The Skin in Celiac Disease Patients: The Other Side of the Coin

Celiac disease (CD) is an autoimmune enteropathy that primarily affects the small intestine and is characterized by atrophy of intestinal villi. The manifestations of the disease improve following a gluten-free diet (GFD). CD is associated with various extra-intestinal diseases. Several skin manifestations are described in CD patients. The present paper reviews all CD-associated skin diseases reported in the literature and tries to analyze the pathogenic mechanisms possibly involved in these associations. Different hypotheses have been proposed to explain the possible mechanisms involved in every association between CD and cutaneous manifestations. An abnormal small intestinal permeability seems to be implicated in various dermatological manifestations. However, most of the associations between CD and cutaneous diseases is based on case reports and case series and a few controlled studies. To better assess the real involvement of the cutaneous district in CD patients, large multicentric controlled clinical trials are required.

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Cutaneous and Mucosal Manifestations Associated to Celiac Disease

10.20944/preprints201805.0158.v1 ◽

2018 ◽

Author(s):

Luis Rodrigo ◽

Valia-Patricia Beteta ◽

Nuria Álvarez ◽

Celia Gómez de Castro ◽

Álvaro de Dios ◽

...

Keyword(s):

Celiac Disease ◽

Skin Diseases ◽

Dermatitis Herpetiformis ◽

Wide Spectrum ◽

Gastrointestinal Symptoms ◽

The Other ◽

Gluten Free ◽

Cutaneous Manifestations ◽

Immune Mediated ◽

Associated Conditions

Celiac disease (CD) is an immune-mediated gluten-induced enteropathy that affects predisposed individuals of all ages. Many patients with CD do not report gastrointestinal symptoms making it difficult to reach an early diagnosis. On the other hand, CD is related to a wide spectrum of extra-intestinal manifestations, being dermatitis herpetiformis (DH) the best characterized. These associated conditions may be the clue for reaching the diagnosis of CD. Over the last years, there have been multiple reports of the association between CD and several cutaneous manifestations that may improve with a gluten-free diet (GFD). The presence of some of these skin diseases, even in absence of gastrointestinal symptoms, should give rise to an appropriate screening for CD. The aim of this paper is to describe the different cutaneous manifestations that have been associated to CD and the possible mechanisms involved.

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Truths, Myths and Needs of Special Diets: Attention-Deficit/Hyperactivity Disorder, Autism, Non-Celiac Gluten Sensitivity, and Vegetarianism

Annals of Nutrition and Metabolism ◽

10.1159/000445393 ◽

2016 ◽

Vol 68 (Suppl. 1) ◽

pp. 42-50 ◽

Cited By ~ 9

Author(s):

Sylvia Cruchet ◽

Yalda Lucero ◽

Verónica Cornejo

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Clinical Trials ◽

Celiac Disease ◽

Attention Deficit ◽

The Other ◽

Clinical Spectrum ◽

Gluten Sensitivity ◽

Gluten Free ◽

Hyperactivity Disorder ◽

Special Diets

Different dietary approaches have been attempted for the treatment of attention-deficit/hyperactivity disorder and autism, but only three of them have been subjected to clinical trials: education in healthy nutritional habits, supplementation and elimination diets. On the other hand, for multiple reasons, the number of people who adopt vegetarian and gluten-free diets (GFD) increases daily. More recently, a new entity, non-celiac gluten sensitivity (NCGS), with a still evolving definition and clinical spectrum, has been described. Although, the benefits of GFD are clearly supported in this condition as well as in celiac disease, in the last two decades, GFD has expanded to a wider population. In this review, we will attempt to clarify, according to the existing evidence, which are the myths and facts of these diets.

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Vitamin C in the Treatment of COVID-19

Nutrients ◽

10.3390/nu13041172 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1172

Author(s):

Gregorio Paolo Milani ◽

Marina Macchi ◽

Anat Guz-Mark

Keyword(s):

Clinical Trials ◽

Vitamin C ◽

Respiratory Infections ◽

Medical Condition ◽

Case Reports ◽

Case Series ◽

Theoretical Background ◽

Current Evidence ◽

Vitamin C Supplementation ◽

Essential Nutrient

Vitamin C is an essential nutrient that serves as antioxidant and plays a major role as co-factor and modulator of various pathways of the immune system. Its therapeutic effect during infections has been a matter of debate, with conflicting results in studies of respiratory infections and in critically ill patients. This comprehensive review aimed to summarize the current evidence regarding the use of vitamin C in the prevention or treatment of patients with SARS-CoV2 infection, based on available publications between January 2020 and February 2021. Overall, 21 publications were included in this review, consisting of case-reports and case-series, observational studies, and some clinical trials. In many of the publications, data were incomplete, and in most clinical trials the results are still pending. No studies regarding prevention of COVID-19 with vitamin C supplementation were found. Although some clinical observations reported improved medical condition of patients with COVID-19 treated with vitamin C, available data from controlled studies are scarce and inconclusive. Based on the theoretical background presented in this article, and some preliminary encouraging studies, the role of vitamin C in the treatment of patients with SARS-CoV-2 infection should be further investigated.

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Collagenous Sprue: A Rare, Severe Small-Bowel Malabsorptive Disorder

Archives of Pathology & Laboratory Medicine ◽

10.5858/2010-0028-rs.1 ◽

2011 ◽

Vol 135 (6) ◽

pp. 803-809

Author(s):

Xiangrong Zhao ◽

Rebecca L. Johnson

Keyword(s):

Celiac Disease ◽

Medical Literature ◽

Case Reports ◽

Disease Entity ◽

Review Of The Literature ◽

Molecular Features ◽

Refractory Sprue ◽

Exact Etiology ◽

Sporadic Cases ◽

Small Intestinal

Abstract Collagenous sprue is a severe malabsorptive disorder, histologically characterized by small intestinal villous and crypt atrophy, and a subepithelial collagen deposit, thicker than 12 µm, that entraps lamina propria cellular elements. Collagenous sprue is a rare disease entity, with only about 60 sporadic cases reported worldwide since it was first described in 1947. Its exact etiology is still under investigation, and its relationship with classic celiac disease and other refractory, spruelike intestinal disorders remains controversial. Two larger-scale studies, in 2009, brought new insights into this elusive, yet emerging, topic. Here, we present a review of the literature on the possible etiology of collagenous sprue, its proposed links to classic celiac disease and to refractory sprue, and its clinical, biochemical, histologic, and molecular features. To our knowledge, all case reports on collagenous sprue in the medical literature to date are summarized.

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Anticoagulation with Warfarin in Infants and Children

Annals of Pharmacotherapy ◽

10.1177/106002809603001117 ◽

1996 ◽

Vol 30 (11) ◽

pp. 1316-1322 ◽

Cited By ~ 15

Author(s):

Marcia L Buck

Keyword(s):

Clinical Trials ◽

Adverse Effects ◽

Case Reports ◽

Initial Dosage ◽

Case Series ◽

Infants And Children ◽

Target Range ◽

Search Term ◽

Cardiac Valves ◽

In Infants And Children

OBJECTIVE: TO provide a comprehensive review of warfarin use in infants and children, including recommendations for appropriate dosage and monitoring parameters. DATA SOURCES: A MEDLINE search (1966-1995) was used to identify pertinent English-language articles in the medical literature. The key search term was warfarin. Additional material was obtained from references cited in articles retrieved through MEDLINE. STUDY SELECTION: All articles involving children younger than 18 years were evaluated. In addition, articles on the pharmacokinetics and pharmacodynamics in adults, adverse effects, and drug interactions were included. DATA EXTRACTION: Material selected for review included clinical trials, case reports, and surveys of practice. DATA SYNTHESIS: Warfarin has been used as prophylactic therapy in children with prosthetic cardiac valves as well as for prevention of thromboembolic complications associated with autoimmune disorders and protein C or protein S deficiency. Warfarin also has been used to prevent embolization in children with deep-vein thrombosis or clots in central venous catheters. According to the literature, an initial dosage of 0.1 mg/kg/d should provide anticoagulation without significant adverse effects. As in adults, dosing should be adjusted to achieve a target international normalized ratio (INR). Although the target range in children is not well established, INR values of 1.5–3 are recommended for most patients. Higher values have been used in children with prosthetic cardiac valves and hereditary clotting disorders. CONCLUSIONS: Due to its infrequent use, there is limited information on the effects of warfarin in children. Basic guidelines for initiating and monitoring warfarin were developed by using data gathered from clinical trials, retrospective reviews, case series, and surveys of practice.

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Molecular Biomarkers for Celiac Disease: Past, Present and Future

International Journal of Molecular Sciences ◽

10.3390/ijms21228528 ◽

2020 ◽

Vol 21 (22) ◽

pp. 8528

Author(s):

Aarón D. Ramírez-Sánchez ◽

Ineke L. Tan ◽

B.C. Gonera-de Jong ◽

Marijn C. Visschedijk ◽

Iris Jonkers ◽

...

Keyword(s):

Small Intestine ◽

Celiac Disease ◽

Early Stage ◽

Villous Atrophy ◽

Upper Endoscopy ◽

Gluten Free ◽

Non Invasive ◽

Immune Mediated ◽

Gastrointestinal Complaints ◽

Small Intestinal

Celiac disease (CeD) is a complex immune-mediated disorder that is triggered by dietary gluten in genetically predisposed individuals. CeD is characterized by inflammation and villous atrophy of the small intestine, which can lead to gastrointestinal complaints, malnutrition, and malignancies. Currently, diagnosis of CeD relies on serology (antibodies against transglutaminase and endomysium) and small-intestinal biopsies. Since small-intestinal biopsies require invasive upper-endoscopy, and serology cannot predict CeD in an early stage or be used for monitoring disease after initiation of a gluten-free diet, the search for non-invasive biomarkers is ongoing. Here, we summarize current and up-and-coming non-invasive biomarkers that may be able to predict, diagnose, and monitor the progression of CeD. We further discuss how current and emerging techniques, such as (single-cell) transcriptomics and genomics, can be used to uncover the pathophysiology of CeD and identify non-invasive biomarkers.

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Improved clinical symptoms and mortality among patients with severe or critical COVID-19 after convalescent plasma transfusion

Blood ◽

10.1182/blood.2020007079 ◽

2020 ◽

Vol 136 (6) ◽

pp. 755-759 ◽

Cited By ~ 22

Author(s):

Xinyi Xia ◽

Kening Li ◽

Lingxiang Wu ◽

Zhihua Wang ◽

Mengyan Zhu ◽

...

Keyword(s):

Clinical Trials ◽

Clinical Benefit ◽

Clinical Symptoms ◽

Case Series ◽

Plasma Transfusion ◽

Controlled Clinical Trials ◽

Early Administration ◽

The Impact

Two case series examining the impact of convalescent plasma on patients with COVID-19 suggest some clinical benefit from early administration and modest impact on parameters of inflammation. Further assessment of the impact of this intervention awaits controlled clinical trials.

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A109 CELIAC DISEASE IS A RARE CAUSE OF BENIGN DUODENAL STRICTURE

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.108 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 126-127

Author(s):

I Balubaid ◽

N Khanna

Keyword(s):

Weight Loss ◽

Celiac Disease ◽

Case Reports ◽

Balloon Dilation ◽

Gluten Free Diet ◽

Gluten Free ◽

Early Satiety ◽

Ulcer Disease ◽

Duodenal Stricture ◽

H Pylori

Abstract Background Benign duodenal stricture is an uncommon problem encountered by gastroenterologists. The most common cause is peptic ulcer disease (PUD). With the diagnosis and eradication of H. Pylori, early diagnosis of PUD and the use of PPIs to treat upper gastrointestinal inflammation, the incidence of benign duodenal stricture has dramatically decreased. Patients with duodenal stricture may present with early satiety, nausea, vomiting and weight loss. We present the case of a man with a refractory web-like stricture in the second part of the duodenum (D2) caused by Celiac disease. Aims To describe a rare endoscopic finding in a patient with Celiac disease Methods Case report with literature review Results We present a case of a 64 year old male was referred for consideration of duodenal stenting of a refractory stricture in the second part of the duodenum D2. The patient had a 1 year history of abdominal pain, early satiety and weight loss (10 lbs). He also reported intermittent episodes of diarrhea. Investigations included a CT scan of the abdomen which showed a stricture at the level of proximal D2 described as a “duodenal band”. Previous attempts at balloon dilation had not resulted in prolonged symptomatic or endoscopic improvement. Testing for H. Pylori was negative and he did not use NSAIDs. Upper endoscopy was performed to assess the stricture prior to consideration of stenting. This showed a tight web-like stricture in proximal D2. The stricture was balloon dilated up to 16.5 mm, enabling the endoscope to pass beyond it. The mucosa in D2 was atrophic with flattening of the folds and scalloping. There was no inflammation seen. Biopsies from D2 revealed moderate villous blunting and intraepithelial lymphocytosis. Celiac serology testing was abnormal, with an anti-tTG Ab level of 32 RU/ml which confirmed the diagnosis of Celiac disease. The balloon dilation and gluten-free diet resulted in resolution of his symptoms. Follow up endoscopy revealed normalization of his duodenal folds and biopsies. In addition, anti-tTG Ab level was normalized. Although stricture improved with prolonged patency, he still has mild recurrence of his stricture requiring balloon dilation on an annual basis. Conclusions This case describes a very uncommon complication of Celiac disease. The likely pathophysiology involves inflammation and potentially ulceration from Celiac disease, resulting in a benign stricture. There have been a few case reports describing duodenal strictures as a complication of Celiac disease. Treatment involves a gluten-free diet and endoscopic therapy. More severe cases of obstruction would likely require surgical intervention. In our case, the gluten-free diet and balloon dilation were successful and duodenal stenting was not necessary. Given the possibility of Celiac disease as a cause of duodenal stricture, it would be reasonable to biopsy D2 and check anti-tTG Ab in cases of duodenal stricture. Funding Agencies None

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Irritable Bowel Syndrome and Gluten-Related Disorders

Nutrients ◽

10.3390/nu12041117 ◽

2020 ◽

Vol 12 (4) ◽

pp. 1117 ◽

Cited By ~ 3

Author(s):

Paolo Usai-Satta ◽

Gabrio Bassotti ◽

Massimo Bellini ◽

Francesco Oppia ◽

Mariantonia Lai ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Celiac Disease ◽

The Other ◽

Gluten Free Diet ◽

Gluten Free ◽

Gut Permeability ◽

Online Search ◽

Systematic Screening ◽

Wheat Sensitivity ◽

Irritable Bowel

Background: Irritable bowel syndrome (IBS) is frequently associated with celiac disease (CD) and nonceliac gluten/wheat sensitivity (NCGS/NCWS), but epidemiological and pathophysiological aspects are still unclear. Furthermore, a gluten-free diet (GFD) can positively influence IBS symptoms. Methods: A comprehensive online search for IBS related to CD, NCGS and GFD was made using the Pubmed, Medline and Cochrane databases. Results: Although a systematic screening for CD in IBS is not recommended, CD prevalence can be increased in diarrhea-predominant IBS patients. On the other hand, IBS symptoms can be persistent in treated CD patients, and their prevalence tends to decrease on a GFD. IBS symptoms may overlap and be similar to those associated to nonceliac gluten and/or wheat sensitivity. Increased gut permeability could explain the gluten/wheat effects in IBS patients. Finally, a GFD could improve symptoms in a subgroup of IBS patients. Conclusions: The possible interplay between IBS and gluten-related disorders represents a scientifically and clinically challenging issue. Further studies are needed to confirm these data and better clarify the involved pathophysiological mechanisms.

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