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  • Scott Adams
    Scott Adams

    Wheat Starch-containing Gluten-free Flour Products in the Treatment of Coeliac Disease and Dermatitis Herpetiformis. A Long-term Follow-up Study.

    Scand J Gastroenterol 1999 Feb;34(2):163-9
    PMID: 10192194, UI: 99206412
    Authors: Kaukinen K, Collin P, Holm K, Rantala I, Vuolteenaho N, Reunala T, Maki M
    Dept. of Medicine, Tampere University Hospital, Finland.

    (Celiac.com 05/14/2000)

    SPECIAL NOTE: European Codex Alimentarius quality wheat starch was used in this study.

    BACKGROUND: We investigated whether wheat starch-based gluten-free products are safe in the treatment of gluten intolerance.

    METHODS: The study involved 41 children and adults with coeliac disease and 11 adults with dermatitis herpetiformis adhering to a gluten-free diet for 8 years on average. Thirty-five newly diagnosed coeliac patients at diagnosis and 6 to 24 months after the start of a gluten-free diet and 27 non-coeliac patients with dyspepsia were investigated for comparison. Daily dietary gluten and wheat starch intake were calculated. Small bowel mucosal villous architecture, celiac disease3+, alphabeta+, and gammadelta+ intraepithelial lymphocytes, mucosal HLA-DR expression, and serum endomysial, reticulin, and gliadin antibodies were investigated. RESULTS: Forty of 52 long-term-treated patients adhered to a strict wheat starch-based diet and 6 to a strict naturally gluten-free diet; 6 patients had dietary lapses. In the 46 patients on a strict diet the villous architecture, enterocyte height, and density of alphabeta+ intraepithelial lymphocytes were similar to those in non-coeliac subjects and better than in short-term-treated coeliac patients. The density of gammadelta(+)cells was higher, but they seemed to decrease over time with the gluten-free diet. Wheat starch-based gluten-free flour products did not cause aberrant upregulation of mucosal HLA-DR. The mucosal integrity was not dependent on the daily intake of wheat starch in all patients on a strict diet, whereas two of the six patients with dietary lapses had villous atrophy and positive serology.

    CONCLUSION: Wheat starch-based gluten-free flour products were not harmful in the treatment of coeliac disease and dermatitis herpetiformis.

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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.

  • Related Articles

    Scott Adams
    Lancet 2002;359:945-946.
    Celiac.com 04/12/2002 - According to a report published in the March 16th issue of The Lancet, a new anti-transglutaminase antibody test developed by Dr. Luis Sorell and colleagues from the Centre for Genetic Engineering and Biotechnology in Havana, Cuba can accurately diagnose people with celiac disease in less than 10 minutes. The assay consists of a nitrocellulose strip that is placed in serum or plasma specimens, and it detects both IgA and IgG antibodies to transglutaminase, which prevents misdiagnosis of patients who have IgA deficiency, a trait that is frequently seen in people with celiac disease. If two dots appear it indicates a positive result. To determine the assays accuracy Dr. Sorell and colleagues evaluated 50 patients with untreated celiac disease along with 40 patients who had other gastrointestinal disorders. The results showed that the assay was 100% accurate, all of the patients with diagnosed celiac disease tested positive, and all of the patients with other disorders tested negative. Ultimately the assay could be used for an inexpensive mass-screening program for celiac disease.

    Scott Adams
    Clin Chem Lab Med. 2004;42(10):1092-7 Celiac.com 01/22/2005 - A study by Italian researchers has found that anti-tissue transglutaminase (tTG) antibodies, once considered to be identical to anti-endomysial antibodies (EMA) in celiac disease, can also be found in patients with inflammatory bowel disease. The researchers looked at serum and intestinal tTG levels in 49 patients with Crohns disease, 29 patients with ulcerative colitis, 45 patients with celiac disease, 85 autoimmune patients as disease controls, and 58 volunteers as healthy controls. Additionally, Immunoglobulin A (IgA) anti-recombinant human tissue transglutaminase and anti-endomysial antibody detection in sera and fecal supernatants, along with adsorption of positive sera with recombinant human tissue transglutaminase, were performed on all patients.
    The researchers detected an increase in tTG concentration in all patients with celiac disease, and also low positive values in those with Crohns disease and ulcerative colitis, however the EMA were only detected in those with celiac disease. According to the researchers, the "Data highlight that both circulating and intestinal anti-tissue transglutaminases are detectable in inflammatory bowel disease, and that they are related to disease activity. These features underline that, in addition to anti-tissue transglutaminase, an anti-endomysial antibody test is necessary in the diagnostic work-up of celiac sprue, especially in patients with known inflammatory bowel disease."
    This study supports others that have found that the sole use of tTG to diagnose celiac disease may lead to misdiagnoses, and EMA testing must be performed to make an accurate celiac disease diagnosis.

    Jefferson Adams
    Celiac.com 09/10/2007 - A study published recently in the journal of Alimentary Pharmacology and Therapeutics shows that the paracellular permeability inhibitor AT-1001 effectively reduces intestinal barrier dysfunction, proinflammatory cytokine production, and gastrointestinal symptoms in people who have celiac disease. At present, a lifetime devoted to following a strict gluten-free diet is the backbone of current treatment for celiac disease. However, as researchers have come to know more about celiac disease, they’re insights are leading to developments that offer more effective prognosis and treatment of the disease.
    One of those promising new approaches involves treating celiac patients with doses of AT-1001, a paracellular permeability inhibitor that is structurally derived from a protein secreted by Vibrio cholerae. Recently, a team of medical researchers set out to assess the safety and tolerability of 12 mg doses of AT-1001 in people with celiac disease who submitted to acute gluten exposure.
    For the in-patient, double-blind, randomized placebo-controlled safety study, researchers looked at twenty men and women with celiac disease and measured intestinal permeability, through fractional excretions of lactulose and mannitol, as an exploratory measure of the efficacy of AT-1001 in treating celiac disease.
    The test subjects were men and women with age ranging from 18 to 59 years old. Each was pre-screened and referred by a gastroenterologist. Each had positive biopsy and antibody screens that indicated celiac disease. Each had also been on a gluten-free diet at least six months, was not known to be IgA deficient, and presented with anti-tTG titres of <10 EU at enrollment.
    Study shows safety and tolerability of 12 mg doses of AT-1001 in celiac disease
    In the placebo group, acute gluten exposure brought an observable 70% increase in intestinal permeability, compared to no change at all in the AT-1001 group. Four of seven patients (57%) of the placebo group showed increased levels of Interferon-gamma levels, but in the AT-1001 group only four of 14 patients (29%) showed such increases. Also, the placebo group showed gastrointestinal symptoms more frequently than the AT-1001 group (P = 0.018).
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    health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.

    Jefferson Adams
    Celiac.com 03/18/2015 - Getting high-quality biopsy specimens is key to making accurate celiac disease diagnoses. Endoscopists may take either a single- or double-biopsy specimen with each pass of the forceps.
    Does it matter whether they take one or two? Is two better than one?
    A team of researchers recently set out to answer those questions, by comparing the quality of biopsy specimens obtained with the single-biopsy and double-biopsy techniques.
    The research team includes M. Latorre, S.M. Lagana, D.E. Freedberg, S.K. Lewis, B. Lebwohl, G. Bhagat, and P. H. Green of the Celiac Disease Center, Department of Medicine, Columbia University, New York, New York, USA.
    Their prospective cohort study looked at patients undergoing upper endoscopy with confirmed, suspected, or unknown celiac disease status. A total of 86 patients enrolled in the study, 47% with known celiac disease, 36% with suspected celiac disease, and 17% with an unknown celiac disease status.
    In each case, patients received four biopsy specimens from the second portion of the duodenum. Two were made using the single-biopsy technique of 1 bite per pass of the forceps, and two more using the double-biopsy technique, which takes 2 bites per pass of the forceps.
    Specimens were blindly reviewed to determine orientation, consecutive crypt-to-villous units, and Marsh score. Well-oriented biopsy specimens were noted in 66% of patients with the single-biopsy technique and 42% of patients with the double-biopsy technique (P < .01).
    Analysis of matched pairs showed improved orientation with the single-biopsy technique (odds ratio 3.1; 95% confidence interval, 1.5-7.1; P < .01). This persisted in subgroup analysis of patients with known celiac disease (P = .02), villous atrophy (P = .02), and a final diagnosis of celiac disease (P < .01).
    Now, this is just a single-center trial, so results need to be compared with results from additional cities.
    Interestingly, these results suggest that one bite is actually better than two, because the single-biopsy technique improves the yield of well-oriented duodenal biopsy specimens.
    For best results, the endoscopists should consider taking only one biopsy specimen per pass of the forceps in patients undergoing biopsies of the duodenal mucosa.
    Source:
    Gastrointest Endosc. 2015 Jan 29. pii: S0016-5107(14)02380-3. doi: 10.1016/j.gie.2014.10.024.

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