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    Celiac Disease Patients at Higher Risk for Clostridium Difficile Infection


    Jefferson Adams


    • Celiac patients showed a Clostridium difficile infection rate of 56 cases per 100,000 person-years


    Image Caption: Photo: CC--Mike Coughlin

    Celiac.com 01/17/2018 - People with celiac disease face a higher risk of infections like tuberculosis, influenza, and pneumococcal pneumonia, but researchers don't know how this might apply to risk of Clostridium difficile infection in those patients.


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    A team of researchers recently set out to identify celiac disease patients using biopsy data from all pathology departments in Sweden over the 39-year period covering July 1969 through February 2008. They compared the risk of Clostridium difficile infection, based on stratified Cox proportional hazards models, among patients with celiac disease versus a control group of patients without celiac disease--matched by age, sex, and calendar period.

    The research team included Benjamin Lebwohl MD, MS, Yael R Nobel MD, Peter H R Green MD, Martin J Blaser MD, and Jonas F Ludvigsson MD, PhD. They are variously affiliated with the Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA; the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; the New York University Langone Medical Center, New York, New York, USA; the Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and with the Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden.

    In all, they isolated 28,339 celiac patients, along with 141,588 control subjects. None of the celiac patients or control subjects had any history of Clostridium difficile infection.

    Celiac patients showed a Clostridium difficile infection rate of 56 cases per 100,000 person-years, compared with a rate of 26 cases per 100,000 person-years among control subjects, yielding an overall hazard ratio (HR) of 2.01. Compared with control subjects, celiac patients in their first 12 months after diagnosis showed the highest risk. However, the risk remained high up to 5 years after celiac diagnosis.

    The researchers found antibiotic data for 251 of the 493 patients with Clostridium difficile infection; they found no significant differences in previous antibiotic use between patients with celiac disease and control subjects.

    This large population-based cohort study showed that celiac patients had substantially higher rates of Clostridium difficile infection than did control subjects.

    The results of this study match prior studies that confirm higher infection rates in celiac patients, and indicate that celiac patients may suffer from altered gut immunity and/or microbial composition.

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    Guest Vee

    Posted

    Wait, wait, wait. "Celiac patients?" Can we be a littler clearer? Does the author mean untreated people with Celiac disease?

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  • About Me

    Jefferson Adams is a freelance writer living in San Francisco. He has covered Health News for Examiner.com, and provided health and medical content for Sharecare.com. His work has appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate, among others.

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  • Related Articles

    Jefferson Adams
    Research indicates that rod-shaped bacteria, of the species Clostridium, Prevotella, and Actinomyces, in the proximal small intestine may contribute to some cases of celiac disease in children.
    Recent data builds on previous research by the team from 1985 to 1996, which proved that rod-shaped bacteria were present in the proximal small intestine of Swedish children with celiac disease, but not in those without celiac disease.
    For the current study, Sten Hammarström and colleagues from Umeå University in Sweden used an electron microscope to scan proximal small intestine biopsies from 45 children with celiac disease taken between 2004 and 2007, and 18 without the condition.
    To identify the bacteria, they used 16S ribosomal DNA sequencing in DNA extracted from biopsies washed with solution containing an agent that enriches bacteria attached to the epithelial lining.
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    Surprisingly, the researchers found that microbial flora of the proximal small intestine in biopsies from celiac disease patients differed only slightly from that of the control subjects. Only a single biopsy tested positive for rod-shaped bacteria.
    This finding made the team to look more closely at the microbial flora of nine frozen celiac disease samples that showed the presence of rod-shaped bacteria. In these samples, microbial flora were substantially richer in Clostridium, Prevotella, and Actinomyces compared with biopsies lacking rod-shaped bacteria.
    The researchers also note that all three types of bacteria could be found in two current celiac disease biopsies taken from children born during the celiac disease epidemic in Sweden in 1985–1996, when the earlier study was carried out. During this time, rates of celiac disease in children younger than 2 years of age increased four-fold.
    “We hypothesize that the increased frequency of rod-shaped bacteria in the jejuna mucosa of celiac disease children at least partly was due to the changes in infant-feeding practice during that time,” write the researchers.
    The changes resulted from new national feeding recommendations for infants to delay the introduction of gluten-containing foods from 4 to 6 months. This meant that many more children consumed their first gluten without the protective benefits of breastfeeding, the researchers write. The recommendation was later reversed.
    The study by Hammarström and co-workers supports their conclusion that these rod-shaped bacteria may contribute to celiac disease in genetically susceptible individuals by uptaking and transforming gluten into large immunogenic peptides, which can then cross with the bacterium through the epithelium, or interfere with the barrier action of the epithelium to permit the passage of gluten into the under-laying tissue.
    “Such bacteria could be seen as an adjuvant promoting T-cell activation,” they say. “Whether the identified bacteria have any of these properties remain to be elucidated.”
     
    Am J Gastroenterol 2009; 104: 3058–3067


    Jefferson Adams
    Celiac.com 02/09/2015 - Do you suffer from persistent celiac symptoms in spite of following a strict gluten-free diet and having normal small bowel mucosa? Many celiac patients do. Moreover, typical explanations, such as accidental gluten-intake or the presence of other gastrointestinal disease, do not account for all of the symptoms in these patients.
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    All celiac patients had been following a strict gluten-free diet for several years, and had restored small bowel mucosa and tested negative for celiac autoantibodies.
    The team rated symptoms using the Gastrointestinal Symptom Rating Scale, and found that gluten-free celiac disease patients with persistent symptoms had different duodenal bacteria than celiac patients without symptoms.
    Gluten-free celiac patients with persistent symptoms had a higher relative abundance of Proteobacteria (P=0.04) and a lower abundance of Bacteroidetes (P=0.01) and Firmicutes (P=0.05). Moreover, they had a much narrower range of bacteria types in their guts.
    The discovery that dysbiosis of microbiota is associated with persistent gastrointestinal symptoms in gluten-free celiac patients offers a new avenue of treatment for such patients.
    Source:
    Am J Gastroenterol. 2014;109(12):1933-1941.

    Jefferson Adams
    Celiac.com 08/08/2016 - Celiac-associated duodenal dysbiosis has not yet been clearly defined, and the mechanisms by which celiac-associated dysbiosis could concur to celiac disease development or exacerbation are unknown. To clarify the situation, a research team recently analyzed the duodenal microbiome of celiac patients.
    The research team included V D'Argenio, G Casaburi, V Precone, C Pagliuca, R Colicchio, D Sarnataro, V Discepolo, SM Kim, I Russo, G Del Vecchio Blanco, DS Horner, M Chiara, G Pesole, P Salvatore, G Monteleone, C Ciacci, GJ Caporaso, B Jabrì, F Salvatore, and L Sacchetti. They are variously affiliated with CEINGE-Biotecnologie Avanzate, Naples, Italy, the Department of Molecular Medicine and Medical Biotechnologies and the Department of Medical Translational Sciences and European Laboratory for the Investigation of Food Induced Diseases at the University of Naples Federico II, Naples, Italy, the Department of Medicine and the University of Chicago Celiac Disease Center, University of Chicago, Chicago, Illinois, USA, the Department of Medicine and Surgery, University of Salerno, Salerno, Italy, the Department of System Medicine, University of Rome Tor Vergata, Rome, Italy, the Department of Biosciences, University of Milan, Milan, Italy, the Institute of Biomembranes and Bioenergetics, National Research Council, Bari, Italy, the Department of Biochemistry and Molecular Biology, University of Bari A. Moro, Bari, Italy, the Northern Arizona University, Flagstaff, Arizona, USA, the IRCCS-Fondazione SDN, Naples, Italy.
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    Whole-genome sequencing of celiac disease-associated Neisseria flavescens and control-Nf showed genetic diversity of the iron acquisition systems, and of some hemoglobin-related genes. Neisseria flavescens was able to escape the lysosomal compartment in CaCo-2 cells and to induce an inflammatory response in DCs and in ex-vivo mucosal explants.
    Marked dysbiosis and the pronounced presence of a peculiar strain characterize the duodenal microbiome in active celiac disease patients.
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    Source:
    Am J Gastroenterol. 2016 Jun;111(6):879-90. doi: 10.1038/ajg.2016.95. Epub 2016 Apr 5.

    Jefferson Adams
    Celiac.com 08/01/2016 - Symptoms and damage in celiac disease is caused by partially-degraded gluten peptides from wheat, barley and rye. Susceptibility genes are necessary to trigger celiac disease, but they can't do it alone. Some researchers suspect that these susceptibility genes might get help from conditions resulting from unfavorable changes in the microbiota.
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    The research team included A Caminero, HJ Galipeau, JL McCarville, CW Johnston, S Bernier, AK Russell, J Jury, AR Herran, J Casqueiro, JA Tye-Din, MG Surette, NA Magarvey, D Schuppan, and EF Verdu. They are variously affiliated with the Farncombe Family Digestive Health Research Institute, and the Department of Biochemistry & Biomedical Sciences, M. G. DeGroote Institute for Infectious Disease Research at McMaster University, Hamilton, Ontario, Canada; the Immunology Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria, Australia; the Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia; Área de Microbiología, Facultad de Biología y Ciencias Ambientales, Universidad de León, León, 24071 Spain; the Immunology Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria, 3052 Australia; the Department of Gastroenterology, The Royal Melbourne Hospital, Grattan St., Parkville, Victoria, 3050 Australia, and the Institute for Translational Immunology and Research Center for Immunotherapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
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    Source:
    Gastroenterology. 2016 Jun 30. pii: S0016-5085(16)34713-8. doi: 10.1053/j.gastro.2016.06.041.

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/23/2018 - If you’re looking for a great gluten-free Mexican-style favorite that is sure to be a big hit at dinner or at your next potluck, try these green chili enchiladas with roasted cauliflower. The recipe calls for chicken, but they are just as delicious when made vegetarian using just the roasted cauliflower. Either way, these enchiladas will disappear fast. Roasted cauliflower gives these green chili chicken enchiladas a deep, smokey flavor that diners are sure to love.
    Ingredients:
    2 cans gluten-free green chili enchilada sauce (I use Hatch brand) 1 small head cauliflower, roasted and chopped 6 ounces chicken meat, browned ½ cup cotija cheese, crumbled ½ cup queso fresco, diced 1 medium onion, diced ⅓ cup green onions, minced ¼ cup radishes, sliced 1 tablespoon cooking oil 1 cup chopped cabbage, for serving ½ cup sliced cherry or grape tomatoes, for serving ¼ cup cilantro, chopped 1 dozen fresh corn tortillas  ⅔ cup oil, for softening tortillas 1 large avocado, cut into small chunks Note: For a tasty vegetarian version, just omit the chicken, double the roasted cauliflower, and prepare according to directions.
    Directions:
    Heat 1 tablespoon oil in a cast iron or ovenproof pan until hot.
    Add chicken and brown lightly on both sides. 
    Remove chicken to paper towels to cool.
     
    Cut cauliflower into small pieces and place in the oiled pan.
    Roast in oven at 350F until browned on both sides.
    Remove from the oven when tender. 
    Allow roasted cauliflower to cool.
    Chop cauliflower, or break into small pieces and set aside.
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    Roxanne Bracknell
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    Jefferson Adams
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    Bakery On Main started in the small bakery of a natural foods market on Main Street in Glastonbury, Connecticut. Founder Michael Smulders listened when his customers with Celiac Disease would mention the lack of good tasting, gluten-free options available to them. Upon learning this, he believed that nobody should have to suffer due to any kind of food allergy or dietary need. From then on, his mission became creating delicious and fearlessly unique gluten-free products that were clean and great tasting, while still being safe for his Celiac customers!
    Premium ingredients, bakeshop delicious recipes, and happy customers were our inspiration from the beginning— and are still the cornerstones of Bakery On Main today. We are a fiercely ethical company that believes in integrity and feels that happiness and wholesome, great tasting food should be harmonious. We strive for that in everything we bake in our dedicated gluten-free facility that is GFCO Certified and SQF Level 3 Certified. We use only natural, NON-GMO Project Verified ingredients and all of our products are certified Kosher Parve, dairy and casein free, and we have recently introduced certified Organic items as well! 
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    We are available during normal business hours at: 1-888-533-8118 EST.
    To learn more about us at: visit our site.

    Jefferson Adams
    Celiac.com 06/20/2018 - Currently, the only way to manage celiac disease is to eliminate gluten from the diet. That could be set to change as clinical trials begin in Australia for a new vaccine that aims to switch off the immune response to gluten. 
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    Read more at the website for Australia’s University of the Sunshine Coast Clinical Trials Centre.

    Source:
    FoodProcessing.com.au