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    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Scott Adams
    Eur J Gastroenterol Hepatol 2000;12:645-648.
    Celiac.com 08/13/2000 - According to Drs. Simon D. Johnston and R.G. Peter Watson from Royal Victoria Hospital in Belfast, Northern Ireland, UK, the incidence of undiagnosed celiac disease is higher among those with small bowel lymphoma, as reported in the June issue of the European Journal of Gastroenterology and Hepatology. According to the researchers: It is not clear whether the increased risk of small bowel lymphoma seen in typical celiac disease also applies to unrecognized or screening-detected celiac patients. To find an answer, they retrospectively identified 69 cases of small-bowel adenocarcinoma and 69 cases of small-bowel lymphoma from five pathology laboratories in Northern Ireland.
    From a group composed of one patient with known celiac disease, and 12 with previously unrecognized celiac disease, the clinical presentation of adenocarcinoma and lymphoma patients was similar, but perforation was much more common among lymphoma patients. Further, 13 of the lymphoma patients, but none of the adenocarcinoma patients, had villous atrophy at a distant site, all of which were enteropathy-associated T-cell lymphomas. According to the researchers: Comparing the small-bowel lymphoma group to our random sample of the general Northern Ireland population as controls, the odds ratio of 15.72 for unrecognized celiac disease in the small-bowel lymphoma group, clearly indicates that there is an increased risk of unrecognized celiac disease among small-bowel lymphoma patients. Additionally, (s)ince a protective role for a strict gluten-free diet has been demonstrated, it follows that every effort should be made to diagnose celiac disease at every opportunity and raises the issue of whether population screening for celiac disease should be carried out.

    Scott Adams
    Gut 2005;54:54-59. Celiac.com 01/20/2005 - A link between untreated celiac disease and a rare enteropathy-type T-cell lymphoma (ETTL) has been well established by several studies. According to Dr. Karin Ekstrom Smedby of the Karolinska Institute in Stockholm and colleagues, there is also an increase in the prevalence of other types of lymphomas in those with celiac disease, such as B cell and non-intestinal lymphomas. In their study the researchers reviewed and reclassified 56 cases of malignant lymphomas that occurred in 11,650 hospitalized celiac disease patients in Sweden. The observed numbers of lymphoma subtypes were compared with those expected in the Swedish population. The researchers discovered that a majority of the lymphomas were not intestinal T-cell lymphomas, but were B-cell non-Hodgkin lymphoma (NHL). In addition, 44% of the patients with B cell NHL had a history of other autoimmune/inflammatory diseases. As expected, the relative risks for T-cell NHL and primary gastrointestinal lymphomas were markedly increased. According to the researchers: "Most lymphomas complicating coeliac disease are indeed related to the disease and are not of the ETTL-type. There was a remarkable aggregation of autoimmune/inflammatory disorders, female sex, coeliac disease, and B cell lymphoma."

    Jefferson Adams
    Celiac.com 01/20/2009 - Refractory celiac disease is a serious condition that occurs when celiac symptoms and intestinal damage continue even when the patient consumes a gluten-free diet.
    There are two types of refractory celiac disease (RCD). In RCD type I,  immuno-phenotype of intraepithelial lymphocytes (IELs) are normal and polyclonal, while RCD) type II, is noted for the presence of an abnormal intraepithelial lymphocyte (IEL) population (CD7+ CD3− CD4/8-cytoplasmic CD3+). More than half of people with this condition develop enteropathy-associated T-cell lymphoma (EATL), a rare but virulent form of cancer with high mortality rates.
    A team of doctors recently set out to examine the relationship between lymphoma development and intraepithelial gamma/delta T-lymphocytes in the small intestine of patients with all types of celiac disease, as compared to the general population.
    The team was made up of Wieke H.M. Verbeek, M.D., B. Mary E. von Blomberg, Ph.D., Petra E.T. Scholten, B.Sc., D. Joop Kuik, M.Sc., Chris J.J. Mulder, M.D. Ph.D., and Marco W.J. Schreurs, Ph.D., all from Amsterdam’s VU University Medical Center.
    A certain type of IELs called TCRγ/δ+ IELs may play an important role in repairing mucosa, maintaining homeostasis, and guarding against tumor development. TCRγ/δ+ IELs in the human intestine have recently shown promise in the regulation of uncomplicated celiac disease.
    In the study, the research team wanted to see if patients with RCD II had fewer TCRγ/δ+ IELs than either RDC I, or celiac disease, an thus provide a possible explanation for ongoing mucosal damage and inflammation, and the development of abnormal T cells that tend to morph into EATL.
    The team used a method called multi-parameter flow cytometric immuno-phenotyping on IELs obtained from recent small bowel biopsy specimens from a fairly large, distinct celiac disease and control groups (N = 87).
    Patients with RCD II showed a much lower ratio of TCRγ δ+ IELs compared to either RCD I or celiac disease patients. Whereas, patients with uncomplicated celiac disease showed significantly higher numbers of TCRγ δ+ IELs than were found in the control group. The results showed the relationship between TCRγ δ+ IELs and aberrant IELs to be negative. It is interesting to note that TCRγ δ+ IELs numbers do rise in RCD II patients after effective treatment.
    The negative relationship between TCRγ δ+ and abnormal IELs, together with their known role in regulating uncomplicated celiac disease, suggests that TCRγ δ+ IELs may play a crucial role in helping the body to repair mucosa, maintain homeostasis and possibly even guard against tumor development.
    These cells may serve as important markers, along with the abnormal T cells, to help distinguish between types of celiac disease, and to gage the effectiveness of treatment efforts.
    Am J Gastroenterol 2008;103:3152–3158


    Jefferson Adams
    Celiac.com 12/29/2010 - A team of researchers recently conducted a prospective study the etiology of lymphocytic duodenosis. Among their findings are that sixteen percent of patients with lymphocytic duodenosis have celiac disease.
    The research team was made up of I. Aziz, K. E. Evans, A. D. Hopper, D. M. Smillie, and D. S. Sanders. They are affiliated with the Department of Gastroenterology at Royal Hallamshire Hospital in Sheffield, UK.
    The study came in response to earlier retrospective studies that have suggested different connections with lymphocytic duodenosis, indicating that patients with this condition should not be diagnosed with celiac disease, solely by histology.
    Lymphocytic duodenosis is marked by normal villous architecture and less than 25 intraepithelial lymphocytes (IELs) per 100 enterocytes.
    For their study, the team thoroughly evaluated one hundred patients with lymphocytic duodenosis for celiac disease and other aspects associatedwith lymphocytic duodenosis by using initial celiac blood screens, and excluding the presence of infection.
    Of thirty-four patients with unexplained lymphocytic duodenosis, twenty-nine underwent repeat duodenal biopsies following a gluten challenge. Biopsy results showed that 16% of patients with lymphocytic duodenosis had celiac disease.
    Once celiac disease was accounted for, the factors most commonly association with lymphocytic duodenosis were as follows: drugs were a factor in twenty-one percent of lymphocytic duodenosis patients; infection was a factor in nineteen percent, immune dysregulation was a factor in four percent, inflammatory bowel disease and microscopic colitis in two percent each, sarcoidosis and IgA deficiency in one percent of cases, respectively.
    Of thirty-four patients with no known associations, eighteen showed symptoms of irritable bowel syndrome (IBS). Of twenty-nine patients examined with repeat duodenal biopsies, the IEL count returned to normal in twenty-two patients.
    The study results show that known associations can be found in sixty-six percent of cases of lymphocytic duodenosis.
    Importantly, sixteen percent will have celiac disease. In cases of lymphocytic duodenosis with no apparent cause, there may be a connection with IBS. In such cases the IEL count returns to normal on repeat biopsy in seventy-six percent.
    Source:

    Aliment Pharmacol Ther. 2010 Dec;32(11-12):1392-7.

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