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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    COLON NEOPLASIA CO-EXISTING WITH CELIAC DISEASE IN OLDER PATIENTS: COINCIDENTAL, PROBABLY; IMPORTANT, CERTAINLY


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    Scand J Gastroenterol. 2002 Sep;37(9):1054-6. Related Articles, Links


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    Celiac.com 08/27/2004 – The following abstract demonstrates the importance of follow up exams with your doctor, and also the importance of regular colon screenings for those with celiac disease.

    BACKGROUND: Coeliac disease and colorectal neoplasia are both common, present most often in patients over 40 and cause similar symptoms. Greater awareness and early use of serological tests have improved the diagnosis of coeliac disease, but raise the concern that co-existing colorectal neoplasia may be missed. This study assessed the prevalence of colorectal neoplasia among patients with coeliac disease diagnosed after the age of 40 who presented with altered bowel habit or iron deficiency.

    METHODS: All patients meeting the above criteria underwent colonoscopy unless this or barium enema had been performed shortly before.

    RESULTS: Of 69 patients with coeliac disease undergoing colonoscopy, 7 (10%) had colon neoplasia: 5 had tubulovillous polyps, and 2 had carcinoma. The prevalence figures for coeliac patients undergoing colonoscopy with iron deficiency and altered bowel habit alone were 11% (5 of 47) and 10% (2 of 22), respectively None of a further 13 who had undergone previous colon investigation (all by barium enema) had neoplasia, although these were probably a selected population. The seven patients with colorectal neoplasia had not reported rectal bleeding. The prevalence of colorectal neoplasia was not significantly higher than in two series of non-coeliac patients undergoing colonoscopy for investigation of iron deficiency (12%) or altered bowel habit (8%).

    CONCLUSIONS: There is a high prevalence of colorectal neoplasia among older patients with coeliac disease who present with iron deficiency or altered bowel habit, though this is no higher than for non-coeliac patients with these presentations. The possibility of dual pathology should be considered and excluded by colon investigation.


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    admin

    The following abstract was submitted to celiac.com directly by William Dickey, Ph.D., a leading celiac disease researcher and gastroenterologist who practices at Altnagelvin Hospital, Londonderry, Northern Ireland.
    Scandinavian Journal of Gastroenterology 2005; 40: 1240-3.
    Dickey W, Hughes DF, McMillan SA.
    Celiac.com 09/27/2005 - What does a positive endomysial antibody (EmA) test mean if the biopsy does not show villous atrophy? The authors studied 35 patients where this was the case. In the authors practice, these patients account for 10% of all EmA positives.
    Firstly, the lack of villous atrophy did not necessarily mean a normal biopsy: 14 patients had excess inflammatory cells (lymphocytes) consistent with a mild abnormality of gluten sensitivity.
    Secondly, many of these patients had typical celiac features: twelve had a family history of celiac, five had dermatitis herpetiformis and thirteen had osteopenia or osteoporosis on DEXA scan.
    After discussion, 27 patients opted to take a gluten-free diet from the first biopsy: 26 of these had clinical improvement. Seven of eight patients who persisted with a normal diet developed villous atrophy on follow-up biopsies.
    The authors conclude that a positive EmA result indicates gluten sensitivity even if biopsies do not show villous atrophy. While a biopsy remains important as a baseline reference, these patients should be offered a gluten-free diet to allow clinical improvement and prevent the development of villous atrophy. There may be no such thing as a "false positive" EmA, although the authors emphasise that the same conclusion cannot yet be applied to tissue transglutaminase antibody results.

    Jefferson Adams
    Celiac,com 10/08/2010 - Many people are familiar with probiotics, such as acidophilus, Bifidobacterium bifidum, Bifidobacterium longum, Lactobacillus acidophilus, Lactobacillus case, which promote beneficial gut bacteria, and are commonly found in yogurt, kefir and other fermented milk products.
    But how many of us have heard of polysaccharides, which are a particular kind of carbohydrate made up of of a number of monosaccharides joined together by something called glycosidic bonds.
    On a simpler note, polysaccharides are also known as pre-biotics, because they serve as fuel for probiotic bacteria, and help to promote healthy ratios of beneficial bacteria to non-beneficial bacteria in the gut.
    It is well-known among scientists that diet has a major influence on the health and diversity of gut microbiota. People with celiac disease must follow a gluten-free diet in order to avoid associated damage and health disorders.
    When people with celiac disease follow a gluten-free diet, their celiac symptoms disappear and their gut begins to heal itself from the damage. The health effects of the diet for people with celiac disease are overwhelmingly positive.
    However, there is some evidence that by eliminating gluten, people with celiac disease are making themselves susceptible to a plunge in beneficial gut bacteria, and an elevated ratio of bad-to-good gut bacteria. This may have immune-system implications for those people.
    To test this hypothesis, a team of scientists recently conducted a preliminary study to determine if a gluten-free diet alone could change the make-up and immune properties of gut microbiota. The team included G. De Palma, I. Nadal, M. C. Collado, and Y. Sanz. Their full results appear in theSeptember, 2009 issue of the British Journal of Nutrition.
    To briefly summarize their study, the team enrolled ten healthy individuals without celiac disease, averaging just over 30 years of age. They put these people on a gluten-free diet for a month. Subsequent analysis of fecal microbiota and dietary intake showed a decrease in healthy gut bacteria, coupled with an increase of unhealthy bacteria that corresponded with reduced intake of polysaccharides after following the gluten-free diet. Another healthy control group that ate a diet that contained gluten, and thus provided polysaccharides. 
    In addition representing an adversely change in gut microbiota, the samples taken while the individuals followed a gluten-free diet also exerted reduced immune stimulatory effects on peripheral blood mononuclear cells than those of subjects on a regular gluten-containing, polysaccharide-rich diet.
    Should these findings be confirmed by subsequent studies, the results could call attention to a more comprehensive approach to proper dietary intake in people with celiac disease, including dietary counseling, and possible supplementation of the diet with polysaccharides.
    Source:

    Br J Nutr. 2009 Oct;102(8):1154-60.

    Jefferson Adams
    Celiac.com 04/01/2013 - There haven't been many studies that evaluate the usefulness of capsule endoscopy in equivocal celiac disease. A team of researchers recently set out to conduct an evaluation of capsule endoscopy in adult celiac disease, and to assess its potential role in equivocal cases of celiac disease compared with patients with biopsy-proven and serology-proven celiac disease who have persisting symptoms.
    The research team included M. Kurien, K.E. Evans, I. Aziz, R. Sidhu, K. Drew, T.L. Rogers, M.E. McAlindon, and D.S.Sanders. They are affiliated with the Department of Gastroenterology at Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust in Sheffield, South Yorkshire, United Kingdom.
    To determine the use of capsule endoscopy in patients with equivocal celiac disease, compared to patients with biopsy-proven and serology-proven celiac disease who have ongoing symptoms.
    To do this, the team conduced a prospective cohort study of 62 patients with equivocal celiac disease and 69 patients with non-responsive celiac disease.
    They measured outcome according to the diagnostic yield of capsule endoscopy in equivocal cases and accuracy of mucosal abnormality detection in patients with non-responsive celiac disease.
    They found that the 62 cases of equivocal celiac disease could be divided into two subgroups: group A, with 32 cases of antibody-negative villous atrophy, and group B with 30 cases of Marsh 1-2 changes.
    In group A, using capsule endoscopy, the team was able to diagnose celiac disease or Crohn's disease in 9 of 32 patients (28%), compared with just 2 of the 30 patients in group B (7%; P = .044).
    In patients with persistent celiac disease symptoms, the team made
    significant capsule endoscopy findings in 8 of 69 patients (12%), including 2 cases of enteropathy-associated lymphoma, 4 cases of type 1 refractory celiac disease, 1 polypoidal mass histologically confirmed to be a fibroepithelial polyp, and 1 case of ulcerative jejunitis.
    This outcome was significantly lower than the diagnostic yield of capsule endoscopy in antibody-negative villous atrophy (P = .048).
    It is important to remember that this study was restricted to a single clinic. That said, this is the first time that researchers have used capsule endoscopy to systematically evaluate equivocal celiac disease.
    Because the diagnostic rates for capsule endoscopy in patients with antibody-negative villous atrophy are better than that of capsule endoscopy in patients with celiac disease with persisting symptoms, the researchers are encouraging the use of capsule endoscopy in equivocal cases, especially in cases where patients antibody-negative villous atrophy.
    Source:
    Gastrointest Endosc. 2013 Feb;77(2):227-32. doi: 10.1016/j.gie.2012.09.031.

    Jefferson Adams
    Celiac.com 06/19/2013 - Currently, immunosuppressant drugs are the only real treatment option for most autoimmune disorders, such as celiac disease and Type 1 diabetes.
    However, researchers are busily exploring the possibilities offered therapeutic vaccines, known as antigen-specific immunotherapy. ImmusanT is one company working to develop a vaccine that will allow patients with celiac disease to safely eat gluten (the antigen). That vaccine is presently undergoing clinical trials.
    ImmusanT and its research partners are looking to build on their expertise in celiac disease to improve their understanding of antigen-specific immunotherapy for other autoimmune diseases.
    In Current Opinion in Immunology, researchers Bob Anderson and Bana Jabri describe how identification of pathogenic T cell epitopes (segment of the antigen) and recent initiatives to optimize immune monitoring have helped drive rational vaccine design in human autoimmune diseases.
    Celiac disease has provided researchers with the first opportunity to design and test epitope-specific immunotherapy with a thorough understanding of disease-causing T cell epitopes.
    This approach offers "truly customized immunotherapy for patients with celiac disease according to their genetics and the molecular specificity of their immune response to gluten," said Bob Anderson, PhD, MBChB, Chief Scientific Officer of ImmusanT.
    Because celiac disease shares key features, such as susceptibility genes, presence of autoantibodies and destruction of specific cells, with other autoimmune disorders, like Type 1 diabetes and rheumatoid arthritis, it provides a model for understanding and exploring the triggers and drivers of autoimmunity, in general, write Drs. Bana Jabri and Ludvig Sollid in the Perspectives section in Nature Reviews Immunology.
    By factoring in the association with the major histocompatibility complex (MHC), post-translation modifications, the antigen and the tissue, researchers can design methods that help to the spot potential drivers of autoimmune disease.
    Because peptide-specific therapy specifically targets the immune cells that drive the disease process, "it offers the potential to prevent and cure disease, without inducing general immunosuppression," said Bana Jabri, MD, PhD, Director, University of Chicago Celiac Center; Professor, Department of Medicine, Pathology and Pediatrics, University of Chicago; and Senior Scientific Advisor to ImmusanT.
    Ludvig M. Sollid, MD, PhD, is Director, Centre for Immune Regulation; Professor of Medicine, Department of Immunology, University of Oslo; Consultant, Oslo University Hospital-Rikshospitalet; and member of ImmusanT's Scientific Advisory Board.
    Dr. Jabri is Co-Chair of the 15(th) International Celiac Disease Symposium to be hosted by the University of Chicago Celiac Disease Center, September 22-25, 2013.
    The event will draw the world's top scientists and physicians to discuss the most recent scientific advances in managing and treating celiac disease and gluten-related disorders.
     

  • Recent Articles

    Jefferson Adams
    Celiac.com 04/23/2018 - A team of researchers recently set out to learn whether celiac disease patients commonly suffer cognitive impairment at the time they are diagnosed, and to compare their cognitive performance with non-celiac subjects with similar chronic symptoms and to a group of healthy control subjects.
    The research team included G Longarini, P Richly, MP Temprano, AF Costa, H Vázquez, ML Moreno, S Niveloni, P López, E Smecuol, R Mazure, A González, E Mauriño, and JC Bai. They are variously associated with the Small Bowel Section, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital; Neurocience Cognitive and Traslational Institute (INECO), Favaloro Fundation, CONICET, Buenos Aires; the Brain Health Center (CESAL), Quilmes, Argentina; the Research Council, MSAL, CABA; and with the Research Institute, School of Medicine, Universidad del Salvador.
    The team enrolled fifty adults with symptoms and indications of celiac disease in a prospective cohort without regard to the final diagnosis.  At baseline, all individuals underwent cognitive functional and psychological evaluation. The team then compared celiac disease patients with subjects without celiac disease, and with healthy controls matched by sex, age, and education.
    Celiac disease patients had similar cognitive performance and anxiety, but no significant differences in depression scores compared with disease controls.
    A total of thirty-three subjects were diagnosed with celiac disease. Compared with the 26 healthy control subjects, the 17 celiac disease subjects, and the 17 disease control subjects, who mostly had irritable bowel syndrome, showed impaired cognitive performance (P=0.02 and P=0.04, respectively), functional impairment (P<0.01), and higher depression (P<0.01). 
    From their data, the team noted that any abnormal cognitive functions they saw in adults with newly diagnosed celiac disease did not seem not to be a result of the disease itself. 
    Their results indicate that cognitive dysfunction in celiac patients could be related to long-term symptoms from chronic disease, in general.
    Source:
    J Clin Gastroenterol. 2018 Mar 1. doi: 10.1097/MCG.0000000000001018.

    Connie Sarros
    Celiac.com 04/21/2018 - Dear Friends and Readers,
    I have been writing articles for Scott Adams since the 2002 Summer Issue of the Scott-Free Press. The Scott-Free Press evolved into the Journal of Gluten Sensitivity. I felt honored when Scott asked me ten years ago to contribute to his quarterly journal and it's been a privilege to write articles for his publication ever since.
    Due to personal health reasons and restrictions, I find that I need to retire. My husband and I can no longer travel the country speaking at conferences and to support groups (which we dearly loved to do) nor can I commit to writing more books, articles, or menus. Consequently, I will no longer be contributing articles to the Journal of Gluten Sensitivity. 
    My following books will still be available at Amazon.com:
    Gluten-free Cooking for Dummies Student's Vegetarian Cookbook for Dummies Wheat-free Gluten-free Dessert Cookbook Wheat-free Gluten-free Reduced Calorie Cookbook Wheat-free Gluten-free Cookbook for Kids and Busy Adults (revised version) My first book was published in 1996. My journey since then has been incredible. I have met so many in the celiac community and I feel blessed to be able to call you friends. Many of you have told me that I helped to change your life – let me assure you that your kind words, your phone calls, your thoughtful notes, and your feedback throughout the years have had a vital impact on my life, too. Thank you for all of your support through these years.

    Jefferson Adams
    Celiac.com 04/20/2018 - A digital media company and a label data company are teaming up to help major manufacturers target, reach and convert their desired shoppers based on dietary needs, such as gluten-free diet. The deal could bring synergy in emerging markets such as the gluten-free and allergen-free markets, which represent major growth sectors in the global food industry. 
    Under the deal, personalized digital media company Catalina will be joining forces with Label Insight. Catalina uses consumer purchases data to target shoppers on a personal base, while Label Insight works with major companies like Kellogg, Betty Crocker, and Pepsi to provide insight on food label data to government, retailers, manufacturers and app developers.
    "Brands with very specific product benefits, gluten-free for example, require precise targeting to efficiently reach and convert their desired shoppers,” says Todd Morris, President of Catalina's Go-to-Market organization, adding that “Catalina offers the only purchase-based targeting solution with this capability.” 
    Label Insight’s clients include food and beverage giants such as Unilever, Ben & Jerry's, Lipton and Hellman’s. Label Insight technology has helped the Food and Drug Administration (FDA) build the sector’s very first scientifically accurate database of food ingredients, health attributes and claims.
    Morris says the joint partnership will allow Catalina to “enhance our dataset and further increase our ability to target shoppers who are currently buying - or have shown intent to buy - in these emerging categories,” including gluten-free, allergen-free, and other free-from foods.
    The deal will likely make for easier, more precise targeting of goods to consumers, and thus provide benefits for manufacturers and retailers looking to better serve their retail food customers, especially in specialty areas like gluten-free and allergen-free foods.
    Source:
    fdfworld.com

    Jefferson Adams
    Celiac.com 04/19/2018 - Previous genome and linkage studies indicate the existence of a new disease triggering mechanism that involves amino acid metabolism and nutrient sensing signaling pathways. In an effort to determine if amino acids might play a role in the development of celiac disease, a team of researchers recently set out to investigate if plasma amino acid levels differed among children with celiac disease compared with a control group.
     
    The research team included Åsa Torinsson Naluai, Ladan Saadat Vafa, Audur H. Gudjonsdottir, Henrik Arnell, Lars Browaldh, and Daniel Agardh. They are variously affiliated with the Institute of Biomedicine, Department of Microbiology & Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; the Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and Division of Pediatrics, CLINTEC, Karolinska Institute, Stockholm, Sweden; the Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden; the Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden; the Diabetes & Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; and with the Nathan S Kline Institute in the U.S.A.
    First, the team used liquid chromatography-tandem mass spectrometry (LC/MS) to analyze amino acid levels in fasting plasma samples from 141 children with celiac disease and 129 non-celiac disease controls. They then crafted a general linear model using age and experimental effects as covariates to compare amino acid levels between children with celiac disease and non-celiac control subjects.
    Compared with the control group, seven out of twenty-three children with celiac disease showed elevated levels of the the following amino acids: tryptophan; taurine; glutamic acid; proline; ornithine; alanine; and methionine.
    The significance of the individual amino acids do not survive multiple correction, however, multivariate analyses of the amino acid profile showed significantly altered amino acid levels in children with celiac disease overall and after correction for age, sex and experimental effects.
    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
    Source:
    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com