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    Celiac Disease 'Pre-Existing,' Firm Cancels Health Insurance for Girl, 17


    Jefferson Adams

    Celiac.com 09/18/2009 - Little did the parents of 17-year-old Brianna Rice realize that her February diagnosis for celiac disease would make her into a poster child for insurance reform. That's because when Brianna was first diagnosed, she was covered by health insurance. Thanks to some extra scrutiny by her insurance company, that is no longer the case.




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    In the months following her diagnosis, Brianna's insurance company, American Community Mutual Insurance, took a microscope to her medical records and canceled her policy after it ruled that her parents had lied on her application last November.

 American Community not only canceled her policy, effective in May, but also denied coverage all the way back to November 1st, 2008, the day Brianna's coverage began.

    After Brianna was diagnosed with celiac disease in February, American Community initiated a review of her medical files and found instances of dizziness, elevated cholesterol levels, ongoing fatigue and a persistent cough. The family received a letter from American Community dated 12 May announcing their choice to rescind coverage.



    The letter stated that "coverage you applied for would not have been issued for Brianna if we had known this medical history at the time of application."

    

Dale Rice claims the firm cherry-picked the instances from different doctors' visits, and that Brianna had no ongoing health issues. He noted the dizziness to was due to a brief bout with dehydration, the fatigue a result of Brianna staying up late surfing online, and the elevated cholesterol due to an inaccurate test, and said her cough was short-lived.

    
The Rices insist they were honest and forthcoming on Brianna's application and say American Community is trying to back out of covering their daughter because of the February diagnosis.

American Community claims it would not have granted coverage based on Brianna's full medical record.

    
The Rices have lodged a complaint with the Illinois Department of Insurance. "We are livid," said Dale Rice, who, along with his wife, is out of work. "When a private insurer gets legitimate claims and seeks to find excuses not to pay them, they are clearly demonstrating morally and ethically bankrupt behavior."

    Insurance companies look for "anything that they could say 'you didn't tell us about,'" says Rice. "They hope that people just lay down and die and don't fight."

    The Rices are not alone. The director of the Illinois Department of Insurance, Michael McRaith, notes that his department has investigated about 400 rescission-related cases industry-wide since 2005. He calls the rate at which customers have complained about American Community 'alarming,' and calls American Community Mutual's rescission numbers 'cause for concern.' 



    The family's situation shows just how quickly health insurance problems can lead to financial ruin. With their daughter's unpaid medical bills exceeding $20,000 and mounting, the Rices fear losing their home. Brianna's mother, Pat Rice says she has liquidated some of her retirement account to pay bills.



    "The next step is really bankruptcy," her husband said.

    This story should strike a nerve with everyone who has celiac disease, or knows someone who does. I wonder how many people with celiac disease might risk cancellation of their insurance if they lost their jobs?  How many people who obtain insurance in good faith, and later find they have celiac disase, risk being with a 'pre-existing' condition label? It seems to me that a crafty insurance company could make an argument that nearly all celiac disease is 'pre-existing,' especially in older people.

    Let us know your thoughts by commenting below.

    Source: Chicago Tribune

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    Guest Janet LaRue

    Posted

    This is disheartening for the Celiac Community in general. I have also wondered if this would indeed start occurring with celiac patients. For this issue alone, I have not recommended having genetic testing for family members as it would be seen as a pre-exisiting condition should a member have the gene and a predisposition to celiac disease.

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    I am disgusted with the insurance company, and that's the only thing I can say that is printable!

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    Guest Eric Young

    Posted

    Is there any question in anyone's mind about the need to fix our health system in this country? Where else on the face of the earth is profit put ahead of someone's well-being? Wouldn't it be poetic justice if the CEO of American Community Mutual was diagnosed with celiac disease, something that I would not wish on anyone. I hope Illinois steps up to the plate for this 17 year-old!

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    Guest former nurse case manager

    Posted

    It is unfortunate you have tied losing medical insurance to the diagnosis of celiac disease. The reality for this family is that they are unemployed, therefore they lost their medical coverage. I believe a simple letter from their daughter's physician stating the facts of her diagnosis would be helpful in fighting this denial of coverage. Their right to challenge the decision to deny insurability needs to be highlighted and pursued by these parents.

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    Guest concerned parent

    Posted

    Truly, this is a concern. I have worried about such an event since my daughter's diagnosis. Luckily, we still have coverage -- but what if we have to switch companies? When she grows and gets insurance as an adult -- will she even be able to get a reasonable and fair policy?

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    Yes, this is one clear reason for health care reform. It's just business as usual for this insurance company; maximize profits at the expense of subscribers' health. The whole issue of denial and the subsequent games the patient has to play with the insurance company is expensive too. We are the only industrialized nation where medicine is a (profitable) business, and the incentive is for patients to come in sick (as opposed to health maintenance and prevention). I had to fight my insurance company regarding testing my daughters (I am a Celiac), but they finally understood it would be cheaper to do the genetic test than to go fishing with numerous doctor visits.

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    Guest Abigail

    Posted

    I have come to the conclusion that anyone associated in any way with insurance companies is allied with the devil. It's all about the Benjamin, Baby.

    Not that having the government run our health care would be much better. It's really a lose-lose situation, it seems.

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    It is unfortunate you have tied losing medical insurance to the diagnosis of celiac disease. The reality for this family is that they are unemployed, therefore they lost their medical coverage. I believe a simple letter from their daughter's physician stating the facts of her diagnosis would be helpful in fighting this denial of coverage. Their right to challenge the decision to deny insurability needs to be highlighted and pursued by these parents.

    A simple letter stating the facts? What universe are you from? When did you retire? Twenty years ago? First the insurance company loses the paper work repeatedly then it stonewalls. They are just hoping you will give up or die. And they don't ever have to give you a reason. Read the newspapers; watch something other than Fox...

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    This is disheartening for the Celiac Community in general. I have also wondered if this would indeed start occurring with celiac patients. For this issue alone, I have not recommended having genetic testing for family members as it would be seen as a pre-exisiting condition should a member have the gene and a predisposition to celiac disease.

    I have a similar case pending with Indiana DOI for this same insurance company. Go figure and I will be sending this article to the Indiana DOI on tomorrow.

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    Guest Elaine

    Posted

    We definitely need REFORM. Sheesh. Having Celiac requires no expensive drugs, just expensive food! Some ins companies need to be hauled on the carpet, they need to STOP the pre-existing condition crap. I hope any of them who refuse or decline a person because of a pre-existing condition gets a slew of them themselves! See how they like it!

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    Guest Kirsti

    Posted

    I have come to the conclusion that anyone associated in any way with insurance companies is allied with the devil. It's all about the Benjamin, Baby.

    Not that having the government run our health care would be much better. It's really a lose-lose situation, it seems.

    We live in Canada and our son and daughter live in the United States. Our children have needed care in the United States, and it has always been prompt and plentiful but expensive (even with good insurance policies). In Canada, we may wait a bit longer and maybe they don't do as many procedures, but in the end, the care is just as good. The government run system is the way to go. I'm so grateful we live here (and very nervous now for my son with celiac disease who lives in the U.S.). I'm surprised Americans put up with their crazy, immoral system.

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    Guest Peaceful Paradox

    Posted

    This is totally immoral what the insurance company did. Suppose a person has celiac and is currently covered by insurance provided by his/her employer. What happens if the person loses his/her job? They may not be able to get coverage because of "pre-existing condition" -- at least until the Obama health care reform act goes into effect (expected in 2014).

     

    If possible, sign up for insurance prior to being tested for celiac. It is harder to get insurance after being diagnosed with celiac.

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  • Related Articles

    Anne Marie Dunphy
    Celiac.com 03/11/2009 - I recently had an unfortunate health experience related to celiac disease.  I learned long ago that it’s my responsibility to manage my own health, so I came up with a strategy that was successful.  Along the way, I also learned some important information that really helped me understand the problem and the eventual solution.  Perhaps this information will help you avoid a similar health crisis.  I’ve included links that can give you additional information.  Disclaimer: I’m not a medical doctor.  This is information that I have gathered based on my own experiences and research.
    Celiac Disease
    I have celiac disease. I manage it quite well through my diet.  However, if I ingest anything with gluten, for instance a wayward crouton in a restaurant salad, I have a severe reaction that starts within five minutes.  All or some of the following will occur: hives from head to toe, stomach cramps, uncontrollable diarrhea, vomiting, asthma, severe lethargy.  I fall into an uncontrollable sleep that takes about four hours to run its course.  Needless to say, I avoid gluten at all costs.
    A Bit of History
    Although I am a remarkable person (like all of us), my health history has been quite unremarkable.  Nothing was ever wrong with me and I wasn’t allergic to anything.  I can count on one hand how many times I’ve taken antibiotics in my entire life.  In the past 30+ years, I never went to the doctor for an illness.  I’ve had colds, various and sundry viruses and infections, but they ran their course with slowing down, plenty of rest and fluids.  I believe that the primary strategy should be to give your body the time to heal itself first, and if that fails look for an alternative strategy from your doctor.
    Imagine my surprise when about six years ago the symptoms of celiac disease manifested themselves.  (Note: I was going through an acute stressful time in my life when this occurred.)  Along the way, other unexpected food allergies have presented themselves as well.
    One of my favorite foods was peanut butter.  Since I was a little girl, I loved feasting on “peanut butter on spoon”.  Out of the blue one day, a typical teaspoon of one of my favorite foods sent me into an anaphylactic reaction.  And then a few months after that incident, a bite of a granola bar with cashews sent me on my first ambulance ride with a rapidly constricting throat to the emergency ward.  My favorite food is now a deadly poison.
    I’ve had mild intestinal reactions to all vinegars and vinegar products (a little balsamic is OK), more than three glasses of red wine (not white wine or champagne), milk and cream (not cheese, thank the Universe!).  I’ve also realized that I’m thirsty all the time.  It seems that no matter how much water I drink, I can’t seem to quench my thirst.  I even sleep with water next to my bed and drink several glasses throughout the night and still wake up thirsty.  The water goes right through me and doesn’t seem to be absorbed.  (I have recently been prodded, poked, examined and tested by a battery of doctors as a result of my once in 50-year checkup and they all agree that I’m the picture of health.)
    Both my mom and my grandmother suffered from asthma; my grandmother dealt with it her whole life.  When I have an asthmatic reaction, my wheezing and coughing sound just like theirs!  I remembered them being armed with their inhalers and their steroids at all times.  I also remembered that these medical weapons didn’t stop the asthma attacks or the wheezing or uncontrollable coughing.  They only dealt with the symptoms, not the underlying problem.  Mom’s asthma went away when she started eating a gluten free diet.
    The Incident
    So I’ve come to enjoy cooking.  Regardless of the disastrous results of my past cooking experiences well documented by my children, close friends and family, this new hobby relaxes me at the end of the day, is creative, saves money and insures a truly gluten and allergy free diet.
    I recently made a delicious French Onion and Ham Cream Soup.  It was inspired by some wonderful French spices I bought from Penzey Spices.  I made a big pot of the soup and had it for different meals throughout the week.  I didn’t notice at the time an increased feeling of lethargy, intestinal rumblings and increased thirst that got progressively worse through the week.
    And then it happened.  About five minutes after devouring the last of my delectable French Onion and Ham Cream Soup, the tell-tale signs of an oncoming asthma attack occurred: mucous pouring into my lungs, wheezing, airways closing up, unrelenting coughing.
    In addition, I had horrible abdominal cramping.  I was tremendously thirsty, but the water just seemed to go through me and make me even thirstier.  At about 4:00 am just as I was about to get myself to the hospital, I started to slowly stabilize, meaning I wasn’t getting worse.
    I slept for a little bit, then woke up coughing uncontrollably.  My throat was so parched it felt like sandpaper.  I dragged myself through a day of work exhausted, not being able to really get a good breath and feeling so very thirsty.
    That night I literally coughed all night long sitting straight up in a chair; I couldn’t lie down because of the coughing.  I couldn’t go to work the next day.  I needed to discover why this happened, how I can prevent it from happening again and implement an immediate strategy for managing this health crisis.
    Hypothesis
    I realized there was a relationship between several factors: celiac disease, since I had no allergies until it manifested itself; cow’s milk, which I knew was a highly allergic food; asthma, as the allergic reaction, and dehydration, because of the incessant thirst.  By understanding how all of these factors related to each other, I thought I could figure out a strategy to 1) get myself into a healthy state quickly and 2) prevent this health crisis from happening again. (Even thought I knew this was an asthma attack, I wanted to make doubly sure it wasn’t pneumonia or something similar.  I had no fever, chills, aches or pains, headache, or upper respiratory infection.  I was fine one minute and not fine the next.)
    Research
    Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted.  When an asthma attack occurs, mucus production is increased, muscles of the bronchial tree become tight, and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing and coughing.  Asthma symptoms are usually worse at night.
    There is high correlation between people who have celiac disease and people who have sensitivities to proteins found in cow's milk.  Milk is one of the most common food allergens in the American diet.  And most cows eat a lot of grain and perhaps there’s a link here.  Milk allergy symptoms can occur within minutes or hours after consuming the dairy product.  They can be triggered by a very small amount of milk protein in the system. 
    There is also a relationship between celiac disease, asthma and dehydration.  People with celiac disease are often very thirsty even after drinking lots of water.  And so are people with asthma.  If fact, many doctors now think that asthma is a symptom of the body managing its water supply.
    This is how it works…
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    When we start to dehydrate, histamine production increases to conserve water in our bodies. 
    This is vital since our lungs must remain moist to work properly.  Excess histamine, a defense against losing more water, makes it difficult to breath and triggers an asthma attack.  Histamine also stimulates mucous production to help seal in moisture, but that also leads to increased breathing difficulties.  Histamines are also important for immune function, but during dehydration they are mostly used to look for water.  If dehydration becomes chronic, the immune system will suffer; allergies, both inhalant and food allergies, will result because histamine is important for the proper balance of Tcells, antibodies and so on.
    Elevated histamine in the lungs causes the spasm of the bronchioles.  This conserves moisture that would normally be lost during breathing.  The mucus that clogs up the airways is the body’s attempt to keep the airways from completely drying out.  Inflammation in the airways is the result of the body bringing more “micro-circulation” to the lungs as a result of dehydration.
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    Allergy symptoms of any kind are a sign that we need to drink more water.  Antihistamines and most medicines, either directly or indirectly, actually are counterproductive for the body because they further dehydrate the body and shut off the body’s search for water.  Pain, inflammation and digestive problems are also typically signs of dehydration.  Dehydration is a common cause of migraines, for example. 
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    The first step was to get myself in a healthy state.  My re-hydration plans included continually drinking filtered water even through the night, teaspoons of honey to soothe my raw throat when needed and pinches of pink Australian sea salt (a Christmas gift from my wonderful mom) on my tongue throughout the day and night when I felt I needed it, although any sea salt would do.  I also had vegetable juice and fruit juice for additional fluids.
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    The second step is to not let this happen again.  I’m now drinking no less than 10 eight-ounce glasses of water every day with a pinch of salt on my tongue if I feel I need it.  I need about ¼ teaspoon of salt for every quart of water I drink.  After a lifetime of poor medical advice, I now know that salt is my friend.  If I drink coffee or wine or if I get the nutty idea to exercise, I have to drink more water.  And no more milk and cream - at least until I’m stabilized for awhile.
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    Conclusion
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    Jefferson Adams
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    onlysometimesclever.wordpress.com Kids With Celiac Disease The Kids are Back in School - Tips for Making the (Gluten-Free) Grade The Gluten Free Kid: a Celiac Survival Guide Gluten-Free School Lunch Recipes How to Pack a Gluten-Free Lunch

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    Jefferson Adams
    Celiac.com 12/05/2014 - To remain healthy, people with serious gluten intolerance, especially people with celiac disease, must avoid foods containing gluten from wheat, barley, and rye. Accordingly, gluten detection is of high interest for the food safety of celiac patients.
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    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

    Jefferson Adams
    Celiac.com 06/12/2018 - A life-long gluten-free diet is the only proven treatment for celiac disease. However, current methods for assessing gluten-free diet compliance are lack the sensitivity to detect occasional dietary transgressions that may cause gut mucosal damage. So, basically, there’s currently no good way to tell if celiac patients are suffering gut damage from low-level gluten contamination.
    A team of researchers recently set out to develop a method to determine gluten intake and monitor gluten-free dietary compliance in patients with celiac disease, and to determine its correlation with mucosal damage. The research team included ML Moreno, Á Cebolla, A Muñoz-Suano, C Carrillo-Carrion, I Comino, Á Pizarro, F León, A Rodríguez-Herrera, and C Sousa. They are variously affiliated with Facultad de Farmacia, Departamento de Microbiología y Parasitología, Universidad de Sevilla, Sevilla, Spain; Biomedal S.L., Sevilla, Spain; Unidad Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Celimmune, Bethesda, Maryland, USA; and the Unidad de Gastroenterología y Nutrición, Instituto Hispalense de Pediatría, Sevilla, Spain.
    For their study, the team collected urine samples from 76 healthy subjects and 58 patients with celiac disease subjected to different gluten dietary conditions. To quantify gluten immunogenic peptides in solid-phase extracted urines, the team used a lateral flow test (LFT) with the highly sensitive and specific G12 monoclonal antibody for the most dominant GIPs and an LFT reader. 
    They detected GIPs in concentrated urines from healthy individuals previously subjected to gluten-free diet as early as 4-6 h after single gluten intake, and for 1-2 days afterward. The urine test showed gluten ingestion in about 50% of patients. Biopsy analysis showed that nearly 9 out of 10 celiac patients with no villous atrophy had no detectable GIP in urine, while all patients with quantifiable GIP in urine showed signs of gut damage.
    The ability to use GIP in urine to reveal gluten consumption will likely help lead to new and non-invasive methods for monitoring gluten-free diet compliance. The test is sensitive, specific and simple enough for clinical monitoring of celiac patients, as well as for basic and clinical research applications including drug development.
    Source:
    Gut. 2017 Feb;66(2):250-257.  doi: 10.1136/gutjnl-2015-310148.