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    What Causes Villus Atrophy in Symptomatic Celiac Patients on a Gluten-free Diet?


    Jefferson Adams
    Image Caption: Some celiac patients experience villous atrophy, even on a gluten-free diet. Why? Photo: CC-- Jon Bunting

    Celiac.com 04/21/2017 - Despite sticking to a gluten-free diet, some celiac patients endure persistent duodenal damage; a condition associated with adverse outcomes.


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    A team of researchers recently set out to determine the prevalence and clinical risk factors for persistent villus atrophy among symptomatic celiac disease patients.

    The researchers included S. Mahadev, J. A. Murray, T.-T. Wu, V. S. Chandan, M. S. Torbenson, C. P. Kelly, M. Maki, P. H. R. Green, D. Adelman, and B. Lebwohl.

    They are variously affiliated with the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, USA, the Division of Gastroenterology and Hepatology, The Mayo Clinic, Rochester, MN, USA, the Department of Laboratory Medicine and Pathology, The Mayo Clinic, Rochester, MN, USA, the Celiac Center, Beth Israel Deaconess Medical Center and Celiac Research Program, Harvard Medical School, Boston, MA, USA, the Tampere Center for Child Health Research, School of Medicine, University of Tampere and Tampere University Hospital, Finland, Europe, the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, USA, and with the Division of Allergy/Immunology, Department of Medicine, University of California, San Francisco, CA, USA.

    The team conducted a nested cross-sectional analysis on celiac disease patients with self-reported moderate or severe symptoms, who were all following a gluten-free diet, and who underwent protocol-mandated duodenal biopsy upon enrollment in the CeliAction clinical trial.

    The team also assessed demographic factors, symptom type, medication use, and serology, to determine predictors of persistent villus atrophy.

    Of 1,345 patients with symptoms patients, the researchers found 511 patients (38%) with active celiac disease with persistent villus atrophy, defined as average villus height to crypt depth ratio ≤2.0.

    Multivariable analysis showed older age (OR, 5.1 for ≥70 vs. 18–29 years, 95% CI, 2.5–10.4) to be a risk factor, while more time following a gluten-free diet provided some protection (OR, 0.37, 95% CI, 0.24–0.55 for 4–5.9 vs. 1–1.9 years).

    People with villus atrophy were more likely to use proton-pump inhibitors (PPIs; OR, 1.6, 95% CI, 1.1–2.3), non-steroidal anti-inflammatory drugs (NSAIDs; OR, 1.64, 95% CI, 1.2–2.2), and selective serotonin re-uptake inhibitors (SSRIs; OR, 1.74, 95% CI, 1.2–2.5). Adjusting for covariates showed that the symptoms alone were not tied to villus atrophy.

    Most patients with celiac disease symptoms did not have active disease on follow-up histology. This study showed symptoms to be poor predictors of persistent mucosal injury. The team is calling for further study of the impact of NSAIDs, PPIs, and SSRIs on mucosal healing in celiac patients.

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    Guest Tyler

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    Have the patients been tested for parasites?

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    Jefferson Adams
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    Dr. Ron Hoggan, Ed.D.
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    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
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    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023