scholarly journals Faecal Scent as a Novel Non-Invasive Biomarker to Discriminate between Coeliac Disease and Refractory Coeliac Disease: A Proof of Principle Study

Biosensors ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 69 ◽  
Author(s):  
Maxine D. Rouvroye ◽  
Alfian Wicaksono ◽  
Sofie Bosch ◽  
Edo Savelkoul ◽  
James A. Covington ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Ion Mobility ◽  
Clinical Symptoms ◽  
Area Under The Curve ◽  
Gluten Free ◽  
Future Studies ◽  
Non Invasive ◽  
Significant Difference ◽  
Volatile Organic ◽  
Refractory Coeliac Disease

Currently, the gold standard for diagnosis of coeliac disease (CD) is based on serology and gastroduodenoscopy with histology of duodenal mucosal biopsies. The aim of this study was to evaluate the potential of faecal volatile organic compounds (VOCs) analysis as a novel, non-invasive tool to discriminate between CD in remission in patients on a gluten-free diet (GFD), refractory coeliac disease (RCD) and controls without CD. Patients with an established diagnosis of CD on a GFD, RCD and healthy controls (HC) were instructed to collect a faecal sample. All subjects completed questionnaires on clinical symptoms, lifestyle and dietary information. Faecal VOCs were measured using gas chromatography-ion mobility spectrometry. A total of 13 CD, 7 RCD and 10 HC were included. A significant difference in VOC profiles between CD and RCD patients (area under the curve (AUC) ± 95% CI: 0.91 (0.79–1) p = 0.000) and between CD and HC (AUC ± 95% CI: 0.71 (0.51–0.91) p = 0.0254) was observed. We found no significant differences between faecal VOC patterns of HC and RCD. Based on faecal VOCs, CD could be discriminated from RCD and HC. This implies that faecal VOC analysis may hold potential as a novel non-invasive biomarker for RCD. Future studies should encompass a larger cohort to further investigate and validate this prior to application in clinical practice.

scholarly journals Correlation between Clinical Symptoms of Coeliac Disease, Serum IgA Anti TTG and Biopsy in Pediatric Population of Northern India

2020 ◽  
Vol 8 (1) ◽  
pp. 65-68
Author(s):  
Sumit Jeena ◽  
Jaswinder Kaur ◽  
Nishant Wadhwa
Keyword(s):  
Coeliac Disease ◽  
Clinical Symptoms ◽  
Tissue Transglutaminase ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
North India ◽  
P Value ◽  
Serum Iga ◽  
Significant Difference ◽  
The Mean

Background: Celiac disease is basically an immune-mediated enteropathic condition produced by permanent sensitivity to gluten in genetically susceptible subjects. There is paucity of data in north India regarding clinical symptoms of coeliac disease, Serum IgA Anti TTG and Biopsy in pediatric population. The present study was conducted with the aim to determine the correlation between clinical symptoms of coeliac disease, Serum IgA Anti TTG and Biopsy in pediatric population of northern India.Materials and Methods: The present study was conducted in prospective including 73 pediatric patients at Department of Pediatric Gastroenterology, Institute of Child Health, Sir Gangaram Hospital, New Delhi, India. Esophagogastroduodenoendoscopy and serum anti Ig A tissue transglutaminase were performed. The characteristic scalloping of the folds were looked for in endoscopy followed by four duodenal biopsies performed from second part of duodenum and histological grading was performed as per modified marsh system. Patients with Serum IgA anti tTG>20 U/ml were confirmed to be at risk. Complete histological work up was done including hemoglobin, RBC indices and peripheral blood smear examination. The association of clinical manifestations with disease grade was also established with correlation coefficient. All the data thus obtained was arranged in a tabulated form and analyzed using SPSS software. Probability value of less than 0.05 was regarded as significant.Results: There were 4 males and 16 females with marsh grade 1 and 2 and mean age of 7.3±1.9 years. There were 5 males and 8 females with marsh grade 3a and mean age of 6.8±2.3 years. The mean weight of 18.11±3.89, height of 103.17±8.73 and BMI of 16.26±3.78 was observed amongst subjects with Marsh grade 1 and 2. The mean weight of 15.12±3.17, height of 99.28±9.19 and BMI of 15.02±3.20was observed amongst subjects with Marsh grade 3a. Diarrhoea was maximum amongst subjects with grade 3c and 4(70%) and minimum amongst Grade 1 and 2 (40%). There was a significant difference between the frequency of anemia amongst different grades as the p value was less than 0.05.Conclusion: The most common presenting signs and symptoms were diarrhea and abdominal pain. The study also concluded that the incidence of anemia increases with higher marsh grades.

scholarly journals The Detection of Wound Infection by Ion Mobility Chemical Analysis

Biosensors ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 19 ◽  
Author(s):  
Emma Daulton ◽  
Alfian Wicaksono ◽  
Janak Bechar ◽  
James A. Covington ◽  
Joseph Hardwicke
Keyword(s):  
Donor Site ◽  
Area Under The Curve ◽  
Cost Effective ◽  
Wound Dressings ◽  
Control Group ◽  
Infected Wound ◽  
Non Invasive ◽  
Volatile Organic ◽  
Split Skin ◽  
Micro Organisms

Surgical site infection represents a large burden of care in the National Health Service. Current methods for diagnosis include a subjective clinical assessment and wound swab culture that may take several days to return a result. Both techniques are potentially unreliable and result in delays in using targeted antibiotics. Volatile organic compounds (VOCs) are produced by micro-organisms such as those present in an infected wound. This study describes the use of a device to differentiate VOCs produced by an infected wound vs. colonised wound. Malodourous wound dressings were collected from patients, these were a mix of post-operative wounds and vascular leg ulcers. Wound microbiology swabs were taken and antibiotics commenced as clinically appropriate. A control group of soiled, but not malodorous wound dressings were collected from patients who had a split skin graft (SSG) donor site. The analyser used was a G.A.S. GC-IMS. The results from the samples had a sensitivity of 100% and a specificity of 88%, with a positive predictive value of 90%. An area under the curve (AUC) of 91% demonstrates an excellent ability to discriminate those with an infected wound from those without. VOC detection using GC-IMS has the potential to serve as a diagnostic tool for the differentiation of infected and non-infected wounds and facilitate the treatment of wound infections that is cost effective, non-invasive, acceptable to patients, portable, and reliable.

Refractory coeliac disease a reality: views from Pakistan

2016 ◽  
Vol 47 (1) ◽  
pp. 51-53
Author(s):  
Rajesh M Mandhwani ◽  
Rajesh K Wadhwa ◽  
Syed Mudassir Laeeq ◽  
Nasir Hasan Luck ◽  
Mohammad Mubarak ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Villous Atrophy ◽  
Immunosuppressive Agents ◽  
Signs And Symptoms ◽  
Intraepithelial Lymphocytes ◽  
Response To Treatment ◽  
Gluten Free ◽  
Refractory Celiac Disease ◽  
Small Intestinal ◽  
Refractory Coeliac Disease

Refractory coeliac disease (RCD) is described as persistence or recurrence of signs and symptoms of malabsorption with small-intestinal villous atrophy despite being on a strict gluten-free diet (GFD) for more than 12 months. RCD is a diagnosis of exclusion. There are two types of RCD, based upon the immunohistochemical features (presence of intraepithelial lymphocytes), response to treatment and prognosis. The treatment of RCD includes GFD and immunosuppressive agents. We hereby present a case of refractory celiac disease type II in a young man who later went on to develop Addisonian crisis and did not survive.

scholarly journals Urinary Volatiles and Chemical Characterisation for the Non-Invasive Detection of Prostate and Bladder Cancers

Biosensors ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 437
Author(s):  
Heena Tyagi ◽  
Emma Daulton ◽  
Ayman S. Bannaga ◽  
Ramesh P. Arasaradnam ◽  
James A. Covington
Keyword(s):  
Gas Chromatography ◽  
Area Under The Curve ◽  
Disease Diagnosis ◽  
Research Area ◽  
Invasive Technique ◽  
Non Invasive ◽  
Flight Mass Spectrometry ◽  
Urinary Volatiles ◽  
Volatile Organic ◽  
Tof Ms

Bladder cancer (BCa) and prostate cancer (PCa) are some of the most common cancers in the world. In both BCa and PCa, the diagnosis is often confirmed with an invasive technique that carries a risk to the patient. Consequently, a non-invasive diagnostic approach would be medically desirable and beneficial to the patient. The use of volatile organic compounds (VOCs) for disease diagnosis, including cancer, is a promising research area that could support the diagnosis process. In this study, we investigated the urinary VOC profiles in BCa, PCa patients and non-cancerous controls by using gas chromatography-ion mobility spectrometry (GC-IMS) and gas chromatography time-of-flight mass spectrometry (GC-TOF-MS) to analyse patient samples. GC-IMS separated BCa from PCa (area under the curve: AUC: 0.97 (0.93–1.00)), BCa vs. non-cancerous (AUC: 0.95 (0.90–0.99)) and PCa vs. non-cancerous (AUC: 0.89 (0.83–0.94)) whereas GC-TOF-MS differentiated BCa from PCa (AUC: 0.84 (0.73–0.93)), BCa vs. non-cancerous (AUC: 0.81 (0.70–0.90)) and PCa vs. non-cancerous (AUC: 0.94 (0.90–0.97)). According to our study, a total of 34 biomarkers were found using GC-TOF-MS data, of which 13 VOCs were associated with BCa, seven were associated with PCa, and 14 VOCs were found in the comparison of BCa and PCa.

scholarly journals Vaginal microbiome as a tool for prediction of chorioamnionitis in preterm labor: a pilot study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daichi Urushiyama ◽  
Eriko Ohnishi ◽  
Wataru Suda ◽  
Masamitsu Kurakazu ◽  
Chihiro Kiyoshima ◽  
...  
Keyword(s):  
Preterm Labor ◽  
Developmental Disorders ◽  
Bacterial Species ◽  
Area Under The Curve ◽  
Vaginal Microbiota ◽  
Scoring Method ◽  
Future Studies ◽  
Α Diversity ◽  
Significant Difference ◽  
Risk Patients

AbstractIntra-amniotic infection (IAI) is a major cause of preterm birth with a poor perinatal prognosis. We aimed to determine whether analyzing vaginal microbiota can evaluate the risk of chorioamnionitis (CAM) in preterm labor cases. Vaginal discharge samples were collected from 83 pregnant women admitted for preterm labor. Based on Blanc’s classification, the participants were divided into CAM (stage ≥ II; n = 46) and non-CAM (stage ≤ I; n = 37) groups. The 16S rDNA amplicons (V1–V2) from vaginal samples were sequenced and analyzed. Using a random forest algorithm, the bacterial species associated with CAM were identified, and a predictive CAM (PCAM) scoring method was developed. The α diversity was significantly higher in the CAM than in the non-CAM group (P < 0.001). The area under the curve was 0.849 (95% confidence interval 0.765–0.934) using the PCAM score. Among patients at < 35 weeks of gestation, the PCAM group (n = 22) had a significantly shorter extended gestational period than the non-PCAM group (n = 25; P = 0.022). Multivariate analysis revealed a significant difference in the frequency of developmental disorders in 3-year-old infants (PCAM, 28%, non-PCAM, 4%; P = 0.022). Analyzing vaginal microbiota can evaluate the risk of IAI. Future studies should establish appropriate interventions for IAI high-risk patients to improve perinatal prognosis.

scholarly journals Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 216 ◽  
Author(s):  
Hugo A. Penny ◽  
Elisabeth M. R. Baggus ◽  
Anupam Rej ◽  
John A. Snowden ◽  
David S. Sanders
Keyword(s):  
Coeliac Disease ◽  
Systematic Approach ◽  
Intestinal Inflammation ◽  
Gluten Free ◽  
Comprehensive Review ◽  
National Centre ◽  
Alternative Condition ◽  
Small Intestinal ◽  
Symptoms And Signs ◽  
Refractory Coeliac Disease

Coeliac disease is a common small intestinal enteropathy which manifests following ingestion of gluten in genetically susceptible individuals. Since gluten was identified as the driving factor in coeliac disease, the gluten-free diet (GFD) has remained the mainstay of treatment. While most individuals will display improvement in symptoms and signs of coeliac disease following institution of the GFD, up to 30% will continue to experience symptoms and/or have persisting intestinal inflammation. These individuals can be classified as having non-responsive coeliac disease (NRCD), which may be associated with dietary indiscretion, slow healing, refractory coeliac disease, and/or an alternative condition. The purpose of this review is to provide an overview of the causes of NRCD in adults, highlight a systematic approach to investigate these patients, and appraise the latest management aspects of this subset of coeliac disease.

scholarly journals Clonal T cell receptor gene rearrangements in coeliac disease: implications for diagnosing refractory coeliac disease

2018 ◽  
Vol 71 (9) ◽  
pp. 825-831 ◽  
Author(s):  
Shafinaz Hussein ◽  
Tatyana Gindin ◽  
Stephen M Lagana ◽  
Carolina Arguelles-Grande ◽  
Suneeta Krishnareddy ◽  
...  
Keyword(s):  
T Cell ◽  
Coeliac Disease ◽  
T Cell Receptor ◽  
Rare Complication ◽  
Cell Receptor ◽  
High Morbidity ◽  
Gene Rearrangements ◽  
Pathological Feature ◽  
Significant Difference ◽  
Refractory Coeliac Disease

AimsRefractory coeliac disease type II (RCDII), a rare complication of coeliac disease (CD) associated with high morbidity, requires identification of a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs) for diagnosis. However, data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII are limited.MethodsWe analysed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active CD, 172 CD on gluten-free diet (GFD), 33 RCDI, and three RCDII patients and 14 patients without CD. TCR-GR patterns were divided into clonal, polyclonal and prominent clonal peaks (PCPs) and these patterns were correlated with clinical and pathological features.ResultsClonal TCR-GR products were detected in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with GFD. PCPs were observed in all disease phases (range 12%–33%). There was no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). A higher frequency of surface CD3(−) IELs was noted in cases with clonal TCR-GR, but the PCP pattern did not show associations with any clinical or pathological feature. Persistence of clonal or PCP pattern on repeat biopsy was seen for up to 2 years without evidence of RCDII.ConclusionsClonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.

scholarly journals Shorter telomere length is associated with a more recent diagnosis of coeliac disease

2018 ◽  
Author(s):  
Pierre Goorkiz ◽  
Nerissa L Hearn ◽  
Saskia van der Kooi ◽  
Christine L Chiu ◽  
Joanne M Lind
Keyword(s):  
Coeliac Disease ◽  
Telomere Length ◽  
Mucosal Damage ◽  
Gluten Free ◽  
Telomere Shortening ◽  
Relative Telomere Length ◽  
Significant Difference ◽  
Autoimmune Conditions ◽  
Recent Diagnosis ◽  
Inflammatory Immune Response

AbstractBackgroundCoeliac disease (CD) is an autoimmune disease that causes an inappropriate inflammatory immune response to dietary gluten. Telomere length is a marker of biological ageing and is reduced in several autoimmune conditions. This observational study measured salivary telomere length (TL) in gluten-free diet (GFD) treated CD individuals to determine if CD, and length of time on a GFD, is associated with salivary TL.MethodsClinical and demographic information was collected from CD individuals currently treated with a GFD and healthy non-affected controls. Only participants aged under 35 years at recruitment were included. Relative telomere length was measured using quantitative PCR in oral mucosa collected from saliva. Linear regression was used to determine whether salivary TL was associated with CD, or length of time on a GFD, adjusting for age and sex.ResultsThis study included 79 participants, 52 GFD-treated CD and 27 non-affected controls. No significant difference in salivary TL between individuals with treated CD and controls was found. Within CD individuals, salivary TL was associated with length of time on a GFD, with individuals who started a GFD ≤3 years ago having shorter salivary TL compared to those who started a GFD > 3 years ago (0.37±0.05 vs 0.50±0.04; p=0.002).ConclusionOur findings indicate that salivary TL shorten while CD is untreated, however following treatment on a GFD, they appear to recover to those seen in unaffected controls. This highlights the importance of early diagnosis and initiation of GFD to minimise mucosal damage and telomere shortening, to enable TL to recover.

scholarly journals Symposium 1: Joint BAPEN and British Society of Gastroenterology Symposium on ‘Coeliac disease: basics and controversies’ Coeliac disease: optimising the management of patients with persisting symptoms?

2009 ◽  
Vol 68 (3) ◽  
pp. 242-248 ◽  
Author(s):  
Kate E. Evans ◽  
David S. Sanders
Keyword(s):  
Coeliac Disease ◽  
Management Strategy ◽  
Villous Atrophy ◽  
Management Plan ◽  
Gluten Free Diet ◽  
British Society ◽  
Gluten Free ◽  
Review Of The Literature ◽  
Refractory Coeliac Disease ◽  
Investigation Strategy

The vast majority of patients with coeliac disease will derive benefit from a gluten-free diet. However, some patients will not improve on the gluten-free diet or they will have a relapse of their symptoms. The present review will focus on this group of patients. Definitions for non-responsive coeliac disease and refractory coeliac disease will be provided. The most common reason for recurrent symptoms is continued gluten exposure. Other causes of persisting symptoms are discussed, including alternative causes of villous atrophy or co-existent pathology. Current literature is reviewed, including an initial investigation strategy for patients with persisting symptoms. A pragmatic management plan is described that can be initiated by any clinician. Finally, the current optimal investigational pathway for patients with refractory (or suspected refractory) coeliac disease is discussed and the reported effects of a number of therapeutic options are summarised. The aim of the present article is to provide clinicians with an up-to-date review of the literature in this clinical field and allow them to determine the most appropriate management strategy.

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

1970 ◽  
Vol 38 (1) ◽  
pp. 11-25 ◽  
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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