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  • Jefferson Adams
    Jefferson Adams

    Advantages to Early Intervention for Asymptomatic Celiac Disease

    Celiac.com 06/13/2011 - Serological screening of asymptomatic people at risk for celiac disease is an effective method for spotting the disease and prompting early treatment, according to the results of a study by researchers from Finland, presented at Digestive Disease Week 2011.

    The study team showed that diagnosing and treating celiac disease in its earliest stages is beneficial in most screen-detected asymptomatic patients.

    Most of the patients the team studied were willing to continue on a gluten-free diet. On that basis, they assert that it is reasonable to screen at-risk groups.

    Lead author Kalle Kurppa, MD, from the University of Tampere in Finland noted that about 2% of the population has celiac disease, but that 90% of affected persons are never formally diagnosed.

    "Screening for celiac disease is problematic, and treatment is difficult. It is also unclear whether early diagnosis and treatment of screen-detected celiac disease is truly beneficial," Dr. Kurppa said.

    The study team set out to assess the benefit of adopting a gluten-free diet in asymptomatic adults with positive endomysial antibody (EmA) serological screens.

    For the study, the team recruited 3031 relatives of patients with celiac disease.  Of these, 148 showed positive EmA scans. 40 of these patients agreed to be randomly assigned to continue their gluten-containing diets (n = 20) , or to start a gluten-free diet (n = 20).

    In addition to screening for EmA testing, the study team tested for transglutaminase 2 antibodies, and surveyed patients using the Gastrointestinal Symptoms Rating Scale and Psychological General Well-Being instrument.

    The team evaluated laboratory parameters, celiac-specific genetics, bone mineral density, and body composition, along with small bowel mucosal morphology and inflammation.

    The team assessed patients at baseline and again after one year, at which time 18 of 20 control patients chose to begin the gluten-free diet as well.

    The team observed improvements in all patient parameters. The gluten-free diet group showed mucosal healing (changes in the villous height/crypt depth ratio); the control patients did not (P < .001).

    As senior investigator Katri Kaukinen, MD, PhD, explained in a press briefing: "After one year, those on a normal gluten diet had persistence or even a worsening of mucosal lesions, but those who started on a gluten-free diet showed recovery of the mucosa. The difference was really significant at one year."

    The group on the gluten-free diet also showed significantly reduced EmA titers (P < .001) and transglutaminase 2 antibody titers (P < .001) from baseline, along with improvements in symptoms (P < .001) and quality of life (P < .001), compared with the control patients.

    Control patients who switched to a gluten-free diet showed similar changes in all areas, except for quality of life after 1 year.

    Average laboratory readings, body mass index, and bone mineral density all registered within normal ranges at baseline, and showed no significant changes with the intervention. Also, folate and vitamin B12 levels showed substantial improvements on the gluten-free diet.

    Overall, patients had positive attitudes toward screening and the dietary intervention, Dr. Kurppa pointed out. Twenty-seven patients (67%) reported adherence to the gluten-free diet, 10 patients (25%) reported minor lapses, and only 3 patients (8%) reported a lack of adherence.

    Thirty-four patients (85%) were open to maintaining the gluten-free diet going forward.

    Five percent of patients found the gluten-free diet  'easy', Sixty-seven percent found it 'quite easy', while just thirteen percent of patients found if 'difficult.' Somehow, fifteen percent were "uncertain" about that question.

    Over half of the patients found the serological screening to be positive or very positive, and none found it to be a negative experience.

    Dr. Kaukinen noted at the press briefing that although patients first showed few, if any, symptoms, they reported feeling much better on the gluten-free diet.

    "We don't know why celiac patients have these different clinical phenotypes, why some get severe symptoms and others do not," said Kaukinen. It could be that people adapt to minor symptoms, and only realize their symptoms after they are gone. "Some patients told us they felt totally different on the diet," she added.

    Dr. Kaukinen says that the goal of early detection is to prevent worsening of symptoms, vitamin deficiencies, and possibly a loss in bone mineral density. "If we see early signs of disease, why should we wait when we can do something for them now?" she asked.

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    I was just diagnosed with celiac disease two days ago - started the gluten-free diet, which helped. I went to a health food store to get some gluten-free cookies. The chocolate ones were gluten-free and I assumed the vanilla ones were also gluten-free, but they were not - I ate the whole package in two days. I never felt different but I never did feel anything eating gluten. I found out I was celiac at a routine physical. I guess I just start all over with the gluten diet - was wondering if that hurt me more eating the whole package because I don't have symptoms but know it is showing up in my body because of the endoscopy I had. Thank you

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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

    Jefferson Adams
    Celiac.com 03/26/2007 - According to a recent Norwegian research report, the adverse immune response to gluten may be tied to a specific set of dendrite cells in the small intestine.
    A team led by Dr. Melinda Raki set out to compare the antigen-presenting cells in the small intestine of patients with celiac disease versus those from normal individuals.
    The study used multiple duodenal biopsy specimens from 14 patients with untreated celiac disease, 6 with treated celiac disease and 4 controls.
    Antigen presenting cells are so termed because they present gluten to the T-cells, which then contribute to the inflammation that damages the villi in the intestinal lining of those with celiac disease.
    Researcher found that in the normal duodenal mucosa, about 20% of the HLA-DQ2 molecules associated with celiac disease were Cd11c+ dendritic cells. These dendritic cells accrued in the celiac lesions of the untreated celiac subjects.
    When these CD11c+ cells were removed from the biopsy samples, they provoked an adverse gluten reaction in the T-cells.
    The study indicates that a greater knowledge of antigen-presenting cells will yield a more complete understanding of the dynamics of celiac disease, the means by which inflammation occurs, and the means by which it can be controlled or avoided altogether.
    Gastroenterology 2006;131:428-438.

    Jefferson Adams
    Celiac.com 02/14/2011 - In what may seem for some like an obvious finding, a team of Australian researchers has shown that people can suffer gluten intolerance without having celiac disease. Their study is published in The American Journal of Gastroenterology.
    I say obvious, because many in the celiac and surrounding community have long understood and accepted the concept of gluten-intolerance as distinct from celiac disease. Surprisingly, there has been very little scientific research to establish the existence of gluten-intolerance as distinct from celiac disease. That is changing, and the recent Australian study offers some support for gluten-intolerance as distinct from celiac disease.
    For their study, a team of researchers led by Peter Gibson, professor of medicine at Eastern Health Clinical School at Monash University in Australia, recruited 34 people with irritable bowel syndrome, but who were clinically proven to be free of celiac disease. All participants had previously benefited from a gluten-free diet.
    The 34 volunteers were all fed bread and muffins, half of which contained gluten, half of which were gluten-free. Nearly 70 per cent of the volunteers who ate the gluten reported pain, bloating, toilet problems and extreme tiredness.
    ''Gluten is indeed a trigger of gut symptoms and tiredness,'' the researchers concluded. Professor Gibson said: ''These symptoms have a big impact on quality of life. But conservative medicine has not been so good at dealing with this because we haven't had any evidence.''
    A number of the volunteers had sought help from alternative health practitioners, a fact that impaired recruitment of volunteers, as many of these folks had adopted a gluten-free diet without proving or disproving celiac disease via colonoscopy and biopsy.
    It was important for the team to exclude celiac disease for several reasons, including the fact that although it was safe to use gluten to test people who may have an intolerance, it could harm people with celiac disease.
    "If you go back on gluten while you have celiac disease - even if you only eat a few pieces of bread - you will damage your body and undo many months of healing," Professor Gibson said.
    For that reason, and also to prove gluten intolerance alone was the symptom cause, the team recruited people  clinically proven to be free of celiac disease, and who were already on gluten-free diets.
    For those patients with irritable bowel syndrome, excluding celiac disease, who were symptomatically controlled on a gluten-free diet, the team crafted a double-blind, randomized, placebo-controlled re-challenge trial.
    Participants received either gluten or placebo in the form of two bread slices plus one muffin per day with a gluten-free diet for up to 6 weeks. The team evaluated symptoms using a visual analog scale and markers of intestinal inflammation, injury, and immune activation monitoring.
    A total of 4 men and 30 women between the ages of 29–59-years old completed the study as per protocol. Overall, 56% showed human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8. Adherence to diet and supplements was very high.
    Of 19 patients (68%) in the gluten-consuming group, 13 reported that symptoms were not adequately controlled compared with 6 of 15 (40%) on placebo (P=0.0001; generalized estimating equation).
    On a visual analog scale, patients were significantly worse within one week of consuming gluten for overall symptoms (P=0.047), pain (P=0.016), bloating (P=0.031), satisfaction with stool consistency (P=0.024), and tiredness (P=0.001).
    In no cases did gluten-consumption trigger anti-gliadin antibodies. Moreover, there where were no significant changes in fecal lactoferrin, levels of celiac antibodies, highly sensitive C-reactive protein, or intestinal permeability. There were no differences in any end point in individuals with the DQ2/DQ8 and those without.
    Gibson calls the general lack of research into gluten intolerance "almost unbelievable." He plans to now investigate the prevalence of non-celiac gluten intolerance, why it occurs and whether low levels of gluten can be eaten safely.

    Source:

    American Journal of Gastroenterology: 11 January 2011. doi: 10.1038/ajg.2010.487

    Jefferson Adams
    Celiac.com 04/19/2012 - A team of researchers examined the effect of corn, rice and amaranth gluten-free sourdoughs on the release of nitric oxide (NO) and synthesis of pro-inflammatory cytokines by duodenal mucosa biopsies of eight celiac disease patients.
    The research team included Maria Calasso, Olimpia Vincentini, Francesco Valitutti, Cristina Felli, Marco Gobbetti and Raffaella Di Cagno.
    The team used select lactic acid bacteria as starters for making corn, rice and amaranth sourdoughs. From these gluten-free sourdough matrices, they made chemically acidified doughs, without bacterial starters, and doughs started with baker’s yeast alone.
    They produced pepsin-trypsin (PT) digests from all sourdoughs and doughs, and used the results to the measure the recovery of biopsy specimens from eight celiac disease patients at diagnosis. They also measured the release of NO and the synthesis of pro-inflammatory cytokines interferon-γ (IFN-γ).
    They found that lactic acid bacteria acidified and grew well (ca. log 9.0 CFU/g) during fermentation, showing strong proteolysis on all gluten-free samples.
    They also found that duodenal biopsy specimens still released NO and IFN-γ when subjected to treatments with basal medium (control), PT-digest from chemically acidified doughs and PT-digest from doughs fermented with baker’s yeast alone.
    In fact, in every case, biopsy specimens treated with PT-digests from all gluten-free matrices with sourdough fermentation substantially reduced NO release and IFN-γ synthesis.
    From their results, the team concludes that sourdough fermentation might offer an easy and effective way to speed recovery from intestinal inflammation of celiac patients beginning a gluten-free diet.
    Source:

    EUROPEAN JOURNAL OF NUTRITION. DOI: 10.1007/s00394-012-0303-y

    Jefferson Adams
    Celiac.com 11/14/2013 - Until now, rates of non-celiac gluten sensitivity were largely a matter of clinical speculation, basically, educated guesswork among doctors.
    Some thought that rates of non-celiac gluten-sensitivity might by much higher than rates of celiac disease in the USA. But there was just no actual clinical data supporting these claims.
    A team of researchers recently set out to get some good clinical data that would tell them how common non-celiac gluten sensitivity actually is.
    The research team included Daniel V. DiGiacomo, Christina A. Tennyson, Peter H. Green, and Ryan T. Demmer. They are variously affiliated with the Department of Medicine, Celiac Disease Center at Columbia University, and the Department of Epidemiology at the Mailman School of Public Health at Columbia University in New York.
    The authors used the Continuous National Health and Nutrition Examination Survey (NHANES) 2009–2010 to enroll 7762 people from the civilian, non-institutionalized, US population free of celiac disease.
    They then analyzed the data to estimate rates of adherence to a gluten-free diet among participants without celiac disease as a surrogate marker for non-celiac gluten sensitivity in the US.
    They also used the data to characterize the demographics and general health status of the study participants.
    Overall, forty-nine participants reported adherence to a gluten-free diet. With a weighted national prevalence of 0.548%, this represents 1.3 million individuals between 6 and 80 years old in the US.
    The prevalence of a gluten-free diet was higher in females (0.58%) than males (0.37%), although this was not statistically significant (p = 0.34).
    Participants reporting a gluten-free diet were older (46.6 vs. 40.5 years, p = 0.005), had higher high-density lipoprotein, lower iron and lower body mass index.
    These numbers put the estimated national prevalence of non-celiac gluten sensitivity at 0.548%, about half the rate of celiac disease.
    However, the team calls for further studies in order to better understand the population burden of non-celiac gluten sensitivity.
    Source:
    Rev Esp Enferm Dig. 2013 Apr;105(4):187-193. doi:10.3109/00365521.2013.809598

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