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    Recovery from Celiac Disease - The New England Journal of Medicine


    Scott Adams

    Celiac.com 03/19/2002 - The following excerpts were taken from The New England Journal of Medicines January 17, 2002 (Vol. 346, No. 30) article on recovery from celiac disease:

    In addition to a gluten-free diet, all patients with newly diagnosed celiac sprue who have clinically evident malabsorption should initially receive a multi-vitamin preparation and appropriate supplements to correct any iron or folate deficiency. Patients with steatorrhea, hypocalcemia, or osteopenic bone disease should receive oral calcium and vitamin D supplementation.

    Approximately 70 percent of patients have symptomatic improvement within two weeks after starting a gluten-free diet. The speed and eventual degree of histologic improvement are unpredictable but invariably lag behind the clinical response and may not be evident on repeated biopsy for two to three months. Although a return to normal histologic findings is common in children, half of adults have only a partial resolution on biopsy. If a patient has no response to the diet, the most common cause is incomplete adherence. Persistent symptoms may be caused by coexisting disorders such as irritable bowel syndrome, lactose intolerance, microscopic colitis, or pancreatic insufficiency.

    In one study strict adherence to a gluten-free diet reduced the risk of all disease-associated cancers including enteropathy-associated T-cell lymphoma. Thus, it seems prudent to recommend lifelong strict adherence to a gluten-free diet in all patients with celiac sprue.

    Regarding untreated celiac sprue:
    Dairy products should be avoided initially because patients with untreated celiac sprue often have secondary lactase deficiency. After three to six months of treatment, diary products can be reintroduced if the patient has no ill effects.

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  • About Me

    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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    Scott Adams
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    AT1001 is an antagonist to the zonulin system -- a signaling pathway discovered by Alessio Fasano, M.D., Professor of Pediatrics, Medicine and Physiology at the University of Maryland School of Medicine, and the basis of Albas extensive intellectual property portfolio.
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    Zonulin is a signaling protein that transiently and reversibly opens the tight junctions ("tj") between the cells of epithelial and endothelial tissues such as the intestinal mucosa, blood brain barrier and pulmonary epithelia. Zonulin appears to be involved in many diseases in which leakage occurs via paracellular transport across epithelial and endothelial tight junctions (tj), and thus may play an important potential role in the treatment of autoimmune diseases.
    About Celiac Disease
    Celiac disease (celiac disease) is a T-cell mediated auto-immune disease that occurs in genetically susceptible individuals and is characterized by small intestinal inflammation, injury and intolerance to gluten. According to the National Institutes of Health, celiac disease affects approximately 3 million Americans, although the diagnosis is rarely made. The only current treatment for celiac disease is complete elimination of gluten from the diet, which results in remission for some patients.
    About Alba
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    Contact: Heather Bakalyar, 410-522-8708 x1106

    Scott Adams
    Celiac.com 05/12/2006 - Dear Colleagues in the Celiac Community: We would like to provide you with a progress report of the Celiac Management Clinic (CMC) at Stanford Medical Center. Realizing that many physicians and gastroenterologists have a limited understanding of the frequency of Celiac Sprue in the population and the subtlety of the clinical manifestations of this disease, we instituted the CMC at Stanford Medical Center in January 2005. This clinic is staffed by Dr. Gail Pyle and myself. A large number of patients who carried the diagnosis of Celiac Sprue have chosen to be seen in consultation--the majority of these did have Celiac Sprue, as estimated from blood antibody tests and the small intestinal (duodenal) biopsy. For many of these patients, comprehensive emphasis on gluten exclusion has been very effective in eliminating symptoms and the malabsorption of nutrients. However, both in this patient group and in those healthy gluten-free Celiac volunteers who participated in the trial supported by the Celiac Sprue Research Foundation in collaboration with the Palo Alto Medical Foundation on pre-treatment of grocery store gluten with a special peptidase(1) there was a surprising discovery. Fully half (~50%) of those presumed to be in remission from the disease had malabsorption of important nutrients. This major finding was a surprise, and it gives us pause concerning Celiac Sprue therapy.
    Is gluten exclusion not optimal or is it insufficient therapy for this large proportion of Celiac Sprue patients?
    The concerns about the effectiveness of long-term dietary therapy in Celiac Sprue have prompted us to reassess our approach to this disease. For those of you who reside within reach of Stanford Medical Center, we invite you to visit us at the Celiac Management Clinic for an up-to-date assessment of the status of your Celiac condition. If you are the one out of every two healthy Celiacs with malabsorption, we will take a comprehensive approach to determine the reasons and to facilitate your return to complete remission.
    If strict gluten exclusion is insufficient to achieve this, we offer other approaches. Indeed, by the end of this year or the beginning of 2007 in collaboration with the Celiac Sprue Research Foundation, we expect to be able to determine the effect of an oral pill therapy for those who continue with malabsorption of nutrients.
    Stanford accepts most PPO insurance and MediCal and MediCare outpatient coverages. Those who suspect they have Celiac Sprue based on symptoms or blood antibody tests will be seen by Dr. Gray, and those with biopsy-verified disease will be seen by Dr. Pyle. For an appointment, call 650-723-6961, and please state that you wish to see us at the Celiac Management Clinic.
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    References:
    Pyle GG, Paaso, B Anderson, BE, Allen D, Marti T, Chaitan Khosla C, Gray, GM. Low-dose Gluten Challenge in Celiac Sprue: Malabsorptive and Antibody Responses. Clinical Gastroenterology and Hepatology, 3: 679-686, 2005. Pyle GG, Paaso, B Anderson, BE, Allen D, Marti T, Li Q, Matthew Siegel, M, Khosla C, Gray, GM. Effect of Pretreatment of Food Gluten With Prolyl Endopeptidase on Gluten-Induced Malabsorption in Celiac Sprue Clinical Gastroenterology and Hepatology, 3: 687-694, 2005.

    Scott Adams
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    Jefferson Adams
    Celiac.com 09/30/2009 - Are non-inflammatory gluten peptide analogs effective as biomarkers for celiac disease? Recent research indicates that they just might represent an effective new tool in the management of celiac disease.
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