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    Danna Korn
    This article originally appeared in the Spring 2003 edition of Celiac.com's Journal of Gluten-Sensitivity.
    -Yes, there’s more to life than rice and corn!
    Variety, it’s been said, is the spice of life.  So what’s a person to do when they’re told to eliminate wheat and/or gluten from their diet?  Most turn to rice, corn, and potatoes—an adequate set of starches, but ones that are sorely lacking in nutrients, flavor, and imagination.
    The superheroes of gluten-free grains are often referred to as “ancient” or alternative grains, which are loaded with nutrients and unique, interesting flavors.  The following is a condensed excerpt from my newly published book, Wheat-Free, Worry-Free: The Art of Happy, Healthy, Gluten-Free Living.
    “Alternative” Grains: The Superheroes of Gluten-Free Grains
    If you’re an adventuresome eater, you’re in for a treat.  In searching for alternatives to wheat, rye, or barley, you’ll discover a variety of wheat-free/gluten-free grains that you may never have heard of before, many of them loaded with nutrients and robust flavors not found in typical grains like wheat and rice.  If you’re not the adventurous type and you just long for the ease of a few tried-and-true favorites, you’ll find them here as well.
    Perhaps you fall into still another category—you’ve been eating a wheat or gluten-free diet for a while and you think you already know everything there is to know.  Okay, what’s quinoa, and how the heck is it pronounced?  Is teff wheat-free?  Do Job’s Tears have religious significance?  If you don’t know the answers to these questions, or if you think ragi is a spaghetti sauce and sorghum is what you get when you have your teeth cleaned, it’s time to move on to lesson one.
    Alternative Grains and Non-Grains
    Even if you can’t eat wheat, rye, barley, or oats, there are several other grains, fruits, and legumes that are not only acceptable alternatives to them, but they also happen to be loaded with flavor and nutrients.  Here are some of the many choices available to those on a wheat and gluten-free diet (WF/gluten-free):

    Amaranth (WF/gluten-free) Buckwheat/groats/kasha (WF/gluten-free) Cassava (arrowroot) (WF/gluten-free) Chickpea (garbanzo) (WF/gluten-free) Job’s Tears (WF/gluten-free) Millet (WF/gluten-free) Montina (WF/gluten-free) Oats (WF/gluten-free, but oats can be contaminated with wheat and other grains) Quinoa (WF/gluten-free) Ragi (WF/gluten-free) Rice (WF/gluten-free; only brown rice is whole grain) Sorghum (WF/gluten-free) Soy (WF/gluten-free) Tapioca (WF/gluten-free) Taro root (WF/gluten-free) Teff (WF/gluten-free)
    Many of the proteins found in these alternatives are a great source of complex carbohydrates.  The fuel from these carbohydrates, found in plant kingdom starches, produces what nutritionists call a protein-sparing effect, which means the body can meet its energy requirements without dipping into its protein reserves. Several of these alternative grains and non-grains are high in lysine, an amino acid that controls protein absorption in the body.  Because this amino acid is absent from most grains, the protein fraction of those grains is utilized only if eaten in conjunction with other foods that do contain lysine.  All high protein grains are better utilized by the body when they are eaten with high-lysine foods such as peas, beans, amaranth, or buckwheat.
    Amaranth (WF/gluten-free): Loaded with fiber and more protein than any traditional grain, amaranth is nutritious and delicious, with a pleasant peppery flavor.  The name means “not withering,” or more literally, “immortal.”  While it may not make you immortal, it is extremely healthful, especially with its high lysine and iron content.
    Buckwheat (groat; kasha) (WF/gluten-free): It sounds as though it would be closely related to wheat, but buckwheat is not related to wheat at all.  In fact, it’s not even a grain; it’s a fruit of the Fagopyrum genus, a distant cousin of garden-variety rhubarb, and its seed is the plant’s strong point.  The buckwheat seed has a three-cornered shell that contains a pale kernel known as a “groat.”  In one form or another, groats have been used as food by people since the 10th century b.c.
    Nutritionally, buckwheat is a powerhouse.  It contains a high proportion of all eight essential amino acids, which the body doesn’t make itself but are still essential for keeping the body functioning.  In that way, buckwheat is closer to being a complete protein than any other plant source.
    Whole white buckwheat is naturally dried and has a delicate flavor that makes it a good stand-in for rice or pasta.  Kasha is the name given to roasted hulled buckwheat kernels.  Kasha is toasted in an oven and tossed by hand until the kernels develop a deep tan color, nutlike flavor, and a slightly scorched smell.
    Be aware, however, that buckwheat is sometimes combined with wheat.  Read labels carefully before purchasing buckwheat products.
    Millet (WF/gluten-free): Millet is said by some to be more ancient than any grain that grows.  Where it was first cultivated is disputed, but native legends tell of a wild strain known as Job’s Tears that grows in the Philippines and sprouted “at the dawn of time.”
    Millet is still well respected in Africa, India, and China, where it is considered a staple.  Here in the United States, it is raised almost exclusively for hay, fodder, and birdseed.  One might consider that to be a waste, especially when considering its high vitamin and mineral content.  Rich in phosphorus, iron, calcium, riboflavin, and niacin, a cup of cooked millet has nearly as much protein as wheat.  It is also high in lysine—higher than rice, corn, or oats.
    Millet is officially a member of the Gramineae (grass) family and as such is related to montina.
    Montina (Indian Rice Grass) (WF/gluten-free): Indian rice grass was a dietary staple of Native American cultures in the Southwest and north through Montana and into Canada more than 7,000 years ago, even before maize (corn) was cultivated.  Similar to maize, montina was a good substitute during years when maize crops failed or game was in short supply.  It has a hearty flavor, and is loaded with fiber and protein.
    Quinoa (“KEEN-wah”) (WF/gluten-free): The National Academy of Science described quinoa as “the most nearly perfect source of protein from the vegetable kingdom.”  Although new to North Americans, it has been cultivated in the South American Andes since at least 3000 b.c.  Ancient Incas called this annual plant “the mother grain,” because it was self-perpetuating and ever-bearing.  They honored it as a sacred food product, since a steady diet appeared to ensure a full, long life; and the Inca ruler himself planted the first row of quinoa each season with a gold spade.
    Like amaranth, quinoa is packed with lysine and other amino acids that make a protein complete.  Quinoa is also high in phosphorus, calcium, iron, vitamin E, and assorted B vitamins.  Technically a fruit of the Chenopodium herb family, quinoa is usually pale yellow in color, but also comes in pink, orange, red, purple, and black.
    Quinoa’s only fault is a bitter coating of saponins its seeds.  The coating comes off with thorough rinsing prior to cooking, and some companies have developed ways to remove the coating prior to delivering quinoa to stores.
    Sorghum (milo) (WF/gluten-free): Sorghum is another of the oldest known grains, and has been a major source of nutrition in Africa and India for years.  Now grown in the United States, sorghum is generating excitement as a gluten-free insoluble fiber.
    Because sorghum’s protein and starch are more slowly digested than that of other cereals, it may be beneficial to diabetics and healthy for anyone.  Sorghum fans boast of its bland flavor and light color, which don’t alter the taste or look of foods when used in place of wheat flour.  Many cooks suggest combining sorghum with soybean flour.
    Soy and Soybeans (WF/gluten-free): Like the ancient foods mentioned at the beginning of this section, soy has been around for centuries.  In China, soybeans have been grown since the 11th century b.c., and are still one of the country’s most important crops.  Soybeans weren’t cultivated in the United States until the early 1800s, yet today are one of this country’s highest yielding producers.
    Soybeans are a legume, belonging to the pea family.  Comprised of nearly 50 percent protein, 25 percent oil, and 25 percent carbohydrate, they have earned a reputation as being extremely nutritious.  They are also an excellent source of essential fatty acids, which are not produced by the body, but are essential to its functioning nonetheless.
    Teff (WF/gluten-free): Considered a basic part of the Ethiopian diet, teff is relatively new to Americans.    Five times richer in calcium, iron, and potassium than any other grain, teff also contains substantial amounts of protein and soluble and insoluble fiber. Considered a nutritional powerhouse, it has a sweet, nutty flavor. Teff grows in many different varieties and colors, but in the United States only the ivory, brown, and reddish-tan varieties can be found. The reddish teff is reserved for purveyors of Ethiopian restaurants, who are delighted to have an American source for their beloved grain.
    A Word About Sprouted Grains
    Some people believe that “sprouted grains,” even ones that contain gluten such as wheat, are gluten-free—not true!  The sprouting process sparks a chemical reaction that begins to break down gluten, so some people who are slightly sensitive to gluten may find that they can tolerate sprouted grains better, but too many of the peptides that are reactive for celiacs are still present, so sprouted grains are not safe for people with celiac disease or gluten intolerance.


    Jefferson Adams
    Celiac.com 11/15/2017 - Quinoa is regarded as safe for people with celiac disease. For many years, some celiac support groups listed quinoa as unsafe due to cross-contamination concerns. But any grain is unsafe for celiacs if it is contaminated with wheat, rye or barley. Some grains have a higher risk of such contamination, others have a low risk.
    Based on its low risk for cross-contamination, Celiac.com has had quinoa on our safe list since 1995. A vast amount of evidence supports that listing.
    The latest research shows that celiac patients can safely tolerate up to 50 g of quinoa daily for 6 weeks. The researchers in this test point out that further studies are needed to assess long-term effects of quinoa consumption. In the short-term test, the researchers looked at 19 treated celiac patients who ate 50 g of quinoa every day for 6 weeks as part of their regular gluten-free diet.
    The team evaluated diet, serology, and gastrointestinal parameters, and made histological assessments of 10 patients, both before and after they consumed quinoa. The results show that celiac patients seem to tolerate quinoa well, and it doesn't trigger any symptoms or cause any gut damage or dysfunction. The team found normal gut structure and mucosa to confirm that assessment.
    In fact, patients saw a general improvement histological and serological results, so better gut conditions and less blood antibodies to gluten in patients who ate quinoa. Celiac patients who ate quinoa for 6 weeks also experienced a mild reduction in blood pressure.
    Overall, this is the first clinical study to show that celiac patients can safely tolerate up to 50 g of quinoa daily for 6 weeks.
    Obviously, future studies need to look at the safety of long-term quinoa consumption. That said, quinoa seems to be safe for celiac patients on a gluten-free diet.
    If you really want to be sure, quinoa grown in main producer countries of Bolivia, Peru and Ecuador, where practically no wheat is grown, is probably the safest bet for those on a gluten-free diet.

    Jefferson Adams
    Celiac.com 11/18/2017 - Just looking at its name, one might wonder if buckwheat is safe for people on a gluten-free diet.
    However, unlike its name, buckwheat does not naturally contain any wheat or gluten. As a result, buckwheat is considered safe for people with celiac disease on a gluten-free diet.
    Turns out that buckwheat and wheat are from different, unrelated botanical families. As with quinoa, buckwheat is the seed of a flowering plant, as such it is not considered a grain or a cereal.
    Buckwheat is actually closely related to rhubarb. It is an excellent source of fiber and nutrients. A serving of cooked buckwheat groats, the small triangular seeds, offers 17 grams of dietary fiber and 22 grams of protein.
    Buckwheat is not only nutritious, but it contains rutin, a compound shown to strengthen capillary walls and improve circulation. As such, buckwheat, is also regarded as beneficial for people with type 2 diabetes and high blood pressure.
    As with grains, buckwheat can become contaminated with wheat during processing, transportation or if it is grown in fields also used to grow wheat.
    To make sure your buckwheat is gluten-free, it is important to find certified gluten-free buckwheat. Also, remember that some products labled as buckwheat may include wheat flour, so double check to make sure your product is labled gluten-free. Otherwise, buckwheat is a healthy, nutritious gluten-free alternative for people with celiac disease.

  • Recent Articles

    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.

    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