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    Young Woman's Mysterious Cardiac Case Tied to Celiac Disease


    Jefferson Adams
    Image Caption: Mysterious heart disease sheds light on celiac disease. Image: CC--Bill Smith

    Celiac.com 09/07/2016 - Sometimes individual medical cases that initially puzzle doctors can yield new revelations for doctors and patients, and sometimes point to new directions for inquiry. The case of a young woman whose serious heart problems led doctors to discover a that she suffered from celiac disease is just the latest example.


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    The research team included Mariam Ghozzi, Chaima Mrizak, Taha Hasnaoui, Sonia Ernez, Maha Kacem, Asma Ommezzine, Laarbi Chaieb, Gouider Jridi, and Ibtissem Ghedira. They are variously affiliated with the Department of Cardiology, the Department of Endocrinology, and the Department of Immunology at Farhat Hached University Hospital in Sousse, Tunisia, with the Department of Biochemistry at Sahloul University Hospital in Sousse, Tunisia, and with the Research Unit (03/UR/07-02) of the Faculty of Pharmacy at Monastir University in Tunisia.

    The 18-year-old girl was admitted for tachycardia and dyspnea of effort stage II of NYHA. Her medical history revealed a stroke four months prior, along with uncontrolled type 1 diabetes since the age of 10 years.

    Physical examination showed a short stature, pallor, muscular atrophy and delayed puberty, but no diabetic neuropathy. By interviewing the patient, doctors found that she had shown signs of celiac disease since early infancy, and secondary amenorrhea for two years. Ophtalmological examination showed no diabetic retinopathy. Echocardiography showed the presence of a big thrombus, hypokinesis and dilated cardiomyopathy with a low rate of left ventricular ejection fraction at 20%.

    Laboratory tests revealed a high level of B-type natriuretic peptide, anemia, vitamin D deficiency, hypocholesterolemia and low level of high density lipoprotein (HDL). Microalbuminuria was negative. All serological markers of celiac disease were highly positive.

    The patient was put on gluten-free diet and she received a re-synchronization cardiac therapy. We emphasize that celiac disease and type 1 diabetes must be kept in mind in etiological diagnosis of dilated cardiomyopathy.

    Source:

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  • Related Articles

    Jefferson Adams
    Celiac.com 07/25/2013 - Numerous studies have shown that people with immune-mediated disorders can suffer from accelerated progression of atherosclerosis and increased cardiovascular risk, but few studies have been done for people with celiac disease.
    A team of researchers recently looked at young adults with celiac disease to see what, if any, added risk they may have for developing atherosclerosis.
    The research team included S. De Marchi, G. Chiarioni, M. Prior, and E. Arosio. They are variously affiliated with the Department of Medicine,and the Division of Vascular Rehabilitation in the Department of Medicine at the University of Verona in Verona, Italy, and with the Division of Gastroenterology and Hepatology, Center for Functional GI and Motility Disorders at the University of North Carolina in Chapel Hill, North Carolina.
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    They also conducted ultrasound measurement of carotid intima-media thickness (IMT) and endothelium-dependent dilatation at diagnosis and after gluten withdrawal.
    The team found average total and HDL-cholesterol (HDL-C) to be within the normal range, at baseline, while average LDL-cholesterol concentration was slightly higher.
    Diet was tied to increment in total and HDL-C (68.2 ± 17.4 vs. 51.4 ± 18.6 mg/dL; P < 0.001). Meanwhile, total/HDL-C ratio was substantially improved (3.05 ± 0.71 vs. 3.77 ± 0.92; P < 0.02).
    Overall plasma homocysteine was elevated and not changed by diet, while C-reactive protein dropped significantly with diet (1.073 ± 0.51 vs. 1.92 ± 1.38 mg/dL; P < 0.05).
    At baseline, celiacs showed increased IMT (0.082 ± 0.011 vs. 0.058 ± 0.012 cm; P < 0.005), with decreased endothelium-dependent dilatation (9.3 ± 1.3 vs. 11.2 ± 1.2%; P < 0.05). A gluten-free diet returned both of those factors to normal.
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    The good news is that adopting a gluten-free diet seems to return the body to a healthy mucosal state and returns the body to the normal risk levels of a healthy non-celiac person.
    Source:
    Alimentary Pharmacology & Therapeutics - Volume 38, Issue 2, pages 162–169, July 2013. DOI: 10.1111/apt.12360

    Jefferson Adams
    Celiac.com 05/05/2014 - People with celiac disease face double the risk of coronary artery disease compared with the general population, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session.
    The data for the study were gathered by researchers using electronic health records of patients from 13 participating health care systems between January 1999 and September 2013. Out of a total of nearly 22.4 million patients, they found 24,530 with celiac disease. Patients without celiac disease served as controls.
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    People with celiac disease have some persistent low-grade inflammation in the gut that can spill immune mediators into the bloodstream, which can then accelerate the process of atherosclerosis and, in turn, coronary artery disease," said R.D. Gajulapalli, M.D., clinical associate at the Cleveland Clinic and co-investigator of the study.
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    The team was surprised by the “strength of the association, especially in younger people,” and, in addition to further study, they are calling for patients and doctors to be aware of this association.
    Source:
    Medical express.com

    Jefferson Adams
    Celiac.com 02/16/2015 - Celiac is predominantly a disease of the small intestine characterized by chronic malabsorption in genetically susceptible individuals who ingest grains containing. gluten, such as wheat, barley, and rye.
    Using strain and strain rate echocardiography imaging, a research team set out to assess left ventricular function in patients with celiac disease.
    The research team included S. Cenk, D.B. Aylin, A. Fatma Ebru, A.B. Nihal, Ö.S. Sevil, B. Serdal, B. Emine, A. Hüseyin, K. Telat, D. Tahir, E. Osman, and B. Engin. For their study, the team included twenty celiac patients and twenty healthy control subjects. They assessed left ventricle systolic and diastolic functions using standard 2-dimension, M-mode, conventional Doppler echocardiography. They obtained strain and strain rate parameters for 8 segments of the left ventricle.
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    Source:
    Turk J Med Sci. 2014;44(2):173-7.

    Jefferson Adams
    Celiac.com 03/14/2016 - Compared with the general population, people with celiac disease are almost twice as likely to have coronary artery disease (CAD), and 1.4 times as likely to suffer a stroke, according to a large retrospective study presented at the American College of Cardiology (ACC) Scientific Sessions.
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    His team is calling on primary-care physicians, gastroenterologists, and other healthcare practitioners to be "mindful of their celiac patients," and to "be on the watch for probable cardiac diseases."
    Higher risk levels were seen even in patients under 65 years old, and may be due to the gut inflammation that can damage the small intestine in people with celiac disease. According to Dr Gajulapalli, "low-grade inflammation in the gut…can spill immune mediators into the bloodstream, which can then accelerate the process of atherosclerosis and, in turn, CAD."
    These findings are important for people with celiac disease, and for the doctors treating them. They support the idea that chronic inflammation of any kind can have a negative impact on heart health. For people with celiac disease, this can lead to higher rates of CAD, among other complications.
    So, the takeaway here is for people with celiac disease to check in with their doctors, and to be aware of any potential problems.
    Source:
    American College of Cardiology (ACC) 2014 Scientific Sessions

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/16/2018 - Summer is the time for chips and salsa. This fresh salsa recipe relies on cabbage, yes, cabbage, as a secret ingredient. The cabbage brings a delicious flavor and helps the salsa hold together nicely for scooping with your favorite chips. The result is a fresh, tasty salsa that goes great with guacamole.
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    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
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    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). 
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    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

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
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    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
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    Source:
    Alimentary Pharmacology & Therapeutics

    Jefferson Adams
    Celiac.com 06/12/2018 - A life-long gluten-free diet is the only proven treatment for celiac disease. However, current methods for assessing gluten-free diet compliance are lack the sensitivity to detect occasional dietary transgressions that may cause gut mucosal damage. So, basically, there’s currently no good way to tell if celiac patients are suffering gut damage from low-level gluten contamination.
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    They detected GIPs in concentrated urines from healthy individuals previously subjected to gluten-free diet as early as 4-6 h after single gluten intake, and for 1-2 days afterward. The urine test showed gluten ingestion in about 50% of patients. Biopsy analysis showed that nearly 9 out of 10 celiac patients with no villous atrophy had no detectable GIP in urine, while all patients with quantifiable GIP in urine showed signs of gut damage.
    The ability to use GIP in urine to reveal gluten consumption will likely help lead to new and non-invasive methods for monitoring gluten-free diet compliance. The test is sensitive, specific and simple enough for clinical monitoring of celiac patients, as well as for basic and clinical research applications including drug development.
    Source:
    Gut. 2017 Feb;66(2):250-257. &nbsp;doi: 10.1136/gutjnl-2015-310148.