Celiac.com 07/12/2005 - In an effort to determine the role of T-cells in celiac disease, researchers in Ireland examined the cells taken from the duodenal biopsies of both treated and untreated celiac disease patients. An assessment was made of the samples cell yields, and analyses were done to determine their viability and flow cytometric characteristics to quantify CD8 expression in the CD4CD8 T-cells.

The researchers were surprised to find that T-cell yields in the epithelial layer were not elevated in active, untreated celiac disease, although enterocyte counts decreased significantly, which gave the appearance of T-cell infiltration. There was a dramatic decrease in the number of CD4CD8 T-cells in untreated patients in both the epithelial layers and in the lamina propria regions, and the levels of CD8 expression by CD4CD8 T-cells in the epithelial layer were also significantly decreased—and these levels did not return to normal even after treatment with a gluten-free diet and the return to normal of their intestinal architecture.

According to the researchers: "No increase of intraepithelial lymphocytes in the celiac lesion may require us to reconsider the definition of celiac disease as an inflammatory condition. Low CD4CD8 populations in treated as well as untreated coeliac patients indicate that these T-cells are inherently absent in individuals genetically predisposed to celiac disease." The reduced levels of CD4CD8 T-cell populations could be the initial trigger of oral gluten tolerance in genetically susceptible individuals, and play a key role in the mucosal damage caused by celiac disease. More research in this area is needed to determine the full implications of these findings.

JAMA. 2005;293:2343-2351, 2410-2412

Celiac.com 05/31/2005 – Researchers in the United States have found that introducing gluten too early or too late in an infants diet may play a key role in whether or not they eventually develop celiac disease autoimmunity. From 1994 to 2004 the researchers followed 1,560 high-risk children (those with either HLA-DR3 or DR4 alleles, or with a first-degree relative with type 1 diabetes) who were periodically screened for celiac disease autoimmunity. Positive results were defined by two positive tissue transglutaminase (tTG) blood serum tests, or one positive tTG and a positive small bowel biopsy. The researchers conducted a prospective observational study in which the parents of the children in the study responded to a questionnaire regarding the timing of gluten introduction into their childrens diets. To avoid a bias on the answers the researchers purposely did not include children who already had celiac disease. During the mean duration period of the study (4.8 years), 51 children developed celiac disease autoimmunity. Their findings indicate that children who were first introduced to gluten when they were less than 3 months of age had a five-fold increased risk of developing celiac disease autoimmunity when compared to children who were first introduced to gluten at 4-6 months old. Additionally, those who were first introduced at 7 months or older had a marginally increased risk of getting celiac disease autoimmunity when compared with the same group.

Based on these findings the researchers recommend that parents should introduce cereals into their childrens diets at 4-6 months of age—even though this conflicts with recent recommendations by the American Academy of Pediatrics, who recommend breast-feeding only until 6 months of age. The researchers stress that much larger international prospective studies need be done in this area to answer the many questions that this study raises.

Celiac.com 04/10/2005 - A study by Spanish researchers has found that celiac disease is highly prevalent among Spanish children—at least 1 in 118 of them are born with it. The study looked at 830 healthy children born between October 1998 and December 1999 whose parents had enrolled them in an early diagnosis program. Of the 830 children who initially enrolled, 613 were screened for anti-tissue transglutaminase antibodies at 1.5 years of age, and 484 were screened at 2.5 years of age. At 1.5 years none of the children screened positive for the antibodies, but by 2.5 years 9 tested positive, and 7 of those 9 also had positive follow-up intestinal biopsies.

The researchers conclude that at least 1 in 118 Spanish children are born with celiac disease, which is comparable to that found in other European populations—but the incidence determined in this study might actually have been higher had all of the children who participated in the initial 1.5 year old screening returned a year later for the second screening. The authors stop short of making a recommendation for a general screening of all Spanish children for celiac disease, and instead define the best timing for such a screening: 2-3 years of age.

This study indirectly highlights just how many celiac disease diagnoses are missed--most people with celiac disease are still never diagnosed and must live with the disease and its associated problems for life. Those who finally get a diagnosis often spend years suffering before it is figured out. Many get lymphoma and die--which is why we must continue to advocate for celiac disease screenings for the general population--perhaps starting as early as 2-3 years of age.

Am J Gastroenterol. 2004 Dec;99(12):2429-36.

Celiac.com 02/27/2005 – In order to determine whether body mass index (BMI) may play a role in gut transit time in those with celiac disease, Swedish researchers conducted a study on 27 patients (16 female) with untreated celiac disease, both before and after a gluten-free diet. Detailed gastrointestinal transit times and BMI calculations were determined for each patient prior to the implementation of a gluten-free diet. Ten patients (5 female) were also studied after the implementation of a gluten-free diet. The researchers used a new radiological procedure to determine the exact transit times in each patient, and the results were compared to that of a control group of 83 healthy people.

The findings of the study indicate that untreated male patients BMI was lower than that of healthy male controls, and their small bowel transit times were significantly slower (3.9 hours versus 2.5 hours). In the group studied after the implementation of a gluten-free diet patients BMI increased significantly, and small bowel transit times accelerated from 3.6 hours prior to dietary treatment to 2.3 hours after. For untreated females BMI did not differ significantly when compared to that of the healthy controls, but 31% of the female patients were overweight--and the small bowel transit times of this overweight female group were markedly shorter when compared to the lean untreated females.

The researchers conclude that: "Small bowel transit seems to be delayed in lean patients with untreated celiac disease. BMI may have some influence on the variations of small bowel transit before and after treatment."

The positive trends noted in this study further support the use of widespread serum screening to detect celiac disease, as it can prevent many of the complications caused by the disease. One thing that isnt clear, however, is why the age of diagnosis is getting higher—even though Open Original Shared Link have determined through mass-screenings that celiac disease is present in at least 1% of all children. Since that number is consistent with the number of people in the USA with the disease, it stands to reason that celiac disease may in fact be a childhood disease, and if so, the 42 year-old average age of diagnosis in the USA would indicate a massive failure of our health care system to detect the disease. More studies need to be done to determine the number of children in the USA with celiac disease.

Since most celiacs have little or no symptoms—Celiac.com believes that the only reasonable way to get them properly diagnosed and treated would be to have widespread serological screenings of the general population. The disease affects at least 1% of the population in the USA, and the benefits for such screenings would far outweigh their cost.

Arch Dis Child 2004;89:499-501,512-515.

Celiac.com 09/12/2004 – According to a recent study by Italian researchers, about 1% of Italian schoolchildren have celiac disease. The scientists screened blood samples taken from 3,188 schoolchildren aged 6 to 12 years for the presence of tissue Transglutaminase (tTG). The results showed that 33 tested positive for tTG, and of those 30 were verified by follow-up biopsies, and 3 refused biopsies but also tested positive for celiac disease-related antibodies and celiac disease-associated HLA DQ2-8. Out of the 33 who tested positive only 12 had symptoms.

The researchers believe that the subsequent treatment of these children will likely help them to avoid future autoimmune disorders associated with untreated celiac disease. They also believe that because tTG screening is less expensive and more accurate than other forms of celiac disease screening, it should be used in the future for all mass-screening programs. They conclude that future mass screening programs deserve careful consideration.

Celiac.com 08/27/2004 – The following abstract demonstrates the importance of follow up exams with your doctor, and also the importance of regular colon screenings for those with celiac disease.

Eur J Gastroenterol Hepatol. 2003 Sep;15(9):995-1000.

Celiac.com 08/27/2004 - Past studies have demonstrated an association, but not a causal connection, between cigarette smoking and celiac disease. Using the Bradford Hill criteria British researchers have now established a causal connection. In a matched case-control study, the researchers utilized a questionnaire to obtain the smoking histories of 138 celiacs and 276 age-matched and sex-matched controls. The subjects were then categorized according to their pre-diagnosis cigarette exposure, and it was found that 10% of celiacs, and 30% of the controls were smokers during this time. A biological gradient was demonstrated for total, recent and current cigarette exposure, and the greatest risk reduction related to current exposure. The researchers conclude:

Celiac.com 07/30/2004 - The following abstract of a study that was done in 2002 emphasizes the importance of vitamin supplementation in the treatment of many celiacs:

Celiac.com 06/28/2004 – The results of this study indicate that the damage caused by celiac disease can be more extensive than once thought, and that it likely affects the entire small bowel, rather than just the lamina propria and crypt regions. These results also give gastroenterologists more tools for discovering the disease, as they can now find indications of it when doing a colonoscopy, which is typically done to screen for other disorders such as colon cancer. If all gastroenterologists follow these new recommendations it will speed up a celiac disease diagnosis for many people, and will also help prevent missed diagnoses.

Celiac.com 06/28/2004 - This study, although small, indicates that there may be additional damage to the second part of the duodenum caused by celiac disease, and that this can also be used for a marker for diagnosing the disease:

Celiac.com 06/08/2004 – To determine what triggers celiac disease, researchers recently used an electron microscope to look at the jejunal biopsies of several groups of children: A group with untreated celiac disease, one with treated celiac disease, another with challenged celiac disease, and a healthy control group. The researchers discovered rod-shaped bacteria attached to the small intestinal epithelium in both the treated and untreated celiac-disease groups, but not in the healthy control group.

The researchers conclude: "Unique carbohydrate structures of the glycocalyx/mucous layer are likely discriminating features of celiac disease patients. These glycosylation differences could facilitate bacterial adhesion. Ectopic production of MUC2, HD-5, and lysozyme in active celiac disease is compatible with goblet and Paneth cell metaplasia induced by high interferon-gamma production by intraepithelial lymphocytes."

The idea that bacteria may be involved in the pathogenesis of celiac disease is a hypothesis that was also proposed by Roy S. Jamron Open Original Shared Link that originally appeared in the Spring 2004 edition of Celiac.coms Open Original Shared Link, which is further supported by this research.