• Join our community!

    Do you have questions about celiac disease or the gluten-free diet?

  • Ads by Google:
     




    Get email alerts Subscribe to Celiac.com's FREE weekly eNewsletter

    Ads by Google:



       Get email alertsSubscribe to Celiac.com's FREE weekly eNewsletter

  • Member Statistics

    77,617
    Total Members
    3,093
    Most Online
    Georgia Fraser
    Newest Member
    Georgia Fraser
    Joined
  • 0

    Older Celiac Disease Patients on a Gluten-Free Diet Slower to Recover by Roy Jamron


    Roy Jamron

    Celiac.com 07/31/2006 - A two-year study in the July 2006 Endoscopy showed older celiac patients on a gluten-free diet have an incomplete histological recovery even after two years. Only the younger patients (5 - 30 years) showed significant improvement of histology within 12 months (P < 0.034); older patients (>30 years) showed histological improvement but this was not statistically significant, even after 24 months on a gluten-free diet. This study was also previously discussed in an article by Dr. Antonio Tursi in the Spring 2006 Celiac.com Scott-Free Newsletter.


    Ads by Google:




    ARTICLE CONTINUES BELOW ADS
    Ads by Google:



    This also means increased intestinal permeability and associated problems such as liver damage may continue to be a lasting problem in older patients beyond two years on a gluten-free diet. Below is the abstract:

     

    Endoscopy 2006 July; 38(7): 702-707

    Endoscopic and histological findings in the duodenum of adults with celiac disease before and after changing to a gluten-free diet: a 2-year prospective study

    Tursi, A.; Brandimarte, G.; Giorgetti, G. M.; Elisei, W.; Inchingolo, C. D.; Monardo, E.; Aiello, F.

     

    Background and study aims:
    Published follow-up data on small-intestinal recovery in patients with celiac disease are scarce and contradictory. This is especially the case for adult patients, who often show incomplete histological recovery after starting a gluten-free diet (GFD). We conducted a 2-year prospective study to evaluate the effectiveness of a GFD in improving the endoscopic and histological duodenal findings in adults with celiac disease.

    Patients and methods:
    We studied 42 consecutive adults with newly diagnosed celiac disease (13 men, 29 women; mean age 32.7 years, range 15 - 72 years). All the patients underwent esophagogastroduodenoscopy and small bowel biopsy. We devised our own grading system for the endoscopic appearance of the duodenum, which ranged from "normal" appearance to "mild", "moderate", or "severe" alterations. Small bowel biopsies were obtained from the second part of the duodenum (and from the duodenal bulb when it had a micronodular appearance). The histopathological appearances were described according to modified Marsh criteria.

    Results:
    A normal endoscopic appearance in the duodenum was found in 5/42 patients (11.9 %) at entry and in 32/42 patients (76.2 %) after 2 years on a GFD. Subdividing the patients according to age, patients aged from 15 years to 60 years showed significant improvement within 12 months (P < 0.0001 for patients aged from 15 years to 45 years; P < 0.003 for patients in the 46 years to 60 years group), whereas the improvement in endoscopic findings in patients older than 60 years was not statistically significant, even 24 months after starting the GFD. "Normal" histology was reported in none of the patients at entry, but in 25 patients (59.5 %) after 24 months on a GFD, but this parameter did not show a significant improvement until the patients had been on the GFD for 12 months (P < 0.0001). Only the younger patients (5 - 30 years) showed significant improvement of histology within 12 months (P < 0.034); older patients (>30 years) showed histological improvement but this was not statistically significant, even after 24 months on a GFD.

    Conclusions:
    This study shows for the first time that endoscopic recovery is faster than histological recovery in adults with celiac disease who go on a GFD. Moreover, older patients showed incomplete endoscopic and histological recovery even 24 months after starting a GFD. We therefore advise, as a minimum recommendation, that follow-up biopsies should be taken 1 - 2 years after starting a GFD in adults with celiac disease.

    0


    User Feedback

    Recommended Comments

    There are no comments to display.



    Your content will need to be approved by a moderator

    Guest
    You are commenting as a guest. If you have an account, please sign in.
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • Ads by Google:

  • About Me

    Roy S. Jamron holds a B.S. in Physics from the University of Michigan and an M.S. in Engineering Applied Science from the University of California at Davis, and independently investigates the latest research on celiac disease and related disorders.

  • Popular Contributors

  • Ads by Google:

  • Who's Online   13 Members, 1 Anonymous, 577 Guests (See full list)

  • Related Articles

    Scott Adams
    The following Medline abstract describes a unique study that was done on the quality of life of two groups of people with celiac disease: One that was diagnosed as the result of having symptoms, and the other which had little or no symptoms and whose diagnosis was reached via screen-detection. Both groups were treated for one year with a gluten-free diet, and were then studied to determine their overall response, including their psychological response. Here is the abstract:
    Eff Clin Pract 2002 May-Jun;5(3):105-13
    Mustalahti K, Lohiniemi S, Collin P, Vuolteenaho N, Laippala P, Maki M.
    Department of Pediatrics, Tampere University Hospital, Finland.
    CONTEXT: Since the advent of serologic testing for celiac disease, most persons who receive a diagnosis of celiac disease have few or no symptoms. Although pathologic changes of celiac disease resolve on a gluten-free diet, how a gluten-free diet affects the quality of life for patients with screen-detected celiac disease is unclear.
    OBJECTIVE: To evaluate the effect of a gluten-free diet on the quality of life of patients with screen-detected celiac disease.
    DESIGN: Prospective study of patients before and 1 year after initiating a gluten-free diet.
    PARTICIPANTS: 19 patients with screen-detected celiac disease (found by serologically testing first-degree relatives of celiac patients) and 21 consecutive patients with symptom-detected disease. In all cases, celiac diagnosis was confirmed by finding villous atrophy and crypt hyperplasia on small-bowel biopsy.
    INTERVENTION: Gluten-free diet (explained during a single physician visit). MAIN OUTCOME
    MEASURES: Gastrointestinal Symptoms Rating Scale (GSRS), in which scores range from 0 to 6 (higher scores represent worse symptoms); and quality of life measured with the Psychological General Well-Being Questionnaire (PGWB). Scores range from 22 to 132 (higher scores mean greater well-being).
    RESULTS: At baseline, patients with symptom-detected celiac disease had poorer quality of life and more gastrointestinal symptoms than those with screen-detected celiac disease. Reported compliance with the gluten-free diet was good. All mucosal lesions of the small bowel had resolved at the follow-up biopsy. After 1 year of following the diet, quality of life for patients with screen-detected disease significantly improved (mean PGWB score increased from 108 to 114; P
    CONCLUSIONS: Gluten-free diet was associated with improved quality of life for patients with symptom-detected celiac disease and patients with screen-detected celiac disease. Concerns about the burden of a gluten-free diet, at least over the short term, may be unfounded.
    PMID: 12088289


    Jefferson Adams
    Celiac.com 12/26/2010 - Should everyone with symptoms of celiac disease go on a gluten-free diet? Current practice allows many patients with symptoms of celiac disease, but no gut damage, and thus no official diagnosis, to forgo a gluten-free diet.
    In a new study, researchers found that people with celiac disease symptoms have the same distinctive metabolic fingerprint as patients with full-blown disease, and who must follow a gluten-free diet to avoid permanent damage to the gut.
    The new study, by Ivano Bertini and colleagues, is stirring up the discussion about just which patients with symptoms of celiac disease should follow a gluten-free diet.
    Their research shows that people currently diagnosed as "potential" celiac disease patients and not advised to follow a gluten-free diet may not be "potential" patients at all.
    Celiac disease is widely regarded as undiagnosed or misdiagnosed. For their study, the researchers used magnetic resonance metabolic profiling to analyze the biochemical markers in the blood and urine of 61 patients with celiac disease, 29 with potential celiac disease, and 51 healthy people.
    The researchers found that people with unproven celiac disease largely shared the same profile as those with confirmed celiac disease and that the biochemical markers in both groups differed sharply from those of healthy individuals.
    The researchers conclude that their findings "demonstrate that metabolic alterations may precede the development of small intestinal villous atrophy and provide a further rationale for early institution of gluten-free diet in patients with potential celiac disease, as recently suggested by prospective clinical studies."
    The authors do note receiving funding from Boehringer Ingelheim Italy.
    Source:

    American Chemical Society Journal of Proteome Research

    Jefferson Adams
    Celiac.com 05/02/2012 - Doctors and researchers are still debating the usefulness of active blood screening for spotting celiac disease in older populations. Studies do suggest that many cases of celiac disease go undetected, especially in the older population. One unanswered question is whether screening does any good for older people who have been eating gluten many decades.
    A team of researchers recently studied the clinical benefit of a gluten-free diet in screen-detected older celiac disease patients. The research team included Anitta Vilppula, Katri Kaukinen, Liisa Luostarinen, Ilkka Krekelä, Heikki Patrikainen, Raisa Valve, Markku Luostarinen, Kaija Laurila, Markku Mäki, and Pekka Collin.
    They are affiliated with the Department of Neurology, the Department of Internal Medicine and the Department of Surgery at Päijät-Häme Central Hospital, and the University of Helsinki's Department of Education and Development in Lahti, Finland, the Department of Gastroenterology and Alimentary Tract Surgery the School of Medicine, and the Paediatric Research Centre at the University of Tampere and Tampere University Hospital, Tampere, Finland.
    For their study, the researchers evaluated the benefit of active detection and implementation of a gluten-free diet in elder populations with for celiac disease.
    The team evaluated thirty-five biopsy-proven celiac patients over 50 years of age, each of whom had celiac disease detected by mass blood screening.
    They looked at bone mineral density, dietary compliance, disease history, quality of life, and symptoms at baseline and after 1-2 years of a gluten-free diet. They also looked at small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density.
    Using surveys, the team established gastrointestinal symptom ratings and quality of life by psychological general well-being. The used this information to rate symptoms.
    They found patient dietary compliance to be good overall.  Initial tests on the patients showed reduced serum ferritin levels, pointing to subclinical iron deficiency. This trend reversed after patients followed a gluten-free diet.
    Initially low vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on a gluten-free diet.
    Patient histories showed that those with celiac disease had sustained more low-energy fractures, and sustained such fractures more frequently than the general population. A gluten-free diet brings with it a beneficial increase in bone mineral density.
    The team also noticed that many gastrointestinal symptoms disappeared, even though though many patients reported only subtle symptoms upon diagnosis.
    Quality of life remained unchanged. According to the study team, two out of three patients would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been factored in.
    Results showed that patients who had celiac disease detected by mass blood screen did, in fact, benefit from a gluten-free diet. For doctors evaluating older patients, the team advocates a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening.
    Source:
    BMC Gastroenterology 2011, 11:136. doi:10.1186/1471-230X-11-136

    Jefferson Adams
    Celiac.com 10/15/2014 - A team of researchers recently set out to assess the benefits of a gluten-free diet for people whose blood screens show markers for celiac disease, but who show no physical symptoms. Specifically, they investigated whether screen-detected and apparently asymptomatic adults with endomysial antibodies (EmA) benefit from a gluten-free diet.
    The research team included K. Kurppa, A. Paavola, P. Collin, H. Sievänen, K. Laurila, H. Huhtala, P. Saavalainen, M. Mäki, and K. Kaukinen. They are variously associated with the Tampere Center for Child Health Research, the Tampere School of Health Sciences of the University of Tampere and Tampere University Hospital, the Department of Gastroenterology and Alimentary Tract Surgery at Tampere University Hospital and School of Medicine, University of Tampere, the UKK Institute in Tampere, Finland, the Research Program Unit of the Immunobiology and Haartman Institute at the Department of Medical Genetics of the University of Helsinki in Helsinki, Finland, and the Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland and Seinäjoki Central Hospital, Seinäjoki, Finland.
    For their study, they conducted a prospective trial of 3031 individuals at risk for celiac disease based on screens for EmA. They found 40 of 148 seropositive individuals who fulfilled inclusion criteria. They randomly assigned the 40 patients to groups receiving either a gluten-free diet, or a gluten-containing diet.
    They then evaluated ratios of small-bowel mucosal villous height:crypt depth, serology and laboratory test results, gastrointestinal symptom scores, physiologic well-being, perception of health by a visual analog scale, bone mineral density, and body composition at baseline and after 1 year. From that point on, they switched the group on the gluten-containing diet to a gluten-free diet, evaluated them a third time. Patients in the first gluten-free diet group remained on that diet.
    After 1 year on the gluten-free diet, the mean mucosal villous height:crypt depth values increased (P < .001), levels of celiac-associated antibodies decreased (P < .003), and gastrointestinal symptoms improved compared to patients on gluten-containing diets (P = .003).
    The gluten-free diet group showed less indigestion (P = .006), reflux (P = .05), and anxiety (P = .025), and better overall health, based on the visual analog scale (P = .017), compared gluten-containing diet group.
    Only social function scores improved more in the gluten-containing diet group than in the gluten-free diet group (P = .031). There were no differences between groups in terms of lab test results, bone mineral density, or body composition.
    Most measured parameters improved when patients in the gluten-containing diet group were placed on gluten-free diets.
    No subjects considered their experience to be negative and most expected to continue eating gluten-free.
    The results show that a gluten-free diet benefits asymptomatic EmA-positive patients, and show the benefits of actively screening patients at risk for celiac disease.
    Source:
    Gastroenterology. 2014 Sep;147(3):610-617.e1. doi: 10.1053/j.gastro.2014.05.003. 

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/21/2018 - Would you buy a house advertised as ‘gluten-free’? Yes, there really is such a house for sale. 
    It seems a Phoenix realtor Mike D’Elena is hoping that his trendy claim will catch the eye of a buyer hungry to avoid gluten, or, at least one with a sense of humor. D’Elena said he crafted the ads as a way to “be funny and to draw attention.” The idea, D’Elena said, is to “make it memorable.” 
    Though D’Elena’s marketing seeks to capitalizes on the gluten-free trend, he knows Celiac disease is a serious health issue for some people. “[W]e’re not here to offend anybody….this is just something we're just trying to do to draw attention and do what's best for our clients," he said. 
    Still, the signs seem to be working. D'elena had fielded six offers within a few days of listing the west Phoenix home.
    "Buying can sometimes be the most stressful thing you do in your entire life so why not have some fun with it," he said. 
    What do you think? Clever? Funny?
    Read more at Arizonafamily.com.

    Advertising Banner-Ads
    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! 
    Our passion is to bake the very best products while bringing happiness to our customers, each other, and all those we meet!
    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. 
    The trials are set to begin at Australia’s University of the Sunshine Coast Clinical Trials Centre. The vaccine is designed to allow people with celiac disease to consume gluten with no adverse effects. A successful vaccine could be the beginning of the end for the gluten-free diet as the only currently viable treatment for celiac disease. That could be a massive breakthrough for people with celiac disease.
    USC’s Clinical Trials Centre Director Lucas Litewka said trial participants would receive an injection of the vaccine twice a week for seven weeks. The trials will be conducted alongside gastroenterologist Dr. James Daveson, who called the vaccine “a very exciting potential new therapy that has been undergoing clinical trials for several years now.”
    Dr. Daveson said the investigational vaccine might potentially restore gluten tolerance to people with celiac disease.The trial is open to adults between the ages of 18 and 70 who have clinically diagnosed celiac disease, and have followed a strict gluten-free diet for at least 12 months. Anyone interested in participating can go to www.joinourtrials.com.
    Read more at the website for Australia’s University of the Sunshine Coast Clinical Trials Centre.

    Source:
    FoodProcessing.com.au

    Jefferson Adams
    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
    Those scientists recently gathered some of the first evidence to show that cheap, over-the-counter antacids can prompt the spleen to promote an anti-inflammatory environment that could be helpful in combating inflammatory disease.
    A type of cell called mesothelial cells line our body cavities, like the digestive tract. They have little fingers, called microvilli, that sense the environment, and warn the organs they cover that there is an invader and an immune response is needed.
    The team’s data shows that when rats or healthy people drink a solution of baking soda, the stomach makes more acid, which causes mesothelial cells on the outside of the spleen to tell the spleen to go easy on the immune response.  "It's most likely a hamburger not a bacterial infection," is basically the message, says Dr. Paul O'Connor, renal physiologist in the MCG Department of Physiology at Augusta University and the study's corresponding author.
    That message, which is transmitted with help from a chemical messenger called acetylcholine, seems to encourage the gut to shift against inflammation, say the scientists.
    In patients who drank water with baking soda for two weeks, immune cells called macrophages, shifted from primarily those that promote inflammation, called M1, to those that reduce it, called M2. "The shift from inflammatory to an anti-inflammatory profile is happening everywhere," O'Connor says. "We saw it in the kidneys, we saw it in the spleen, now we see it in the peripheral blood."
    O'Connor hopes drinking baking soda can one day produce similar results for people with autoimmune disease. "You are not really turning anything off or on, you are just pushing it toward one side by giving an anti-inflammatory stimulus," he says, in this case, away from harmful inflammation. "It's potentially a really safe way to treat inflammatory disease."
    The research was funded by the National Institutes of Health.
    Read more at: Sciencedaily.com

    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.