Gluten-Induced Extra-Intestinal Manifestations in Potential Celiac Disease—Celiac Trait

Celiac disease patients may suffer from a number of extra-intestinal diseases related to long-term gluten ingestion. The diagnosis of celiac disease is based on the presence of a manifest small intestinal mucosal lesion. Individuals with a normal biopsy but an increased risk of developing celiac disease are referred to as potential celiac disease patients. However, these patients are not treated. This review highlights that patients with normal biopsies may suffer from the same extra-intestinal gluten-induced complications before the disease manifests at the intestinal level. We discuss diagnostic markers revealing true potential celiac disease. The evidence-based medical literature shows that these potential patients, who are “excluded” for celiac disease would in fact benefit from gluten-free diets. The question is why wait for an end-stage disease to occur when it can be prevented? We utilize research on dermatitis herpetiformis, which is a model disease in which a gluten-induced entity erupts in the skin irrespective of the state of the small intestinal mucosal morphology. Furthermore, gluten ataxia can be categorized as its own entity. The other extra-intestinal manifestations occurring in celiac disease are also found at the latent disease stage. Consequently, patients with celiac traits should be identified and treated.

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Nutritional Status in Spanish Adults with Celiac Disease Following a Long-Term Gluten-Free Diet Is Similar to Non-Celiac

Nutrients ◽

10.3390/nu13051626 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1626

Author(s):

Catalina Ballestero-Fernández ◽

Gregorio Varela-Moreiras ◽

Natalia Úbeda ◽

Elena Alonso-Aperte

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Celiac Disease ◽

Vitamin E ◽

Nutritional Status ◽

Bone Mineral ◽

Biochemical Parameters ◽

Gluten Free ◽

Mineral Density

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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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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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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Sa1993 Constitutional and Functional Small Intestinal Microbiome of Patients With Celiac Disease, First Degree Relatives and Effect of Gluten Free Diet on Them

Gastroenterology ◽

10.1016/s0016-5085(14)61262-2 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-349

Author(s):

Sudarshan A. Shetty ◽

Dhiraj P. Dhotre ◽

Khushboo Bhatia ◽

Anil K. Verma ◽

Asha Mishra ◽

...

Keyword(s):

Celiac Disease ◽

Gluten Free Diet ◽

Intestinal Microbiome ◽

Gluten Free ◽

First Degree Relatives ◽

Small Intestinal

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The patient with haematuria

10.1093/med/9780199592548.003.0046 ◽

2015 ◽

Author(s):

John Neary ◽

Neil Turner

Keyword(s):

Renal Disease ◽

Acute Inflammation ◽

Kidney Diseases ◽

Urinary Tract Obstruction ◽

Screening Tests ◽

Cystic Kidney ◽

Increased Risk ◽

End Stage ◽

Cystic Kidney Diseases

Haematuria is a common presenting feature of diseases of the kidney or the renal tract. It is also common in screening tests, single dipstick tests being positive in perhaps 5% of individuals. Age and whether the blood is visible (macroscopic) or non-visible (microscopic) impact largely on whether the explanation is likely to be broadly urological or nephrological. Origins are most commonly simple or urological. Macroscopic bleeding is rare in renal disease, and urine colour is then usually more rather smoky than red except when there is very acute inflammation. The chief urological causes are neoplasia, infection, stones, and trauma. Some traditionally medical conditions may cause simple bleeding; examples include cystic kidney diseases, papillary necrosis and macro- or microvascular ischaemic lesions. The major concern to nephrologists is that even non-visible haematuria may be a pointer to inflammatory or destructive glomerular processes. The presence of casts or dysmorphic red cells is a pointer to glomerular disease; more important in clinical practice are the three other key markers of renal disease: proteinuria, renal impairment in the absence of urinary tract obstruction, and hypertension. In the general population, microscopic haematuria does associate with a long-term increased risk of end-stage renal failure, so after negative investigations, occasional long-term checks are indicated. The case for population screening for haematuria appears weak.

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Fluctuations in plasma potassium in patients on dialysis

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz209 ◽

2019 ◽

Vol 34 (Supplement_3) ◽

pp. iii19-iii25

Author(s):

Csaba P Kovesdy

Keyword(s):

Potassium Concentration ◽

Plasma Potassium ◽

Total Body Potassium ◽

Potassium Balance ◽

Increased Risk ◽

Total Body ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

Abstract Plasma potassium concentration is maintained in a narrow range to avoid deleterious electrophysiologic consequences of both abnormally low and high levels. This is achieved by redundant physiologic mechanisms, with the kidneys playing a central role in maintaining both short-term plasma potassium stability and long-term total body potassium balance. In patients with end-stage renal disease, the lack of kidney function reduces the body’s ability to maintain normal physiologic potassium balance. Routine thrice-weekly dialysis therapy achieves long-term total body potassium mass balance, but the intermittent nature of dialytic therapy can result in wide fluctuations in plasma potassium concentration and consequently contribute to an increased risk of arrhythmogenicity. Various dialytic and nondialytic interventions can reduce the magnitude of these fluctuations, but the impact of such interventions on clinical outcomes remains unclear.

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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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Hematologic manifestations of celiac disease

Blood ◽

10.1182/blood-2006-07-031104 ◽

2006 ◽

Vol 109 (2) ◽

pp. 412-421 ◽

Cited By ~ 190

Author(s):

Thorvardur R. Halfdanarson ◽

Mark R. Litzow ◽

Joseph A. Murray

Keyword(s):

Celiac Disease ◽

T Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Iga Deficiency ◽

Gluten Free ◽

Strict Adherence ◽

Increased Risk ◽

Systemic Disorder ◽

Iron Folic Acid

AbstractCeliac disease is a common systemic disorder that can have multiple hematologic manifestations. Patients with celiac disease may present to hematologists for evaluation of various hematologic problems prior to receiving a diagnosis of celiac disease. Anemia secondary to malabsorption of iron, folic acid, and/or vitamin B12 is a common complication of celiac disease and many patients have anemia at the time of diagnosis. Celiac disease may also be associated with thrombocytosis, thrombocytopenia, leukopenia, venous thromboembolism, hyposplenism, and IgA deficiency. Patients with celiac disease are at increased risk of being diagnosed with lymphoma, especially of the T-cell type. The risk is highest for enteropathy-type T-cell lymphoma (ETL) and B-cell lymphoma of the gut, but extraintestinal lymphomas can also be seen. ETL is an aggressive disease with poor prognosis, but strict adherence to a gluten-free diet may prevent its occurrence.

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