• 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

    77,342
    Total Members
    3,093
    Most Online
    Sha in
    Newest Member
    Sha in
    Joined
  • 1 1

    How GliadinX Saved My Mom on Thanksgiving


    Advertising Product-Review
    Image Caption: Image: CC--TheCulinaryGeek

    Celiac.com 12/09/2017 - For those of you who haven't yet heard about GliadinX, it is a dietary supplement with the highest concentration of AN-PEP, Prolyl Endopeptidase (Aspergillus Niger), and, unlike other enzymes, these have been shown in studies to break down gluten in the stomach.


    Ads by Google:




    ARTICLE CONTINUES BELOW ADS
    Ads by Google:



    I've been using them regularly for months, and I tend to take them whenever I eat out, or eat at a friend's house, so basically whenever I don't have control over my food's preparation. Since I began doing this I haven't had any incidents of upset stomach, which are my typical symptoms if I get any cross contamination. However, it is hard to prove a negative...after all, perhaps I haven't had any issues because all of the food I ate was 100% gluten-free...right?

    I will now describe a recent glutening incident that involved none other than my Mother, who visited us this past Thanksgiving. How this could happen in my home, after all I'm the owner of Celiac.com, is an embarrassing but true story which I will share here in the hope that it will help you avoid my errors, and perhaps give you a way to recover should something similar ever happen.

    My brother brought over three pies for Thanksgiving dessert, one was a gluten-free apple pie, and the other two were pumpkin pies: one was gluten-free, but the other was not. What could go wrong, right? My brother's reasoning for bringing a non gluten-free pie into my house was pretty basic: several of the guests were not on a gluten-free diet, so he wanted to offer them what they were used to.

    What you need to know about my Mother is that she's very gluten sensitive. A tiny amount of gluten leaves her wrecked for days. I think you probably know where I'm going here, but basically everyone was busy socializing, eating, or cleaning while dessert was being served, and a friend grabbed a piece of the gluten-containing pumpkin pie (she assumed that if it was in MY house it was gluten-free) and handed it to my Mother. After she swallowed two bites we realized the mistake, but it was too late. My Mother had the look of horror on her face as she realized that the rest of her trip to California was probably ruined.

    I immediately flew into action and gave her several capsules of GliadinX, which she took with lots of water. We carried on with the evening, and I checked in with her over the next couple of hours. Amazingly she didn't have any noticeable symptoms or issues, but she was still certain that they were coming, and that she wouldn't get any sleep and would feel horrible the next day. Remarkably, none of her worries came true. She slept fine, and woke up feeling great. We were both amazed because any past similar incidents always ended badly for her.

    Suffice it to say that my Mother now keeps a bottle of GliadinX with her all the time...just in case!

    --by Scott Adams

    pixel.gif

    Quote

     

    12. Treatment of the Extra-Intestinal Manifestations of CD

    the only one that is currently on the market is the gluten-specific enzyme, GliadinX (AN-PEP). Unfortunately, it is only capable of detoxifying 0.2 g of gluten or roughly that of 1/8 of a slice of gluten-containing bread. For this reason, it should only be used as an adjunct to the GFD when there are concerns for accidental gluten contamination and in an effort to ameliorate symptoms, not as a replacement for the GFD.

     

    Many people have asked Celiac.com how they can order this product, so we've included a "Buy Now" link below to order them directly from the manufacturer:

    PayPal - The safer, easier way to pay online!

     

    Sources: Scientific publications on AN-PEP enzymes:

    1 1


    User Feedback

    Recommended Comments

    Guest Charlene Ratzinger

    Posted

    I bought a bottle of Gliadin X and do the same thing, always take one when I eat out anywhere. So far so good! I would certainly recommend them also!

    Share this comment


    Link to comment
    Share on other sites
    Guest coloradosue

    Posted

    Hey Scott, you said your mother is highly sensitive/allergic to gluten. Are her reactions to contamination like violent vomiting, unable to move, unable to talk, etc., to the point that she would wind up in the ER,? I unfortunately had that happen to me 3 days before this past Christmas. Again! I ask this as I am so leary of anything that sounds too good to be true. I don't go out to eat anymore because of my truly severe reactions to gluten. Hope your Mom continues to be OK!

    Share this comment


    Link to comment
    Share on other sites
    Guest Scott Adams

    Posted

    Hey Scott, you said your mother is highly sensitive/allergic to gluten. Are her reactions to contamination like violent vomiting, unable to move, unable to talk, etc., to the point that she would wind up in the ER,? I unfortunately had that happen to me 3 days before this past Christmas. Again! I ask this as I am so leary of anything that sounds too good to be true. I don't go out to eat anymore because of my truly severe reactions to gluten. Hope your Mom continues to be OK!

    Although she would not need to go to the emergency room (what could the ER do for you for gluten ingestion anyway? Just curious.), she would be unable to leave home for a few days, and would be feeling poorly for longer. If you never eat out and always prepare your own food, you probably don't need this (although there is still some risk, even with products marked "gluten-free.")

    Share this comment


    Link to comment
    Share on other sites
    Guest Michelle

    Posted

    Interesting to see another product that works. I have been doing the same, taking enzymes whenever I have a meal out to ward off a cross contamination reaction, for close to 10 years. I have posted about it on the forums but people poo poo it. However when I go on vacation with my mom and give her the enzymes every meal and force her to order gluten free by the end of the week a disheveled, tired, confused person becomes sparkly, sharp dressing, and greeted me on the last day of the trip by doing deep knee bends. I used to use Gluten Ease but as I got older I switched to Digest Spectrum. Will have to look at trying this one also.

    Share this comment


    Link to comment
    Share on other sites
    Guest KarenD

    Posted

    I am extremely sensitive to gluten. All my medications are guaranteed gluten-free, including OTC's. I recently gave up my beloved sesame seeds! There is never any cross-contamination in our kitchen. For six months I took large amounts of probiotics which were ordered online and cost way too much; they did nothing to help my symptoms. I don't get it; if GliadinX works so well then why can't we take it and eat what we want?!

    Share this comment


    Link to comment
    Share on other sites
    Guest Scott Adams

    Posted

    I am extremely sensitive to gluten. All my medications are guaranteed gluten-free, including OTC's. I recently gave up my beloved sesame seeds! There is never any cross-contamination in our kitchen. For six months I took large amounts of probiotics which were ordered online and cost way too much; they did nothing to help my symptoms. I don't get it; if GliadinX works so well then why can't we take it and eat what we want?!

    This isn't a treatment for celiac disease, although it may be far better than nothing in cases where you may get some contamination.

    Share this comment


    Link to comment
    Share on other sites
    Guest Robert

    Posted

    My most severe gluten symptoms don't appear until days later, then I'm really screwed. How do you know if the supplement worked long term?

    Share this comment


    Link to comment
    Share on other sites
    9 hours ago, Guest Robert said:

    My most severe gluten symptoms don't appear until days later, then I'm really screwed. How do you know if the supplement worked long term?

    Might have to take it several times a day...I found it helps alleviate symptoms, last few gluten exposure taking it have preventing the violent vomiting, gut pain, and motor loss.....but I have still had minor D more of really soft  stools, numbness, and other quirks .....it really lessons symptoms in my experience. it is not a cure but does make accidentally glutening less traumatic. It is not a cure, or a miracle pill but it sure seems to help a bit.

    Share this comment


    Link to comment
    Share on other sites

    I just had the genetic tests for celiac done on the 13th.  I have so many of the symptoms associated with this disorder, that I will be surprised if the test is negative.  The first profile of tests (gliadin, and others were negative, but thats because I stopped eating all gluten.  My gastro doc said it was a mistake to do that, so thats why got the script for the genetic tests.

    Share this comment


    Link to comment
    Share on other sites

    At 64 this going gluten-free is not an easy undertaking, to say the least, but I lost 20 lbs in a three month period, and I wasn't trying to lose weight.  Even if the test comes back negative, I will never consume gluten again, it makes me feel that bad.

    Share this comment


    Link to comment
    Share on other sites


    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.


  • Popular Contributors

  • Ads by Google:

  • Who's Online   25 Members, 0 Anonymous, 1,256 Guests (See full list)

  • Related Articles

    Advertising Product-Review
    SweetLeaf® Stevia Sweetener is an outstanding choice in place of sugar or any other replacement sweetener. For a variety of reasons, it is far superior to other sweeteners like aspartame, sucralose, saccharin, acesulfame K, or neotame.
    It is also gluten-free and doesn't contain calories, carbohydrates, or any artificial ingredients, and yet it tastes exactly like sugar but does not trigger a glycemic response so it is perfect for people with diabetes.
    SweetLeaf® is available in 35- or 70-packet boxes, or in a shaker jar, and they also produce a liquid stevia version which comes in a variety of flavors.
    For more information, visit www.SweetLeaf.com.
     
     
    Review written by Scott Adams.

    Advertising Banner-Ads
    GliadinX is a dietary supplement with the highest concentration of AN-PEP, Prolyl Endopeptidase (Aspergillus Niger), the most effective enzyme proven to break down gluten in the stomach. This high potency enzyme formulation is specifically designed to break down gliadin, and unlike other enzyme formulas that claim to do the same, there is a growing body of research that backs up the effectiveness of GliadinX (see Sources below).
    GliadinX does not prevent and is not a cure for celiac disease, however, extensive scientific research has been conducted at multiple medical centers which has shown that it effectively breaks down gliadin into small, harmless fragments before it can reach the small intestine. GliadinX is perfect for celiacs who still want to eat outside of their home, and not have to worry about cross-contamination, and for those who are gluten sensitive and wish to continue eating gluten.
     
    For more info visit their site.
    Sources:
    Extra-Intestinal Manifestation of Celiac Disease in Children. Nutrients 2018, 10(6), 755; doi:10.3390/nu10060755 Efficient degradation of gluten by a prolyl endoprotease in a gastrointestinal model Enzymatic gluten detoxification: the proof of the pudding is in the eating! Highly efficient gluten degradation with a newly identified prolyl endoprotease: implications for celiac disease Degradation of gluten in wheat bran and bread drink by means of a proline-specific peptidase

    Advertising Product-Review
    I tried a Q Cups™ Savory Garlic & Mushroom for lunch yesterday and was pleasantly surprised. Many of the meals in a cup that I've tried are overpowering in flavor, but not Q Cups™.
    The hearty texture and taste came mostly from the quinoa and shiitake mushrooms. There was a mild hint of seasonings that included chives, garlic, celery, thyme, and bay leaves.
    My overall impression was that in just 5 minutes I could have a healthy, gluten-free meal. Q Cups™ are perfect for a quick lunch at the office, or to take on camping trips or planes.
    Visit their site for more info.

    Advertising Product-Review
    GliadinX is a dietary supplement with the highest concentration of AN-PEP, Prolyl Endopeptidase (Aspergillus Niger), the most effective enzyme proven to break down gluten in the stomach. This high potency enzyme formulation is specifically designed to break down gliadin, and unlike other enzyme formulas that claim to do the same, there is a growing body of research that backs up the effectiveness of GliadinX (see Sources below).
    GliadinX does not prevent and is not a cure for celiac disease, however, extensive scientific research has been conducted at multiple medical centers which has shown that it effectively breaks down gliadin into small, harmless fragments before it can reach the small intestine. GliadinX is perfect for celiacs who still want to eat outside of their home, and not have to worry about cross-contamination, and for those who are gluten sensitive and wish to continue eating gluten.
    Many people have asked Celiac.com how they can order this product, so we've included a "Buy Now" link below to order them directly from the manufacturer:

     
    Sources: Scientific publications on AN-PEP enzymes:
    Extra-Intestinal Manifestation of Celiac Disease in Children. Nutrients 2018, 10(6), 755; doi:10.3390/nu10060755 Efficient degradation of gluten by a prolyl endoprotease in a gastrointestinal model Enzymatic gluten detoxification: the proof of the pudding is in the eating! Highly efficient gluten degradation with a newly identified prolyl endoprotease: implications for celiac disease Degradation of gluten in wheat bran and bread drink by means of a proline-specific peptidase

  • Recent Articles

    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.

    Jefferson Adams
    Celiac.com 06/16/2018 - Summer is the time for chips and salsa. This fresh salsa recipe relies on cabbage, yes, cabbage, as a secret ingredient. The cabbage brings a delicious flavor and helps the salsa hold together nicely for scooping with your favorite chips. The result is a fresh, tasty salsa that goes great with guacamole.
    Ingredients:
    3 cups ripe fresh tomatoes, diced 1 cup shredded green cabbage ½ cup diced yellow onion ¼ cup chopped fresh cilantro 1 jalapeno, seeded 1 Serrano pepper, seeded 2 tablespoons lemon juice 2 tablespoons red wine vinegar 2 garlic cloves, minced salt to taste black pepper, to taste Directions:
    Purée all ingredients together in a blender.
    Cover and refrigerate for at least 1 hour. 
    Adjust seasoning with salt and pepper, as desired. 
    Serve is a bowl with tortilla chips and guacamole.

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    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). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    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

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics