Recovery of the small intestine in coeliac disease on a gluten-free diet: Changes in intestinal permeability, small bowel morphology and T-cell activity

1991 ◽  
Vol 6 (1) ◽  
pp. 53-57 ◽  
Author(s):  
A. G. CUMMINS ◽  
I. A. PENTTILA ◽  
J. T. LABROOY ◽  
T. A. ROBB ◽  
G. P. DAVIDSON
Keyword(s):  
Small Intestine ◽  
T Cell ◽  
Small Bowel ◽  
Coeliac Disease ◽  
Intestinal Permeability ◽  
Cell Activity ◽  
Gluten Free Diet ◽  
Gluten Free

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.

Investigation of molecular markers in the diagnosis of refractory coeliac disease in a large patient cohort: Table 1

2008 ◽  
Vol 61 (11) ◽  
pp. 1200-1202 ◽  
Author(s):  
U O’Shea ◽  
M Abuzakouk ◽  
C O’Morain ◽  
D O’Donoghue ◽  
K Sheahan ◽  
...  
Keyword(s):  
Molecular Markers ◽  
T Cell ◽  
Coeliac Disease ◽  
Cell Population ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Histological Lesion ◽  
Strict Adherence ◽  
Small Intestinal ◽  
Refractory Coeliac Disease

Aims:Some patients with coeliac disease, despite strict adherence to a gluten-free diet, continue to have significant symptoms and/or a severe small intestinal histological lesion. The term “refractory coeliac disease” (rCD) is used to describe this condition. The purpose of this study was to investigate the value of tissue molecular markers reported to help in the diagnosis of rCD.Methods:Details on 61 patients with suspected rCD were collected. The clinical and laboratory findings in these patients were carefully evaluated, in part to determine whether patients were adhering to a strict gluten-free diet. The co-expression of CD3 and CD8 on intraepithelial lymphocytes was investigated by monoclonal antibody staining of small intestinal biopsy tissue; a finding of less than 50% CD3+ cells co-expressing CD8 was defined as an aberrant phenotype. T cell receptor gene rearrangement was assessed when a sufficient tissue sample was available.Results:A diagnosis of rCD was made in 38 patients based on clinical, laboratory and histological data. An aberrant intraepithelial lymphocyte population was found in 20 of these patients and in this group a clonal T cell population was found in five of seven patients tested. In the remaining 18 patients, the CD3/CD8 ratio was normal and two of seven tested had a clonal T cell population. After detailed monitoring, a diagnosis of rCD was excluded in the remaining 23 patients.Conclusions:This study supports the use of phenotypic and T cell clonality investigations in identifying patients with true rCD.

scholarly journals Activated gut-homing CD8+ T cells for coeliac disease diagnosis on a gluten-free diet

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Fernando Fernández-Bañares ◽  
Natalia López-Palacios ◽  
María Corzo ◽  
Beatriz Arau ◽  
Mercedes Rubio ◽  
...  
Keyword(s):  
T Cells ◽  
T Cell ◽  
Coeliac Disease ◽  
Disease Diagnosis ◽  
T Cell Response ◽  
Gluten Free Diet ◽  
T Cell Subsets ◽  
Intestinal Damage ◽  
Gluten Free ◽  
Ifn Γ

Abstract Background The diagnosis of coeliac disease (CD) in individuals that have started a gluten-free diet (GFD) without an adequate previous diagnostic work-out is a challenge. Several immunological assays such as IFN-γ ELISPOT have been developed to avoid the need of prolonged gluten challenge to induce the intestinal damage. We aimed to evaluate the diagnostic accuracy of activated gut-homing CD8+ and TCRγδ+ T cells in blood after a 3-day gluten challenge and to compare it with the performance of IFN-γ ELISPOT in a HLA-DQ2.5 subsample. Methods A total of 22 CD patients and 48 non-CD subjects, all of them following a GFD, underwent a 3-day 10-g gluten challenge. The percentage of two T cell subsets (CD8+ CD103+ β7hi CD38+/total CD8+ and TCRγδ+ CD103+ β7hi CD38+/total TCRγδ+) in fresh peripheral blood drawn baseline and 6 days after the challenge was determined by flow cytometry. IFN-γ ELISPOT assays were also performed in HLA-DQ2.5 participants. ROC curve analysis was used to assess the diagnostic performance of the CD8+ T cell response and IFN-γ ELISPOT. Results Significant differences between the percentage of the two studied subsets of CD8+ and TCRγδ+ cells at days 0 and 6 were found only when considering CD patients (p < 10−3 vs. non-CD subjects). Measuring activated CD8+ T cells provided accurate CD diagnosis with 95% specificity and 97% sensitivity, offering similar results than IFN-γ ELISPOT. Conclusions The results provide a highly accurate blood test for CD diagnosis in patients on a GFD of easy implementation in daily clinical practice.

scholarly journals T Cell Response Toward Tissue-and Epidermal-Transglutaminases in Coeliac Disease Patients Developing Dermatitis Herpetiformis

2021 ◽  
Vol 12 ◽  
Author(s):  
Marzia Caproni ◽  
Manuela Capone ◽  
Maria Caterina Rossi ◽  
Veronica Santarlasci ◽  
Laura Maggi ◽  
...  
Keyword(s):  
T Cells ◽  
T Cell ◽  
Coeliac Disease ◽  
Cell Response ◽  
Dermatitis Herpetiformis ◽  
T Cell Response ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Skin Damage ◽  
The Impact

The reason why only few coeliac patients develop the cutaneous manifestation of the disease, named dermatitis herpetiformis (DH), is still unknown. Epidermal transglutaminase (TG3) has been described as the main autoantigen of humoral immunity in DH but the mechanisms leading to this autoimmune response remain obscure. Here we characterized T cells from skin, gut and peripheral blood of DH and coeliac disease (CD) patients, evaluated the impact of the gluten-free diet on circulating T lymphocytes’ phenotype and investigated antigen specific T cell response toward epidermal and tissue transglutaminase (TG2). DH patients showed an increased frequency of skin-derived T cells producing TNFα when compared to CD patients. Moreover, circulating T cells producing TNFα and IL-17A positively correlated with clinical score of skin disease activity and decreased after gluten-free diet. Finally, TG2 and TG3-specific T cells resulted more reactive to antigens stimulation in DH patients and showed cross reactivity toward the two autoantigens in both the group of patients. Our data suggest a role of TNFα and IL-17A producing cells in the development of DH and, for the first time, show the existence of a crossed T cell response toward the two transglutaminases isoforms, thus suggesting new insights on T cells role in skin damage.

Studies of Celiac Sprue. IV. The Response of the Whole Length of the Small Bowel to a Gluten-Free Diet

1964 ◽  
Vol 47 (6) ◽  
pp. 573-589 ◽  
Author(s):  
W.C. MacDonald ◽  
L.L. Brandborg ◽  
A.L. Flick ◽  
J.S. Trier ◽  
C.E. Rubin
Keyword(s):  
Small Bowel ◽  
Gluten Free Diet ◽  
Celiac Sprue ◽  
Gluten Free
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