New Research

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Epilepsy and celiac

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Epilepsy and Celiac Disease: Favorable Outcome With a Gluten-Free Diet in a Patient Refractory to Antiepileptic Drugs. Neurologist. 2006 Nov;12(6):318-321

Canales P, Mery VP, Larrondo FJ, Bravo FL, Godoy J.

From the *Department of Neurology, Hospital Regional de Talca, Talca, Chile; and the daggerDepartment of Neurology and double daggerDepartment of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.

BACKGROUND:: There is a well-documented relationship between epilepsy and celiac disease, including a syndrome characterized by epilepsy, occipital calcifications, and celiac disease. REVIEW SUMMARY:: We report the case of a 23-year-old woman with an 11-year history of refractory epileptic seizures and newly diagnosed biopsy-proven celiac disease with increased antiendomysium immunoglobulin A antibodies. The patient showed a dramatic improvement after starting a gluten-free diet. CONCLUSION:: This case emphasizes the need to include celiac disease in the differential diagnosis when investigating the etiology of epilepsy in refractory patients.

Celiac and Lymphoma

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Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2069-77. Links

Malignant lymphomas in autoimmunity and inflammation: a review of risks, risk factors, and lymphoma characteristics.Smedby KE, Baecklund E, Askling J.

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, S-171 77 Stockholm, Sweden. karin.ekstrom@meb.ki.se.

Certain autoimmune and chronic inflammatory conditions, such as Sjogren's syndrome and rheumatoid arthritis (RA), have consistently been associated with an increased risk of malignant lymphomas, but it is unclear whether elevated lymphoma risk is a phenomenon that accompanies inflammatory conditions in general. Likewise, it is debated whether the increased risk identified in association with some disorders pertains equally to all individuals or whether it varies among groups of patients with different phenotypic or treatment-related characteristics. It is similarly unclear to what extent the increased lymphoma occurrence is mediated through specific lymphoma subtypes. This update reviews the many findings on risks, risk levels, and lymphoma characteristics that have been presented recently in relation to a broad range of chronic inflammatory, including autoimmune, conditions. Recent results clearly indicate an association between severity of chronic inflammation and lymphoma risk in RA and Sjogren's syndrome. Thus, the average risk of lymphoma in RA may be composed of a markedly increased risk in those with most severe disease and little or no increase in those with mild or moderate disease. The roles of immunosuppressive therapy and EBV infection seem to be limited. Furthermore, RA, Sjogren's syndrome, systemic lupus erythematosus, and possibly celiac disease may share an association with risk of diffuse large B-cell lymphoma, in addition to well-established links of Sjogren's syndrome with risk of mucosa-associated lymphoid tissue lymphoma and of celiac disease with risk of small intestinal lymphoma. However, there is also obvious heterogeneity in risk and risk mediators among different inflammatory diseases. (Cancer Epidemiol Biomarkers Prev 2006;15(11):2069-77).

Celiac, thyroid, and elderly

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J Endocrinol Invest. 2006 Oct;29(9):831-3. Links

Occurrence of overt celiac disease in the elderly following total thyroidectomy.Caputo M, Brizzolara R, Schiavo M, Salmaso C, Pesce G, Bagnasco M.

Medical and Radiometabolic Therapy Unit, Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy.

We report the case of a female patient in whom gluten-induced entheropathy was revealed at the age of 71 yr by resistance to treatment with levothyroxine (L-T4), calcium carbonate and alfacalcidol. Hypothyroidism and hypoparathyroidism were the consequence of a total thyroidectomy performed at the age of 65 yr for a large multinodular goiter. Six months after thyroid ablation the patient started to complain of abdominal pain, diarrhea and weight loss. Following, anemia and osteopenia were documented. A progressive increase of replacement therapy for hypothyroidism and hypoparathyridism was necessary. The clinical presentation suggested a malabsorption syndrome: celiac disease (celiac disease) was diagnosed by serological markers and duodenal biopsy. Following gluten-free diet a normalization of clinical and serological findings was observed, bone mass density improved and a reduction of L-T4, calcium and vitamin D requirements was observed.

Celiac Study

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Can J Gastroenterol. 2006 Nov;20(11):719-22. Links

Gluten intolerance: Gender and age-related features.Llorente-Alonso M, Fernandez-Acenero MJ, Sebastian M.

Hospital General of Mostoles, Madrid, Spain.

OBJECTIVE: Gluten intolerance is an immune-mediated enteropathy associated with gluten-containing foods in genetically susceptible patients. The typical form mainly affecting children shows failure to thrive and/or gastrointestinal symptoms. The adult form is less typical, presenting vague gastrointestinal symptoms, iron deficiency (with or without anemia) or nonspecific serum chemistry abnormalities. The present study aims to analyze clinical and biochemical differences of celiac disease (celiac disease) according to sex and age. PATIENTS AND METHODS: The present study reviewed clinical and biochemical features of patients with suspected celiac disease admitted to the Hospital General of Mostoles (Madrid, Spain) between July 2001 and June 2005. Two hundred fifty-two patients were analyzed, in whom intestinal biopsy was performed due to clinical and/or biochemical abnormalities suggestive of celiac disease. One hundred seventy-eight asymptomatic relatives of the affected patients were also included. Overall, 125 patients showed diagnostic features of celiac disease in the intestinal biopsy. RESULTS: The results confirmed higher prevalence of typical forms of celiac disease in children (67% in children compared with only 14.3% in adults). celiac disease seemed to be more frequent in adult women than in men (ratio of women to men 4:1), but it is worth noting that men diagnosed were most often referred with a typical clinical picture, so atypical forms of the disease in men may have been underdiagnosed. CONCLUSIONS: celiac disease shows atypical features in adults, and physicians must include this disorder in the differential diagnosis of adults with iron deficiency or slight hypertransaminasemia. Increased awareness of the disease and extensive availability of accurate sero-logical tests will lead to improved diagnosis of this disorder, both in children and adults.