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  • Jefferson Adams
    Jefferson Adams

    An Overview of Prevention Measures and Exploratory Pharmacological Treatments of Celiac Disease

    Caption: New American Journal of Gastroenterology paper examines celiac disease prevention measures.

    Celiac.com 12/08/2010 - A team of researchers recently compiled an overview of prevention measures and exploratory pharmacological treatments of celiac disease. Maud Pinier, Gregor Fuhrmann, Elena Verdu and Jean-Christophe Leroux comprised the research team.

    First, a bit of background. Human leukocyte antigens (HLAs) is the name scientists give to the major histocompatibility complex (MHC) in humans.

    HLAs are host to a group of genes that influence human immune system function. The HLA group of genes on chromosome 6 encodes cell-surface antigen-presenting proteins, along with numerous other genes. The proteins encoded by certain genes are also known as antigens. The major HLA antigens are key components of immune function. HLA DP,DM, DOA,DOB,DQ, and DR present antigens from outside of the cell to T-lymphocytes.

    Celiac disease is common worldwide, and 90–95% of people with celiac disease exhibit HLA-DQ2 molecules and the rest exhibit HLA-DQ8.

    Celiac disease affects about 1 in 100 individuals in the general population, but recent studies show a substantial increase in American and Finnish populations in the recent years. This rise in celiac disease rates cannot be explained by better screening methods, and other factors have been suggested including environmental factors such as breast-feeding, time of gluten introduction, and infections.

    Celiac disease patients can present a wide variety of pathological and clinical symptoms, ranging from severe to subtle, and the clinical expression is not always indicated by the presence of intestinal atrophy.

    Classic celiac symptoms include diarrhea, abdominal bloating, and discomfort. However, numerous people with celiac disease go undiagnosed because their symptoms are not apparent, as in cases of silent celiac disease, or because their symptoms are atypical.

    Complications of celiac disease include refractory celiac disease, a rare, but complex disorder with severe and recurrent symptoms, in which patients remain unresponsive after at least 6 months on a strict gluten-free diet.

    It's rare for patients with non-responsive celiac disease to develop enteropathy-associated T-cell lymphoma, a complication of celiac disease that requires drug-based therapies. Only about 0.5–1/1.000.000 celiac patients develop this rare disorder.

    Other autoimmune disorders, such as autoimmune thyroiditis and type 1 diabetes, are also more common in people with celiac disease.

    Among siblings of children with type I diabetes, rates of celiac disease have been shown to correlate with the prevalence of celiac disease-associated HLA-DQB1 alleles.

    Moreover, the risk of celiac disease is significantly higher in children with type 1 diabetes who also carry the HLA-DQB1*02–DQA1*05 genotype.

    A recent genotyping study comparing 8,064 people with type 1 diabetes with 9,339 control subjects showed that patients with type 1 diabetes and celiac disease share seven common alleles that regulate autoimmune responses.

    Recent data also confirm an elevated risk of mortality in individuals with mild gluten-induced inflammation who show no villous atrophy.

    The team concludes by noting that, due to the high prevalence of celiac disease, and its rising numbers, early prevention may represent a cost-effective strategy.

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  • About Me

    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
    The following was taken from THE SPRUE-NIK PRESS, September 1995. The University of Maryland School of Medicine sponsored a conference on July 14-15, 1995 entitled Celiac Disease: The Dark Side of the Gastrointestinal Planet, by Salvatore Auricchio, MD, summarized by Jim Lyles. Dr. Auricchio is Professor and Chairman of Pediatrics at the University Frederico II in Naples, Italy.
    celiac disease manifests itself in the small intestine. A distinct pattern of abnormalities has been observed [comments in braces have been added by Jim Lyles]:
    Villous atrophy [partial or complete flattening of the finger-like projections in the small intestine] Hyperplasia of the crypts of Lieberkuhn [the crypts under the villi become highly elongated when compared with normal crypts] Increased plasma cell and lymphocyte infiltration of the lamina propria [more lymphocytes under the epithelial or outer layer of the villi. Lymphocytes are the cells that fight off viruses, etc.] Increased intraepithelial lymphocytes [more lymphocytes within the epithelial cells. The epithelial cells form the outer layer of the intestine and allow nutrients to pass through from the intestine into the bloodstream] Abnormalities in the epithelial cells which become flattened, cuboidal, and pseudo- stratified [layered].

    Jefferson Adams
    Celiac.com 02/18/2008 - A greater awareness of celiac disease, coupled with better and more accurate tests for celiac disease have helped to bring about a situation where most people currently diagnosed with celiac disease show no symptoms at the time of their diagnosis. Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. This finding has caused doctors to call for an adjustment to screening procedures for high-risk populations.
    A team of researchers led by Dr. Grzegorz Telega recently surveyed medical records of people diagnosed with celiac disease at Children's Hospital of Wisconsin from 1986 to 2003. The statistics showed that the number of celiac disease diagnosis rose from a single case in 1986 to 93 cases in 2003. The total number of cases during that period was 143.
    Before the mid-1990’s, more than 85% of children diagnosed with celiac disease were under 10 years old, with the average age being just over 5 years old. After 1995, less than 50% of children diagnosed with celiac disease were under 10 years old, and the average age at diagnosis had risen to about 8.5 years of age. Children diagnosed before the age of 3 years old usually complained of classic celiac-associated gastrointestinal symptoms, such as malnutrition, diarrhea, abdominal pain, and bloating, while children diagnosed at older ages had less pronounced symptoms.
    One of the important conclusions made by the research group is that the possibility of celiac disease should be strongly considered in people with other autoimmune disorders, even if those people do not show gastrointestinal symptoms traditionally associated with celiac disease.
    The research team called upon primary care doctors to adopt a practice of celiac screening for all people with elevated risk factors, including people with a family history of celiac disease, people with Addison’s disease Down Syndrome type 1 diabetes, thyroiditis, Turner syndrome, and type 1 diabetes. The team also called for screening of patients with short stature, iron deficiency anemia, and high transaminase levels.
    Arch Pediatr Adolesc Med 2008;162:164-168.


    Jefferson Adams
    Celiac.com 03/10/2009 - A recent study confirms that B-vitamin supplements are helpful in raising vitamin B6, B12 and folate levels and in reducing homocysteine levels in people with celiac disease.
    Celiac disease is a typical malabsorption syndrome, and is associated with higher rates of numerous deficiencies, including folate and vitamin B12. People with celiac disease face higher rates of Hyperhomocysteinemia than do healthy controls.
    A team of Dutch researchers led by Dr. Muhammed Hadithi recently set out to evaluate the efficacy of daily supplements of vitamin B6, B12 and folate on homocysteine levels in patients with celiac disease.
    The study measured levels of vitamin B6, folate, vitamin B12, and fasting plasma homocysteine in 51 adults with celiac disease and 50 healthy control subjects of similar age and sex.
    The results show that the celiac disease subjects who used vitamin supplements had higher blood levels of vitamin B6 (P = 0.003), folate (P < 0.001), and vitamin B12 (P = 0.012) than celiac patients who did not use supplements, or healthy controls (P = 0.035, P < 0.001, P = 0.007, for vitamin B6, folate, and vitamin B12, respectively).
    Patients who use vitamin supplements also showed lower levels of plasma homocysteine than in patients who did not (P = 0.001) or healthy controls (P = 0.003). Vitamin B6 and folate were both associated with homocysteine levels, whereas vitamin B12 was not. Twenty-four (48%) of 50 controls and 23 (50%) of 46 of the celiac disease patients carried the MTHFR thermolabile variant T-allele (P = 0.89).
    The research team concludes that Homocysteine levels are dependent on Marsh classification and the regular use of B-vitamin supplements reduces of homocysteine levels in patients with celiac disease.The study confirms earlier studies suggesting that both the presence and severity of celiac disease determined homocysteine levels.
    The regular use of supplemental B vitamins resulted in higher levels of serum vitamin B6, folate, vitamin B12 and lower levels of plasma homocysteine in patients with celiac disease. Moreover, supplemental B vitamins seem to offer protection against the effects of villous atrophy on homocysteine levels, independent of the genetic susceptibility status as determined by carriage of the C677T polymorphism of 5,10 methylenetetrahydrofolate reductase.

    World J Gastroenterol. 2009;15:955–960


    Jefferson Adams
    Celiac.com 02/24/2010 - Proper clinical diagnosis of celiac diseasestill relies on confirmation of histological evidence of villousatrophy via biopsy. Getting a good sample can sometimes be tricky. Ifhistological sections are not optimally oriented, then diagnosis may bemore difficult. As a result, doctors can sometimes fail to confirm theproper diagnosis.
    A team of researchers recently set out tostudy the viability of confirming histological evidence of villousatrophy in real time, during upper gastrointestinal endoscopy, in liveduodenal mucosa of patients with celiac disease, using endocytoscopy, anovel diagnostic technique allowing in vivo real-time visualization ofmucosa under 450x magnification.
    The research team included T. Matysiak-Budnik, E.  Coron1, J.-F.  Mosnier, M.  Le Rhun1, H.  Inoue,and J.-P.  Galmiche. They are associated variously with the Institutdes Maladies de l'Appareil Digestif - INSERM U913, CIC 04 et Serviced'Hépato-Gastroentérologie, Hôtel Dieu, CHU de Nantes, France, theService d'Anatomie Pathologique, E.A. Biometadys, CHU de Nantes,France, and the Digestive Disease Center, Showa University NorthernYokohama Hospital, Japan
    The team studied sixteen subjects withclinically proven celiac disease, together with seven controls subjectswith no celiac disease. They took endocytoscopic images from multipleareas and then made a blind comparison against standard histology.
    Endocytoscopy revealed three distinct patterns of in vivo histology.
    First,in all controls and eight celiac disease patients (n = 15),endocytoscopy revealed the presence of normal-appearing, long, thinvilli, lined with clearly distinguishable surface epithelial cells,considered to be normal duodenal mucosa.
    Second, in four celiacdisease patients, endocytoscopy revealed the presence of thick,shortened villi, reflecting partial villous atrophy.
    Finally,in four celiac disease patients, endocytoscopy revealed the totalabsence of villi, along with the presence of enlarged crypt orifices,reflecting total villous atrophy.
    The team found solid agreement between endocytoscopy and standard histology in all 16 patients with celiac disease.
    Fromtheir results, they conclude that endocytoscopy permits live,real-time, noninvasive imaging and assessment of villous architecture,and looks to be a promising method for in vivo evaluation of duodenalmucosa in celiac disease.
    Source:
    Endoscopy: DOI: 10.1055/s-0029-12438


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