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      Frequently Asked Questions About Celiac Disease   04/24/2018

      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 is Celiac Disease and the Gluten-Free Diet? 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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    MOVING TOWARD CLINICAL CONSENSUS ON MICROSCOPIC ENTERITIS


    Jefferson Adams

    Celiac.com 04/20/2015 - Microscopic enteritis is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms, nutrient and micronutrient deficiency. The idea of microscopic enteritis arose from mucosal changes associated with celiac disease and was originally described in detail by Marsh in 1992.


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    Photo: CC--A. SynMicroscopic enteritis is marked by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy.

    A recent study addresses the need to characterize disorders with microscopic and submicroscopic features, currently regarded as functional or non-specific entities, to obtain further understanding of their clinical relevance.

    Following the 5th International Course in Digestive Pathology in Bucharest in November 2012, an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on Microscopic enteritis.

    The research team included Kamran Rostami, David Aldulaimi, Geoffrey Holmes, Matt W. Johnson, Marie Robert, Amitabh Srivastava, Jean-François Fléjou, David S. Sanders, Umberto Volta, Mohammad H. Derakhshan, James J Going, Gabriel Becheanu, Carlo Catassi, Mihai Danciu, Luke Materacki, Kamran Ghafarzadegan, Sauid Ishaq, Mohammad Rostami-Nejad, A. Salvador Peña, Gabrio Bassotti, Michael N. Marsh, and Vincenzo Villanacci. 

    The team reviewed statements about the etiology, diagnosis and symptoms associated with microscopic enteritis and proposes an algorithm for its investigation and treatment.  They employed a five-step agreement scale (ranging from strong agreement to strong disagreement) to score 21 statements, independently. They found strong agreement on all statements about Microscopic enteritis histology (95%-100%).

    They found 85% to 100% agreement regarding statements concerning diagnosis, while agreement on a statement about the management of microscopic enteritis ranged from the 60% to 100%. They also found general agreement between experts on clinical presentation (75%-95%) and pathogenesis (80%-90%) of Microscopic enteritis.

    Lastly, they found strong agreement on the histological definition of Microscopic enteritis. The weaker agreement on management invites further studies, better definitions and clinical trials to produce quality guidelines for management.

    This microscopic enteritis consensus is a step toward greater recognition of a significant issue for symptomatic patients previously labelled as non-specific or functional enteropathy.

    Source:


    Image Caption: Photo: CC--A. Syn
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  • Related Articles

    Jefferson Adams
    Celiac.com 06/15/2008 - Many people with celiac disease have stories to tell about the about how difficult it can be to get a getting a proper diagnosis. Celiac disease can mimic so many other conditions. Irritable Bowel Syndrome (IBS) is one of those conditions. The symptoms for Irritable Bowel Syndrome and for celiac disease are often similar as a result the diagnosis of celiac disease can be delayed or missed and misdiagnosed as irritable bowel syndrome.
    In an effort to reduce the misdiagnosis of celiac disease as Irritable Bowel Syndrome, Britain’s National Institute for Health and Clinical Excellence has drawn up new guidelines covering the diagnosis of Irritable Bowel Syndrome. The guidelines call for all diagnosis of Irritable Bowel Syndrome to be preceded by a screen for celiac disease. Keeping this in mind, anyone suffering from Irritable Bowel Syndrome, and who has not been tested for celiac disease, might want to take the initiative and check with their doctor to see if further testing might be in order.
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    References:
    1.    The Economic Burden of Coeliac Disease in the UK research paper
    2.    Recent advances in Coeliac Disease by D.A. van Heel and J. West, published in Gut 2006 55, pp 1037-1046
    3.    Coeliac Society of the UK


    Jefferson Adams
    Celiac.com 09/16/2008 - Cytokines are regulatory proteins that act as mediators in the generation of an immune response. Interleukin 21 (IL-21) is on such cytokine.
    A team of Italian and British researchers recently evaluated the production of IL-21 in the intestinal mucosa of patients with untreated celiac disease. Several studies have documented the ability of IL-21's to regulate cytokine production by certain T cells. Another recent study demonstrated a connection between celiac disease and what is called the susceptibility locus in the chromosome 4q27, which harbors the IL-21 gene.
    The researchers, led by Dr. G. Monteleone at Universita Tor Vergata in Rome, set out to examine the molecular mechanisms tying IFN-gamma with celiac disease. The team found that people with celiac disease produce excess IL-21, and that IL-21 is responsible for encouraging production of interferon-gamma (IFN-gamma).
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    When the research team stimulated biopsy cultures with a peptic-tryptic digest of gliadin (PT) explants, the biopsies of patients with treated celiac disease showed elevated IL-21, while the controls showed no such elevation. The team was able to use an anti-IL-21 antibody to substantially reduce the enhancement of T-bet expression by PT (P = 0.01), whereas they saw no such reduction using a control antibody.
    These results indicate that up-regulation of IL-21 in celiac disease depends on gluten-driven active inflammation. As such, IL-21 may have a crucial role in promoting the destructive inflammation in celiac disease. If so, neutralizing the production or presence of IL-21 might offer a promising and alternative therapeutic approach in treating celiac disease, especially in treating cases of celiac disease that are unresponsive to a gluten-free diet.
    In a side note, several doctors have noted that the role of IL-21 does not seem to be exclusive to celiac disease, as the biopsies of patients with Helicobacter pylori infections, and those suffering from Crohn's disease show similar increases in IL-21 synthesis.
    Gut 2008: 57; 879-881,887-892.



    Jefferson Adams
    Celiac.com 07/01/2009 - Immunity to food allergens such as gliadin, or the proteins in cow's milk is central to prevention of certain diseases via an appropriate restriction diet. Detecting heightened levels immune reactions to antigen(s) in food is important because scientists have credible reports of certain health disturbances, such as celiac disease, and some pre-malignant conditions, such as monoclonal gammopathy of undetermined significance (MGUS), disappearing under a regimen of appropriate food restriction diets.
    Only a small number of genetically predisposed individuals show a toxic  small bowel mucosa reaction to gliadin. Since levels of immunogenic gliadin may vary between different wheat species, a team of researchers first set out to assess immunogenic gliadin levels in ten bread wheat types and in three strains of commercially grown durum wheat.
    The team was made up of Aleksandra Konic-Ristic, Dejan Dodig, Radmilo Krstic, Svetislav Jelic, Ivan Stankovic, Aleksandra Ninkovic, Jelena Radic, Irina Besu, Branka Bonaci-Nikolic, Njegica Jojic, Milica Djordjevic, Dragan Popovic, and Zorica Juranic.
    They were spurred by previous studies that showed sera of some of multiple myeloma (MM) patients with elevated levels of anti-gliadin IgA, without enhanced levels of anti-gliadin IgG antibodies, as determined by commercial ELISA test.
    They designed their own specifically to uncover any hidden anti-gliadin IgG immunoreactivity in patient blood samples. For this reason, researchers tested blood of both MM patients and celiac disease patient for immunoreaction with native gliadin isolated from regional wheat species used for bread and pasta making.
    The team isolated gliadin from wheat flour by two step 60% ehanolic extraction. They determined gliadin levels by commercial R5 Mendez Elisa using PWG gliadin as the standard.
    Results showed immunogenic gliadin content varies between 50.4 and 65.4 mg/g in bread wheat samples and between 20 and 25.6 mg/g in durum wheat samples.
    Anti-gliadin IgA and IgG immunoreactivity of patients'sera in (IU/ml) was first measured by commercial diagnostic Binding Site ELISA test, and then additionally by non-commercial ELISA tests, using standardized ethanol wheat extracts -gliadin as the antigen.
    In both patient groups, IgA immunoreactivity to gliadin from different samples was almost homogenous and in correlation with results from commercial test, except for one IgA(lambda) myeloma patient. However, results for IgG immunoreactivity were less homogeneous.
    Results showed different immunogenic gliadin epitope levels in various species of wheat. They also point to a need for developing a new standard antigen, a representative mixture of gliadin isolated from local wheat species used for bread production in corresponding geographic region for ELISA diagnostic tests.
    Source:
    BMC Immunology 2009, 10:32
     

    Jefferson Adams
    Celiac.com 04/22/2011 - A research team recently set out to examine multiple independent variants in 6q21-22 associated with susceptibility to celiac disease in the Dutch, Finnish and Hungarian populations.
    The study team included Elisabet Einarsdottir, Marianna R Bevova, Alexandra Zhernakova, Alienke Monsuur, Lotta LE Koskinen, Ruben van't Slot, Chris Mulder, M Luisa Mearin, Ilma R Korponay-Szabo, Katri Kaukinen, Kalle Kurppa, Juha Kere, Markku Mäki, Cisca Wijmenga and Päivi Saavalainen.
    Studies in Dutch, Finnish and Hungarian populations have shown that a locus on chromosome 6q21-22 carries higher susceptibility to celiac disease.
    This same locus has previously been associated with susceptibility to other autoimmune diseases such as Crohn's disease and type 1 diabetes.
    The study team conducted fine mapping on 446 independent individuals with celiac disease and 641 control subjects of Dutch origin. The team tested 872 tagging single-nucleotide polymorphisms (SNPs) in a 22 Mb region of chromosome 6.
    To identify risk variants in this region, the team followed up on the 12 most promising SNPs in 2071 individuals from 284 Finnish and 357 Hungarian celiac disease families.
    Numerous markers in the region showed strong associations with celiac disease in the Dutch material. Two SNPs, rs9391227 and rs4946111, showed strong association with celiac disease in the Finnish population.
    The rs9391227 connection is the strongest such connection yet found in the Finnish (P=0.003, OR 0.66), as well as the combined Dutch, Finnish and Hungarian populations (P=3.6 × 10−5, OR 0.76).
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    A meta-analysis of the three populations showed two additional independent, susceptibility variants in the 6q21-22 region.
    The team confirmed the 6q21-22 region as a celiac disease susceptibility locus; one that is independently associated with a number of other conditions, and which may implicate ubiquitin-pathways in celiac disease susceptibility.
    Source:

    European Journal of Human Genetics , (16 February 2011) | doi:10.1038/ejhg.2011.2

  • Recent Articles

    Tammy Rhodes
    Celiac.com 04/24/2018 - Did you know in 2017 alone, the United States had OVER TENS OF THOUSANDS of people evacuate their homes due to natural disasters such as fires, floods, hurricanes, tornadoes and tsunamis? Most evacuation sites are not equipped to feed your family the safe gluten free foods that are required to stay healthy.  Are you prepared in case of an emergency? Do you have your Gluten Free Emergency Food Bag ready to grab and go?  
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    You can find my Gluten Free Emergency Food Bags and other useful products at www.allergynavigator.com.  

    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.
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    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. 
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    "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.” 
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    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.
     
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    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