scholarly journals Non-Celiac Gluten Sensitivity: A Challenging Diagnosis in Children with Abdominal Pain

2018 ◽  
Vol 73 (Suppl. 4) ◽  
pp. 39-46 ◽  
Author(s):  
Frank M. Ruemmele
Keyword(s):  
Abdominal Pain ◽  
Celiac Disease ◽  
Clinical Symptoms ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Clear Cut ◽  
Clinical Presentations ◽  
New Findings ◽  
Three Phase ◽  
Gi Symptoms

Several disorders related to the ingestion of gluten are well recognized despite overlapping clinical presentations: celiac disease, an autoimmune enteropathy triggered by gluten ingestions in susceptible individuals, allergy to wheat, and more recently non-celiac gluten sensitivity (NCGS). While celiac disease and wheat allergy are well-known disorders with a clear-cut diagnosis based on clinical tests and biological parameters, NCGS is a more difficult diagnosis, especially in children with functional gastrointestinal (GI) complaints. NCGS is considered a syndrome of intestinal but also extraintestinal symptoms occurring within hours, but sometimes even after several days of gluten ingestion. In children, the leading symptoms of NCGS are abdominal pain and diarrhea, while extraintestinal symptoms are rare, in contrast to adult patients. No precise diagnostic test nor specific biomarkers exist, except a rather cumbersome three-phase gluten-exposure, gluten-free diet, followed by a blinded placebo-controlled gluten challenge with crossover to provoke symptoms elicited by gluten in a reproducible manner that disappear on gluten-free alimentation. Recent data indicate that the peptide part of wheat proteins is not necessarily the sole trigger of clinical symptoms. Mono- or oligosaccharides, such as fructan and other constituents of wheat, were able to provoke GI symptoms in clinical trials. These new findings indicate that the term gluten sensitivity is probably too restrictive. The incidence of NCGS was reported in the range of 1–10% in the general population and to increase steadily; however, most data are based on patients’ self-reported gluten intolerance or avoidance without a medically confirmed diagnosis. Treatment consists of gluten avoidance for at least several weeks or months. Patients with NCGS require regular reassessment for gluten tolerance allowing with time the reintroduction of increasing amounts of gluten.

scholarly journals The Role of a Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyol Diet in Nonceliac Gluten Sensitivity

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
P. Priyanka ◽  
S. Gayam ◽  
J. T. Kupec
Keyword(s):  
Systematic Review ◽  
Celiac Disease ◽  
Wheat Germ ◽  
Clinical Symptoms ◽  
Additional Benefit ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Wheat Allergy ◽  
Fodmap Diet

Background. Nonceliac gluten sensitivity (NCGS) is a recently defined clinical entity characterized by intestinal and extraintestinal symptoms associated with gluten ingestion in individuals in whom celiac disease (CD) or wheat allergy (WA) has been excluded. Despite its name and definition, gluten has been shown to precipitate symptoms in only 16–30% of these patients. In addition to gluten, other components of wheat, including fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), alpha-amylase trypsin inhibitors (ATIs) and wheat germ agglutinin have been implicated in the causation of the symptoms of NCGS, with FODMAPs garnering the most attention. We present a review of the existing literature evaluating the role of FODMAPs in NCGS symptomatology. Methods. A systematic review of PubMed, Cochrane, EMBASE, and Google Scholar for keywords fructans, non-celiac gluten sensitivity, NCGS, FODMAPs, and gluten-free diet (GFD) was conducted through a series of advanced searches. Articles related to the use of fructans or FODMAPs were analyzed. Results. FODMAPs were found to be associated with gastrointestinal and extraintestinal symptoms in NCGS. Conclusions. A low FODMAP diet has potential for improvement of clinical symptoms in NCGS. In addition, some evidence suggests an additional benefit to simultaneous adherence to both low FODMAP diet and GFD.

scholarly journals Gluten-Associated Pathology: Focusing on Patients with Irritable Bowel Syndrome

2020 ◽  
Vol 16 (30) ◽  
pp. 66-73
Author(s):  
O.V. Gaus ◽  
◽  
M.A. Livzan ◽  
D.V. Popello
Keyword(s):  
Irritable Bowel Syndrome ◽  
Celiac Disease ◽  
Clinical Symptoms ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Wheat Allergy ◽  
The World ◽  
Wheat Products ◽  
Irritable Bowel ◽  
The Many

Wheat is an essential part of the diet of many people around the world. Despite the many beneficial aspects of eating wheat products, they can be associated with the development of a variety of diseases. The spectrum of gluten-associated pathologies includes celiac disease, wheat allergy, and non-celiac gluten sensitivity (NCGS). The clinical symptoms of gluten-associated pathology are similar to those of irritable bowel syndrome (IBS). Diagnosis of celiac disease and wheat allergy is now straightforward. NCGS remains a diagnosis of exclusion due to the lack of specific biomarkers and standardized research methods. Many patients with IBS consider themselves gluten-sensitive and their symptoms are relieved by a gluten-free diet. Most likely it is NCGS that occurs in a heterogeneous group of patients with IBS. However it remains controversial whether the development of symptoms in this case is associated with gluten itself or with other components of wheat, such as non-gluten proteins and FODMAPs.

scholarly journals Gluten and Functional Abdominal Pain Disorders in Children

Nutrients ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 1491 ◽  
Author(s):  
Alejandro Llanos-Chea ◽  
Alessio Fasano
Keyword(s):  
Abdominal Pain ◽  
Pediatric Patients ◽  
Functional Gastrointestinal Disorders ◽  
Gastrointestinal Symptoms ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Functional Abdominal Pain ◽  
Adults And Children ◽  
Small Intestinal ◽  
Irritable Bowel

In children, functional gastrointestinal disorders (FGIDs) are common at all ages. Consumption of certain foods, particularly gluten, is frequently associated with the development and persistence of FGIDs and functional abdominal pain disorders (FAPDs) in adults and children. However, this association is not well defined. Even without a diagnosis of celiac disease (CD), some people avoid gluten or wheat in their diet since it has been shown to trigger mostly gastrointestinal symptoms in certain individuals, especially in children. The incidence of conditions such as non-celiac gluten sensitivity (NCGS) is increasing, particularly in children. On the other hand, CD is a chronic, autoimmune small intestinal enteropathy with symptoms that can sometimes be mimicked by FAPD. It is still unclear if pediatric patients with irritable bowel syndrome (IBS) are more likely to have CD. Abdominal, pain-associated FGID in children with CD does not seem to improve on a gluten-free diet. The threshold for gluten tolerance in patients with NCGS is unknown and varies among subjects. Thus, it is challenging to clearly distinguish between gluten exclusion and improvement of symptoms related solely to functional disorders.

scholarly journals 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

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.

Lupus Enteritis, a Severe and Potentially Fatal Complication of Systemic Lupus Erythematosus

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S64-S64 ◽  
Author(s):  
Hany Meawad ◽  
Andrew Kobalka ◽  
Yaseen Alastal ◽  
Brooke Koltz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Pain ◽  
Lupus Erythematosus ◽  
Clinical Symptoms ◽  
Meckel’S Diverticulum ◽  
Severe Abdominal Pain ◽  
Meckel's Diverticulum ◽  
Systemic Lupus ◽  
Gi Symptoms ◽  
Lupus Enteritis

Abstract Objectives Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that can show wide manifestations in many organs. The gastrointestinal tract (GI) is commonly affected in SLE; symptoms are often related to the side effect of medications or to infections. One rare GI complication of SLE is lupus enteritis, a complex of manifestations including intestinal vasculitis and enteric ischemia, which presents with vague symptoms of severe abdominal pain, nausea, vomiting, and diarrhea. Methods We present the case of a 25-year-old female who was admitted to the hospital with complaints of abdominal pain, vomiting, diarrhea, and a history of SLE. Complicating the patient’s clinical picture and diagnosis was gastrointestinal bleeding requiring multiple blood product transfusions secondary to bleeding Meckel’s diverticulum, lupus flare, and positive stool culture for campylobacter antigen. Repeated upper and lower GI endoscopies with biopsy failed to identify the exact cause of bleeding and GI symptoms; the patient underwent exploratory laparotomy with right hemicolectomy to control bleeding. Microscopic examination revealed marked small vessel acute vasculitis consistent with lupus enteritis, ischemic enteritis, and Meckel’s diverticulum with gastric heterotopia. Results Our patient was subsequently aggressively treated; however, she developed further associated complications and died. Conclusion The pathologic diagnosis of lupus enteritis is challenging due to the nonspecific clinical symptoms and paucity of pathologic findings on most biopsy specimens. Lupus enteritis must be considered in the differential diagnosis of severe abdominal pain in lupus patients to aid in early diagnosis and treatment as this condition could be severe and potentially fatal.

scholarly journals Metabolic effects in patients with celiac disease, patients with nonceliac gluten sensitivity, and asymptomatic controls, after six months of a gluten-free diet

2020 ◽  
Vol 85 (2) ◽  
pp. 109-117 ◽  
Author(s):  
J.M. Remes-Troche ◽  
O. De J. Cobos-Quevedo ◽  
X. Rivera-Gutiérrez ◽  
G. Hernández ◽  
E. de la Cruz-Patiño ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Gluten Free Diet ◽  
Metabolic Effects ◽  
Gluten Sensitivity ◽  
Gluten Free

The Effect of Gluten-free Diet on Clinical Symptoms and the Intestinal Mucosa of Patients With Potential Celiac Disease

2018 ◽  
Vol 66 (4) ◽  
pp. 654-656 ◽  
Author(s):  
Roberta Mandile ◽  
Valentina Discepolo ◽  
Serena Scapaticci ◽  
Maria Rosaria Del Vecchio ◽  
Maria Antonia Maglio ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Intestinal Mucosa ◽  
Clinical Symptoms ◽  
Gluten Free Diet ◽  
Gluten Free

scholarly journals MODERN RESOURCES OF CELIAC DISEASE TREATMENT EFFECTIVENESS IMPROVEMENT

2020 ◽  
Vol 16 (3) ◽  
pp. 33-38
Author(s):  
O.Yu. Gubska ◽  
Yu.V. Chichula ◽  
A.K. Sizenko ◽  
L.M. Kupchik
Keyword(s):  
Small Intestine ◽  
Celiac Disease ◽  
Clinical Remission ◽  
Clinical Symptoms ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Breath Tests ◽  
Complete Clinical Remission ◽  
Comprehensive Examination ◽  
Hydrogen Breath Tests

Relevance. Although monotherapy with a gluten-free diet (BGD) for celiac disease is highly effective, it does not in all cases achieve complete remission of the disease. Therefore, an additional comprehensive examination of patients for the purpose of prescribing reasonable therapy is relevant. Objective: to study the causes of the persistence of clinical symptoms in patients with celiac disease who are on a gluten-free diet for 6 months. Materials and methods. Patients with celiac disease (n = 41) who were on a gluten-free diet (GFD) for 6 months were studied. The average age is 35.42 ± 0.45 years. Group 1 (n = 17) – patients who subjectively noted a positive dynamics of treatment and with a significant improvement in general condition, but without complete clinical remission. Group 2 (n = 24) – patients with unsatisfactory treatment results, no clinical effect from treatment, or weak positive dynamics on the background of GFD. The study included two stages: 1) assessment of patients' compliance and their diet (through the analysis of food diaries) in order to identify disorders of a gluten-free diet as the main cause of the persistence of clinical symptoms; 2) identification of other causes of the persistence of symptoms: exocrine pancreas insufficiency (EPI), lactase deficiency (LD) and the syndrome of increase bacterial growth (SIBR). A C13 triglyceride breath test (IRIS analyzer) was performed to diagnose EPI. To diagnose LD and SIBR in the small intestine, hydrogen breath tests (Micro H2-meter analyzer) were used – a test with lactose and D-xylose, respectively. Also, the titer of antibodies to tissue transglutaminase (TTG) to deaminated gliadin peptides (DPG) was determined in all patients, and their DPG/TTG ratio was calculated. Results. The main reason for the ineffectiveness of treatment is a violation of a gluten-free diet, found in 63.4% of subjects (incompletely formed mushy stool, polyfaeces, steatorrhea; recurrent abdominal pain, bloating, flatulence). Revision of food intake and elimination of sources of latent gluten from the diet of patients with celiac disease allowed to achieve complete serological remission (normalization of titers specific for celiac disease antibodies) in all patients, but complete clinical remission was achieved in only 34.6%. Therefore, it is concluded that there are other causes of incomplete remission of celiac disease associated with concomitant diseases of the digestive tract. Using carbon and hydrogen breath tests, it was found that, in addition to diet, the reasons for the lack of complete remission in patients with celiac disease are EPI (19%), SIBR in the small intestine (16%), LD (47%) and a combination of EPI with SIBR. Conclusion. The inclusion of respiratory tests (C13-triglyceride, hydrogen with lactose, and D-xylose) in a comprehensive examination of patients with celiac disease can significantly improve treatment outcomes and reduce the duration of clinical remission.

Impact of a Gluten-Free Diet on Quality of Life and Health Perception in Patients with Type 1 Diabetes and Asymptomatic Celiac Disease

2021 ◽  
Author(s):  
Daniel I Weiman ◽  
Farid H Mahmud ◽  
Antoine B M Clarke ◽  
Esther Assor ◽  
Charlotte McDonald ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 1 Diabetes ◽  
Celiac Disease ◽  
Health Perception ◽  
Lifestyle Changes ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Gi Symptoms

Abstract Context Celiac disease (CD) is a common comorbidity seen in patients with type 1 diabetes (T1D) and is frequently asymptomatic. As chronic conditions requiring significant lifestyle changes, there are limited reports assessing changes in health-related quality of life (HRQoL) during transition to a gluten-free diet (GFD) in patients with both T1D and who are asymptomatic for CD. Objective To prospectively assess HRQoL and health perception in children and adults with T1D and asymptomatic CD after randomization to GFD versus usual diet. Design, Setting, and Participants Patients with T1D aged 8-45 years without CD symptoms were serologically screened for CD, with positive results confirmed with intestinal biopsy. Participants were randomized in an open-label fashion to a GFD or gluten-containing diet (GCD) for 12 months. Generic and diabetes-specific HRQoL and self-perceived wellness (SPW) were assessed longitudinally. Results 2,387 T1D patients were serologically screened. CD was biopsy-confirmed in 82 patients and 51 participants were randomized to a GFD (N=27) or GCD (N=24). Excellent adherence to the assigned diets was observed. Overall, no changes in generic (P=0.73) or diabetes-specific HRQoL (P=0.30), or SPW (P=0.41) were observed between groups over 12 months. HemoglobinA1c (HbA1c) and GI symptoms were consistent predictors of HRQoL and SPW. Conclusions HRQoL and SPW were not significantly impacted by the adoption of a GFD over 12 months, but worsened with symptom onset and increased HbA1c. Our findings indicate that transition to a GFD can be made successfully in this population without adversely impacting quality of life.

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