Seronegative celiac disease: a case report

The only available treatment for celiac disease is life-long gluten exclusion. We conducted a cross-sectional age- and gender-matched study in 64 celiac adults on a long-term (>1 year) gluten-free diet and 74 non-celiac volunteers from Spain, using dietary, anthropometric, and biochemical parameters, as well as assessing bone mineral density and physical activity. Celiac adults had deficient intake (below 2/3 of the recommended intake) for folates, vitamin E, and iodine and low intake of calcium (below 80% of the recommended intake). Iron intake was also below 2/3 of the recommended intake in celiac women. Vitamin D intake was extremely low, and 34% of celiac patients had moderately deficient plasma levels. According to bone mineral density, celiac women may be more prone to osteopenia and osteoporosis. However, we found a perfectly analogous nutritional status scenario in celiac as compared to healthy volunteers, with the dietary deviations found being similar to those of the Spanish population, i.e., both groups followed a high-lipid, high-protein, and low-carbohydrate diet. Values for biochemical parameters were found within the reference ranges. Celiac disease had no influence on body weight, but body fat in celiac patients tended to be higher. According to our results, vitamin D, calcium, folates, vitamin E, iodine, and iron nutritional status should be specifically assessed and monitored in the celiac population.

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Rationale for Timing of Follow-Up Visits to Assess Gluten-Free Diet in Celiac Disease Patients Based on Data Mining

Nutrients ◽

10.3390/nu13020357 ◽

2021 ◽

Vol 13 (2) ◽

pp. 357

Author(s):

Alfonso Rodríguez-Herrera ◽

Joaquín Reyes-Andrade ◽

Cristina Rubio-Escudero

Keyword(s):

Data Mining ◽

Celiac Disease ◽

Cultural Context ◽

Gluten Free Diet ◽

Gluten Free ◽

Adherence To Diet ◽

And Gender ◽

Few Data

The assessment of compliance of gluten-free diet (GFD) is a keystone in the supervision of celiac disease (CD) patients. Few data are available documenting evidence-based follow-up frequency for CD patients. In this work we aim at creating a criterion for timing of clinical follow-up for CD patients using data mining. We have applied data mining to a dataset with 188 CD patients on GFD (75% of them are children below 14 years old), evaluating the presence of gluten immunogenic peptides (GIP) in stools as an adherence to diet marker. The variables considered are gender, age, years following GFD and adherence to the GFD by fecal GIP. The results identify patients on GFD for more than two years (41.5% of the patients) as more prone to poor compliance and so needing more frequent follow-up than patients with less than 2 years on GFD. This is against the usual clinical practice of following less patients on long term GFD, as they are supposed to perform better. Our results support different timing follow-up frequency taking into consideration the number of years on GFD, age and gender. Patients on long term GFD should have a more frequent monitoring as they show a higher level of gluten exposure. A gender perspective should also be considered as non-compliance is partially linked to gender in our results: Males tend to get more gluten exposure, at least in the cultural context where our study was carried out. Children tend to perform better than teenagers or adults.

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Nutritional Management of Celiac Disease

10.2310/tywc.9036 ◽

2018 ◽

Author(s):

Ciarán P Kelly ◽

Satya Kurada ◽

Mariana Urquiaga

Keyword(s):

Immune Response ◽

Celiac Disease ◽

Tight Junction ◽

Villous Atrophy ◽

Gastrointestinal Symptoms ◽

Gluten Free Diet ◽

Intestinal Biopsy ◽

Nutritional Management ◽

Gluten Free ◽

Antigliadin Antibodies

Celiac disease (CD) is an autoimmune disorder characterized by an immune response to gluten peptides in wheat, barley, and rye. The diagnosis of celiac disease is confirmed by three important characteristics: consistent symptoms, positive celiac-specific serology, and small intestinal biopsy findings of inflammation, crypt hyperplasia, and villous atrophy. CD may present with overt gastrointestinal symptoms, including diarrhea (or constipation), weight loss, and abdominal bloating and discomfort, or covertly with micronutrient deficiencies such as iron deficiency with anemia. A gluten-free diet (GFD) remains the mainstay of treatment. The aim of this review is to highlight the pathogenesis of CD, concepts and challenges associated with a GFD, and nutritional management of CD applicable in clinical practice to internists, gastroenterologists, and dietitians. Patients should be referred to an expert celiac dietitian for education on adherence to a GFD to address gluten contamination in the diet, the psychosocial implications of following a GFD, and macro- and micronutrient disequilibria arising from celiac disease and the GFD. Several novel therapeutics are on the horizon in various stages of development, including glutenases, antigliadin antibodies, tight junction regulators, modulation of the immune response to gliadin, and efforts to engineer less toxic gluten-containing foodstuffs. This review contains 3 figures, 5 tables, and 61 references. Key words: celiac disease, genetic engineering, food engineering, gluten, glutenases, gluten-free diet, oats, IgY, nutrition, tight junction regulators, wheat

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Nutritional Management of Celiac Disease

10.2310/im.9036 ◽

2017 ◽

Author(s):

Ciarán P Kelly ◽

Satya Kurada ◽

Mariana Urquiaga

Keyword(s):

Immune Response ◽

Celiac Disease ◽

Tight Junction ◽

Villous Atrophy ◽

Gastrointestinal Symptoms ◽

Gluten Free Diet ◽

Intestinal Biopsy ◽

Nutritional Management ◽

Gluten Free ◽

Antigliadin Antibodies

Celiac disease (CD) is an autoimmune disorder characterized by an immune response to gluten peptides in wheat, barley, and rye. The diagnosis of celiac disease is confirmed by three important characteristics: consistent symptoms, positive celiac-specific serology, and small intestinal biopsy findings of inflammation, crypt hyperplasia, and villous atrophy. CD may present with overt gastrointestinal symptoms, including diarrhea (or constipation), weight loss, and abdominal bloating and discomfort, or covertly with micronutrient deficiencies such as iron deficiency with anemia. A gluten-free diet (GFD) remains the mainstay of treatment. The aim of this review is to highlight the pathogenesis of CD, concepts and challenges associated with a GFD, and nutritional management of CD applicable in clinical practice to internists, gastroenterologists, and dietitians. Patients should be referred to an expert celiac dietitian for education on adherence to a GFD to address gluten contamination in the diet, the psychosocial implications of following a GFD, and macro- and micronutrient disequilibria arising from celiac disease and the GFD. Several novel therapeutics are on the horizon in various stages of development, including glutenases, antigliadin antibodies, tight junction regulators, modulation of the immune response to gliadin, and efforts to engineer less toxic gluten-containing foodstuffs. This review contains 3 figures, 5 tables, and 61 references. Key words: celiac disease, genetic engineering, food engineering, gluten, glutenases, gluten-free diet, oats, IgY, nutrition, tight junction regulators, wheat

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A Phase I Study to Determine Safety, Tolerability and Bioactivity of Nexvax2® in HLA DQ2+ Volunteers With Celiac Disease Following a Long-Term, Strict Gluten-Free Diet

Gastroenterology ◽

10.1016/s0016-5085(11)61794-0 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-437-S-438 ◽

Cited By ~ 23

Author(s):

Gregor J. Brown ◽

James Daveson ◽

Joanne K. Marjason ◽

Rose A. Ffrench ◽

Danielle Smith ◽

...

Keyword(s):

Celiac Disease ◽

Phase I ◽

Phase I Study ◽

Gluten Free Diet ◽

Gluten Free ◽

Hla Dq2

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The Broad Spectrum of Celiac Disease and Gluten Sensitive Enteropathy

Medicine and Pharmacy Reports ◽

10.15386/cjmed-698 ◽

2016 ◽

Vol 89 (3) ◽

pp. 335-342 ◽

Cited By ~ 3

Author(s):

Oana Mocan ◽

Dan L. Dumitrașcu

Keyword(s):

Celiac Disease ◽

Viral Infections ◽

Villous Atrophy ◽

Intraepithelial Lymphocytes ◽

Intestinal Biopsy ◽

Gluten Free ◽

Serological Tests ◽

Genetic Transmission ◽

Intestinal Involvement ◽

Gluten Sensitive Enteropathy

The celiac disease is an immune chronic condition with genetic transmission, caused by the intolerance to gluten. Gluten is a protein from cereals containing the following soluble proteins: gliadine, which is the most toxic, and the prolamins. The average prevalence is about 1% in USA and Europe, but high in Africa: 5.6% in West Sahara. In the pathogenesis several factors are involved: gluten as external trigger, genetic predisposition (HLA, MYO9B), viral infections, abnormal immune reaction to gluten. Severity is correlated with the number of intraepithelial lymphocytes, cryptic hyperplasia and villous atrophy, as well as with the length of intestinal involvement. The severity is assessed according to the Marsh–Oberhuber staging. Diagnostic criteria are: positive serological tests, intestinal biopsy, the reversal after gluten free diet (GFD). Beside refractory forms, new conditions have been described, like the non celiac gluten intolerance. In a time when more and more people adhere to GFD for nonscientific reasons, practitioners should be updated with the progress in celiac disease knowledge.

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S2041 Improved Performance of Celiac Disease-Related Serology Tests in Predicting the Degree of Patients' Compliance With Long-Term Gluten-Free Diet. New Cut-Offs are Necessary

Gastroenterology ◽

10.1016/s0016-5085(10)61413-8 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-307

Author(s):

Fabio D. Nachman ◽

Emilia Sugai ◽

Horacio Vázquez ◽

Andrea F. Gonzalez ◽

Paola J. Andrenacci ◽

...

Keyword(s):

Celiac Disease ◽

Gluten Free Diet ◽

Gluten Free ◽

Improved Performance

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Long-Term Management of Patients with Celiac Disease: Current Practices of Gastroenterologists in Canada

Canadian Journal of Gastroenterology ◽

10.1155/2010/140289 ◽

2010 ◽

Vol 24 (8) ◽

pp. 499-509 ◽

Cited By ~ 9

Author(s):

Jocelyn Anne Silvester ◽

Mohsin Rashid

Keyword(s):

Celiac Disease ◽

Practice Guideline ◽

Long Term Care ◽

Intestinal Biopsy ◽

Term Care ◽

Follow Up Care ◽

Long Term Follow Up ◽

Current Practices

BACKGROUND: Long-term follow-up of patients with celiac disease is important for monitoring their clinical status, dietary compliance and complications.AIM: To examine the current practices of Canadian gastroenterologists providing long-term care to patients with celiac disease.METHODS: All gastroenterologists in Canada (n=585) were surveyed regarding their practice demographics, familiarity with celiac disease practice guidelines, and follow-up clinical examination and investigations.RESULTS: Of the 585 surveys mailed to gastroenterologists, 567 were expected to be returned. A total of 242 completed surveys (43%) were received. Of these, 237 (184 adult, 51 pediatric and two mixed) had an active practice that included patients with celiac disease. Long-term follow-up care was provided routinely by 76% of respondents. Follow-up consisted of annual clinic visits (67%), dietary review (77%), reinforcement of the need for adherence to a gluten-free diet (90%) and recommending membership in an advocacy group (65%). Physical examination was performed by 78%; most ordered laboratory tests including serology (65%).Adult gastroenterologists performed routine follow-up intestinal biopsy more often than their pediatric counterparts (46% versus 10%), but performed serology less frequently (48% versus 86%). Pediatric patients were more likely to be followed by a multidisciplinary team. All pediatric gastroenterologists were familiar with at least one celiac disease practice guideline, whereas 15% of adult gastroenterologists were not familiar with any practice guideline. The majority of gastroenterologists who did not routinely provide follow-up expected care to be provided by the patient’s primary physician (86%).CONCLUSIONS: Most gastroenterologists in Canada who responded to the survey provided long-term follow-up care to patients with celiac disease. The diverse practices reported underscore the need to develop consensus-based guidelines for long-term care of these patients.

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