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    Epilepsy and Celiac Disease


    Scott Adams


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    November 1993. European Journal of Pediatrics. Authors Hilhorst MI. Brink M. Wauters EA. Houwen RH. Institution: Department of gastro-enterology, Wilhelmina Childrens Hospital, Utrecht, The Netherlands.

    Among 783 patients referred to our institute with different types of seizures as presenting symptom, systematic evaluation of antigliadin and antiendomysial antibodies in the serum has identified nine in whom jejunal biopsy has subsequently confirmed the diagnosis of celiac disease (celiac disease). In three of them brain imaging showed the presence of calcified areas in the occipital region. They had complex partial seizures (CPS), associated in two with transient episodes of blindness.

    In another patient with CPS and generalized tonic-clonic seizures (GTCS) progressive multifocal cerebral calcifications were noted. In the other six patients with CPS and/or GTCS cerebral calcifications were absent. Symptoms of celiac disease in all these cases were either not previously taken into account, or they were very mild or completely absent. In a group of 36 patients with clinically manifest celiac disease, regular follow-up, and good compliance with the dietary regimen, no clinical seizures were reported. The pathogenic mechanism and the relationship between epilepsy and an early diagnosis and treatment of celiac disease are discussed (Footnote #1).

    Bilateral occipital calcifications, occurring in celiac disease, are factors coming under a particular cerebral syndrome, which also includes epilepsy, migraine-like headache, visual troubles and mental deterioration. They seem to arise from hypofolatemia following gluten-induced enteropathy (Footnote #2).

    There have been anecdotal reports of an association between celiac disease and epilepsy with cerebral calcifications that resemble those of the Sturge-Weber syndrome. A series of patients who had epilepsy with calcifications, in whom celiac disease (celiac disease) was incidentally observed, prompted us to study this association. 43 patients (15 male, age range 4.6-30.7 years) were selected from two series. 31 patients with cerebral calcifications of unexplained origin and epilepsy (series A) underwent intestinal biopsy. 12 patients with celiac disease and epilepsy (series B) underwent computed tomography. Antibodies to gluten, folic acid serum concentrations, were measured, and HLA typing was done in most patients. 24 of the series A patients were identified as having celiac disease on the basis of a flat intestinal mucosa (15/22 with a high concentration of serum antigluten), and 5 series B patients showed cerebral calcifications, giving a total of 29 cases with the combination of celiac disease, epilepsy, and cerebral calcifications (CEC). In 27 of these CEC patients, calcifications were located in the parieto-occipital regions. Only 2 of the series A patients had gastrointestinal symptoms at the time of intestinal biopsy; most patients had recurrent diarrhea, anemia, and other symptoms suggestive of celiac disease in the first 3 years of life. The epilepsy in CEC patients was poorly responsive to antiepileptic drugs. Gluten-free diet beneficially affected the course of epilepsy only when started soon after epilepsy onset. Cases of atypical Sturge-Weber syndrome (characterized by serpiginous cerebral calcifications and epilepsy without facial port-wine naevus) should be reviewed, and celiac disease should be ruled out in all cases of epilepsy and cerebral calcifications of unexplained origin (Footnote #3).

    4. We report the electroclinical findings of four epileptic patients with clinically asymptomatic celiac disease (celiac disease). Celiac disease diagnosis was suspected by past history and/or computed tomography (CT) findings in all patients and confirmed by laboratory tests and jejunal biopsy. All patients had paroxysmal visual manifestations and ictal EEG discharges arising from the occipital lobe. Epilepsy evolution was favorable in two patients and severe in 2, regardless of CT evidence of occipital corticosubcortical calcifications in 2 patients. Occipital lobe seizures may be characteristic of the epilepsy related to celiac disease, and epileptic patients with these seizures of unknown etiology should be carefully investigated for malabsorption. If past history and/or laboratory tests suggest gastrointestinal (GI) dysfunction they should also undergo small intestinal biopsy even if they do not have GI tract symptoms (Footnote #4).

    References:
    • Fois A; Vascotto M; Di Bartolo RM; Di Marco V, Celiac disease and epilepsy in pediatric patients,Childs Nerv Syst; 10 (7) p450-4, Sep 1994.
    • Cerebral occipital calcifications in celiac disease, Crosato F; Senter S, Neuropediatrics; 23 (4) p214-7, Aug 1992.
    • Celiac disease, epilepsy, and cerebral calcifications. The Italian Working Group on Celiac Disease and Epilepsy Gobbi G; Bouquet F; Greco L; Lambertini A; Tassinari CA; Ventura A; Zaniboni MG ,Lancet; 340 (8817) p439-43, Aug 22 1992.
    • Ocipital lobe seizures related to clinically asymptomatic celiac disease in adulthood , mbrosetto G; Antonini L; Tassinari CA, Epilepsia; 33 (3) p476-81, May-Jun 1992.

    A MEDLINE search showed these additional articles on celiac and epilepsy:

    • Convulsive disorder in celiac disease, Cohen O; River Y; Zelinger I, Harefuah; 126 (12) p707-10, 763, Jun 15 1994.
    • Need for follow up in celiac disease, Bardella MT; Molteni N; Prampolini L; Giunta AM; Baldassarri AR, Arch Dis Child; 70 (3) p211-3, Mar 1994.
    • Familial unilateral and bilateral occipital calcifications and epilepsy, Tortorella G; Magaudda A; Mercuri E; Longo M; Guzzetta F, Neuropediatrics; 24 (6) p341-2, Dec 1993.
    • Endocranial calcifications, infantile celiac disease, and epilepsy, Piattella L; Zamponi N; Cardinali C; Porfiri L; Tavoni MA, Childs Nerv Syst; 9 (3) p172-5, Jun 1993.
    • Cortical vascular abnormalities in the syndrome of celiac disease, epilepsy, bilateral occipital calcifications, and folate deficiency, Bye AM; Andermann F; Robitaille Y; Oliver M; Bohane T; Andermann E, Ann Neurol; 34 (3) p399-403, Sep 1993.
    • Progressive cerebral calcifications, epilepsy, and celiac disease, AU- Fois A; Balestri P; Vascotto M; Farnetani MA; Di Bartolo RM; Di Marco V; Vindigni C, Brain Dev; 15 (1) p79-82, Jan-Feb 1993.
    • Celiac disease, posterior cerebral calcifications and epilepsy, Gobbi G; Ambrosetto P; Zaniboni MG; Lambertini A; Ambrosioni G; Tassinari CA, Brain Dev; 14 (1) p23-9, Jan 1992.
    • Intracranial calcifications--seizures--celiac disease: a case presentation, Della Cella G; Beluschi C; Cipollina F, Pediatr Med Chir; 13 (4) p427-30, Jul-Aug 1991.
    • Celiac disease, folic acid deficiency and epilepsy with cerebral calcifications, Ventura A; Bouquet F; Sartorelli C; Barbi E; Torre G; Tommasini G, Acta Paediatr Scand; 80 (5) p559-62, May 1991.
    • Ramsay Hunt syndrome and celiac disease: a new association?, Lu CS; Thompson PD; Quinn NP; Parkes JD; Marsden celiac disease, Mov Disord; 1 (3) p209-19, 1986.
    • Celiac disease associated with epilepsy and intracranial calcifications: report of two patients, Molteni N; Bardella MT; Baldassarri AR; Bianchi PA, Am J Gastroenterol; 83 (9) p992-4, Sep 1988.
    • Bilateral cerebral occipital calcifications and migraine-like headache, Battistella PA; Mattesi P; Casara GL; Carollo C; Condini A; Allegri F; Rigon F Cephalalgia; 7 (2) p125-9, Jun 1987.
    • Blood selenium content and glutathione peroxidase activity in children with cystic fibrosis, celiac disease, asthma, and epilepsy, Ward KP; Arthur JR; Russell G; Aggett PJ, Eur J Pediatr; 142 (1) p21-4, Apr 1984.
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    Guest Mary Anne

    Posted

    I had a relative with epilepsy, and they couldn't find the cause. He went blind when he was in his 70's. His son has celiac so I'm sure he had undiagnosed celiac disease.

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    Guest John B. Symes, DVM (aka "Dogtorj")

    Posted

    I have had phenomenal results controlling epileptic dogs with diet alone using formulas free of all gluten, casein,soy and corn. The lectins of gluten are not the only (potentially) neurotoxic glycoprotein. I am now compiling an ever-growing list of humans who have experienced remarkable recoveries as well. In them, we must also eliminate all MSG, aspartame, legumes and nuts, which are RICH in glutamate and aspartate. I call the diet 'The GARD'...the glutamate-aspartate restricted diet.

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    My 21 year old daughter has been ill for 18 months, bedridden. Diagnosed with fibromyalgia in May 2007. In December, 2007, she suffered a GTC seizure. Again on January 14, 2008, less than a month later. Given diagnosis of Juvenile Myoclonic Epilepsy. One week ago, (2/10/08) hospitalized and diagnosed with Celiac disease. AMAZING improvement after just 1 week gluten free. Praying the diet will be enough to stop all seizures anti- seizure medication.

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    Guest jamie aucoin

    Posted

    Very insightful. Full of well needed info. Just one question? Have you come across anyone with constant ringing in their ears and persistent migraine aura, with no relief ? Just wondering. I was born with Celiac, have crohn's disease and suffer from the noted for the past 4 years.

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    Guest lisa petrone

    Posted

    My son has epilepsy of unknown origin. We took him off of gluten as a last resort, before brain surgery. He has not has one seizure since! Now we need a doctor to help us possibly take him of his seizure medications.

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    My son has epilepsy of unknown origin. We took him off of gluten as a last resort, before brain surgery. He has not has one seizure since! Now we need a doctor to help us possibly take him of his seizure medications.

    My grandson was diagnosed with epilepsy at 2. He has had every tests known to man..eg..EKG, etc and all have come back normal. His seizures are at night when he is sleeping. We have an appointment next week to talk about surgery. We are also exploring celiac.

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    Guest Kathy Smith

    Posted

    My grandson was diagnosed with epilepsy at 2. He has had every tests known to man..eg..EKG, etc and all have come back normal. His seizures are at night when he is sleeping. We have an appointment next week to talk about surgery. We are also exploring celiac.

    I am more than happy to have found information related to Celiac Disease and epilepsy. I personally have Celiac Disease which was not diagnosed until I was 42 years old. I also have a grandson who was diagnosed with epilepsy at age 2, with seizures that are highly resistant to medical interventions. Now at the age of 12 his seizures occur almost exclusively at night when he is sleeping, in particular upon falling asleep and just before waking. I would love to network with others who have had the experience of exploring Celiac Disease in relationship to epilepsy. I have only recently begun to research all of this, mainly after becoming acquainted with Jenny McCarthy's book, Mother Warriors. I guess it's possible to be a grandmother warrior - I would love to believe that there is still hope after all this time.

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    Guest Jeff Ilstrup

    Posted

    I am more than happy to have found information related to Celiac Disease and epilepsy. I personally have Celiac Disease which was not diagnosed until I was 42 years old. I also have a grandson who was diagnosed with epilepsy at age 2, with seizures that are highly resistant to medical interventions. Now at the age of 12 his seizures occur almost exclusively at night when he is sleeping, in particular upon falling asleep and just before waking. I would love to network with others who have had the experience of exploring Celiac Disease in relationship to epilepsy. I have only recently begun to research all of this, mainly after becoming acquainted with Jenny McCarthy's book, Mother Warriors. I guess it's possible to be a grandmother warrior - I would love to believe that there is still hope after all this time.

    Kathy,

    What changes have you experienced since 20 Oct 09 regarding progress of combating your Celiac Disease? As of today, 26 Nov 2010 I have started questioning weather my Dad of 87 years of age might possibly have developed some type of celiac disease. He has had three major seizure attacks and maybe had quite a few less notable seizures that may have followed this past fall. My Dad had every imaginable test the doctors could think of. His case was presented to numerous doctors of various specialties at a medical seminar/symposium and still remain baffled. So my Dad continues to slowly battle back through the maze of anti-seizure meds every so slowly. He has lost 14 lbs over a month and a half at a nursing home. May you continue to gain success on your continued quest. Lord knows the American Medical Association needs all the help imaginable despite getting paid the big bucks for going to all their years of post high school education.

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    Guest Sarah Nevin

    Posted

    I have had phenomenal results controlling epileptic dogs with diet alone using formulas free of all gluten, casein,soy and corn. The lectins of gluten are not the only (potentially) neurotoxic glycoprotein. I am now compiling an ever-growing list of humans who have experienced remarkable recoveries as well. In them, we must also eliminate all MSG, aspartame, legumes and nuts, which are RICH in glutamate and aspartate. I call the diet 'The GARD'...the glutamate-aspartate restricted diet.

    At 62 years old now I have been having seizures for five and a half years on a "regular" two week cycle, similar to ovulation and menstruation. I now suspect hormones to be a factor. When I was 21 years old I was diagnosed with celiac disease, after a three year spell of working in American and Danish Bakeries, while I was a college student as well. I now suspect celiac disease to be a prominent factor, even though I have not eaten wheat for decades. The GARD diet is definitely my next step, as I am only learning about this recently, in between the "regular seizures" which cause memory loss temporarily. I do not seem to have brain damage yet, according to brain MRI and FMRI sessions, and the neurologists, but that may well be next, as I am wearing out of this and want it to end. I now see that nuts are off the diet list and I LOVE nuts, especially almonds, and eat nuts every day. Thank you John Symes for this information and more please about what you have learned.

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    Guest Donna

    Posted

    I am more than happy to have found information related to Celiac Disease and epilepsy. I personally have Celiac Disease which was not diagnosed until I was 42 years old. I also have a grandson who was diagnosed with epilepsy at age 2, with seizures that are highly resistant to medical interventions. Now at the age of 12 his seizures occur almost exclusively at night when he is sleeping, in particular upon falling asleep and just before waking. I would love to network with others who have had the experience of exploring Celiac Disease in relationship to epilepsy. I have only recently begun to research all of this, mainly after becoming acquainted with Jenny McCarthy's book, Mother Warriors. I guess it's possible to be a grandmother warrior - I would love to believe that there is still hope after all this time.

    My 42 year old son started having Gran Mall seizures at the age of 8. He was put on Dilantin and phenobarb, but still had an occasional seizure. The Dilantin caused gum overgrowth on his teeth, and the dentist wanted to do gum surgery. That I did not okay having it done. I wrote to the Epilepsy Society to buy a book giving information about all of the available drugs. We didn't have a computer at that time. I found that Tegretol was used exclusively in Europe, especially for kids and teenagers, but not used much in the US. I liked what it said about it, and asked the Neurologist to change him to it. Of course doctors don't like being told what to do, but I insisted. His seizures stopped, and since his teens he has had only three seizures because he forgot his medicine! That is the negative side of it. I told the principal at the high school about changing his meds, and she called me after he took the beginning of the school tests, and was astonished at how much better his scores were since his medication change. He has to take it 3 times a day. He has lived a normal life since then. He would not have been able to drive, and would have had problems finding a job. He graduated from college, has a good job in an accounting office, married 16 years and has two children. I thank God that I'm pro-active as far as medicine is concerned, because it changed his life. By the way, I found out five years ago that I have celiac!

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    I am epileptic and had run across this information by reference after my brain surgery. I was diagnosed with Hypocampal Sclerosis (my hypocampus was deteriorizing) after my original diagnosis of epilepsy. I believe that there is documentation from the same doctor and report covering this diagnosis. Basically it creates calcification to the occipital lobe which in turn causes a deteriorization (right side for me) to the Hypocampus and there on epilepsy. They said the median age for this occurrence is early to mid thirties. I was 32 when this developed for me. I will now have to keep an eye on my two children and hope they take after my wife in their dietary intake and tolerances.

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    I also had continued seizures (albeit to a much lighter recurrence and intensity) after surgery and was it was referred to as refractory (No response to the medication). After I went gluten free, I have decreased my epileptic reactions almost completely, unless I forget my medication or consume gluten. Fortunately it is not to the degree that I am not able to drive again.

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    Guest kvcat

    Posted

    I have had phenomenal results controlling epileptic dogs with diet alone using formulas free of all gluten, casein,soy and corn. The lectins of gluten are not the only (potentially) neurotoxic glycoprotein. I am now compiling an ever-growing list of humans who have experienced remarkable recoveries as well. In them, we must also eliminate all MSG, aspartame, legumes and nuts, which are RICH in glutamate and aspartate. I call the diet 'The GARD'...the glutamate-aspartate restricted diet.

    Can we consider celiac in animals also ?

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    Gryphon Myers
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    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much 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. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal 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.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023