Celiac Disease Related Articles

[Guest Doll]

Change in lipid profile in celiac disease: beneficial effect of gluten-free diet.

Brar P, Kwon GY, Holleran S, Bai D, Tall AR, Ramakrishnan R, Green PH.

Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.

PURPOSE: Celiac disease is associated with hypocholesterolemia, which is thought to contribute to a favorable cardiovascular risk profile. This led to suggestions that the diagnosis of celiac disease and its treatment with a gluten-free diet may result in elevation of the serum cholesterol level and worsen this risk profile. However, no study proves this in adults. We therefore examined the effect of a gluten-free diet on the lipid profile in patients with celiac disease. SUBJECTS AND METHODS: We identified 132 patients with celiac disease who adhered to a gluten-free diet and had lipid profiles performed before and after a median of 20.5 months on the diet. The patients lacked diseases that may affect serum lipids. RESULTS: There were significant increases in total cholesterol and high-density lipoprotein (HDL) cholesterol (P < .0001) but not low-density lipoprotein (LDL) cholesterol (P=.06). The LDL/HDL ratio decreased by 0.36+/-0.7 (P < .0001). Both men and women had a significant increase in total cholesterol and HDL and a significant decrease in the LDL/HDL ratio. Only men had increases in LDL (P=.02). The greatest increase in lipid values was seen in those with the lowest initial values. The largest increase in HDL was seen in subjects with more severe disease as indicated by low albumin level and presence of total villous atrophy. CONCLUSIONS: Diagnosis of celiac disease and its treatment with a gluten-free diet resulted in improvement in the lipoprotein profile, which included an increase in HDL and a decrease in the LDL/HDL ratio.

PMID: 16945614 [PubMed - in process]

Bowel sonography in adult celiac disease: diagnostic accuracy and ultrasonographic features.

Castiglione F, Rispo A, Cozzolino A, Camera L, D'Argenio G, Tortora R, Grassia R, Bucci C, Ciacci C.

Department of Gastroenterology, Facolta di Medicina e Chirurgia, University "Federico II", Via S. Pansini 5, 80131, Naples, Italy, fabcasti@unina.it.

BACKGROUND: Celiac disease (celiac disease) is a chronic intolerance to gluten, which induces intestinal mucosal lesions in genetically predisposed individuals. Transabdominal bowel sonography (TABS) is a safe and noninvasive procedure that allows to detect intestinal abnormalities in many conditions, but actually is not routinely part of the diagnostic management of celiac disease. AIM: To evaluate the diagnostic accuracy of TABS in celiac disease patients. PATIENTS AND METHODS: Fifty celiac disease patients and 50 dyspeptic subjects (control group) underwent TABS. The presence of fluid-distended small bowel loops with thickened valvulae conniventes and increased peristalsis was considered a TABS sign of celiac disease. All clinical, biochemical, and TABS features were assessed at the diagnosis and revaluated after 1 year of gluten-free diet. RESULTS: TABS signs were present in 66% of celiac disease patients. Sensitivity, specificity, positive and negative predictive value were 66%, 96%, 94%, and 74%, respectively. TABS findings were recorded in 82% of patients with endoscopical markers of celiac disease, in 87.5% of symptomatic patients, and in 61% of patients without symptoms. After 1 year of gluten-free diet TABS was still abnormal in 20% patients, with no correlation with laboratory tests e/o symptoms. CONCLUSIONS: Patients with celiac disease frequently present TABS signs of the disease and operators performing sonography every day have to consider the possibility to suggest celiac disease diagnosis and aTTG determination in these subjects.

PMID: 16944036 [PubMed - as supplied by publisher]

[ravenwoodglass]

Thanks for posting this.

The lipid profile describes my experience when retested at 3.5 years gluten-free.

The sonogram sounds like it could be a great noninvasive test method to include when they suspect celiac. I hope they pay attention to it on this continent. We seem to be so far behind many other countries in our understanding of celiac and spectrum of disorders it is linked to. I recently had a sonogram of my lower abdominal cavity. At one point the tech said my intestines were misplaced, that's an exact quote. No explination for how or why and I wonder if this test was done in Italy what the tech might have said, I doubt it would have been that.

[eKatherine]

Hypocholesterolemia runs in my family. My father's was always low, mine has been between 112 and 165, and the last time my daughter was tested it was so low the doctor told her somebody might want to do research on her.

[Guest Doll]

Current epidemiology and accessibility to diet compliance in adult celiac disease.

[Article in English, Spanish]

Casellas F, Lopez Vivancos J, Malagelada JR.

Service of Digestive Diseases, University Hospital Vall d'Hebron, Barcelona, Spain.

BACKGROUND: The widespread of serologic diagnosis for celiac disease has brought about an epidemiologic shift. Little up-to-date information is available on relevant epidemiologic issues regarding diagnosis, information, and therapy. OBJECTIVE: To examine forms of presentation, diagnostic difficulties, follow-up, information sources, and treatment-related issues regarding celiac disease. METHOD: A cross-sectional observational study using a self-completed questionnaire. RESULTS: Seventy-three adult patients were included; 15.0% of cases were diagnosed over 60 years of age. Most were non-smokers (91.8%). The rate of first-degree relatives with celiac sprue was 10.9%. The disease had a classic presentation in only 54.7% of cases. A functional gastrointestinal disorder was initially suspected in 42.4% of patients. Diet adherence is adequate, with unintentional lack of compliance in 15.5% of patients. Diet results in absent or improved symptoms in virtually all patients, but most of them consider compliance a challenge. Forty percent had difficulty finding gluten-free food, and 50.8% had problems in labelling recognition. CONCLUSIONS: Celiac disease presents at any age, has a great variety of manifestations, and responds very well to gluten-free diet. It is crucial that patients be highly motivated and informed, and that they know for certain which foods and manufactured products are to be to used. Therefore, adequate control will result from coordination and cooperation regarding all resources involved, including medical care, and information provided by associations and other sources such as the Web.

PMID: 16948540 [PubMed - in process]

Oral proteases: a new approach to managing coeliac disease.

Cerf-Bensussan N, Matysiak-Budnik T, Cellier C, Heyman M.

INSERM U793, Paris, France.

A constraining life-long gluten-free-diet is the only current treatment for celiac disease. The human gastrointestinal tract does not possess the enzymatic equipment to efficiently cleave the gluten-derived proline-rich peptides driving the abnormal immune intestinal response in coeliac patients. Oral therapy by exogenous prolyl-endopeptidases able to digest ingested gluten was therefore propounded as an alternative treatment to the diet. The feasibility of this approach is discussed by confronting recent data on the intestinal transport of gliadin peptides, properties of available enzymes and preliminary clinical assays. Development of new enzymes or enzymatic cocktail offers potentially more potent therapeutic tools that need however meticulous evaluation based on clinical, biological and histological criteria.

Abnormal fatty acid pattern in intestinal mucosa of children with celiac disease is not reflected in serum phospholipids.

Steel DM, Ryd W, Ascher H, Strandvik B.

Department of Paediatrics, Goteborg University, Goteborg, Sweden. dsteel@fy.chalmers.se

OBJECTIVE: Celiac disease (celiac disease) is characterized by chronic inflammation of the small intestinal mucosa with disturbed epithelial transport. The fatty acid (FA) composition of intestinal membranes is important for epithelial function, and disturbances may contribute to the pathophysiology of the disease. We aimed to evaluate whether the intestinal mucosal FA status was reflected in serum phospholipids of patients with celiac disease. PATIENTS AND METHODS: Samples were obtained from 7 pediatric patients with active celiac disease showing mucosal atrophy, 6 pediatric patients with celiac disease in remission, and 11 control pediatric patients with morphologically healthy intestinal mucosa. Small intestinal biopsies were obtained using a Watson biopsy capsule under fluoroscopic control. Blood samples were collected on the same morning after an overnight fast. Tissue phospholipids were isolated by high-performance liquid chromatography, and FAs were analyzed by capillary gas-liquid chromatography. RESULTS: Serum phospholipid FA showed marginal differences between the patients with celiac disease and the controls. Significant differences were observed in mucosa with active celiac disease compared with controls. Linoleic acid (18:2n-6) level was decreased, whereas those of its derivatives were elevated, indicating increased transformation of n-6 FA. Mead acid (20:3n-9) level was increased, with an increased ratio of Mead acid to arachidonic acid (20:4n-6) levels, suggesting essential fatty acid deficiency. The n-3 FA levels were not significantly changed. During remission, the FA pattern of the intestinal mucosa was mainly similar to that in controls. CONCLUSIONS: The FA abnormality of intestinal mucosa in patients with active celiac disease was not reflected in serum values. Altered FA content may contribute to the pathophysiology of the disease because FAs are important for enzymes and for the transport and receptor functions of epithelial membranes.