Palmoplantar pustulosis and gluten sensitivity: a study of serum antibodies against gliadin and tissue transglutaminase, the duodenal mucosa and effects of gluten-free diet

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.

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IMPACT OF A SARS-COV-2 INFECTION IN PATIENTS WITH CELIAC DISEASE

10.1101/2020.12.15.20248039 ◽

2020 ◽

Author(s):

Luca Elli ◽

Federica Facciotti ◽

Vincenza Lombardo ◽

Alice Scricciolo ◽

David S Sanders ◽

...

Keyword(s):

Risk Factors ◽

Celiac Disease ◽

Tissue Transglutaminase ◽

Duodenal Mucosa ◽

Gluten Free Diet ◽

Gluten Free ◽

The World ◽

The Impact ◽

Lower Expression ◽

N Proteins

Objective. The SARS-CoV-2 pandemic has spread across the world causing a dramatic number of infections and deaths. No data are available about the effects of an infection in patients affected by celiac disease (CD) in terms of the development of related symptoms and antibodies. We aimed to investigate the impact of the SARS-CoV-2 pandemic in celiac patients. Design. During a lockdown, the celiac patients living in the Milan area were contacted and interviewed about the development of COVID-19 symptoms as well as adherence to an anti-virus lifestyle and a gluten-free diet (GFD). They were also given a stress questionnaire to fill in. The development of anti-SARS-CoV-2 IgG and IgA (anti-RBD and N proteins) and the expression of the duodenal ACE2 receptor were investigated. When available, duodenal histology, anti-tissue transglutaminase IgA (tTGA), presence of immunologic comorbidities and adherence to the GFD were analysed as possible risk factors. Results. 362 celiac patients have been interviewed and 42 (11%) presented with COVID-19 symptoms. The presence of symptoms was not influenced by tTGA positivity, presence of duodenal atrophy or adherence to GFD. 37% of the symptomatic patients presented anti-SARS-CoV-2 immunoglobulins (Ig). Globally, 18% of celiac patients showed anti-SARS-CoV-2 Ig vs 25% of the non-celiac control (p=0.18). The values of anti-RBD IgG/IgA and anti-N IgG did not differ from the non-celiac controls. Celiac patients had a significant lower level of anti-N IgA. The ACE2 receptor was detected in the non-atrophic duodenal mucosa of celiac patients; atrophy was associated with a lower expression of the ACE2 receptor. Conclusion. CD patients have an anti-SARS-CoV-2 Ig positiveness and profile similar to non-celiac controls, except for anti-N IgA. The main celiac parameters and adherence to the GFD do not influence the development of a different Ig profile.

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Pilot study on non-celiac gluten sensitivity: effects of Bifidobacterium longum ES1 co-administered with a gluten-free diet

Minerva Gastroenterologica e Dietologica ◽

10.23736/s1121-421x.20.02673-2 ◽

2020 ◽

Vol 66 (3) ◽

Author(s):

Francesco Di Pierro ◽

Francesca Bergomas ◽

Paolo Marraccini ◽

Maria R. Ingenito ◽

Lorena Ferrari ◽

...

Keyword(s):

Pilot Study ◽

Bifidobacterium Longum ◽

Gluten Free Diet ◽

Gluten Sensitivity ◽

Gluten Free

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Descriptive Study of the Different Tools Used to Evaluate the Adherence to a Gluten-Free Diet in Celiac Disease Patients

Nutrients ◽

10.3390/nu10111777 ◽

2018 ◽

Vol 10 (11) ◽

pp. 1777 ◽

Cited By ~ 5

Author(s):

Luis Rodrigo ◽

Isabel Pérez-Martinez ◽

Eugenia Lauret-Braña ◽

Adolfo Suárez-González

Keyword(s):

Celiac Disease ◽

Multidisciplinary Approach ◽

Descriptive Study ◽

Duodenal Mucosa ◽

Gluten Free Diet ◽

Gluten Free ◽

Autoimmune Process ◽

Duodenal Biopsies

Celiac disease (CD) is a genetically conditioned autoimmune process that appears in susceptible people. It can affect people of any age, and slightly predominates in females. It has a fairly homogenous global distribution, with an average prevalence of 1–2%, the frequency having increased in recent decades. The only effective treatment is a strict and permanent gluten-free diet (GFD), although the level of compliance is poor, at about 50% of cases. To monitor the effectiveness of the GFD, several procedures involving various approaches are employed: (a) Periodic visits by expert Nutritionists; (b) Clinical follow-up; (c) Serological time controls of specific antibodies; (d) Serial endoscopies with collection of duodenal biopsies; (e) Use of structured questionnaires; and (f) Determination of gluten peptides derived from gluten in faeces and/or urine. All of these procedures are useful when applied, alone or in combination, depending on the cases. Some patients will only need to consult to their doctors, while others will require a multidisciplinary approach to assess their compliance with the GFD. In children, normalization of duodenal mucosa was achieved in 95% of cases within two years, while it is more delayed in adults, whose mucosa take longer time (3–5 years) to heal completely.

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Neurological disorders associated with gluten sensitivity

Terapevticheskii arkhiv ◽

10.17116/terarkh201789299-102 ◽

2017 ◽

Vol 89 (2) ◽

pp. 99-102

Author(s):

D A Degterev ◽

I V Damulin ◽

A I Parfenov

Keyword(s):

Clinical Features ◽

Neurological Disorders ◽

Gluten Free Diet ◽

Gluten Sensitivity ◽

Gluten Free ◽

Gluten Ataxia

The review considers the pathogenetic, clinical, and therapeutic aspects of neurological disorders associated with gluten sensitivity. Gluten ataxia and polyneuropathy are most common. The clinical features of neurological disorders in patients with gluten sensitivity and the effects of a gluten-free diet are described.

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The Relationship of Perceived Health Benefits and Information Sources to Following a Gluten-Free Diet Among People Without Celiac Disease or Non-Celiac Gluten Sensitivity

Current Developments in Nutrition ◽

10.1093/cdn/nzaa051_001 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 704-704

Author(s):

Kristina Arslain ◽

Pratiksha Baishya ◽

Christopher Gustafson ◽

Devin Rose

Keyword(s):

Celiac Disease ◽

Information Sources ◽

Agricultural Research ◽

Health Benefits ◽

Perceived Health ◽

Gluten Free Diet ◽

Gluten Sensitivity ◽

Gluten Free ◽

Relationship Of ◽

The Relationship

Abstract Objectives The gluten-free diet (GFD) has been adopted by many people who do not have Celiac disease or non-Celiac gluten sensitivity, but no studies examine the relationship of perceived health benefits of, and the sources that recommend trying, the GFD to the decision to follow the diet. Methods We surveyed a large, nationally representative sample of 3051 US residents about their attitudes, perceptions, and experiences with the GFD. Logistic regression was used to compare respondents who had no diagnosed need for a GFD but were currently avoiding or had avoided gluten previously (GF-Consumer) to the consumers that had never tried a GFD. Results Over one-fifth of our respondents were GF-Consumers. Beliefs that “a gluten-reduced diet is healthier for people than a full-gluten containing diet” (OR 1.55; P < 0.01), that “gluten-free products are generally more nutritious than their gluten-containing variant” (OR 1.53; P < 0.01) and that a GFD can help clear acne (OR 1.44; P < 0.01) were all positively associated with trying a GFD. The most influential source that suggested the diet was oneself who learned about a GFD through personal research (OR 3.35; P < 0.01). This was followed by “family member or friend” (OR 2.68; P < 0.01) and “healthcare center or health professional (doctor, dietitian, etc.)” (OR 2.10; P < 0.01). Conclusions Positive, but scientifically unsubstantiated, beliefs about the benefits of the GFD were strongly associated with trying a GF diet. Both conventional and unconventional sources of information about the GFD were positively associated with following the diet. These findings about beliefs and information sources highlight potential barriers to the promotion of scientifically based nutritional recommendations to consumers. Funding Sources University of Nebraska Agricultural Research Division Innovation Fund for Wheat/Cereal Crops.

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Clinical Characteristics and Management of 50 Patients with Anti-GAD Ataxia: Gluten-Free Diet Has a Major Impact

The Cerebellum ◽

10.1007/s12311-020-01203-w ◽

2020 ◽

Author(s):

M. Hadjivassiliou ◽

P. G. Sarrigiannis ◽

P. D. Shanmugarajah ◽

D. S. Sanders ◽

R. A. Grünewald ◽

...

Keyword(s):

Autoimmune Diseases ◽

Clinical Characteristics ◽

Age At Onset ◽

Gluten Free Diet ◽

Gluten Sensitivity ◽

Gluten Free ◽

Progressive Ataxia ◽

Progressive Cerebellar Ataxia ◽

Limb Ataxia ◽

History Of

Abstract The objective of this study is to report the clinical characteristics and treatment of patients with progressive cerebellar ataxia associated with anti-GAD antibodies. We performed a retrospective review of all patients with anti-GAD ataxia managed at the Sheffield Ataxia Centre over the last 25 years. We identified 50 patients (62% females) with anti-GAD ataxia. The prevalence was 2.5% amongst 2000 patients with progressive ataxia of various causes. Mean age at onset was 55 and mean duration 8 years. Gaze-evoked nystagmus was present in 26%, cerebellar dysarthria in 26%, limb ataxia in 44% and gait ataxia in 100%. Nine patients (18%) had severe, 12 (24%) moderate and 29 (58%) mild ataxia. Ninety percent of patients had a history of additional autoimmune diseases. Family history of autoimmune diseases was seen in 52%. Baseline MR spectroscopy of the vermis was abnormal at presentation in 72%. Thirty-five patients (70%) had serological evidence of gluten sensitivity. All 35 went on gluten-free diet (GFD). Eighteen (51%) improved, 13 (37%) stabilised, 3 have started the GFD too recently to draw conclusions and one deteriorated. Mycophenolate was used in 16 patients, 7 (44%) improved, 2 stabilised, 6 have started the medication too recently to draw conclusions and one did not tolerate the drug. There is considerable overlap between anti-GAD ataxia and gluten ataxia. For those patients with both, strict GFD alone can be an effective treatment. Patients with anti-GAD ataxia and no gluten sensitivity respond well to immunosuppression.

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A Gluten Free Diet in the Management of Epilepsy in People with Coeliac Disease or Gluten Sensitivity

Gastrointestinal Disorders ◽

10.3390/gidisord2030026 ◽

2020 ◽

Vol 2 (3) ◽

pp. 281-299

Author(s):

Zoë Gilbey ◽

Justine Bold

Keyword(s):

Coeliac Disease ◽

Small Sample ◽

Gluten Free Diet ◽

Gluten Sensitivity ◽

Gluten Free ◽

Exclusion Criteria ◽

Search Terms ◽

Small Sample Sizes ◽

Eeg Pattern

The aim of this review was to assess the effects of a gluten free diet (GFD) in the management of epilepsy in people with coeliac disease (CD) or gluten sensitivity (GS). A systematic approach was used to undertake a literature review. Five electronic databases (PubMed; Scopus; Google Scholar; Cochrane Epilepsy Group specialised register; Cochrane Register of Controlled Trails (CENTRAL) via the Cochrane Register of Online Trials) were searched using predetermined relevant search terms. In total, 668 articles were identified. Duplicates were removed and predefined inclusion and exclusion criteria were applied, and a PRISMA flow chart was produced. Data was extracted using Covidence software. Twelve studies on Epilepsy and CD involving a total of 70 participants were selected for analysis; narrative synthesis was used owing to the small sample sizes in the selected studies. None of the 12 studies meeting inclusion criteria investigated gluten sensitivity and epilepsy. All the included studies support a link between epilepsy and CD. GFD was effective in 44 out of 70 participants across the studies in terms of a reduction of seizures, reduction of antiepileptic drugs (AEDs) or normalisation of EEG pattern. A total of 44 participants showed a reduction in seizures (across eight studies) and complete cessation of seizures was reported in 22 participants. In general, the earlier the GFD is implemented after the onset of seizures, the better the likelihood of the GFD being successful in supporting control of seizures. Mechanisms linking gluten with epilepsy are not fully understood; possible hypotheses include gluten mediated toxicity, immune-induced cortical damage and malabsorption. Evidence suggests the effectiveness of a GFD in supporting the management of epilepsy in patients with CD, although the quality of evidence is low. There appears to be a growing number of neurologists who are prepared to advocate the use of a GFD. A multidisciplinary approaches and further research are recommended. It could be argued that when balancing potential treatments such as AEDs or surgery, a GFD has a low likelihood of harm.

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A Single Institution’s Experience of Primary Headache in Children With Celiac Disease

Journal of Child Neurology ◽

10.1177/0883073819873751 ◽

2019 ◽

Vol 35 (1) ◽

pp. 37-41 ◽

Cited By ~ 1

Author(s):

Grant L. Hom ◽

Brian L. Hom ◽

Barbara Kaplan ◽

A. David Rothner

Keyword(s):

Celiac Disease ◽

Tissue Transglutaminase ◽

Primary Headache ◽

Tension Type Headache ◽

Gluten Free Diet ◽

Gluten Free ◽

Phone Survey ◽

Type Headache ◽

The Impact ◽

Histologic Changes

Background: Few studies exist examining the frequency of primary headache in children with celiac disease and the impact of a gluten-free diet on primary headache symptomology. This study explores characteristics and frequency of headaches in children with celiac disease and response to gluten-free diet at a single institution. Methods: Medical records were reviewed for children with celiac disease confirmed by the presence of elevated tissue transglutaminase IgA levels and histologic changes consistent with the diagnosis of celiac disease on small bowel biopsy. Eligible participants were contacted via letter for participation in a phone survey regarding headaches. Phone interviews were conducted 2 weeks after notification and lasted approximately 10 minutes. Headaches were classified according to ICHD-3 criteria. Results: 247 eligible patients or their families were contacted. A total of 132 (53.44%) agreed to participate. One participant was excluded due to insufficient information provided. Overall, 51 of 131 participants had recurrent headache defined as at least 1 episode per month (39%, 95% confidence interval [CI]: 31%-47%) and 33 had migraine with or without aura (25%, 95% CI: 18%-33%). Twenty-eight had frequent tension-type headache (22%, 95% CI: 15%-29%). Thirty-two participants noted headaches before a confirmed diagnosis of celiac disease. Twenty-two of 32 participants (68.75%) noticed decreased headache frequency or intensity, or both, after starting the gluten-free diet. Conclusion: This study suggests that at least one-third of children and adolescents with celiac disease have recurrent headaches at the time of diagnosis. A gluten-free diet led to improved headache symptomology in a significant number of these patients.

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