Orally Based Diagnosis of Celiac Disease: Current Perspectives

Celiac disease (CD) is a lifelong immune-mediated disorder caused by the ingestion of wheat gluten in genetically susceptible persons. Most cases of CD are atypical and remain undiagnosed, which exposes the individuals to the risk of life-threatening complications. Serologic endomysial and tissue transglutaminase antibody tests are used to screen at-risk individuals, although a firm diagnosis requires demonstration of characteristic histopathologic findings in the small-intestinal mucosa. A gluten challenge, with a repeat biopsy to demonstrate recurrence of histopathologic changes in the intestinal mucosa after the re-introduction of gluten, is considered for those persons in whom diagnosis remains in doubt. In this paper, we review studies that evaluated: (1) the possibility of using oral mucosa for the initial diagnosis of CD or for local gluten challenge; and (2) the possibility of using salivary CD-associated antibodies as screening tests. Our review shows that orally based diagnosis of CD is attractive and promising, although additional evaluations with standardized collection and analysis methods are needed. There is some evidence of a dissociation between systemic and oral mucosal immune responses in CD. The hypothesis that gluten could stimulate naïve lymphocytes directly in the oral cavity would have important implications for the understanding, diagnosis, and management of CD.

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Contribution of Infectious Agents to the Development of Celiac Disease

Microorganisms ◽

10.3390/microorganisms9030547 ◽

2021 ◽

Vol 9 (3) ◽

pp. 547

Author(s):

Daniel Sánchez ◽

Iva Hoffmanová ◽

Adéla Szczepanková ◽

Věra Hábová ◽

Helena Tlaskalová-Hogenová

Keyword(s):

Celiac Disease ◽

Intestinal Mucosa ◽

Wheat Gluten ◽

Small Intestinal Mucosa ◽

Beneficial Effects ◽

Immune Mediated ◽

Healthy State ◽

Food Antigens ◽

Small Intestinal ◽

And Function

The ingestion of wheat gliadin (alcohol-soluble proteins, an integral part of wheat gluten) and related proteins induce, in genetically predisposed individuals, celiac disease (CD), which is characterized by immune-mediated impairment of the small intestinal mucosa. The lifelong omission of gluten and related grain proteins, i.e., a gluten-free diet (GFD), is at present the only therapy for CD. Although a GFD usually reduces CD symptoms, it does not entirely restore the small intestinal mucosa to a fully healthy state. Recently, the participation of microbial components in pathogenetic mechanisms of celiac disease was suggested. The present review provides information on infectious diseases associated with CD and the putative role of infections in CD development. Moreover, the involvement of the microbiota as a factor contributing to pathological changes in the intestine is discussed. Attention is paid to the mechanisms by which microbes and their components affect mucosal immunity, including tolerance to food antigens. Modulation of microbiota composition and function and the potential beneficial effects of probiotics in celiac disease are discussed.

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Celiac disease and its histopathology

Journal of Pathology of Nepal ◽

10.3126/jpn.v7i1.16948 ◽

2017 ◽

Vol 7 (1) ◽

pp. 1118-1123 ◽

Cited By ~ 1

Author(s):

S Pudasaini

Keyword(s):

Celiac Disease ◽

Wheat Gluten ◽

Duodenal Biopsy ◽

Inflammatory Disorder ◽

Small Intestinal Mucosa ◽

Positive Serology ◽

Chronic Inflammatory Disorder ◽

Immune Mediated ◽

Systemic Manifestations ◽

Hla Dq2

Celiac disease is gluten induced enteropathy and is a chronic inflammatory disorder of the small intestine characterized by malabsorption. It is a common immune mediated disorder which is triggered by consumption of wheat (gluten). It occurs in genetically predisposed individuals (carriers of HLA-DQ2 and DQ8 haplotypes). It is characterized by inflammation of the small-intestinal mucosa and myriad gastrointestinal and systemic manifestations. A duodenal biopsy with positive serology is the gold standard for the diagnosis of Celiac disease. As there are changing presentation for Celiac disease, communication of pathologist and gastroenterologists is essential for appropriate interpretation of duodenal biopsy.

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The Production of the Oral Mucosa of Antiendomysial and Anti—Tissue-Transglutaminase Antibodies in Patients with Celiac Disease: A Review

The Scientific World JOURNAL ◽

10.1100/tsw.2010.228 ◽

2010 ◽

Vol 10 ◽

pp. 2385-2394 ◽

Cited By ~ 6

Author(s):

Domenico Compilato ◽

Giuseppina Campisi ◽

Luca Pastore ◽

Antonio Carroccio

Keyword(s):

Celiac Disease ◽

Oral Mucosa ◽

Intestinal Mucosa ◽

Villous Atrophy ◽

Tissue Transglutaminase ◽

Mucosal Injury ◽

Small Intestinal Mucosa ◽

Serological Tests ◽

Main Site ◽

Small Intestinal

Celiac disease (CD) is a lifelong, T cell—mediated enteropathy, triggered by the ingestion of gluten and related prolamins in genetically susceptible subjects, resulting in minor intestinal mucosal injury, including villous atrophy with crypt hyperplasia and intraepithelial lymphocytosis, and subsequent nutrient malabsorption. Although serological tests for antiendomysial (EMA) and anti—tissue transglutaminase (anti-tTG) autoantibodies are used to screen and follow up on patients with CD, diagnostic confirmation is still based on the histological examination of the small intestinal mucosa. Although the small intestinal mucosa is the main site of the gut involved in CD, other mucosal surfaces (such as gastric, rectal, ileal, and esophageal) belonging to the gastrointestinal tract and the gut-associated lymphoid tissue (GALT) can also be involved. A site that could be studied less invasively is the mouth, as it is the first part of the gastrointestinal system and a part of the GALT. Indeed, not only have various oral ailments been reported as possible atypical aspects of CD, but it has been also demonstrated that inflammatory changes occur after oral supramucosal application and a submucosal injection of gliadin into the oral mucosa of CD patients. However, to date, only two studies have assessed the capacity of the oral mucosa of untreated CD patients to EMA and anti-tTG antibodies. In this paper, we will review studies that evaluate the capacity of the oral mucosa to produce specific CD autoantibodies. Discrepancies in sensitivity from the two studies have revealed that biopsy is still not an adequate procedure for the routine diagnostic purposes of CD patients, and a more in-depth evaluation on a larger sample size with standardized collection and analysis methods is merited. However, the demonstration of immunological reactivity to the gluten ingestion of the oral mucosa of CD, in terms of IgA EMA and anti-tTG production, needs to be further evaluated in order to verify whether the oral mucosa is colonized by lymphocytes activated in the intestine or if gluten could stimulate naïve lymphocytes directly in the oral mucosa. This would have important implications for the pathogenesis, diagnosis, and treatment of CD.

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Magnifying endoscopy of the duodenum with dye scattering method in a case with celiac disease

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032003000200009 ◽

2003 ◽

Vol 40 (2) ◽

pp. 110-113 ◽

Cited By ~ 2

Author(s):

Tetsuo Morishita ◽

Toshiaki Kamiya ◽

Hiromasa Ishii

Keyword(s):

Celiac Disease ◽

Intestinal Mucosa ◽

Indigo Carmine ◽

Duodenal Mucosa ◽

Magnifying Endoscopy ◽

Scattering Method ◽

Small Intestinal Mucosa ◽

Before And After ◽

Dye Scattering Method ◽

Magnifying Endoscope

AIM: To know the more detailed findings of the small intestinal mucosa with the use of a magnifying endoscope and a vital dye, and the efficacy of the both tools. PATIENT AND METHODS: A 54-year old female patient with celiac disease. The duodenal mucosa downward as far as the descending portion was observed with a magnifying endoscope (Olympus GIF HM) before and after spraying the mucosa with 0.1% indigo carmine. RESULTS: The endoscopy clarified the atrophy and edema of each villus, and scattering of the dye revealed shorter villi with the relatively longer villi remaining in islands. CONCLUSION: The combination of magnifying endoscopy and the dye scattering method is useful for closer observation of the intestinal mucosa in celiac diseases.

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Screening Tests Using Serum Tissue Transglutaminase IgA May Facilitate the Identification of Undiagnosed Celiac Disease among Japanese Population

International Journal of Medical Sciences ◽

10.7150/ijms.8854 ◽

2014 ◽

Vol 11 (8) ◽

pp. 819-823 ◽

Cited By ~ 8

Author(s):

Hideyuki Nakazawa ◽

Hideki Makishima ◽

Toshiro Ito ◽

Hiroyoshi Ota ◽

Kayoko Momose ◽

...

Keyword(s):

Celiac Disease ◽

Japanese Population ◽

Tissue Transglutaminase ◽

Screening Tests

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Expression Pattern of Fatty Acid Binding Proteins in Celiac Disease Enteropathy

Mediators of Inflammation ◽

10.1155/2015/738563 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 11

Author(s):

Natalia M. Bottasso Arias ◽

Marina García ◽

Constanza Bondar ◽

Luciana Guzman ◽

Agustina Redondo ◽

...

Keyword(s):

Celiac Disease ◽

Fatty Acid ◽

Expression Pattern ◽

Intestinal Mucosa ◽

Binding Proteins ◽

Fatty Acid Binding Proteins ◽

Small Intestinal Mucosa ◽

Mrna Levels ◽

Fatty Acid Binding ◽

Small Intestinal

Celiac disease (CD) is an immune-mediated enteropathy that develops in genetically susceptible individuals following exposure to dietary gluten. Severe changes at the intestinal mucosa observed in untreated CD patients are linked to changes in the level and in the pattern of expression of different genes. Fully differentiated epithelial cells express two isoforms of fatty acid binding proteins (FABPs): intestinal and liver, IFABP and LFABP, respectively. These proteins bind and transport long chain fatty acids and also have other important biological roles in signaling pathways, particularly those related to PPARγand inflammatory processes. Herein, we analyze the serum levels of IFABP and characterize the expression of both FABPs at protein and mRNA level in small intestinal mucosa in severe enteropathy and normal tissue. As a result, we observed higher levels of circulating IFABP in untreated CD patients compared with controls and patients on gluten-free diet. In duodenal mucosa a differential FABPs expression pattern was observed with a reduction in mRNA levels compared to controls explained by the epithelium loss in severe enteropathy. In conclusion, we report changes in FABPs’ expression pattern in severe enteropathy. Consequently, there might be alterations in lipid metabolism and the inflammatory process in the small intestinal mucosa.

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