearly established. A rare case of concomitant dermatomyositis and celiac disease in a 40-year-old woman is presented. After having been diagnosed with dermatomyositis and iron deficiency anemia, this patient was referred to the gastroenterology clinic to exclude a gastrointestinal malignancy. Blood tests revealed various vitamin deficiencies consistent with malabsorption. The results of gastroscopy with duodenal biopsy were consistent with celiac disease. After she was put on a strict gluten-free diet, both nutritional deficiencies and the dermatomyositis resolved. The patient’s human leukocyte antigen haplotype study was positive for DR3 and DQ2, which have been shown to be associated with both juvenile dermatomyositis and celiac disease. It is suggested that patients with newly diagnosed dermatomyositis be investigated for concomitant celiac disease even in the absence of gastrointestinal symptoms.

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Beneficial Effects of a Low-Nickel Diet on Relapsing IBS-Like and Extraintestinal Symptoms of Celiac Patients during a Proper Gluten-Free Diet: Nickel Allergic Contact Mucositis in Suspected Non-Responsive Celiac Disease

Nutrients ◽

10.3390/nu12082277 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2277 ◽

Cited By ~ 1

Author(s):

Raffaele Borghini ◽

Natascia De Amicis ◽

Antonino Bella ◽

Nicoletta Greco ◽

Giuseppe Donato ◽

...

Keyword(s):

Celiac Disease ◽

Rating Scale ◽

Gastrointestinal Symptoms ◽

Gluten Free Diet ◽

Rank Test ◽

Gluten Free ◽

Gastrointestinal Symptom Rating Scale ◽

Histological Remission ◽

Allergic Contact ◽

Age Range

Background and Aim: Nickel (Ni)-rich foods can induce allergic contact mucositis (ACM) with irritable bowel syndrome (IBS)-like symptoms in predisposed subjects. Ni ACM has a high prevalence (>30%) in the general population and can be diagnosed by a Ni oral mucosa patch test (omPT). Many celiac disease (CD) patients on a gluten-free diet (GFD) often show a recrudescence of gastrointestinal and extraintestinal symptoms, although serological and histological remission has been achieved. Since a GFD often results in higher loads of ingested alimentary Ni (e.g., corn), we hypothesized that it would lead to a consequent intestinal sensitization to Ni in predisposed subjects. We wanted to (1) study Ni ACM prevalence in still symptomatic CD patients on a GFD and (2) study the effects of a low-Ni diet (LNiD) on their recurrent symptoms. Material and Methods: We recruited 102 consecutive CD patients (74 female, 28 male; age range 18–65 years, mean age 42.3 ± 7.4) on a GFD since at least 12 months, in current serological and histological remission (Marsh–Oberhuber type 0–I) who complained of relapsing gastrointestinal and/or extraintestinal symptoms. Inclusion criteria: presence of at least three gastrointestinal symptoms with a score ≥5 on the modified Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Exclusion criteria: IgE-mediated food allergy; history of past or current cancer; inflammatory bowel diseases; infectious diseases including Helicobacter pylori; lactose intolerance. All patients enrolled underwent Ni omPT and followed a LNiD for 3 months. A 24 symptoms questionnaire (GSRS modified according to the Salerno Experts’ Criteria, with 15 gastrointestinal and 9 extraintestinal symptoms) was administered at T0 (free diet), T1 (GFD, CD remission), T2 (recurrence of symptoms despite GFD), and T3 (GFD + LNiD) for comparisons. Comparisons were performed using Wilcoxon signed-rank test. RESULTS: Twenty patients (all female, age range 23–65 years, mean age 39.1 ± 2.9) out of 102 (19.6%) were finally included. All 20 patients enrolled (100%) showed positive Ni omPT, confirming an Ni ACM diagnosis. A correct GFD (T0 vs. T1) induced the improvement of 19 out of the total 24 (79.2%) symptoms, and 14 out of 24 (58.3%) were statistically significant (p-value < 0.0083 according to Bonferroni correction). Prolonged GFD (T1 vs. T2) revealed the worsening of 20 out of the total 24 (83.3%) symptoms, and 10 out of 24 (41.7%) were statistically significant. LNiD (T2 vs. T3) determined an improvement of 20 out of the total 24 (83.4%) symptoms, and in 10 out of 24 (41.7%) symptoms the improvement was statistically significant. Conclusions: Our data suggest that the recrudescence of gastrointestinal and extraintestinal symptoms observed in CD subjects during GFD may be due to the increase in alimentary Ni intake, once gluten contamination and persisting villous atrophy are excluded. Ni overload can induce Ni ACM, which can be diagnosed by a specific Ni omPT. Improvement of symptoms occurs after a proper LNiD. These encouraging data should be confirmed with larger studies.

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Nutritional Management of Celiac Disease

10.2310/gastro.9036 ◽

2017 ◽

Author(s):

Ciarán P Kelly ◽

Satya Kurada ◽

Mariana Urquiaga

Keyword(s):

Immune Response ◽

Celiac Disease ◽

Tight Junction ◽

Villous Atrophy ◽

Gastrointestinal Symptoms ◽

Gluten Free Diet ◽

Intestinal Biopsy ◽

Nutritional Management ◽

Gluten Free ◽

Antigliadin Antibodies

Celiac disease (CD) is an autoimmune disorder characterized by an immune response to gluten peptides in wheat, barley, and rye. The diagnosis of celiac disease is confirmed by three important characteristics: consistent symptoms, positive celiac-specific serology, and small intestinal biopsy findings of inflammation, crypt hyperplasia, and villous atrophy. CD may present with overt gastrointestinal symptoms, including diarrhea (or constipation), weight loss, and abdominal bloating and discomfort, or covertly with micronutrient deficiencies such as iron deficiency with anemia. A gluten-free diet (GFD) remains the mainstay of treatment. The aim of this review is to highlight the pathogenesis of CD, concepts and challenges associated with a GFD, and nutritional management of CD applicable in clinical practice to internists, gastroenterologists, and dietitians. Patients should be referred to an expert celiac dietitian for education on adherence to a GFD to address gluten contamination in the diet, the psychosocial implications of following a GFD, and macro- and micronutrient disequilibria arising from celiac disease and the GFD. Several novel therapeutics are on the horizon in various stages of development, including glutenases, antigliadin antibodies, tight junction regulators, modulation of the immune response to gliadin, and efforts to engineer less toxic gluten-containing foodstuffs. This review contains 3 figures, 5 tables, and 61 references. Key words: celiac disease, genetic engineering, food engineering, gluten, glutenases, gluten-free diet, oats, IgY, nutrition, tight junction regulators, wheat

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One-year follow-up of the nutritional status of celiac people on a gluten-free diet

10.21203/rs.3.rs-445540/v1 ◽

2021 ◽

Author(s):

Gesala Perez-Junkera ◽

Maialen Vazquez-Polo ◽

Francisco Jose Eizagirre ◽

Laura Benjumea ◽

Carlos Tutau ◽

...

Keyword(s):

Nutritional Status ◽

Dietary Habits ◽

Clinical Investigation ◽

Gastrointestinal Symptoms ◽

Gluten Free Diet ◽

Dietary Advice ◽

Gluten Free ◽

Dietary Counseling ◽

One Year

Abstract Background The gluten-free diet (GFD), the only effective treatment for celiac disease, is usually nutritionally imbalanced. The present work aimed to analyze the evolution of the nutritional status, dietary profile, and symptoms present among celiac people over one year on a GFD while receiving individualized dietary advice. Methods Twenty-seven adults and thirty-one celiac children/adolescents participated in the cohort study. They were followed by 3 visits, at diagnosis (vt0) and after 3 and 12 months (vt3;vt12). Participants filled out dietary and gastrointestinal symptoms questionnaires and received a personalized form from dietitians containing dietary advice and anthropometric and biochemical data evolution. Results Most patients presented normal BMI, fat and muscle mass, and biochemical parameters at diagnosis and vt12. By contrast, all participants consumed protein and lipids in excess and carbohydrates in defect, in both vt0 and vt12. Low intakes of cereals, fruits and vegetables and high of meat were observed, these also remain-ing unchanged after dietary counseling. Symptoms present decreased after vt3 but rebounded in vt12. Conclusions Few changes in dietary pattern and symptom elimination suggested that the intervention was not effective enough. More research is necessary to evaluate whether closer follow up and face-to-face dietary advice improve dietary habits of celiac people. Trial registration: Code PI2016069, Ethical Comitee of the Clinical Investigation of the Basque Country. Registered on 15 July 2016.

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Gluten-Related Disorders: Gluten Ataxia

Digestive Diseases ◽

10.1159/000369509 ◽

2015 ◽

Vol 33 (2) ◽

pp. 264-268 ◽

Cited By ~ 33

Author(s):

Marios Hadjivassiliou ◽

David D. Sanders ◽

Daniel P. Aeschlimann

Keyword(s):

Age At Onset ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Cerebellar Atrophy ◽

Gluten Free Diet ◽

Neurological Dysfunction ◽

Gluten Free ◽

Strict Adherence ◽

Gluten Ataxia ◽

Antigliadin Antibodies

The term gluten-related disorders (GRD) refers to a spectrum of diverse clinical manifestations triggered by the ingestion of gluten in genetically susceptible individuals. They include both intestinal and extraintestinal manifestations. Gluten ataxia (GA) is one of the commonest neurological manifestations of GRD. It was originally defined as otherwise idiopathic sporadic ataxia in the presence of circulating antigliadin antibodies of IgA and/or IgG type. Newer more specific serological markers have been identified but are not as yet readily available. GA has a prevalence of 15% amongst all ataxias and 40% of all idiopathic sporadic ataxias. It usually presents with gait and lower limb ataxia. It is of insidious onset with a mean age at onset of 53 years. Up to 40% of patients have evidence of enteropathy on duodenal biopsy. Gastrointestinal symptoms are seldom prominent and are not a reliable indicator for the presence of enteropathy. Furthermore, the presence of enteropathy does not influence the response to a gluten-free diet. Most patients will stabilise or improve with strict adherence to gluten-free diet depending on the duration of the ataxia prior to the treatment. Up to 60% of patients with GA have evidence of cerebellar atrophy on MR imaging, but all patients have spectroscopic abnormalities primarily affecting the vermis. Recent evidence suggests that patients with newly diagnosed coeliac disease presenting to the gastroenterologists have abnormal MR spectroscopy at presentation associated with clinical evidence of subtle cerebellar dysfunction. The advantage of early diagnosis and treatment (mean age 42 years in patients presenting with gastrointestinal symptoms vs. 53 years in patients presenting with ataxia) may protect the first group from the development and/or progression of neurological dysfunction.

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