scholarly journals The Challenge of Treatment in Potential Celiac Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Chiara Maria Trovato ◽  
Monica Montuori ◽  
Francesco Valitutti ◽  
Beatrice Leter ◽  
Salvatore Cucchiara ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Immunoglobulin A ◽  
Intraepithelial Lymphocytes ◽  
Gluten Free Diet ◽  
Small Intestinal Mucosa ◽  
Gluten Free ◽  
Main Challenge ◽  
Genetic Features ◽  
Diagnostic Work ◽  
Work Up

Potential celiac disease (PCD) is defined by the presence of positive serum antibodies, HLA-DQ2/DQ8 haplotypes, and a normal small intestinal mucosa (Marsh grade 0-1). This condition occurs in one-fifth of celiac disease (CD) patients and usually represents a clinical challenge. We reviewed genetic, histologic, and clinical features of this specific condition by performing a systematic search on MEDLINE, Embase, and Scholar database. Accordingly, we identified different genetic features in patients with PCD compared to the classical forms. Frequently, signs of inflammation (deposits of immunoglobulin A (IgA) and/or increased number of intraepithelial lymphocytes) can be clearly identify in the mucosa of PCD patients after an accurate histological assessment. Finally, the main challenge is represented by the treatment: the gluten-free diet should be considered only in the presence of gluten-dependent symptoms in both children and adults. What is known: (i) potential celiac disease (PCD) occurs in one-fifth of all celiac diseases (CD), and (ii) despite the absence of classical lesions, clear signs of inflammation are often detectable. What is new: (i) patients with PCD show different genetic features, and (ii) the presence of gluten-dependent symptoms is the main determinant to initiate the gluten-free diet, after a complete diagnostic work-up.

scholarly journals Assessing of Celiac Disease and Nonceliac Gluten Sensitivity

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
N. Ontiveros ◽  
M. Y. Hardy ◽  
F. Cabrera-Chavez
Keyword(s):  
Celiac Disease ◽  
Healthcare Professionals ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Wheat Allergy ◽  
Exclusion Criteria ◽  
Food Components ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The publication of papers on the topic of gluten related disorders has substantially increased over the last few years. This has motivated healthcare professionals to pay attention not only to celiac disease and wheat allergy but also to a condition termed nonceliac gluten sensitivity (NCGS). Until now this condition has been diagnosed clinically on the basis of exclusion criteria and clinical response to gluten withdrawal. In addition, recent research in this field has shown that other food components distinct from gluten are implicated in NCGS cases, thereby changing our general understanding of NCGS diagnosis in either individuals on gluten containing diets or those already following a gluten-free diet with no proper diagnostic work-up of celiac disease. With this in mind, the assessment of NCGS will require extensive knowledge of celiac disease manifestations and the laboratory tests commonly performed during diagnosis of celiac disease.

scholarly journals High Prevalence of Celiac Disease in Patients with Type 1 Diabetes Detected by Antibodies to Endomysium and Tissue Transglutaminase

2001 ◽  
Vol 15 (5) ◽  
pp. 297-301 ◽  
Author(s):  
PM Gillett ◽  
HR Gillett ◽  
DM Israel ◽  
DL Metzger ◽  
L Stewart ◽  
...  
Keyword(s):  
British Columbia ◽  
Type 1 Diabetes ◽  
Celiac Disease ◽  
Growth Parameters ◽  
Morphological Changes ◽  
Tissue Transglutaminase ◽  
Immunoglobulin A ◽  
Gluten Free Diet ◽  
Gluten Free

OBJECTIVE: To establish the prevalence of celiac disease (CD) in children with type 1 diabetes in British Columbia.PATIENTS AND METHODS: Two hundred thirty-three children with type 1 diabetes were prospectively screened for CD using blind testing with the current 'gold standard', immunoglobulin A endomysium antibody (EmA), and the novel immunoglobulin A tissue transglutaminase (tTG) antibody. Those children with positive results were offered small bowel biopsy; a gluten-free diet was recommended if CD was confirmed.RESULTS: Nineteen children were positive for EmA and had an elevated tTG level. One patient from this group was already known to have CD, and the other 18 patients consented to biopsy. One biopsy was normal, three biopsies demonstrated elevated intraepithelial lymphocyte counts with normal morphology and 14 biopsies had morphological changes consistent with CD. Growth parameters were normal in all patients, and nine of 19 children who were positive for EmA were asymptomatic. Seven patients had mild elevation of tTG levels alone. Two children from this latter group had normal biopsies, and five declined biopsy.CONCLUSIONS: At least 14 new cases of CD were detected in addition to four known cases, yielding an overall biopsy-confirmed prevalence of CD of 7.7% (18 of 233). The present study confirms that CD is as prevalent in the pediatric type 1 diabetic population in British Columbia as it is in Europe. Serological screening of these children is important because many children have no symptoms or signs suggestive of CD. This study suggests that tTG serology may also be useful in monitoring response and compliance with a gluten-free diet.

Celiac Disease and Endocrine Autoimmunity

2015 ◽  
Vol 33 (2) ◽  
pp. 155-161 ◽  
Author(s):  
George J. Kahaly ◽  
Detlef Schuppan
Keyword(s):  
Celiac Disease ◽  
Storage Proteins ◽  
Tissue Transglutaminase ◽  
T Cell Response ◽  
Gluten Free Diet ◽  
Small Intestinal Mucosa ◽  
Gluten Free ◽  
Autoimmune Thyroid Diseases ◽  
Autoimmune Thyroid ◽  
Small Intestinal

Background: Celiac disease (CD) is a small-intestinal inflammatory disease that is triggered by the ingestion of the storage proteins (gluten) of wheat, barley and rye. Key Messages: Endocrine autoimmunity is prevalent in patients with CD and their relatives. The genes that predispose to endocrine autoimmune diseases, e.g. type 1 diabetes, autoimmune thyroid diseases, and Addison's disease, i.e. DR3-DQ2 and DR4-DQ8, are also the major genetic determinants of CD, which is the best understood HLA-linked disease. Thus, up to 30% of first-degree relatives both of patients with CD and/or endocrine autoimmunity are affected by the other disease. In CD, certain gluten proteins bind with high affinity to HLA-DQ2 or -DQ8 in the small-intestinal mucosa, to activate gluten-specific T cells which are instrumental in the destruction of the resorptive villi. Here, the autoantigen tissue transglutaminase increases the T cell response by generating deamidated gluten peptides that bind more strongly to DQ2 or DQ8. Classical symptoms such as diarrhea and consequences of malabsorption like anemia and osteoporosis are often absent in patients with (screening-detected) CD, but this absence does not significantly affect these patients' incidence of endocrine autoimmunity. Moreover, once autoimmunity is established, a gluten-free diet is not able to induce remission. However, ongoing studies attempt to address how far a gluten-free diet may prevent or retard the development of CD and endocrine autoimmunity in children at risk. Conclusions: The close relationship between CD and endocrine autoimmunity warrants a broader immune genetic and endocrine screening of CD patients and their relatives.

scholarly journals Dilated cardiomiopathy associated with celiac disease: Case report and literature review

2012 ◽  
Vol 140 (9-10) ◽  
pp. 641-643 ◽  
Author(s):  
Nemanja Milisavljevic ◽  
Mirjana Cvetkovic ◽  
Goran Nikolic ◽  
Branka Filipovic ◽  
Nikola Milinic
Keyword(s):  
Celiac Disease ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Gluten Free Diet ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Cardiac Complications ◽  
Small Intestinal Mucosa ◽  
Gluten Free ◽  
Autoimmune Myocarditis ◽  
Disease Case

Introduction. Celiac disease is an inflammatory condition of the small intestinal mucosa induced by gluten consumption in genetically susceptible individuals, leading to a spectrum of gastrointestinal presentation. A number of autoimmune and other disorders are highly associated with celiac disease. Cardiomyopathy associated with celiac disease has been rarely reported in the literature. Case Outline. We present a case of a 27-year-old male with one month history of diarrhea, weight loss, fatigue, dyspeptic symptoms, peripheral edema, and cardiac palpitations. After positive serological screening with immunoglobulin A anti-tissue transglutaminase antibody test, the diagnosis of celiac disease was confirmed with histopathology examination of duodenal biopsy specimen. Echocardiographic findings were consistent with acute myocarditis. After common causes of myocarditis had been excluded, probable celiac disease-associated autoimmune myocarditis was diagnosed. The patient was recommended to undergo a strict life-long gluten-free diet. IgA anti-transglutaminase antibodies, and anti-gliadin antibodies, were both significantly elevated during the 6-, 12- and 18-month follow-up. Low compliance to gluten-free diet in our patient led to progressive worsening of the left ventricular ejective fraction and other serious cardiac complications which warranted invasive cardiac interventions. Conclusion. Dilated cardiomyopathy associated with celiac disease is a serious condition which requires multidisciplinary approach involving gastroenterologist and cardiologist. Compliance with gluten-free diet is mandatory if patients are to avoid progression of cardiomyopathy. Screening of patients with idiopathic dilated cardiomyopathy for celiac disease is advisable.

scholarly journals Quantification of Accidental Gluten Contamination in the Diet of Children with Treated Celiac Disease

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 190
Author(s):  
Chiara Monachesi ◽  
Anil K. Verma ◽  
Giulia N. Catassi ◽  
Tiziana Galeazzi ◽  
Elisa Franceschini ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Food Samples ◽  
Gluten Free Diet ◽  
Assay Method ◽  
Enzyme Linked Immunosorbent Assay ◽  
Small Intestinal Mucosa ◽  
Gluten Free ◽  
Food Diary ◽  
Daily Diet ◽  
Contaminated Food

A strict gluten-free diet is extremely difficult to maintain. Protracted ingestion of gluten traces (>10 mg/day) is sufficient to cause significant damage in the architecture of the small intestinal mucosa in patients on treatment for celiac disease. The aim of this study was to directly measure the level of contaminating gluten in the daily diet of celiac children following a gluten-free diet. From April 2019 to December 2019, celiac disease children (2–18 years old) on a gluten-free diet for ≥6 months were offered to participate in this prospective-observational study. Patients and their caregivers were invited to provide a representative portion (about 10 g) of all meals consumed during a 24-h period. Participants were requested to weigh all ingested food and report items in a 24-h food diary. The gluten content was quantified by the R5 sandwich enzyme-linked immunosorbent assay method. Sixty-nine children completed the protocol. Overall, 12/448 (2.7%) food samples contained detectable amounts of gluten; of them, 11 contained 5–20 ppm and 1 >20 ppm. The 12 contaminated food samples belonged to 5/69 enrolled patients. In these 5 children, the daily gluten intake was well below the safety threshold of 10 mg/day. The present findings suggest that in a country characterized by high celiac disease awareness, the daily unintended exposure to gluten of treated celiac children on regular follow-up is very low; reassuringly, the presence of gluten traces did not lead to exceed the tolerable threshold of 10 mg/day of gluten intake in the gluten-free diet.

A Clinical and Histochemical Study of Celiac Disease Before and During a Gluten-Free Diet

1965 ◽  
Vol 48 (2) ◽  
pp. 155-172 ◽  
Author(s):  
I. Michael Samloff ◽  
John S. Davis ◽  
Eric A. Schenk
Keyword(s):  
Celiac Disease ◽  
Histochemical Study ◽  
Gluten Free Diet ◽  
Gluten Free

Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

2016 ◽  
Vol 25 (4) ◽  
pp. 555-558
Author(s):  
Alina Popp
Keyword(s):  
Celiac Disease ◽  
International Normalized Ratio ◽  
Gluten Free Diet ◽  
Alveolar Hemorrhage ◽  
Severe Anemia ◽  
Gluten Free ◽  
Pulmonary Infiltrates ◽  
Pulmonary Hemosiderosis ◽  
Threatening Condition ◽  
Life Threatening

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

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