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    Scott Adams
    Celiac.com 06/02/2002 Prepared by Laura Yick - There are currently two bills in congress regarding food labeling that affect people with celiac disease. Both HR 1356 and HR 4704 were introduced by Representative Nita M. Lowey (D-NY) in the House of Representatives. S 2499 is the same as HR 4704 and was introduced by Senator Edward M. Kennedy (D-MA) in the Senate. It appears that HR 1356 is somewhat conflicting with HR 4704 and is a weaker version with less detail. HR 4704/S 2499 bill looks to be more beneficial for us (we all know the frustrations of having to verify the gluten status of foods, even if they are labeled gluten-free!), as it contains a section that deals with cross-contamination (see p.9 lines 13-25, p.10, and p.11 lines 1-2). HR 4704/S 2499 is under the control of the Secretary of Health and Human Services, however, the enforcement of cross-contamination labeling is not clear. You can compare them for yourself by going to the US Congress websites listed below. Here is a summary of each bill and a listing of the committee and subcommittee members who have control over the fate of the bills:
    House Bill H.R.1356
    Sponsor: Rep Lowey, Nita M.(introduced 4/3/2001)
    Title: To amend the Federal Food, Drug, and Cosmetic Act to require that foods containing spices, flavoring, or coloring derived from meat, poultry, other animal products (including insects), or known allergens bear labeling stating that fact and their names.
    SUMMARY AS OF: 4/3/2001--Introduced.
    Food Ingredient Right to Know Act
    Amends the Federal Food, Drug, and Cosmetic Act to provide that a food shall be deemed to be misbranded if it contains any spice, flavoring, or coloring derived from meat, poultry, any other animal product (including insects), or a known food allergen unless its labeling bears a statement with appropriate prominence on the information panel providing that fact and the name of the meat, poultry, other animal product, or known food allergen.
    STATUS:
    4/3/2001: Referred to the House Committee on Energy and Commerce (see below for list of committee members).
    4/25/2001: Referred to the Subcommittee on Health (see below for list of subcommittee members).
    07/29/2002: The food Allergen Bill S.2499 has been rescheduled for discussion after the August recess.

    House Bill H.R.4704
    Sponsor: Rep Lowey, Nita M.(introduced 5/9/2002)
    Title: To amend the Federal Food, Drug, and Cosmetic Act to establish labeling requirements regarding allergenic substances in food, and for other purposes.
    STATUS: (color indicates Senate actions)
    5/9/2002: Referred to the House Committee on Energy and Commerce.
    5/17/2002: Referred to the Subcommittee on Health.
    Senate Bill S.2499
    Sponsor: Sen. Kennedy, Edward M.(introduced 5/9/2002)
    Title: A Bill to amend the Federal Food, Drug, and Cosmetic Act to establish labeling requirements regarding allergenic substances in food, and for other purposes.
    STATUS:
    5/9/2002: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
    The current laws of the United States can be found at:
    http://law2.house.gov/download.htm
    Note that HR 4704 and S 2499 have exactly the same wording except for the sponsors. Bills in committees or subcommittees have three fates: (1) Tabled (i.e., they are essentially postponed, possibly forever), (2) Releasing it for a full House or Senate vote with a recommendation to pass it, (3) Revised and then released as in (2). Bills in committees also may be referred to subcommittees within the committee. It is possible that the Senate Committee on Health, Education, Labor, and Pensions may refer S 2499 to the Subcommittee on Public Health. The bill needs to pass with a simple majority (218 of 435 in the House, 26 of 50 in the Senate). The bill then goes to the other congressional body where the process begins again. Once both the House and Senate pass the bill, any differences between the House version and Senate version must be worked out by a conference committee of both House and Senate members. Then the bill must finally be approved by both the House and Senate. Because HR 4704 and S 2499 are concurrent, the entire process may be faster than if only one body of Congress were working on it. Finally, the President needs to approve it; otherwise, the bill goes back to the House and Senate and must pass by a 2/3 majority in both.
    If your representative or senator is listed below on a committee and/or subcommittee that is reviewing a bill, it is important that you request them to speed the committee recommendation of the bill to the full House or Senate vote and to ensure that it is not weakened. If your representative or senator is not on one of the committees or subcommittees, you could still urge them to support the speedy passage of the bills. Speedy passage is essential because there is a clause that gives a four year grace period.
    Politically, it may be especially effective for you to write your congress people regarding these bills if they are up for re-election, or if they are seeking higher office in an upcoming election, but any e-mail to your representatives will be helpful. To see who your representative is:
    http://www.house.gov/house/MemberWWW.html
    To write your representative:
    http://www.house.gov/writerep/
    To see who your senators are:
    http://www.senate.gov/senators/senator_by_state.cfm
    To write your senators:
    http://www.senate.gov/contacting/index.cfm

    Tips from the GIG on writing your letters or e-mails:
    Address the Congressman as Honorable. Keep the letter to one page. Stay on the message - The passage of Representative Lowey and Senator Kennedy Bill, the Food Allergen Consumer Protection Act is important to the health and safety of thousands of persons suffering from allergies and intolerances. Use the language used in the Bill ...gluten and allergens, not celiac disease. Tell them what you want -- for them to support passage of this Bill. Sharing a bad experience and how passage of this bill would have made a difference can be helpful...but keep it brief. Remind them you follow their votes and that you appreciate their support. Sign your name, provide your full address, and phone number. The names of Subcommittee and Committee Members who control the fate of these bills. We can make a difference with our letters and e-mail to them:
    The current House Committee on Energy and Commerce:
    W. J. Billy Tauzin, Chairman
    Michael Bilirakis, Florida
    Joe Barton, Texas
    Fred Upton, Michigan
    Cliff Stearns, Florida
    Paul E. Gillmor, Ohio
    James C. Greenwood, Pennsylvania
    Christopher Cox, California
    Nathan Deal, Georgia
    Richard Burr, North Carolina, Vice Chairman
    Ed Whitfield, Kentucky
    Greg Ganske, Iowa
    Charlie Norwood, Georgia
    Barbara Cubin, Wyoming
    John Shimkus, Illinois
    Heather Wilson, New Mexico
    John B. Shadegg, Arizona
    Charles Chip Pickering, Mississippi
    Vito Fossella, New York
    Roy Blunt, Missouri
    Thomas Davis, Virginia
    Ed Bryant, Tennessee
    Robert Ehrlich, Maryland
    Steve Buyer, Indiana
    George Radanovich, California
    Charles F. Bass, New Hampshire
    Joseph Pitts, Pennsylvania
    Mary Bono, California
    Greg Walden, Oregon
    Lee Terry, Nebraska
    Ernie Fletcher, Kentucky
    John D. Dingell, Michigan, Ranking Member
    Henry A. Waxman, California
    Edward J. Markey, Massachusetts
    Ralph M. Hall, Texas
    Rick Boucher, Virginia
    Edolphus Towns, New York
    Frank Pallone Jr., New Jersey
    Sherrod Brown, Ohio
    Bart Gordon, Tennessee
    Peter Deutsch, Florida
    Bobby L. Rush, Illinois
    Anna G. Eshoo, California
    Bart Stupak, Michigan
    Eliot L. Engel, New York
    Tom Sawyer, Ohio
    Albert R. Wynn, Maryland
    Gene Green, Texas
    Karen McCarthy, Missouri
    Ted Strickland, Ohio
    Diana DeGette, Colorado
    Tom Barrett, Wisconsin
    Bill Luther, Minnesota
    Lois Capps, California
    Mike Doyle, Pennsylvania
    Chris John, Louisiana
    Jane Harman, California
    House Committee on Energy and Commerce Subcommittee on Health:
    Michael Bilirakis, Florida, Chairman
    Joe Barton, Texas
    Fred Upton, Michigan
    James C. Greenwood, Pennsylvania
    Nathan Deal, Georgia
    Richard Burr, North Carolina
    Ed Whitfield, Kentucky
    Greg Ganske, Iowa
    Charlie Norwood, Georgia, Vice Chairman
    Barbara Cubin, Wyoming
    Heather Wilson, New Mexico
    John B. Shadegg, Arizona
    Charles W. Chip Pickering, Mississippi
    Ed Bryant, Tennessee
    Robert L. Ehrlich, Jr., Maryland
    Steve Buyer, Indiana
    Joseph R. Pitts, Pennsylvania
    W.J. Billy Tauzin, Louisiana
    Sherrod Brown, Ohio, Ranking Member
    Henry A. Waxman, California
    Ted Strickland, Ohio
    Tom Barrett, Wisconsin
    Lois Capps, California
    Ralph M. Hall, Texas
    Edolphus Towns, New York
    Frank Pallone, Jr., New Jersey
    Peter Deutsch, Florida
    Anna G. Eshoo, California
    Bart Stupak, Michigan
    Eliot L. Engel, New York
    Albert R. Wynn, Maryland
    Gene Green, Texas
    John D. Dingell, Michigan
    Senate Committee on Health, Education, Labor, and Pensions:
    Edward M. Kennedy, MA, Chairman
    Christopher Dodd, CT
    Tom Harkin, IA
    Barbara Mikulski, MD
    James Jeffords, VT
    Jeff Bingaman, NM
    Paul Wellstone, MN
    Patty Murray, WA
    Jack Reed, RI
    John Edwards, NC
    Hillary Clinton, NY
    Judd Gregg, NH, Ranking Member
    Bill Frist, TN
    Mike Enzi, WY
    Tim Hutchinson, AR
    John Warner, VA
    Christopher Bond, MO
    Pat Roberts, KS
    Susan Collins, ME
    Jeff Sessions, AL
    Mike DeWine, OH
    Senate Committee on Health, Education, Labor, and Pensions Subcommittee on Public Health:
    Edward M. Kennedy, MA, Chairman
    Tom Harkin, IA
    Barbara Mikulski, MD
    James Jeffords, VT
    Jeff Bingaman, NM
    Paul Wellstone, MN
    Jack Reed, RI
    John Edwards, NC
    Hillary Clinton, NY
    Judd Gregg, NH,
    Bill Frist, TN
    Michael Enzi, WY
    Tim Hutchinson, AR
    Christopher Bond, MO
    Pat Roberts, KS
    Susan Collins, ME
    Jeff Sessions, AL

    Scott Adams
    The House of Representatives has, once again, acknowledged celiac disease. It has passed the funding bill for the Department of Health and Human Services (HHS), which includes the NIH. The report language detailed below was included in that legislation. This language serves as guidance from Congress to the NIH to focus on certain issues (in this case celiac disease). A special round of thanks is due Representative Nita Lowey (D-NY) for her tireless efforts on behalf of the celiac community. Further thanks go out to Representative Ralph Regula (R-OH), Chairman, House Appropriations Subcommittee on Labor-HHS-Education, for his leadership on this important bill.
    We now wait to see what happens with the Senate version of the funding bill, and whether it is passed before the Congress adjourns later this month.
    HR 5006; Passed House on Sept. 9, 2004
    House Report. 108-636
    "Celiac disease.--The Committee commends NIDDK for recognizing the lack of understanding, and under-diagnosis of the genetic, autoimmune disorder, Celiac disease (celiac disease), and for including celiac disease in the NIH Consensus Development Program for 2004. Although readily diagnosed in European countries, it takes on average eleven years for Americans to be properly diagnosed. Delays in diagnosis place individuals at risk for osteoporosis, anemia, miscarriages, and small bowel cancer. Current evidence demonstrates that celiac disease is the most common genetic disorder in the world, with a treatment-- strict, gluten-free diet--that can be managed almost exclusively by the individual, or family. Education about celiac disease is needed for health care professionals and patients. The Committee encourages NIDDK to coordinate informational and educational programs directed at health professionals, patients and the public to raise awareness and understanding about celiac disease, and the need for early diagnosis."
    A copy of the report is available at: http://thomas.loc.gov/cgi-bin/cpquery/R?cp108:FLD010:@1(hr636):
    Allison Herwitt
    Co-Chair, Legislative Project
    American Celiac Task Force

    Scott Adams
    Celiac.com 08/31/2006 - On July 27, 2006, Representative Nita Lowey (D - NY) introduced H.Con.Res. 457, which, if passed, would recognize the month of May as national “Celiac Awareness Month.” The bill also requests an increase in federal funding for celiac disease research. Rep. Lowey was the driving force in Congress in support of the Food Allergen Labeling and Consumer Protection Act that passed in 1994, which requires food manufacturers to list the top eight allergens on their products’ ingredient labels.
    Celiac.com supports Rep. Lowey in her efforts to raise celiac disease awareness, and asks you to get involved. Please contact your representatives in congress and ask them to support H.Con.Res. 457—to do so simply visit: http://capwiz.com/celiac/issues/bills/?bill=8945821

    Jefferson Adams
    Celiac.com 08/31/2012 - Since August 4th, 2012, Canadian Food Allergen Labeling Regulations require all food products containing gluten, or any of ten other major allergens, to clearly state their presence on the label.
    This change marks an important step in consumer safety that will benefit the estimated three million Canadians with celiac disease and gluten sensitivity, as well as others with sensitivities to major food allergens.
    For people with celiac disease, consuming gluten can cause anemia, nutritional deficiencies, a blistering skin rash, and an increased risk of other autoimmune diseases such as Type 1 diabetes. It can also lead to some cancers of the gut.
    One major problem for people with celiac disease or gluten sensitivity is that, unless clearly stated on the label, it can be difficult to tell whether or not gluten is present in foods they may buy.
    A 2009 Health Canada survey of approximately 7,000 people revealed that 96.1% of individuals read every ingredient on all food products to figure out whether the product contains gluten.
    Nearly eighty percent of those surveyed said that their greatest challenge was with incomplete labeling.
    For people who are sensitive to gluten and/or other major allergens, this new labeling rule will remove much of the guesswork from grocery shopping, and substantially reduce the risk to individuals sensitive or intolerant to gluten or other allergens.
    Those risks include an estimated 14,000 emergency hospital wards each year that are the result of reactions to gluten and other allergens, which carry a projected $5 million in extra health care costs.
    Source:
    PRWeb

  • 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