Celiac Disease Prevalence Among Children with Dermatologic Pathology: Cross Sectional Study with Clinical Case Series

Background. Celiac disease (gluten enteropathy) is relatively rare disease. However, such patients have higher risk of skin pathology than general the population, and their therapy efficacy is limited by the use of gluten-free diet. Therefore, screening of dermatologic patients on celiac disease may be relevant. Objective. Our aim was to study the prevalence of celiac disease among children with skin pathology. Methods. The study included children hospitalized in dermatology department. Screening for celiac disease included detection in blood serum of antibodies (IgA, IgG, IgM) to tissue transglutaminase via rapid tests. In case of positive result of rapid test, we have repeated the estimation of antibodies (IgA, IgG) to tissue transglutaminase via immunochemiluminescent method with ImmunoCAP technology or via enzyme immunoassay. In case of positive serological test, we have performed HLA typing to determine haplotypes of DQ2 and DQ8, as well as esophagogastroduodenojejunoscopy (EGDJS) with biopsy of the duodenal and jejunal mucosa for further histological verification of the diagnosis. Results. We examined 1,000 children with various dermatologic pathologies. Rapid tests showed positive result in 21 patients (2.1%; 95% C11.3-3.2%). The presence of antibodies to tissue transglutaminase was confirmed via additional serological examination in all cases. HLA-haplotypes DQ2/8 were revealed in all patients with positive rapid test results. Typical form of gluten enteropathy was confirmed in 18/21 patients (86%) according to a histological study, thus, estimated prevalence of celiac disease is 1.8% (95% C11.1-2.8%). Conclusion. The prevalence of celiac disease remains underestimated among children with skin diseases. More studies are needed on the diagnostic features of rapid tests on tissue transglutaminase, as well as the benefits of screening for celiac disease to achieve patient-relevant clinical outcomes of skin pathology with wider gluten-free diet.

Effective Degradation of Gluten and Its Fragments by Gluten-Specific Peptidases: A Review on Application for the Treatment of Patients with Gluten Sensitivity

To date, there is no effective treatment for celiac disease (CD, gluten enteropathy), an autoimmune disease caused by gluten-containing food. Celiac patients are supported by a strict gluten-free diet (GFD). However, in some cases GFD does not negate gluten-induced symptoms. Many patients with CD, despite following such a diet, retain symptoms of active disease due to high sensitivity even to traces of gluten. In addition, strict adherence to GFD reduces the quality of life of patients, as often it is difficult to maintain in a professional or social environment. Various pharmacological treatments are being developed to complement GFD. One promising treatment is enzyme therapy, involving the intake of peptidases with food to digest immunogenic gluten peptides that are resistant to hydrolysis due to a high prevalence of proline and glutamine amino acids. This narrative review considers the features of the main proline/glutamine-rich proteins of cereals and the conditions that cause the symptoms of CD. In addition, we evaluate information about peptidases from various sources that can effectively break down these proteins and their immunogenic peptides, and analyze data on their activity and preliminary clinical trials. Thus far, the data suggest that enzyme therapy alone is not sufficient for the treatment of CD but can be used as a pharmacological supplement to GFD.

Microbial Transglutaminase Is a Very Frequently Used Food Additive and Is a Potential Inducer of Autoimmune/Neurodegenerative Diseases

Microbial transglutaminase (mTG) is a heavily used food additive and its industrial transamidated complexes usage is rising rapidly. It was classified as a processing aid and was granted the GRAS (generally recognized as safe) definition, thus escaping full and thorough toxic and safety evaluations. Despite the manufacturers claims, mTG or its cross-linked compounds are immunogenic, pathogenic, proinflammatory, allergenic and toxic, and pose a risk to public health. The enzyme is a member of the transglutaminase family and imitates the posttranslational modification of gluten, by the tissue transglutaminase, which is the autoantigen of celiac disease. The deamidated and transamidated gliadin peptides lose their tolerance and induce the gluten enteropathy. Microbial transglutaminase and its complexes increase intestinal permeability, suppresses enteric protective pathways, enhances microbial growth and gliadin peptide’s epithelial uptake and can transcytose intra-enterocytically to face the sub-epithelial immune cells. The present review updates on the potentially detrimental side effects of mTG, aiming to interest the scientific community, induce food regulatory authorities’ debates on its safety, and protect the public from the mTG unwanted effects.

The Place of Histochemical Stains for Differential Diagnosis in Duodenal Biopsies

The biopsy is the primary examination method in diagnosing duodenal pathologies and Gluten enteropathy that can cause symptoms such as gas, diarrhea, weight loss, anemia, osteoporosis. Allows monitoring of response to therapy. Histochemical studies are inevitable in specific findings such as reactive changes, giardia, subepithelial collagen thickening, fibrosis, and gastric metaplasia. We aimed to understand the contribution of histochemical applications to differential diagnosis and to show their superiority compared to hematoxylin-eosin sections in routine use by simultaneously making histomorphological evaluations on hematoxylin and eosin sections. This research is a retrospective study conducted in 2011, using the archives of Yüzüncü Yıl University, Faculty of Medicine, Department of Pathology, between 2001-2010. Ten normal, 50 Gluten enteropathy and 50 duodenitis samples; Along with histopathological examinations, we applied Masson Trichrome, Periodic acid-Schiff, Periodic acid-Schiff with diastasis, Periodic acid Schiff-Alcian Blue, High Iron Diamine-Alcian Blue. Chi-square, likelihood ratio tests, and SPSS (ver: 13) statistical package program used. We detected microscopic findings parallel to diagnostic criteria. While the number of goblet cells and intraepithelial neutrophils did not differ in the groups (P =0.176 and P=0.096), there was a significant variation in the intraepithelial lymphocyte count (P=0.010). The frequency of flattening and blunting of the villi, crypt hyperplasia, and Brunner gland hyperplasia were significant in gluten enteropathies (P=0.000). Conclusion We could not find any difference in specific pathologies associated with histochemical studies in our group, so hematoxylin-eosin sections are more valuable in the differential diagnosis.

Cereal products: beneficial properties and intolerance

The article discusses the composition and useful properties of grain products. Special attention is paid to the issues of intolerance to certain types of cereals, associated with the content of gluten in them, which leads to the development of such a disease as celiac disease. Aspects of the prevalence, etiopathogenesis, and clinical course of celiac disease are presented. Special emphasis is placed on the principles of nutrition in gluten enteropathy, products that explicitly and covertly contain gluten are presented. The composition of the gluten‑free diet is justified. A set of products recommended and not recommended for inclusion in the gluten‑free diet, as well as approximate options for its menu, is provided. The issues of prevention of celiac disease, the use of mixtures for enteral nutrition and specialized gluten‑free products are discussed.

The need for a multidisciplinary approach to the diagnosis and treatment procedures of isolated lesions of the oral mucosa in herpetiform Dühring dermatitis

The defeat of the oral mucosa in herpetiform Dhring dermatitis is a rare pathology. According to the literature, it is detected in 9.6% 10% of cases. Granular deposits of immunoglobulin A in the papillae of the dermis in herpetiform Dhring dermatitis are associated with gluten enteropathy, lead to the development of inflammatory processes on the skin and oral mucosa and the appearance of polymorphic itchy rashes and chronic recurrent course of the disease. The article describes a clinical case of a patient diagnosed with herpetiform dermatitis, manifestations in the oral cavity (ICD-10 L13.0X code). The need for a multidisciplinary approach to the diagnosis, differential diagnosis, treatment and dynamic observation of isolated lesions of the oral mucosa in herpetiform Dhring dermatitis is indicated. A scheme of measures required by a dentist is developed.

ENDOCRINOLOGICAL INTERRELATED DISEASES: CELIAC DISEASE AND DIABETES MELLITUS

The results of the analytical review of scientific material presented in the article are devoted to the problem of intolerance of wheat protein gliadin in people with a predisposition to this food Allergy, as well as materials related to modern means against diabetes, based on the study of the endocrine system. The DPP-4 enzyme (dipeptidylpeptidase 4), which breaks down gluten protein in the human body, and the consequences of deficiency and excessive production of this enzyme in the form of chronic diseases (celiac disease and type II diabetes), were considered as one of the probable causes that combine these diseases. During the evaluation of the scientific material, the principle of determinism was applied to DPP-4, since this enzyme is the only one specifically interacting in the small intestine with gliadin and casein, and violations of the production and activity of this enzyme cause the appearance of gluten enteropathy. The review also presents data from foreign and Russian sources on the means for controlling diabetes based on substances that suppress the production of the enzyme DPP-4, hypersynthesis of which suppresses the production of insulin, which is one of the endocrinological causes of diabetes. Based on the studied data, it can be argued that the most positive and progressive solution to the problem of both chronic diseases is the method proposed by Japanese scientists, based on a special treatment of ginger root protease a, since, having the ability to break down gluten, this drug also leads to the suppression of dipeptidylpeptidase 4, while being a relatively affordable drug.

Features of the development of diets for preschool children in celiac patients

The article presents the results of a study on the development of diets for feeding children with food polyvalent allergy, incl. and gluten at the age of 3–7 years for feeding children in pre-school educational organizations. Food allergies to gluten or gluten enteropathy (celiac disease) is a chronic human disease in which eating food from wheat, rye, and barley grain causes a wide range of pathological changes in the body: damage to the small intestine mucosa, a sharp deterioration in the digestion and absorption of nutrients. The developed 10 day menu, corresponding to the principles of the child's nutritional needs (physiological norms of consumption), distribution of nutrition during the day, the child's need for food. The data of caloric distribution of the diet for individual meals are presented. The evaluation of the nutrition balance of children was carried out on the basis of the SanPiN guidelines 2.4.1.3049-13. Satisfaction of diurnal physiological norms of consumption on the main macronutrients, vitamins, minerals and energy value of the diet on the basis of the analysis of menu-layouts is considered. It is shown that measures to form healthy food habits in preschool children as part of a healthy lifestyle should be systemic, ensuring continuity and continuity of this process, as well as taking into account the age and individual characteristics of children. Since the gluten-free diet is a health preventive for people with celiac compliance, it needs a long time.