• Join our community!

    Do you have questions about celiac disease or the gluten-free diet?

  • Ads by Google:
     




    Get email alerts Subscribe to Celiac.com's FREE weekly eNewsletter

    Ads by Google:



       Get email alertsSubscribe to Celiac.com's FREE weekly eNewsletter

  • Member Statistics

    77,471
    Total Members
    3,093
    Most Online
    Rakhi
    Newest Member
    Rakhi
    Joined
  • 0

    Celiac and Obesity - The Truth About Following a Gluten-Free Diet


    Destiny Stone

    Celiac.com 03/08/2010 - Celiac, a genetic autoimmune disease, has long been associated with a medical picture of patients that lookunderweight, and malnourished. However, recent studies are findingthat obesity and a high BMI (Body Mass Index) may also be prominentin celiac patients. New studies were conducted to determine BMIchanges after initiation of a gluten-free diet, and they offer cluesto the importance of eating gluten free after being diagnosed withceliac disease.


    Ads by Google:




    ARTICLE CONTINUES BELOW ADS
    Ads by Google:



    Doctors at the Celiac Disease Center ofColumbia University studied the BMI of 369 patients proven throughbiopsy to have celiac disease, spanning from 1981 to 2007. Men andwomen were evaluated separately for the sake of this study and thetest patients were classified as “classical” meaning diarrheaprominent, or “atypical” meaning they had no diarrhea at the timeof celiac diagnosis. Atypical patients were further divided intogroups of 'anemia present' and 'no anemia present' at time ofdiagnosis. Body Mass Index was then categorized into four groupsbased on the criteria of the World Health Organization.

    The BMI of all test celiac patientswere compared to the general United States population. Using theregression model, the study found that there are obvious predictorsfor low BMI; patients classified as “classical” celiac,female, and with severe villous atrophy, were all revealed aspredictors for low BMI. These findings further exemplify that themost dramatic changes in BMI rates were in underweight females withceliac disease. Celiac females had a considerably lower mean BMIthan the general population, thereby indicating an importantassociation between females with celiac disease and low BMI. In fact,celiac females that tested with a normal or low BMI were also foundto have higher rates of critical villous atrophy than those with ahigher BMI. However, more males with celiac were found to beoverweight compared to the general population.

    After initiating a gluten free diet,most BMI changes were shown to be directly associated with an initialbaseline appearance of “classical” symptoms. While on a glutenfree diet, over 50% of the overweight and obese patients lostweight, and of the group who initially had a low BMI, 42.4% attaineda normal weight. Thereby concluding that treatment of a gluten freediet after celiac diagnosis provides advantageouschanges in BMI results. Further evidence of the importance in earlydiagnosis and prompt treatment of celiac disease.

    Of course it is critical to note that,all the patients utilized for this study were monitored closely by a care center dedicated to celiac disease, and continually followed byan experienced dietician with expert knowledge of celiac disease. And, while you may not be able to afford the kind of dietician thesepatients were provided with, it is always very important to be underthe care of a doctor or clinic dedicated to treating celiac disease,as well as to be receiving experienced dietary counseling whentransitioning to a gluten free diet.

    Source:

    0


    User Feedback

    Recommended Comments

    Guest Karen

    Posted

    Just got diagnosed. This article could have been written about me. So grateful to have a diagnosis after being sick for so long with a laundry list of auto-immune disorders!

    Share this comment


    Link to comment
    Share on other sites
    Guest ColoradoSue

    Posted

    Which doesn't explain why the hell I GAINED weight after diagnosis, (both positive blood and biopsy), and continue to fight weight gain to this day. My initial diagnosis was confirmed only after a week of severe pain, diarrhea, and dehydration and the loss of 12pounds in 5 days. Since that time and going on the gluten free diet, I have gained 38 lbs. The only explanation I can offer is that I have other autoimmune disorders which are present but cannot be confirmed due to the lack of truly accurate testing procedures that are in use today. The doctors continue to suggest the possibility of scleroderma, mixed connective tissue disease, or lupis but nothing they can or will put a name to! The only other positive diagnosis is fibromyalgia which apparently is still quite the mystery to most medical professions.

    Medications, used to fight continuing symptoms, are the other probable cause of weight gain, i.e., medications used to fight those horrible cramps that suddenly hit because of an accidental gluten contamination. Or in the epidural shots that I need every 3 months due to severe back problems. How about the medical researchers work on that correlation. I'm really resent being told by medical professionals that I need to LOSE THE WEIGHT while not offering help as to how. Hey, I know... I'll just eat a piece of bread!!! That should do the trick don't ya think!!!

    Signed - Someone Who is sick and tired of being sick, tired in constant pain and depressed.

    Share this comment


    Link to comment
    Share on other sites
    Which doesn't explain why the hell I GAINED weight after diagnosis, (both positive blood and biopsy), and continue to fight weight gain to this day. My initial diagnosis was confirmed only after a week of severe pain, diarrhea, and dehydration and the loss of 12pounds in 5 days. Since that time and going on the gluten free diet, I have gained 38 lbs. The only explanation I can offer is that I have other autoimmune disorders which are present but cannot be confirmed due to the lack of truly accurate testing procedures that are in use today. The doctors continue to suggest the possibility of scleroderma, mixed connective tissue disease, or lupis but nothing they can or will put a name to! The only other positive diagnosis is fibromyalgia which apparently is still quite the mystery to most medical professions.

    Medications, used to fight continuing symptoms, are the other probable cause of weight gain, i.e., medications used to fight those horrible cramps that suddenly hit because of an accidental gluten contamination. Or in the epidural shots that I need every 3 months due to severe back problems. How about the medical researchers work on that correlation. I'm really resent being told by medical professionals that I need to LOSE THE WEIGHT while not offering help as to how. Hey, I know... I'll just eat a piece of bread!!! That should do the trick don't ya think!!!

    Signed - Someone Who is sick and tired of being sick, tired in constant pain and depressed.

    I wonder if you also have an (undiagnosed) thyroid disorder, as they seem to run together? A thyroid diagnosis can also be difficult to get if in fact your doctor goes by TSH values only. I have Hashimoto's and am finally on meds (many docs won't treat Hashimoto's) due to hypothyroid *symptoms* and very high antibodies. Some symptoms have went away...EXCEPT the weight gain...which lead me here (and terrible nighttime stomach pain). My niece with a thyroid problem just lost considerable weight going gluten (and dairy) free. You may have more than one issue going on. I wish you the best.

    Share this comment


    Link to comment
    Share on other sites
    Which doesn't explain why the hell I GAINED weight after diagnosis, (both positive blood and biopsy), and continue to fight weight gain to this day. My initial diagnosis was confirmed only after a week of severe pain, diarrhea, and dehydration and the loss of 12pounds in 5 days. Since that time and going on the gluten free diet, I have gained 38 lbs. The only explanation I can offer is that I have other autoimmune disorders which are present but cannot be confirmed due to the lack of truly accurate testing procedures that are in use today. The doctors continue to suggest the possibility of scleroderma, mixed connective tissue disease, or lupis but nothing they can or will put a name to! The only other positive diagnosis is fibromyalgia which apparently is still quite the mystery to most medical professions.

    Medications, used to fight continuing symptoms, are the other probable cause of weight gain, i.e., medications used to fight those horrible cramps that suddenly hit because of an accidental gluten contamination. Or in the epidural shots that I need every 3 months due to severe back problems. How about the medical researchers work on that correlation. I'm really resent being told by medical professionals that I need to LOSE THE WEIGHT while not offering help as to how. Hey, I know... I'll just eat a piece of bread!!! That should do the trick don't ya think!!!

    Signed - Someone Who is sick and tired of being sick, tired in constant pain and depressed.

    ColoradoSue - There are several meds used for fibromyalgia that most patients swear causes uncontrollable weight gain. Lots of docs don't acknowledge that side effect. Possible you may be on one or two of those? May be worth looking into. All our best to you!

    Share this comment


    Link to comment
    Share on other sites

    I agree with Dea... you should get your thyroid checked. I hope you get some answers soon. It's hard living that way.

    Share this comment


    Link to comment
    Share on other sites


    Your content will need to be approved by a moderator

    Guest
    You are commenting as a guest. If you have an account, please sign in.
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • Popular Contributors

  • Ads by Google:

  • Who's Online   5 Members, 0 Anonymous, 330 Guests (See full list)

  • Related Articles

    Jefferson Adams
    Celiac.com 05/25/2012 - A team of researchers recently set out to examine body mass and obesity risk in a large population of people with celiac disease who are following a gluten-free diet.
    The research team included T. A. Kabbani, A. Goldberg, C. P. Kelly, K. Pallav, S. Tariq, A. Peer, J. Hansen, M. Dennis & D. A. Leffler. They are affiliated with the Department of Medicine and Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, Massachusetts.
    Diagnosis for celiac disease is on the rise, and many people who are diagnosed experience weight changes once they adopt a gluten-free diet. There's a pretty good amount of study data on weight change on a gluten-free diet, but a very limited amount of data regarding changes in body mass.
    The researchers wanted to look at a large population of people with celiac disease, who followed a gluten-free diet to better understand changes in body mass index (BMI) following celiac diagnosis.
    To do this, they looked at a total of 1018 patients with biopsy confirmed celiac disease. The patients had all previously visited the Beth Israel gastroenterology clinic in Boston.
    The team recorded data for initial and follow-up BMIs, and used an expert dietitian to assess patient compliance with a gluten-free diet. They found a total of 679 patients with at least two recorded BMIs and GFD adherence data, and used data from those patients in their study. The average amount of time from first BMI measurement to follow-up measurement was 39.5 months.
    When they compared the results against data for the general population, they found that celiac disease patients on a gluten-free diet were significantly less likely to be overweight or obese (32% vs. 59%, P < 0.0001).
    They also found that average body mass increased significantly after patients adopted a gluten-free diet (24.0 to 24.6; P < 0.001). Overall, 21.8% of patients with normal or high BMI at study entry increased their BMI by more than two points.
    The results of this study show that celiac disease patients on a gluten-free diet have lower BMI than the regional population at diagnosis, but that BMI increases with a gluten-free diet, especially in those who follow the diet closely.
    Still, even though overall risk of obesity is lower than the regular population, once celiac patients adopt a gluten-free diet, 15.8% of patients move from a normal or low BMI class into an overweight BMI class, and 22% of patients overweight at diagnosis gain weight.
    As a result, the study team feels that weight maintenance counseling should be an integral part of celiac dietary education.
    Source:
    Alimentary Pharmacology & Therapeutics. 2012;35(6):

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
    Those scientists recently gathered some of the first evidence to show that cheap, over-the-counter antacids can prompt the spleen to promote an anti-inflammatory environment that could be helpful in combating inflammatory disease.
    A type of cell called mesothelial cells line our body cavities, like the digestive tract. They have little fingers, called microvilli, that sense the environment, and warn the organs they cover that there is an invader and an immune response is needed.
    The team’s data shows that when rats or healthy people drink a solution of baking soda, the stomach makes more acid, which causes mesothelial cells on the outside of the spleen to tell the spleen to go easy on the immune response.  "It's most likely a hamburger not a bacterial infection," is basically the message, says Dr. Paul O'Connor, renal physiologist in the MCG Department of Physiology at Augusta University and the study's corresponding author.
    That message, which is transmitted with help from a chemical messenger called acetylcholine, seems to encourage the gut to shift against inflammation, say the scientists.
    In patients who drank water with baking soda for two weeks, immune cells called macrophages, shifted from primarily those that promote inflammation, called M1, to those that reduce it, called M2. "The shift from inflammatory to an anti-inflammatory profile is happening everywhere," O'Connor says. "We saw it in the kidneys, we saw it in the spleen, now we see it in the peripheral blood."
    O'Connor hopes drinking baking soda can one day produce similar results for people with autoimmune disease. "You are not really turning anything off or on, you are just pushing it toward one side by giving an anti-inflammatory stimulus," he says, in this case, away from harmful inflammation. "It's potentially a really safe way to treat inflammatory disease."
    The research was funded by the National Institutes of Health.
    Read more at: Sciencedaily.com

    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.

    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.
    Ingredients:
    3 cups ripe fresh tomatoes, diced 1 cup shredded green cabbage ½ cup diced yellow onion ¼ cup chopped fresh cilantro 1 jalapeno, seeded 1 Serrano pepper, seeded 2 tablespoons lemon juice 2 tablespoons red wine vinegar 2 garlic cloves, minced salt to taste black pepper, to taste Directions:
    Purée all ingredients together in a blender.
    Cover and refrigerate for at least 1 hour. 
    Adjust seasoning with salt and pepper, as desired. 
    Serve is a bowl with tortilla chips and guacamole.

    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.
    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