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  • Jefferson Adams
    Jefferson Adams

    Celiac Disease in Northern India More Common Than Previously Believed

    Celiac.com 03/23/2011 - A group of researchers in India recently conducted a community-based study on the prevalence of celiac disease in the northern part of India.

    The research group included Govind K Makharia, Anil K Verma, Ritvik Amarchand, Shinjini Bhatnagar, Prasenjit Das, Anil Goswami, Vidyut Bhatia, Vineet Ahuja, Siddhartha Datta Gupta and Krishnan Anand.

    They are affiliated with the Departments of Gastroenterology and Human Nutrition, and Pediatrics and Pathology at the Centre for Community Medicine of the All India Institute of Medical Sciences in New Delhi.

    Worldwide celiac disease rates are estimated at about 1%, but the disease is thought to be uncommon in both India and Asia. However, there has generally been a lack of study data on the actual prevalence of celiac disease in Asian nations.

    The research team set out to accurately estimate the prevalence of celiac disease in a specific Indian community. The team crafted a cross sectional study to estimate rates of celiac disease in urban and rural populations in the National Capital Region, Delhi, India.

    The team gathered data using a structured questionnaire administered via door-to-door visits. The questionnaire provided socio-demographic data and basic screening for features of celiac disease, such as chronic or recurrent diarrhea, and anemia.

    For children, the questionnaire included additional factors, namely short stature (linear height below 5th percentile for age) and failure to thrive/gain weight.

    All test subjects with positive screens and 10% of negative screen individuals were called for anti-tissue transglutaminase antibody blood test.

    All those with positive blood tests were invited to undergo endoscopic biopsy. The team diagnosed celiac disease on the basis of a positive blood screens, the presence of villous atrophy and/or response to gluten free diet.

    The team contacted 12,573 people in all. A total of 10,488 (83.4%) (50.6% male) agreed to participate. Screening showed 5,622 (53.6%) positive results. Of those who screened positive, 2167 (38.5%) submitted to anti-tissue transglutaminase antibody blood tests. The team also tested 712 (14%) subjects who had tested negative.

    The data showed an overall sero-prevalence of celiac disease was 1.44% (95% conï¬dence interval [CI] 1.22 1.69) and the overall prevalence of celiac disease was 1.04% (95% CI 0.85 1.25).

    Celiac disease in this north Indian community is 1 in 96, or about 1%. That means that celiac disease is more common than is recognized in India, and that rates are about the same as in other parts of the world, not lower, as conventional wisdom has held.

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    There is an error in this article: "All test subjects with positive blood screens and 10% of screen negative individuals were called for anti-tissue transglutaminase antibody blood tests."

     

    The word "blood" is in error. All test subjects who reported chronic or recurrent diarrhea and/or anemia, as well as children with short stature and/or failure to thrive or gain weight were THEN called back for the blood test, which was for the anti-tissue transglutaminase antibody.

     

    Perhaps the most important conclusion of the study was left out of this article as well:

     

    "The diagnostic criteria for celiac disease requires small-intestinal mucosal villous atrophy with crypt hyperplasia (Marsh III). However, mucosal damage develops gradually and patients may develop clinical symptoms even before classical histological changes have appeared. Two recent studies by Kurppa et al., all have elegantly demonstrated that even those with a positive serology and no villous atrophy do respond to a gluten free diet. In a subset of patients having Marsh I–II histology and positive serology, Kurppa et al. in a randomized controlled trial demonstrated alleviation of symptoms, decrease in antibody titers and improvement in histology in those who were randomized to receive gluten-free diet while there was deterioration in the small intestinal lesions in those who were continued on a gluten diet. In another study, the same author showed similar observations in anti- endomysial antibody positive children with either completely normal histology (Marsh 0) or at most Marsh I lesions. These two studies are quite intriguing and may lead to a change in the diagnostic criteria of celiac disease."

     

    The paper, "Prevalence of Celiac Disease in the Northern Part of India: A Community-Based Study," was presented in the Asia Pacific Digestive Week 2010 in Kuala Lumpur, Malasia. The abstract was published in the Journal of Gastroenterology and Hepatology (J Gastroenterol Hepatol 2010; 25 (Suppl 2): A12).

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    Guest Prof. V.K.Bharadwaj

    Posted

    At least in cases serologically positive but histologically negative for celiac disease; in these cases, stool test for fat could have been done.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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    Jefferson Adams
    Celiac.com 09/06/2012 - Researchers at the Department of Food Technology of the Universidad Politécnica de Madrid have used teff flour to develop a new biscuit they claim is suitable for "celiac patients and sportsmen."
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    Before you picture a light, fluffy, fresh-from-the-oven biscuit, it's important to remember that the Europeans use the term biscuit for what Americans call a 'cracker.' So, the final product is likely something drier and crunchier than the American biscuit, and much more like an American cracker.
    The developers have applied for a patent on their process, and say that manufacturers will be able to use the process to create new products once it is granted.
    One of the current challenges for manufacturers of gluten-free foods is to modify their production process in order to mimic the natural, chewy, elastic properties that are inherent to wheat flour. That challenge is one reason so many gluten-free products are dry and brittle.
    That is not true of this new product, say the researchers. Unlike many non-wheat flours, teff has a "high capacity to absorb water and act also as binder in the dough, alleviating the problems deriving from the absence of gluten in cereal,” said the researchers.
    According to the research team, 100g of teff contains between 9 and 15 grams of protein, 73 grams of carbohydrates, 2 grams of fat and 3 grams of fiber.
    This means that their product needs no added fats or artificial thickeners commonly used in other gluten-­free foods, which reduces calories and improves texture and flavor. Moreover, the biscuits can be made using existing manufacturing processes.
    Teff also has a remarkable essential amino acids profile, note the researchers. It is high in zinc and iron, and has a naturally low glycemic index, resulting in a slow breakdown of its carbohydrates.
    The resulting product, they say, will appeal to athletes, diabetics and people with anemia, and celiac disease, and will likely sell at a lower price than similar products.
    Other than teff flour, the biscuits also include skimmed milk, non­fat plain yogurt, brown sugar, defatted cocoa powder, orange zest and hazelnuts.
    Source:
    Nutraingredients.com

    Jefferson Adams
    Celiac.com 09/16/2013 - Until recently, researchers thought celiac disease was mainly a problem in Northern Europe and Australasia, and uncommon in North America and the Middle East. However, with better data, researchers now regard celiac disease to be equally common in all these places.
    Celiac disease is still generally seen as rare in Asia and Sub-Saharan Africa, but a team of researchers wanted to get a better idea of geographical differences and time trends in the frequency of celiac disease.
    The research team included J. Y. Kang, A. H. Y. Kang, A. Green, K. A. Gwee, and K.Y. Ho. They are affiliated with the Department of Gastroenterology, St George's Hospital, London, UK, the Yong Loo Lin School of Medicine at the National University of Singapore, and with the Department of Gastroenterology and Hepatology at the National University Health System in Singapore.
    To get the data that would help them to compare geographical differences and time trends, the team conducted Medline and Embase searches covering a period from 1946 to 1980, using the key words: coeliac disease or celiac disease + prevalence, incidence or frequency.
    Their data showed significant differences between and within countries in the prevalence and incidence of celiac disease. For example, in all of reported English medical literature, there have been only 24 ethnic Chinese and Japanese patients with celiac disease.  Of celiac-associated HLA DQ antigens, DQ2 occurs in 5–10% of Chinese and sub-Saharan Africans, compared to 5–20% in Western Europe. DQ8 occurs in 5–10% of English, Tunisians and Iranians, but in less than 5% of Eastern Europeans, Americans and Asians.
    Rates and overall numbers of both clinically and serologically diagnosed celiac disease have risen in recent years. Celiac disease is increasing in frequency, with significant geographical differences.
    The team's geographical and temporal differences seem genuine, but a large number of hypothesis and lack of diagnostic facilities have made it difficult to reach any solid conclusions.
    Although few cases have been found in Asia and Sub-Saharan Africa, there is a significant prevalence of HLA DQ2 and wheat consumption is about the same as in Western Europe.
    It is possible that celiac disease may become more common in these countries in the future.
    Source:
    Aliment Pharmacol Ther. 2013;38(3):226-245.

    Jefferson Adams
    BioLineRx Clears Latest Hurdle for Celiac Treatment Drug
    Celiac.com 12/09/2014 - Biopharmaceutical company BioLineRx Ltd., has announced successful final results from its Phase 1/2 study for BL-7010, a novel co-polymer for the treatment of celiac disease.
    BL-7010 is a new, non-absorbable, orally available co-polymer intended for the treatment of celiac disease. The drug works by sequestering gliadins, effectively masking them from enzymatic degradation and preventing the formation of immunogenic peptides that trigger an adverse immune reaction when people with celiac disease consume wheat.
    This significantly reduces the immune response triggered by gluten. BL-7010 is excreted with gliadin from the digestive tract and is not absorbed into the blood.
    The trial results showed BL-7010 to be safe and well tolerated in both single- and repeated-doses, and pharmacokinetic analyses revealed no systemic exposure of BL-7010 in plasma and urine samples.
    The company has also settled on a one gram, three times per day regimen of BL-7010 as the optimal repeated dose for an upcoming randomized, placebo-controlled efficacy study set to begin in the last half of 2015.
    The absence of systemic exposure will likely support a medical-device classification for BL-7010, which would significantly accelerate its development in Europe.

    Source:
    Marketwatch.com

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