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

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.

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

Clinical Science ◽

10.1042/cs0380011 ◽

1970 ◽

Vol 38 (1) ◽

pp. 11-25 ◽

Cited By ~ 29

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.

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Micronutrient deficiencies in children with coeliac disease; a double-edged sword of both untreated disease and treatment with gluten-free diet

Clinical Nutrition ◽

10.1016/j.clnu.2021.03.006 ◽

2021 ◽

Author(s):

Lorcan McGrogan ◽

Mary Mackinder ◽

Fiona Stefanowicz ◽

Maria Aroutiounova ◽

Anthony Catchpole ◽

...

Keyword(s):

Coeliac Disease ◽

Gluten Free Diet ◽

Gluten Free ◽

Micronutrient Deficiencies

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

Nutrients ◽

10.3390/nu13030947 ◽

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.

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The impact of symptoms on quality of life before and after diagnosis of coeliac disease: the results from a Polish population survey and comparison with the results from the United Kingdom

BMC Gastroenterology ◽

10.1186/s12876-021-01673-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Emilia Majsiak ◽

Magdalena Choina ◽

Dominik Golicki ◽

Alastair M. Gray ◽

Bożena Cukrowska

Keyword(s):

Quality Of Life ◽

United Kingdom ◽

Coeliac Disease ◽

Gluten Free Diet ◽

Gluten Free ◽

The United Kingdom ◽

Before And After ◽

The Mean ◽

The Uk

Abstract Background Coeliac disease (CD) is characterised by diverse clinical symptoms, which may cause diagnostic problems and reduce the patients’ quality of life. A study conducted in the United Kingdom (UK) revealed that the mean time between the onset of coeliac symptoms and being diagnosed was above 13 years. This study aimed to analyse the diagnostic process of CD in Poland and evaluate the quality of life of patients before and after CD diagnosis. In addition, results were compared to the results of the original study conducted in the UK. Methods The study included 2500 members of the Polish Coeliac Society. The patients were asked to complete a questionnaire containing questions on socio-demographic factors, clinical aspects and quality of life, using the EQ-5D questionnaire. Questionnaires received from 796 respondents were included in the final analysis. Results The most common symptoms reported by respondents were bloating (75%), abdominal pain (72%), chronic fatigue (63%) and anaemia (58%). Anaemia was the most persistent symptom, with mean duration prior to CD diagnosis of 9.2 years, whereas diarrhoea was observed for the shortest period (4.7 years). The mean duration of any symptom before CD diagnosis was 7.3 years, compared to 13.2 years in the UK. CD diagnosis and the introduction of a gluten-free diet substantially improved the quality of life in each of the five EQ-5D-5L health dimensions: pain and discomfort, anxiety and depression, usual activities, self-care and mobility (p < 0.001), the EQ-Index by 0.149 (SD 0.23) and the EQ-VAS by 30.4 (SD 28.3) points. Conclusions Duration of symptoms prior to the diagnosis of CD in Poland, although shorter than in the UK, was long with an average of 7.3 years from first CD symptoms. Faster CD diagnosis after the onset of symptoms in Polish respondents may be related to a higher percentage of children in the Polish sample. Introduction of a gluten-free diet improves coeliac patients’ quality of life. These results suggest that doctors should be made more aware of CD and its symptoms across all age groups.

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