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Found 1,243 results

  1. Celiac.com 09/05/2018 - About one out of every twenty celiac patients fails to respond to a gluten-free diet, and goes on to develop refractory celiac disease (RCD). RCD is a serious condition marked by appearance of intraepithelial T lymphocytes. Depending on the phenotype of the lymphocytes, people develop either RCD I or RCD II. Patients with RCD type II (RCDII) show clonal expansions of intraepithelial T lymphocytes, and face an especially poor prognosis. Just over half of these patients will die within five years of onset due to aggressive enteropathy-associated T-cell lymphoma. At this time, researchers don’t know whether genetic variations might play a role in the severe progression from celiac disease to RCDII. A team of researchers recently set out to try to get some answers. The team began by conducting the first genome-wide association study to identify the causal genes for RCDII, along with the molecular pathways at play in cases of RCDII. For their genome-wide association study, the team used 38 Dutch patients with RCDII, and replicated the 15 independent top-associated single nucleotide polymorphism (SNP) variants (P<5×10) in 56 independent French and Dutch patients with RCDII. The team found that, after replication, SNP rs2041570 on chromosome 7 was significantly associated with progression to RCDII (P=2.37×10, odds ratio=2.36), but not to celiac disease susceptibility. They also found that SNP rs2041570 risk allele A was associated with lower levels of FAM188B expression in blood and small intestinal biopsies. Stratifying RCDII biopsies by rs2041570 genotype revealed differential expression of innate immune and antibacterial genes that are expressed in Paneth cells. The team’s efforts resulted in the identification of a new SNP associated with the severe progression of celiac disease to RCDII. Their data suggest that genetic susceptibility to celiac disease might be unrelated to celiac progression to RCDII, and suggests that Paneth cells might play a role in RCDII progression. Source: Eur J Gastroenterol Hepatol. 2018 Aug;30(8):828-837. The research team included B Hrdlickova, CJ Mulder, G Malamut, B Meresse, M Platteel, Y Kamatani, I Ricaño-Ponce, RLJ van Wanrooij, MM Zorro, M Jan Bonder, J Gutierrez-Achury, C Cellier, A Zhernakova, P Nijeboer, P Galan, S Withoff, M Lathrop, G Bouma, RJ Xavier, B Jabri, NC Bensussan, C Wijmenga, and V Kumar. They are variously affiliated with the Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Department of Gastroenterology, VUMC, Amsterdam, The Netherlands, INSERM U1163, Imagine Institute and Paris Descartes University, the Department of Gastroeneterology, Georges Pompidou European Hospital, the Paris 13 University Sorbonne Paris Cité, UREN, Inserm (U557), Inra (U1125), Cnam, Bobigny, France, the scientific director of McGill University and Génome Québec Innovation Centre, Montréal, Québec, Canada, the Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital and Harvard Medical School, Boston, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, the Department of Medicine, University of Chicago, Chicago, Illinois, USA., and the K.G. Jebsen Coeliac Disease Research Centre, Department of Immunology, University of Oslo, Norway.
  2. Celiac.com 09/10/2018 - Anyone diagnosed with celiac disease needs to eat a gluten-free diet if they hope to see their condition improve, and not lead to worse outcomes. So, how much gluten exposure do celiacs get on a gluten-free diet? William F. Balistreri, MD, Director Emeritus, Pediatric Liver Care Center; Medical Director Emeritus, Liver Transplantation at Cincinnati Children's Hospital in Cincinnati, Ohio presented data at this year's Digestive Disease Week that focused on the challenges celiac patients face in trying to follow a gluten-free diet. Gluten-free standards and labels help improve awareness, but even so, eating gluten-free can be a challenge. Anyone with celiac disease can tell you that the chances of accidental gluten contamination are many, and that consent vigilance is required. Even ”gluten-free foods" are not always free from variable amounts of gluten, whether by imprecise food production, processing, packaging, or preparation. Accidental gluten exposure can also come via non-foods, such as lipstick, shampoo, toothpaste and the like. Regular, low-level gluten exposure can cause many celiac patients to have mucosal inflammation despite maintaining a gluten-free diet. Product by product, gluten levels are generally well-known, but not much is known about how much gluten exposure levels in people with celiac disease who are following a gluten-free diet. Such information could be quite helpful in designing disease management and patient follow-up strategies. Gluten immunogenic peptide (GIP) analysis provides direct and quantitative measurement of gluten exposure, has proven useful in diagnosis and clinical management of non-responsive or refractory celiac patients. To figure out the amounts of gluten ingested by highly motivated, educated celiac patients following a gluten-free diet, the research team measured levels of GIPs in food, urine, and stool. They noted the connections between gluten exposure and persistent villous atrophy or related conditions. The study also analyzed food samples from restaurant “doggie bags" saved by the study subjects. The team detected gluten in at least one food sample from nearly 90% of patients consuming a gluten-free diet. That indicates that nearly nine out of ten people with celiac disease, who are trying hard to follow a gluten-free diet, as being exposed to gluten when they eat out. Overall, approximately 33% of food samples tested positive for GIPs above 20 ppm, and the estimated GIPs ingested ranged from 0.23 mg to > 40 mg per exposure. This new information confirms what many people with celiac disease have long suspected. Namely, that avoiding gluten is really hard to do, even for who are highly aware of gluten-related celiac disease issues, and who work hard to avoid gluten. Read more at: Medscape.com
  3. Celiac.com 09/06/2018 - What are the most common foods that can trigger allergic reactions in people? First, and it's important to be clear about this, a food allergy is not to be confused with a food sensitivity. Food sensitivities are common and usually harmless, if sometimes uncomfortable. Food sensitivity can cause symptoms like gas, bloating, stomach upset, indigestion, and the like when some people eat certain foods. A food allergy, on the other hand, is an immune reaction that happens when the body mistakes harmless food, a peanut for example, for something that could make you sick. When you eat a food you're allergic to, your immune system thinks you’re body is being harmed, and reacts to protect you from that harm. This reaction can be as mild as a light skin rash or red, itchy eyes, or it could be serious enough to cause difficulty breathing, swelling, pain, shock and even death. An allergic reaction can happen very soon after eating an allergenic food, or it can happen many hours later. Either way, food allergies are potentially serious, and should be treated as such. According to WebMD, these nine foods account for about 90% of all food allergies: Peanuts Tree nuts, such as walnuts, almonds, pine nuts, brazil nuts, and pecans Soy Milk Eggs Wheat, barley, and rye—Celiac disease Oats Fish Shellfish Mild symptoms of a food allergy reaction include: Red, swollen, dry, or itchy skin and rash (hives or eczema) Runny or stuffy nose, sneezing, or a slight, dry cough Itchy, watery, red eyes Itchy mouth or inside your ear Funny taste in your mouth Upset stomach, cramps, vomiting, or diarrhea Though any of these foods can cause an allergic reaction, peanuts, nuts, fish, and shellfish are well known for causing severe allergic reactions. Symptoms of a sever allergic reaction to food include: Trouble breathing or swallowing Swollen lips, tongue, or throat Feeling weak, confused, or light-headed, or passing out Chest pain or a weak, uneven heartbeat If you suspect that you or someone you know is having an allergic reaction to food, especially a severe reaction, definitely seek medical attention immediately.
  4. Celiac.com 09/01/2018 - Celiac disease is a common disease triggered by gliadin exposure in genetically sensitive individuals. It has long been known that untreated celiac disease is associated with intestinal malabsorption, but it is also associated with ongoing inflammation. This inflammation may have adverse effects on the uptake of important nutrients. This is probably the underlying reason for the increased risk of osteoporosis demonstrated in patients with celiac disease. Malabsorption and ongoing inflammation in untreated celiac disease could also potentially have a negative effect on fetal development. Several reports have indicated an adverse effect of untreated celiac disease on pregnancy outcome. We set out to use the national registers of Sweden to: Evaluate the association of untreated celiac disease and birth weight, pregnancy duration and intrauterine growth. Evaluate the same association in treated celiac disease. Compare the risk of the above two groups with a reference group of 2.8 million births to mothers who never had a diagnosis of celiac disease. A fourth objective was to evaluate placental weight to see if lower placental weight was more frequent in women with celiac disease. We found that untreated celiac disease (women diagnosed after pregnancy, but most likely having untreated celiac disease at time of pregnancy) was associated with a two-fold risk of low birth weight, pre-term birth, intrauterine growth retardation and cesarean section. The low birth weight and intrauterine growth retardation may have been mediated through malabsorption, since placental weight was lowest in women with untreated celiac disease. This study was published in Gastroenterology Aug 2005. A link to this paper can be found here: gastrojournal.org After that we set out to evaluate the association between adverse pregnancy outcome in males with untreated and treated celiac disease. In a previous paper, we had found an increased risk of adverse pregnancy outcome when the father had celiac disease (Ludvigsson et al, Gut, 2001). Now, taking advantage of the large Swedish national registers (all births since 1973 and onwards are recorded), we found no increased risk of low birth weight, pre-term birth or cesarean section in infants to fathers with untreated or treated celiac disease. This study was published in the Scandinavian Journal of Gastroenterology in Feb 2006.
  5. Celiac.com 07/19/2018 - Maintaining a gluten-free diet can be an on-going challenge, especially when you factor in all the hidden or obscure gluten that can trip you up. In many cases, foods that are naturally gluten-free end up contain added gluten. Sometimes this can slip by us, and that when the suffering begins. To avoid suffering needlessly, be sure to keep a sharp eye on labels, and beware of added or hidden gluten, even in food labeled gluten-free. Use Celiac.com's SAFE Gluten-Free Food List and UNSAFE Gluten-free Food List as a guide. Also, beware of these common mistakes that can ruin your gluten-free diet. Watch out for: Watch out for naturally gluten-free foods like rice and soy, that use gluten-based ingredients in processing. For example, many rice and soy beverages are made using barley enzymes, which can cause immune reactions in people with celiac disease. Be careful of bad advice from food store employees, who may be misinformed themselves. For example, many folks mistakenly believe that wheat-based grains like spelt or kamut are safe for celiacs. Be careful when taking advice. Beware of cross-contamination between food store bins selling raw flours and grains, often via the food scoops. Be careful to avoid wheat-bread crumbs in butter, jams, toaster, counter surface, etc. Watch out for hidden gluten in prescription drugs. Ask your pharmacist for help about anything you’re not sure about, or suspect might contain unwanted gluten. Watch out for hidden gluten in lotions, conditioners, shampoos, deodorants, creams and cosmetics, (primarily for those with dermatitis herpetaformis). If your child has celiac disease be sure to avoid Play-Doh because it contains wheat flour. Be careful about hidden gluten in toothpaste, lipstick and mouthwash. Be careful about common cereal ingredients, such as malt flavoring, or other non-gluten-free ingredient. Be extra careful when considering packaged mixes and sauces, including soy sauce, fish sauce, catsup, mustard, mayonnaise, etc., as many of these can contain wheat or wheat by-product in their manufacture. Be especially careful about gravy mixes, packets & canned soups. Even some brands of rice paper can contain gluten, so be careful. Lastly, watch out for foods like ice cream and yogurt, which are often gluten-free, but can also often contain added ingredients that can make them unsuitable for anyone on a gluten-free diet. Eating Out? If you eat out, consider that many restaurants use a shared grill or shared cooking oil for regular and gluten-free foods, so be careful. Also, watch for flour in otherwise gluten-free spices, as per above. Ask questions, and stay vigilant.
  6. Celiac.com 08/31/2018 - Until recently the only way to get a proper screening for celiac disease would be to convince your doctor or health care provider to order the tests, and then pay a visit to the lab where they would draw a test tube or two full of blood. Depending on your situation, it can sometimes be difficult to convince your doctor or health care provider to actually order the tests. They can also be expensive, even if you are lucky enough to have decent health insurance coverage. Did you know that you can now use a LetsGetChecked home screening kit to carry out a full celiac disease screening in the privacy of your own home? I recently took the opportunity to use their kit to re-screen my son for celiac disease, as it's been a while since his last screening, and he should be getting screened annually. The test kit arrived quickly, and upon opening it I found all the items necessary to collect a specimen, plus a very clear set of eight step-by-step instructions, complete with graphics, to make it super easy to follow. The kit requires “activation,” which was done in just a few minutes on their Web site. The activation process allows the lab to connect you with your specimen, so that you can get your results via their Web site. After activating my kit we moved on to the specimen collection, which went far easier than I expected. The kit comes with a few lancets, and we used only one of them to painlessly prick my son's finger. We gathered around 8 or 9 drops of his blood to fill the collection tube. After snapping the lid on it, we put it in the addressed, stamped envelope and dropped it off at our local UPS Store. A few days later I was surprised to get a call from a their medical team who took the time to go over my son's results with me over the phone—which, happily for my son—were negative! I also received an email with the results, and I was able to view them on their Web site as well. Whether you want to save money, wish to have more privacy with your testing and results, or would like to get screened quickly—using LetsGetChecked kit to screen for celiac disease makes a lot of sense. I've already recommended it to several friends and family members, and believe that this is one of the best home test kits available, and will be a big part of the future of celiac disease screening.
  7. Celiac.com 08/30/2018 - Celiac disease is a disorder characterized by a clinical syndrome of intestinal malabsorption and a characteristic though not specific histological lesion consisting in total, subtotal or partial small-bowel villous atrophy (predominating in the proximal segments). A correct gluten-free diet results in clinical and histological improvement(1,2). It has become increasingly apparent that the prevalence of celiac disease is higher than previously thought, and that this is mainly because of increasing awareness of atypical, mildly symptomatic, or silent cases(3). Therefore, many patients have upper gastrointestinal endoscopy as an initial investigation, which provides an opportunity to perform a biopsy in the second portion of the duodenum. The role of endoscopy in diagnosing celiac disease It has long been known that celiac disease can produce changes in the appearance of small intestine on barium contrast radiographs, one such change being so-called “loss” of duodenal folds. However, over the last two decades it has been recognized that a number of changes in the duodenum clearly associated with celiac disease can be identified endoscopically. Because it is now understood that the manifestations of celiac disease are wide and variable, and that the disease is more common than recognized in the past, the clinical significance of these endoscopic observations has been greatly amplified. Awareness of these endoscopic features may alert the endoscopist to the presence of celiac disease and the need for duodenal biopsies in patients undergoing endoscopy for symptoms unrelated to the disease as well as those with vague, non-specific manifestations. The endoscopic features in the duodenum that are well-established as markers for celiac disease include: loss of folds; scalloping of folds; mucosal mosaic pattern; whilst less commonly described findings include a visible vascular pattern and micronodularity in the duodenal bulb. 1. Loss of folds “Loss” of folds is defined as an obvious reduction in height or number of folds in the second portion when viewed with maximal air insufflation. The sensitivity and specificity of this marker range from 73 to 88% and from 83 to 97% respectively (4,5). 2. Scalloping of duodenal folds Scalloping occurs when multiple grooves run over the apex of a duodenal fold. Grooves in the mucosa between folds have also associated with celiac disease and likely a manifestation of the same process that leads to scalloping. The sensitivity and specificity of this marker are 88% and 87% respectively (6,7). 3. Mucosal mosaic pattern Mucosal mosaic pattern may be recognized both in the duodenal bulb and in the second portion of the duodenum, and its assessment may be easily performed by chromoendoscopy. Unfortunately, the sensitivity of this marker is quite low (57%) (8). 4. Micronodularity in duodenal bulb This marker is quite frequent in childhood and adolescent patients, but it can be also recognized in young adults 9-11. 5. Visible vascular pattern This marker describes a prominence of underlying duodenal blood vessels in patients with celiac disease. Unfortunately, this is the least sensitive endoscopic marker in all studies in which it was specifically evaluated (6,12,13). All these markers are helpful in recognising celiac disease. Moreover, in some cases specific endoscopic features can be associated with specific histological damage and may be associated with the clinical form of the disease. We found in fact that endoscopic appearance of the duodenum may be predictive of histological damage grading. Moreover, we showed that in young patient with subclinical/silent celiac disease there is a greater probability of finding slight/mild endoscopic abnormal/mild histological damage (11). Unfortunately, an endoscopic marker suspected for celiac disease itself is not specific for celiac disease. For example, looking at scalloping, Shah, et. al., described 13 cases in which scalloping of duodenal folds was not caused by celiac disease but due to other causes (HIV-related infection, tropical sprue, giardiasis, eosinophilic gastroenteritis)(14). On the other hand, the presence of one or more endoscopic markers increases the sensitivity and specificity ranging from 87.5 to 94% and from 99 to 100% respectively (12,15). There is non-existing classification of endoscopic lesions in celiac disease. However, I think that it may be graded according to some simple considerations. Celiac disease is considered a crianial-caudal disease which affects primarily the proximal segments (first the duodenal bulb and then the second and third duodenal portions) and then the distal segments of the small bowel (first jejeunum and then the ileum). Therefore, we may hypothesize that endoscopic damage occurs first in the duodenal bulb and then in the distal tracts of the duodenum. For this reason, and according to other endoscopists in Italy, I proposed the following classification in 2002(11): a. Slight/mild endoscopic damage: micronodular bulb, granular mucosa of the second duodenal portion, scalloping of duodenal folds, reduction of duodenal folds; b. Severe damage: “mosaic” pattern of the duodenal mucosa, visible vascular pattern, loss of duodenal folds. The effectiveness of this grading system was confirmed in the same study. In fact we found that the so-called “slight-mild endoscopic damages” seen at endoscopy was associated with a mild-moderate histological damage (p<0.005), while the so-called “severe endoscopic damages” was related to severe histological damage (p<0.0005). Unfortunately, no Consensus Conference on celiac disease has discussed this problem yet. New endoscopic methods Several new endoscopic techniques have been recently developed to increase the sensitivity and specificity of endoscopy in diagnosing celiac disease. a. “Immersion” technique. The “immersion” technique consists in observing duodenal mucosa using a high-resolution, high-magnifying (x2) videoendoscope that observes the villous architecture with a water film. This approach seems to be effective in allowing the visualization of duodenal villi and the detection of total villous atrophy(16). A recent study found that this approach is highly accurate in detecting total villous atrophy in suspected celiac cases, and it seems both accurate and cost-sparing to diagnose celiac disease in subjects with marked duodenal villous atrophy, having a sensitivity, specificity, and positive and negative predicting values of 100%17. Moreover, this approach also seems to be effective in detecting patchy villous atrophy in celiac patients with patchy lesions (18). b. Zoom endoscopy This technique provides a very impressive magnification capability of x115. This approach may allow the macroscopic detection of unrecognised villous atrophy in patients with unsuspected celiac disease. Badreldin, et. al., found recently that zoom endoscopy may be valuable in assessing degree of villous atrophy, having a positive predicting value of 83% and a negative predicting value of 77% in detecting villous atrophy (19). c. Double-balloon endoscopy (DBE) This technique will become probably the best endoscopy technique in investigating small bowel. It allows high-resolution visualization, biopsies and therapeutic interventions in all segments of the GI tract. DBE is a safe and feasible diagnostic and therapeutic tool for suspected or documented small-bowel diseases. However, it requires a long time for small bowel exploration (about 70 minutes from the oral route and about 90 minute from the anal route) and requires expertise personnel to obtain better results 20. At present, the best candidates for the procedure appear to be those with obscure GI bleeding. d. Wireless capsule endoscopy Celiac disease is an inflammatory disease that involves the entire small intestine. Even in the 1960s was documented, by using peroral biopsies, that the inflammatory atrophic process can extend a variable distance down the small intestine, not uncommonly involving the ileum(21). These data have been recently confirmed by endoscopic studies, that found ileal inflammatory changes predicting villous atrophy in duodenal biopsy specimens(22). Wireless capsule endoscopy is a new effective and easy method to investigate small bowel. The M2A video capsule endoscope (Given Imaging LTd; Yokneam, Israel) is a wireless capsule (11 mmx27 mm) comprised a light source, lens, CMOS imager, battery and a wireless transmitter. The slippery out side coating of the capsule allows easy ingestion and prevents adhesion of intestinal contents, while the capsule moves via peristalsis from mouth to anus. The battery provides seven to eight hours of work in which the capsule photographs two images per second (between 50,000-60,000 images all together), which are transmitted to a recorder which is worn on the belt. The recorder is downloaded into a computer and seen as a continuous video film. Since its development additional support systems have been added, a localization system, a blood detector and a double picture viewer. All of this is intended to assist the interpreter of the film and to shorten the reviewing period. The full range of indications for CE became apparent with time. The initial device was invented to address for a better diagnostic tool for small bowel pathologies (such as obscure gastrointestinal bleeding or Crohn’s disease)(23). In light of this high specificity for the diagnosis of small bowel diseases, it is considered that capsule endoscopy may be of value in the diagnosis of celiac disease for patients with a positive endomysial or tissue transglutaminase antibody and who are unable to or unwilling to undergo EGDscopy(24). The very important limit of this new technique in celiac disease is represented by the absence of histological-proven damage. It is recognised that the endoscopic signs of villous atrophy are not sensitive for the lesser degrees of villous atrophy, so partial villous atrophy may be missed by this approach(13). On the other hand, I think that the patients who appear to be ideal candidates for capsule endoscopy are those patients who fail to respond to a gluten-free diet, or who develop alarm symptoms while on a gluten-free diet. These patients often undergo extensive radiologic, and sometimes, surgical evaluation, because of concern for the development of complications (such as lymphoma(25,26) or ulcerative jejunitis(27). It is clear that lesions detected by capsule endoscopy in this high-risk group will require further evaluation of these abnormalities through biopsy. Capsule endoscopy may thus be used to select patients to undergo enteroscopy(28) or, more probably in the near future, double-balloon endoscopy(29). The role of endoscopy in the follow-up of celiac disease Data on small-intestinal recovery in patients with celiac disease are scarce and contradictory. This is especially the case for adult patients, who often show incomplete histological recovery after starting GFD. On the other hand, there are very few data about the endoscopic recovery on GFD. We recently conducted a two-year prospective study on 42 consecutive adults with newly diagnosed celiac disease. All the patients underwent EGDscopy and small-bowel biopsy. A normal endoscopic appearance (absence or mucosal irregular findings, normal duodenal folds) was found in 76.2% after two-year on a GFD. Subdividing the patients according to age, patients aged from 15 to 60 years showed significant improvement within 12 months but faster in patients in patients <45 years, whereas the improvement in endoscopic findings in patients older than 60 years was not statistically significant even 24 months after starting GFD. On the contrary, histological recovery was much more slower, since only younger patients (5-30 years) showed significant improvement of histology within 24 months(30). These data showed for the first time that endoscopic recovery is faster than histological recovery after starting GFD. Conclusive Advice A number of studies have demonstrated a strong correlation between the endoscopic duodenal findings and celiac disease. Furthermore, absence of specific features suspected from celiac disease does not exclude celiac disease and specimens should always be obtained when there is a suspicion that the disease may be present. For this reason, capsule endoscopy should be not recommended as first endoscopic step in searching celiac disease, but it may be best used to recognize endoscopic recovery and to exclude complication in celiac patients on GFD. The last question is: How long should we continue with endoscopic and histological follow-up? Looking at the results recently obtained from our group, my advice on follow-up could be summarized as follows: patients aged under 30 years should undergo endoscopic/histological assessment after one year; patients aged 30-45 years should be reassessed after two years; and patients aged 50 years and over should be reassessed after two years, including an immunohistological assessment to exclude refractory celiac disease. References: 1) Martucci S, Biagi F, Di Sabatino A, Corazza GR. Coeliac disease. Digest Liver Dis 2002;34 (suppl. 2): S150-S153. 2) When is a celiac a celiac? Report of a working group of the United European Gastroenterology Week in Amsterdam, 2001. Eur J Gastroenterol Hepatol 2001;13: 1123-8. 3) Tursi A, Giorgetti GM, Brandimarte G, Rubino E, Lombardi D, Gasbarrini G. Prevalence and clinical presentation of subclinical/silent coeliac disease in adults: an analysis on a 12-year observation. Hepato-gastroenterol 2001; 39: 462-4. 4) Brocchi E, Corazza G, Caletti G et al. Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac disease. N Engl J Med 1988;319: 741-4. 5) Mc Intere AS, Mg DP, Smith JA , Amoah J, Long RG. The endoscopic appearance of duodenal folds is predictive of untreated adult celiac disease. Gastrointest Endosc 1992;38: 148-51. 6) Corazza GR, Caletti GC, Lazzari R et al. Scalloped duodenal folds in childhood celiac disease. Gastrointest Endosc 1993; 29: 543-5. 7) Smith AD, Graham I, Rose JD. A prospective endoscopic study of scalloped folds and grooves in the mucosa of the duodenum as sign of villous atrophy. Gastrointest Endosc 1998;47: 461-5. 8) Stevens FM, McCarthy CF. The endoscopic demonstration of coeliac disease. Endoscopy 1976;8: 177-80. 9) Brocchi E, Corazza GR, Brusco G, Mangia L, Gasbarrini G. Unsuspected celiac disease diagnosed by endoscopic visualization of duodenal bulb micronodules. Gastrointest Endosc 1996;4: 610-1. 10) Vogelsang H, Hänel S, Steiner B, Oberhuber G. Diagnostic duodenal bulb biopsy in celiac disease. Endoscopy 2001;33: 336-40. 11) Tursi A, Grandimarte G, Giorgetti GM, Gigliobianco A. Endoscopic features of celiac disease in adults and their correlation with age, histological damage, and clinical form of the disease. Endoscopy 2002;34: 787-92. 12) Niveloni S, Fiorini A, Dezi R et al. Usefulness of videoduodenoscopy and vutal dye staining as indicators of mucosal atrophy of celiac disease: assessment of interobserver agreement. Gastrointest Endosc 1998;47: 223-9. 13) Dickey W, Hughes D. Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: inplication for celiac disease diagnosis during routine endoscopy. Am J Gastroenterol 2001;96: 2126-8. 14) Shah VH, Rotterdam H, Kjotler DP, Fasano A, Green PH. All that scallops is not celiac disease. Gastrointest Endosc 2000;51: 717-20. 15) Dickey W, Hughes D. Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy. Am J Gastroenterol 1999;94: 2182-6. 16) Cammarota G, Martino A, Pirozzi GA et al. Direct visualization of intestinal villi by high-resolution magnifying upper endoscopy: a validation study. Gastrointest Endosc 2004;60: 732-8. 17) Cammarota G, Cesaro P, Martino A et al. High accuracy and cost-effetciveness of a biopsy-avoiding endoscopic approach in diagnosing celiac disease. Aliment Pharmacol Ther 2006;23: 61-9. 18) Cammarota G, Martino A, Di Caro S et al. High-resolution magnifying upper endoscopy in a patient with patchy celiac disease. Dig Dis Sci 2005;50: 601-4. 19) Badreldin R, Barrett P, Wooff DA, Mansfield J, Yiannakou Y. How good is zoom endoscopy for assessment of villous atrophy in coeliac disease? Endoscopy 2005;37: 994-8. 20) Di Caro S, May A, Heine DG, Fini L et al. The European experience with bouble-balloon enteroscopy: indications, methodology, safety, and clinical impact. Gastrointest Endosc 2005;62: 545-50. 21) MacDonald WC, Brandiborg LL, Flick AL et al. Studies of celiac sprue. IV. The response of the whole length of the small bowel to a gluten-free diet. Gastroenterology 1964;47: 573-89. 22) Dickey W, Hughes DF. Histology of the terminal ileum in coeliac disease. Scand J Gastroenterol 2004;39: 665-7. 23) Eliakim R. Wireless capsule video endoscopy: three years experience. World J Gastroenterol 2004;10: 1238-9. 24) Cellier C, Green PH, Collin P et al. The role of capsule endoscopy in coeliac disease: the way forward. Endoscopy 2005;37: 1055-9. 25) Green PH, Fleichauer AT, Baghat G et al. Risk of malignancy in patients with celiac disease. Am J Med 2003;115: 191-5. 26) Cellier C, Delabasse E, Helmer C et al. Refractory sprue, coeliac disease and enteropathy-associated T-cell lymphoma. French Coeliac Disease Study Group. Lancet 2000;356: 203-8. 27) Green JA, Barkin JS, Gregg PA et al. Ulcerative jejunitis in refractory celiac disease: enteroscopic visualization. Gastrointest Endosc 1993;39: 584-5. 28) Gay G, Delvaux M, Fassler I. Outcome of capsule endosocpy in determining indication and route for push-and-pull enteroscopy. Endoscopy 2006;38: 49-58. 29) Yamamoto H, Kita H, Sunada K et al. Clinical outcomes of double-baloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2004;2: 1010-6. 30) Tursi A, Brandimarte G, Giorgetti GM. Endoscopic and histological findings in the duodenum of adults with celiac disease before and after changing to a gluten-free diet: a 2-year prospective study. Endoscopy 2006; 38: in press.
  8. Celiac.com 08/22/2018 - There’s been some data to support the idea that local pharmacists might have an important role to play in helping people with celiac disease to remain gluten-free by providing information about possible gluten in drugs, and even liaising with manufacturers for gluten information on the patient’s behalf, as needed. But how solid is your local pharmacist when it comes to celiac disease awareness? A team of researchers recently set out to evaluate pharmacists' knowledge of celiac disease, and to look for areas where further information may be beneficial. The research team included Carmela Avena-Woods, PharmD, BS Pharm; Robert A. Mangione, EdD; and Wenchen Kenneth Wu, PhD, MBA. They are all with St. John's University in Queens, New York. To gather data for their evaluation, their team sent a survey to community pharmacists who practice in a national chain pharmacy in one region of New Jersey and New York. A total of 418 pharmacists, just under 40%, responded to the survey. Sixty percent of the responses correctly noted that there are currently no federal regulations requiring manufacturers to designate medications as gluten-free. Still, forty percent got that wrong. Perhaps most alarmingly, of the pharmacists who claimed a basic or advanced understanding of celiac disease, only 27% correctly indicated that celiac disease is both an autoimmune and a chronic lifelong disease. Interestingly, twenty percent of pharmacists said they often suggested a change of diet to people with suspected celiac disease before a clinical diagnosis was made. This study suggests that community pharmacists have some understanding of celiac disease, but that additional celiac education is advisable if they are to play an integral role in helping people with celiac disease to maintain a gluten-free diet. Read more at: Am J Pharm Educ. 2018;82(2)
  9. Celiac.com 08/29/2018 - Up to one in twelve patients with gluten sensitivity develops neurological symptoms such as ataxia, dementia, seizures or peripheral neuropathy, though the reasons for this are still poorly understood. As a means of better understanding the immunological mechanisms behind this reality, a team of researchers recently reported the case of a 68‐year‐old male patient suffering from progressive ataxia and dementia associated with chronic diarrhea, and both elevated IgG and IgA antigliadin‐antibodies. The research team included Michel Mittelbronn, Jens Schittenhelm, Gellert Bakos, Rob A. De Vos, Manfred Wehrmann, Richard Meyermann, and Katrin Bürk. They are variously affiliated with the Institute of Brain Research at the University of Tübingen, and the Institute for Cell Biology, Department of Immunology at the University of Tübingen, Tübingen, Germany, the Neurological Institute/Edinger Institute, Goethe University Medical School, Frankfurt, the Department of Pathology, St. Georg Hospital, Leipzig, Germany, and with the Laboratory for Pathology, Enschede, the Netherlands. Autopsy indicated that frequent argyrophilic glial and neuronal inclusions within the basal nucleus of Meynert were the structural markers of the cognitive decline. The patient showed substantial neuronal loss in the cerebellar cortex and the inferior olives, along with infiltrating CD8+/perforin+/granzyme B+ cells, and reactive astrogliosis and microglial activation. In patients with gluten sensitivity and neurological disease, it is likely that CD8+ cytotoxic T and NK cells function as effector cells that trigger neuronal cell death, and thus might play some role in triggering cerebellar symptoms in gluten ataxia cases. The team concludes by noting that an absence of B‐ or plasma cells, along with multiple CD8+, granzyme B and perforin expressing cells in ataxia‐associated brain areas, indicates pronounced cytotoxic effects in neuro-pathogenesis of gluten sensitivity. This is one of the first reports to indicate that CD8+, perforin+, and granzyme B+ effector cells infiltrate the cerebellum and inferior olives in cases of gluten ataxia. Read more in: Neuropathology
  10. Celiac.com 08/28/2018 - There have been a number of studies that tried to estimate risk levels for celiac disease in patients with osteoporosis, but the data has been highly variable and inconclusive. To address this, a team of researchers recently set out to investigate rates of celiac disease among individuals with osteoporosis. The research team included M. Laszkowska, S. Mahadev, J. Sundström, B. Lebwohl, P. H. R. Green, K. Michaelsson, and J. F. Ludvigsson. They are variously affiliated with the Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA, the Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University in Uppsala, Sweden, the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet in Stockholm, Sweden, the Department of Paediatrics, Örebro University Hospital in Örebro, Sweden, and with the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham in Nottingham, UK. The team conducted a systematic review of articles that appeared in PubMed, Medline or EMBASE through May 2017 to find studies on rates of celiac disease in patients with osteoporosis. Search terms included “coeliac disease” combined with “fractures”, “bone disease”, “bone density”, “densitometry”, “osteoporos*”, “osteomal*”, “osteodys” or “dexa” or “dxa” or “skelet”. Non‐English papers with English‐language abstracts were included. To confirm their data, the team used fixed‐effects inverse variance‐weighted models, and tested heterogeneity through both subgroup analysis and meta‐regression. They found a total of eight relevant studies, containing data from 3,188 people with osteoporosis. From this group, the team found 59 individuals, or just under 2%, with celiac disease. A weighted pooled analysis showed biopsy‐confirmed celiac disease in 1.6% of osteoporosis patients. The team found moderate heterogeneity (I2 = 40.1%), which was influenced by the underlying celiac disease rates in the general population. After adding four studies covering a total of 814 people with celiac disease, based on positive tissue transglutaminase or endomysial antibodies, the pooled rate was comparable (1.6%; 95% CI = 1.2%‐2.0%). About 1.6% of people with osteoporosis have biopsy‐verified celiac disease. That’s about the same rate as the general population. Based on this data, the team sees no need to routinely screen osteoporosis patients for celiac disease, contrary to current guidelines. They suggest additional studies to assess the benefits and desirability of such screening programs. So, it looks like there’s no reason for people with osteoporosis, or their doctors, to be concerned about celiac disease unless patients shows some physical symptoms or signs. Read more in: Alimentary Pharmacology & Therapeutics
  11. 08/21/2018 - Does celiac disease have any kind of adverse effect on ovarian reserve levels in women of reproductive age? To get an answer, a team of researchers recently conducted a study of ovarian reserve in patients of reproductive age with celiac disease using anti-Müllerian hormone (AMH) levels, antral follicle counts (AFCs), and ovarian volume. The research team included Erol Cakmak, Savas Karakus, Ozlem Demirpence, and Banu Demet Coskun. They are variously affiliated with the Department of Gastroenterology, the Department of Obstetrics and Gynecology, the Department of Biochemistry, Cumhuriyet University Faculty of Medicine, Sivas, Turkey, and with the Department of Gastroenterology, Kayseri Training and Research Hospital in Kayseri, Turkey. For this study, their team included 46 female celiac patients and 40 healthy female subjects of reproductive age, 18–45 years of age. The team drew blood samples from both groups on days 2–4 of the menstrual cycle, and measured follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), and AMH levels. On the same day, the team measured AFCs and ovarian volume for each patient. They also recorded patient body mass index (BMI), gravidity/parity/abortions/alive counts, disease duration, and Marsh histological classification. The results showed no statistically significant differences between celiac disease patients and control groups in terms of mean age, BMI, or median gravidity/parity/abortions/alive counts. Also, there were no statistically significant differences between the groups in terms of average FSH, LH, E2, PRL levels, right and left ovarian volumes, and median right and left ovarian AFCs. The team found AMH levels to be markedly lower in the celiac group. The Spearman correlation test showed no significant connection between AMH levels and age, BMI, FSH, LH, E2, PRL levels, right and left ovarian volumes, right and left ovarian AFCs, or Marsh histological classification. However, the team did find that, compared to healthy controls, female celiac patients of reproductive age showed decreased AMH levels and ovarian reserves that reflected the length of celiac duration; the longer the celiac disease, the greater the decrease. It appears that, especially over time, celiac disease can reduce ovarian reserves, which could have an adverse affect on fertility. Read more at: Med Sci Monit. 2018; 24: 1152–1157.
  12. Celiac.com 08/23/2018 - With the market for gluten-free goods and ingredients going like gang-busters, the proliferation of new flours made from previously unavailable ingredients is helping to change the product manufacturing landscape and to open up whole new avenues of nutrition, health benefits and flavor for people with celiac disease. One of the latest gluten-free flours to hit the market is banana flour, an alternative to wheat flour that has gained popularity for its light, fluffy baking results. Made of 100% dried, ground green bananas, banana flour is not only gluten-free but also paleo, Whole30-approved, and vegan. Highly nutritious banana flour also touts numerous health benefits. In addition to being naturally gluten-free, banana flour is similar in calories to regular white flour, but is made from a completely different type of carbohydrate. While white flour is made from simple starches that are quickly absorbed and turned into energy, banana flour contains high levels of what is called “resistant starch.” Resistant starches are so-called, because they work a bit like soluble fiber, slowing the digestion of carbohydrates, and resisting absorption by the gut. Resistant starches are also found in foods such as whole grains, vegetables, and legumes. “Resistant starch has been found to be beneficial for colon health, increasing satiety levels, and lowering blood sugar,” said registered dietitian Amy Margulies. “Banana flour also contains high levels of phenolic acid, a type of phytochemical found in many plant foods, which works like an antioxidant and supplies both potassium and vitamin B6.” Banana flour not only produces light, fluffy baked goods with a good nutrition profile, it is also easy to use. When substituting banana flour for wheat flour in a recipe, simply use about 30% less banana flour.
  13. Celiac.com 08/27/2018 - Imagine the difficulty of diagnosing celiac disease without the associated blood antibodies, with seemingly normal blood tests. Seronegative celiac disease is one of the most common causes of seronegative villous atrophy, so a biopsy is crucial in such cases, but it can be hard for doctors to justify a biopsy in the face of seemingly normal blood tests. How can researchers learn more? Seronegative celiac disease seems like a simple enough condition. It's just the presence celiac disease without the celiac-associated blood antibodies typically found in people with the disorder. Isn't it? Well, not exactly. For one thing, seronegative celiac disease is rare, and the little data that exist are contradictory. Some data has even indicated that seronegative enteropathies have lead to higher rates of death than standard celiac disease. Yet, seronegative celiac disease remains poorly defined, partly from an absence of consensus on an exact definition, and partly due to an imprecise use of specific celiac serology. Due to these factors, accurate celiac diagnosis can be extra difficult in patients with seronegative celiac disease. Even when doctors spot seronegative villous atrophy, they still need to exclude other enteropathies as a potential cause. To try to shed some light on the nature of seronegative celiac disease, a team of researchers recently set out to provide a critical summary of the most recent work on this topic, along with a working definition of seronegative celiac disease. The research team included A Schiepatti, DS Sanders, and F Biagi. They are variously affiliated with the Coeliac Centre/First Department of Internal Medicine, University of Pavia, Pavia, Italy, and with the Academic Department of Gastroenterology, Royal Hallamshire Hospital & University of Sheffield, UK. Finding an accepted definition of seronegative celiac disease is crucial in order to ensure that patients receive a correct diagnosis, and thus avoid inappropriate treatment, and the perils associated with long-term untreated celiac disease. Since cases of seronegative celiac disease are commonly dealt with individually, it is important to establish strict criteria for the diagnosis of seronegative celiac disease to ensure prompt identification and treatment of these celiac patients. Doing so will require further study, along with input from the scientific community. Source: Curr Opin Gastroenterol. 2018 May;34(3):154-158.
  14. Celiac.com 08/20/2018 - Following a gluten-free diet is critical for people with celiac disease. However, the factors that influence gluten-free diet success for people with celiac disease are not well understood on a population-wide scale. A team of researchers recently set out to assess the factors that influence gluten‐free diet adherence in patients with celiac disease. The research team included E. P. Halmos, M. Deng, S. R. Knowles, K. Sainsbury, B. Mullan, and J. A. Tye‐Din. The team asked celiac patients to complete an online survey that included the validated Celiac Dietary Adherence Test, along with questions on demographics, details of diagnosis and management and assessment of diet knowledge, quality of life and psychological distress. The team then reviewed the survey data for predictors of adherence and quality of life. There were a total of 7,393 survey responses, with 5,310 people completing the Celiac Dietary Adherence Test, and 3,230 of whom were following a gluten‐free diet. Multivariate regression showed that predictors of gluten-free dietary adherence included older age, being male, symptoms severity after gluten consumption, above average gluten-free food knowledge, and lower risk of psychological distress. People with celiac disease who followed a gluten-free diet also reported better quality of life. Respondents who reported having poor food knowledge were more likely to wrongly identify gluten‐free foods, though they could still recognize gluten‐containing foods. This indicates that poor overall food knowledge may lead people with celiac disease to over‐restrict their diet. Poor understanding of gluten‐free diet and stressful psychological well-being were the main modifiable risk factors for failure to follow a gluten‐free diet in patients with celiac disease. From these responses, the team concluded that access to a dietitian and mental health care professional, in cases of psychological stress, is likely necessary to improve gluten-free dietary observation, and thus to improve overall patient health and well-being. Read more at: Alimentary Pharmacology & Therapeuticsdoi.org/10.1111/apt.14791 The researchers in this study are variously affiliated with the Department of Gastroenterology, The Royal Melbourne Hospital in Parkville, Victoria, Australia, the Department of Gastroenterology, Central Clinical School, Monash University in Melbourne, Victoria, Australia, the Cartovera Pty. Ltd. in Adelaide, SA, Australia, the Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology in Hawthorn, Victoria, Australia, the Department of Mental Health, St Vincent's Hospital in Fitzroy, Victoria, Australia, the Department of Psychiatry, University of Melbourne in Parkville, Victoria, Australia, Institute of Health and Society, Faculty of Medical Sciences, Newcastle University in Newcastle Upon Tyne, UK, the Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University in Bentley, WA, Australia, the Immunology Division, The Walter and Eliza Hall Institute of Medical Research in Parkville, Victoria, Australia, and the Department of Medical Biology, University of Melbourne in Parkville, Victoria, Australia.
  15. Celiac.com 08/17/2018 - Mucosal dryness is among the top non-gastrointestinal complaints of patients with gluten intolerance and celiac disease. Prolonged eye dryness, itching and chronic inflammation of the eye lids (blepharitis), mouth dryness, excessive thirst, frequent yeast infections, skin dryness and vaginal dryness in women may represent clinical symptoms of Sjogren’s syndrome. Named after Swedish ophthalmologist Henrik Sjögren, Sjogren’s syndrome is one the most common (and one of the most commonly underdiagnosed) rheumatic/autoimmune diseases. The disease most frequently affects women (10 women for every man) and usually appears in women around and after menopause. However, the disease can affect either gender at any age. In addition to mucosal and skin dryness, Sjogren’s syndrome can cause joint pain and stiffness, damage to peripheral nerves leading to numbness and tingling of fingers and toes, fatigue, brain fog, inflammation of blood vessels, hair loss, poor food digestion due to pancreatic damage and various problems with the cardiac muscle and its conduction system causing arrythmia and myocarditis. Patients suffering from Sjogren’s syndrome quite frequently deal with recurring yeast infections, chronic periodontal disease, recurring canker sores and poor dental health. The diagnosis of Sjogren’s syndrome is based on: Demonstration of mucosal dryness upon physical examination Specific blood tests (positive anti-SSA/Ro and anti-SSB/La antibodies, elevated levels of serum immunoglobulin G) Ultrasound imaging of salivary glands On rare occasions, a diagnosis of Sjogren’s syndrome requires confirmation through a small salivary gland biopsy or special nuclear medicine studies. It is well documented that patients with gluten intolerance and celiac disease have an increased risk of Sjogren’s syndrome. Similarly, patients with Sjogren’s syndrome are characterized by the increased prevalence of gluten intolerance and celiac disease. The connection between Sjogren’s syndrome and gluten intolerance is not a coincidental one: there are well-studied molecular mechanisms explaining this link. In the late 1980s/early 1990s genetic studies in Sjogren’s patients demonstrated an increased presence of the class II major histocompatibility complex protein HLA DQ2. Furthermore, HLA DQ2 positivity was found to be associated with increased titers of Sjogren’s specific anti-SSA/Ro and anti-SSB/La antibodies. The link between gluten and Sjogren’s syndrome became obvious in the mid to late 1990s when it was discovered that HLA-DQ2 binds to deamidated gluten peptides and presents them to mucosal CD4+ T cells thus initiating a chain of events eventually leading to autoimmune responses. The second set of data came from the discovery of BM180 protein. This protein regulates tear secretion in the lacrimal acinar cells. Suprisingly, amino acid sequence of BM180 has a similarity with alpha-gliadin and, therefore, can attract inflammatory cells activated by gluten thus contributing to the development of eye dryness. The actual prevalence of gluten intolerance in Sjogren’s patients based on published data varies from 20% to 40% depending on the criteria used to define gluten intolerance. The data from our clinic (Institute for Specialized Medicine) indicate that gluten intolerance can affect almost half of patients with Sjogren’s syndrome. Additionally, our data show that one third of patients with gluten intolerance have evidence of mucosal dryness and Sjogren’s syndrome. The frequency of documented celiac disease in patients with Sjogren’s syndrome is in the vicinity of 5%. The following is a patient case history from our clinic: A 28 year old woman was seen in our clinic due to her complaints of long-standing irritable bowel syndrome and recent onset of eye dryness. Her initial presentation included abdominal pain, bloating and irregular bowel movements. She was seen by several gastroenterologists and underwent several upper endoscopies and colonoscopies with mucosal biopsies which were non-diagnostic. Her lab test results showed positive IgG anti-gliadin antibodies and she was told that “this is a common finding among healthy people, and is not indicative of any illnesses.” She was seen by her ophthalmologist and prescribed with contact lenses which she could not wear due to significant eye discomfort and irritation. Further eye examination showed that she had diminished tear production and was referred to our clinic to rule out Sjogren’s syndrome. Upon physical examination in our clinic the patient not only demonstrated profound eye dryness but also showed evidence of dry mouth, fissured tongue and patchy areas of thrush as well as very dry skin. A sonographic evaluation of her major salivary glands was suspicious for moderately advanced Sjogren’s syndrome. Her laboratory test results showed: positive anti-SSA/Ro antibodies, elevated serum immunoglobulin G, low neutrophil count as well as low levels of vitamin D and ferritin (a serum marker of iron storage state). Also, the patient was found to have positive serum IgG and salivary IgA anti-gliadin antibodies as well as positive HLA DQ2 (a molecular marker associated with gluten intolerance). Based on a combination of clinical history, physical findings and laboratory test results, the patient was diagnosed with gluten intolerance and Sjogren’s syndrome. In addition to the aforementioned tests, the patient underwent food intolerance testing based on serum IgG4 antibodies which showed not only gluten but also cow’s casein intolerance. Her treatment options included a traditional route of therapy based on drugs or an integrative approach based on dietary modifications and food supplements. She opted for the integrative approach and started a gluten-free and dairy-free diet as well as iron glycinate, vitamin D, specific probiotics and digestive enzymes. After the first month on the diet and supplements, she reported a remarkable improvement of her irritable bowel symptoms and in three months, she started noticing an improvement of the dryness. Laboratory tests performed six months after initiation of the therapy showed normalization of the IgG level, disappearance of anti-SSA/Ro antibodies and a slightly suppressed neutrophil count. Through following the prescribed diet and supplements she is now symptom free. Why do we need to treat Sjogren’s syndrome? Left untreated, Sjogren’s syndrome can cause debilitating dryness affecting gastrointestinal and respiratory tracts. Clinically, this manifests as difficulty in swallowing solid foods, heartburn, malabsorption of nutrients and minerals, bloating, weight loss, chronic sinus infections and prolonged dry cough. Sjogren’s syndrome also significantly increases the risk for malignancies affecting lymphatic nodules, known as lymphomas. Therapy for Sjogren’s syndrome is based on the treatment of mucosal dryness and the autoimmune component of the disease. In addition, patients affected by Sjogren’s syndrome need to have regular screenings for malignancies (specifically lymphomas) and premalignant conditions. Traditional therapy for Sjogren’s syndrome (treatment of dryness): Cyclosporin (brand name Restasis) eye drops and artificial tears for dry eyes. Numoisyn lozenges and liquid, as well as Caphosol for mouth dryness and mucositis. Cevimeline (brand name Evoxac) and pilocarpine (brand name Salagen) for systemic dryness therapy. Treatment of autoimmune disturbances: Hydroxychloroquin (brand name Plaquenil). Leflunomide (brand name Arava). Severe autoimmune conditions associated with Sjogren’s syndrome are treated with the biologic drug rituximab (brand name Rituxan). Integrative therapy for Sjogren’s syndrome. Ear acupuncture (auricular therapy) and body acupuncture to stimulate tear and saliva production. Elimination diet based on individual food-intolerance profiles. Oral probiotics (for example, BLIS K12) and intestinal probiotics. Digestive enzymes. Fish and krill oils. Black currant seed oil. Cordyceps sinensis in combination with wormwood extract to treat the autoimmune component of Sjogren’s syndrome. Zinc and elderberry lozenges. N-acetyl-L-cysteine and glutathione. Our extensive clinical experience demonstrate that early cases of Sjogren’s syndrome can be completely reversed (by both clinical and laboratory criteria) by the strict gluten-free and elimination diet. The advanced cases cannot be reversed; however, even in advanced cases the gluten-free and elimination diet can slow the progression of the disease. If you’re concerned that dryness may represent Sjogren’s syndrome, see a rheumatologist for further evaluation and management of your condition. References: Alvarez-Celorio MD, Angeles-Angeles A, Kraus A. Primary Sjögren’s Syndrome and Celiac Disease: Causal Association or Serendipity? J Clin Rheumatol. 2000 Aug;6(4):194-7. Asrani AC, Lumsden AJ, Kumar R, Laurie GW. Gene cloning of BM180, a lacrimal gland enriched basement membrane protein with a role in stimulated secretion. Adv Exp Med Biol. 1998;438:49-54. Feuerstein J. Reversal of premature ovarian failure in a patient with Sjögren syndrome using an elimination diet protocol. J Altern Complement Med. 2010 Jul;16(7):807-9. Iltanen S, Collin P, Korpela M, Holm K, Partanen J, Polvi A, Mäki M. Celiac disease and markers of celiac disease latency in patients with primary Sjögren’s syndrome. Am J Gastroenterol. 1999 Apr;94(4):1042-6. Lemon S, Imbesi S., Shikhman A.R. Salivary gland imaging in Sjogren’s syndrome. Future Rheumatology, 2007 2(1):83-92. Roblin X, Helluwaert F, Bonaz B. Celiac disease must be evaluated in patients with Sjögren syndrome. Arch Intern Med. 2004 Nov 22;164(21):2387. Teppo AM, Maury CP. Antibodies to gliadin, gluten and reticulin glycoprotein in rheumatic diseases: elevated levels in Sjögren’s syndrome. Clin Exp Immunol. 1984 Jul;57(1):73-8.
  16. Celiac.com 08/16/2018 - What is the significance of vitamin D serum levels in adult celiac patients? A pair of researchers recently set out to assess the value and significance of 25(OH) and 1,25(OH) vitamin D serum levels in adult celiac patients through a comprehensive review of medical literature. Researchers included F Zingone and C Ciacci are affiliated with the Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; and the Celiac Center, AOU San Giovanni di Dio e Ruggi di Aragona, University of Salerno, Department of Medicine and Surgery, Salerno, Italy. Within the wide spectrum of symptoms and alteration of systems that characterizes celiac disease, several studies indicate a low-level of vitamin D, therefore recent guidelines suggest its evaluation at the time of diagnosis. This review examines the data from existing studies in which vitamin D has been assessed in celiac patients. Our review indicates that most of the studies on vitamin D in adult celiac disease report a 25 (OH) vitamin D deficiency at diagnosis that disappears when the patient goes on a gluten-free diet, independently of any supplementation. Instead, the researchers found that levels of calcitriol, the active 1,25 (OH) form of vitamin D, fell within the normal range at the time of celiac diagnosis. Basically, their study strongly suggests that people with celiac disease can recover normal vitamin D levels through a gluten-free diet, without requiring any supplementation. Source: Dig Liver Dis. 2018 Aug;50(8):757-760. doi: 10.1016/j.dld.2018.04.005. Epub 2018 Apr 13.
  17. Celiac.com 08/06/2018 - Okay, so it’s not a gluten-free donut, but Dunkin’ Donuts has announced the debut of a gluten-free fudge brownie, the company’s first-ever gluten-free bakery product, that will be available in all of Dunkin's 8,500 US stores. A company statement said that Dunkin’ Donuts recognizes "the importance of providing alternative choices for people with dietary restrictions or who choose a gluten-free diet." Gluten-free food sales are projected to exceed $2 billion in sales by 2020, up 20% from 2015, according to industry research group Packaged Facts. Dunkin's gluten-free brownie is one of several new items the company is introducing, although it is the only one that is gluten-free. Other new non-gluten-free items include waffle-breaded chicken tenders, pretzel bites and ham and cheese roll-ups. All of these items are priced at $2 each, as part of the chain's new Dunkin' Run menu, which the company hopes will draw customers beyond the usual breakfast rush. The latest menu changes are all part of a concerted effort by the company to rebrand, including ditching the ”Donuts" part of its name in some new stores, reducing its food offerings, emphasizing its drink selections, and pursuing plans to double the number of stores. Gluten-free donut lovers may have to wait indefinitely for a genuine gluten-free Dunkin’ donut, but a reliable, readily available gluten-free brownie is a good start. If you get a chance to try Dunkin’s new gluten-free brownie, please let us know your thoughts.
  18. Celiac.com 08/13/2018 - It’s not uncommon for people to have psychiatric reactions to stressful life events, and these reactions may trigger some immune dysfunction. Researchers don’t yet know whether such reactions increase overall risk of autoimmune disease. Are psychiatric reactions induced by trauma or other life stressors associated with subsequent risk of autoimmune disease? Are stress-related disorders significantly associated with risk of subsequent autoimmune disease? A team of researchers recently set out to determine whether there is an association between stress-related disorders and subsequent autoimmune disease. The research team included Huan Song, MD, PhD; Fang Fang, MD, PhD; Gunnar Tomasson, MD, PhD; Filip K. Arnberg, PhD; David Mataix-Cols, PhD; Lorena Fernández de la Cruz, PhD; Catarina Almqvist, MD, PhD; Katja Fall, MD, PhD; Unnur A. Valdimarsdóttir, PhD. They are variously affiliated with the Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; the Department of Rheumatology, University Hospital, Reykjavík, Iceland; the Centre for Rheumatology Research, University Hospital, Reykjavík, Iceland; the National Centre for Disaster Psychiatry, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; the Stress Research Institute, Stockholm University, Stockholm, Sweden; the Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; the Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; the Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden; the Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. The team conducted a Swedish register-based retrospective cohort study that included 106, 464 patients with stress-related disorders, 1,064 ,640 matched unexposed individuals, and 126 ,652 full siblings to determine whether a clinical diagnosis of stress-related disorders was significantly associated with an increased risk of autoimmune disease. The team identified stress-related disorder and autoimmune diseases using the National Patient Register. They used Cox model to estimate hazard ratios (HRs) with 95% CIs of 41 autoimmune diseases beyond 1 year after the diagnosis of stress-related disorders, controlling for multiple risk factors. The data showed that being diagnosed with a stress-related disorder, such as post-traumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions, was significantly associated with an increased risk of autoimmune disease, compared with matched unexposed individuals. The team is calling for further studies to better understand the associations and the underlying factors. Source: JAMA. 2018;319(23):2388-2400. doi:10.1001/jama.2018.7028
  19. Celiac.com 08/03/2018 - Do you know that there are numerous sites on the web to help you with the symptoms of getting glutened, and other suggestions to prevent you from ever getting "glutened". There are tips to help heal gluten exposure even for the gluten sensitive or person with dermatitis herpetiformis to speed up the process of getting the gluten out of your system. The dermatitis herpetiformis sores can be assisted with some simple home remedies that can ease you through to the scabbing and eventual disappearance, save for the scarring which is slower to heal.. First, we need to really "get" the fact that this is a disease that you will not grow out of despite what some advertisers attest. There are fewer people being mis-diagnosed today because of the blood test being readily available. Most physicians have crawled into the 21st Century and know about the symptoms of celiac disease, but some are still at a loss when looking at a severe outbreak of dermatitis herpetiformis. The United States and Canada have different laws concerning allergy labeling. A recent survey presented at the AAAAI Allergists' Convention in Los Angeles in March revealed that 40 percent of consumers avoiding one or more allergens when buying foods "Manufactured in a facility that also processes allergens.” Beyond buying habits the researchers also found a lack of awareness of labeling. Another problem occurs with differences in the food laws between the United States and Canada, and with the fluctuating Canadian dollar many Americans close to the border are taking advantage of the savings and shopping in Canada. 45% of people were unaware that precautionary labeling is not required by law. In Canada, labeling regulations require manufacturers to clearly indicate if major allergens are ingredients of a product. But there are no legal guidelines on how companies should identify products that may have come into contact with food allergens during manufacturing. I did a survey of six bakeries this past month that baked gluten free products. Out of the six, four cleaned their ovens and pans by pressure washing and only baked gluten-free on one particular day a week. Even their gluten-free home made noodles were made on a separate day and had to be ordered ahead of time. Recently Health Canada recommended companies limit the advisories to the phrase "May contain", but even that is not yet a legal issue, just a precautionary one I was told. A recent study tested 186 products with precautionary peanut labels and found 16 (just under 9%) contained the allergen. It becomes very serious after a 22 year old Minnesota man, with a peanut allergy died in January of anaphylaxis after eating a chocolate candy with a label that it had been made in a plant that also processed peanuts. "Not the same', you say but it brings to the foreground the fact that there are too many different types of wording, says author Dr. Susan Waserman, a professor of medicine in the division of allergy and immunology at McMaster University in Hamilton, Ontario. "Patients assume that differences in wording imply a lower level of risk, which they don't. " Gupta and Waserman would like to see precautionary labels reduced to one or two clearly defined phrases. For instance, Dr. Gupta says if a "May Contain" label meant that the food might have up to 100 milligrams of an allergen, then the patient could work with their doctors to find out just how much of their allergen may be safe to consume and purchase foods accordingly. The study shows that there is already research "underway to develop thresholds for such labels." Did you know that the outward manifestations of getting glutened may be different for everyone, and can cause a variety of symptoms such as brain fog, diarrhea, constipation, headache, rash, weakness, joint pain, swelling, vomiting and fatigue. Inside your body gluten is perceived as a toxin that causes inflammation and damage to the intestines. Ridding yourself of this toxin, reducing inflammation and healing your gut from the damage are essential to recovering as quickly as possible. Did you know that digestive enzymes help speed up the breakdown and absorption of micronutrients. Be sure to take an enzyme that includes dipeptidyl peptidase (DPP-IV) and or AN-PEP, both of which help to break down gluten. In fact several sites recommend that those with celiac and gluten intolerance take enzymes with DPP-IV and/or AN-PEP when dining out. Activated charcoal and bentonite clay rid toxins and help reduce gas and bloating. It is best to increase water intake when taking either of these to avoid constipation, which will only delay healing. Speaking of water intake, it is one of the biggest ways of removing gluten from your body. Cleanse, don't drown yourself, but drink as much water or a pure juice, (not pop) is one of the fastest ways of doing a body cleanse from a celiac outbreak, whether a diagnosed celiac, gluten sensitive, or those afflicted with dermatitis herpetiformis. I have been nagged so many times to drink more water when experiencing a dermatitis herpetiformis outbreak. You can try coconut water, which contains electrolytes that may have been lost through vomiting or diarrhea. Decreasing inflammation occurs naturally in our body when there has been an insult or inflammation to it. Decreasing inflammation is essential in healing your gut. 10 tips may help you reduce inflammation and recover quickly should you accidentally ingest gluten: Omega-3 fatty acids, fish oils, flax and chia seeds are full of anti-inflammatory omega 3 fatty acids. It is recommended to take 1 - 2 grams of omega 3 oils daily. You can go up to 4 grams a day for a week after an accidental gluten ingestion. Never play guessing games with celiac disease, or cheat. In the scheme of things it is NOT worth it, and deep inside when you are really suffering you know that sneaking a regular donut is definitely not worth it. The man that said to me, "Every time I come back from Japan to the U.S.A. I have to have Kentucky Fried Chicken and to heck with the consequences", I noticed the last sabbatical when he came over for a visit he did not succumb to his favorite Kentucky Fried Chicken. He now had dermatitis herpetiformis, which is basically celiac disease of the skin. I have been told it can often be caused by extreme stress or constantly cheating on the gluten-free diet. If you think being a celiac is "The Poor Me Syndrome" think again! Dermatitis herpetiformis on your scalp can give you an extreme desire to shave your hair off, and pick the itchy sores off your legs until they not only scar, but look like a shark attack. Don't do it! And I am not even telling you about what it does to the lining in your bowel and the nutrients that are flowing through your body right down the toilet. Ginger has high levels of gingerol, which gives it a natural spicy flavor and acts as an anti-inflammatory in the body. It also has potent anti-nausea properties and can ease stomach cramping, Drinking warm ginger tea is a great idea. Turmeric is a member of the ginger family that contains the active ingredient curcumin, which is known for its antioxidant and anti-inflammatory properties. Try an anti-inflammatory smoothie with turmeric. It is a great drink to help you quickly recover from getting glutened. Did you know that nearly 70% of our immune system is in our gut? Having a healthy gut is crucial for optimal health. Probiotics. Many researchers suggest or recommend taking a highly concentrated probiotic (24-100 billion units a day). Amy Myers, M.D., is a renowned leader in functional medicine and a New York Times best selling author of "The Auto-Immune Solution".She received her doctorate in Autoimmune Diseases and has several books on celiac disease and its mystifying complex symptoms. Celiac disease reacts differently with each person, and childhood celiac disease symptoms are often different than adult onset celiac disease. L-Glutamine. It is an amino acid that is great for repairing damage to the gut, helping the gut lining to regrow and repair, undoing the damage caused by gluten. Dr, Myers recommends 3 -5 grams a day for a week after exposure. *MY ADVICE to you all is to write these suggestions down and show them to your general practitioner, research them on the internet, Do not take my word for it or the words of these authors; check and re-check your facts. It is your body, and just like you would change grocery stores if they sold you a bunch of out-dated food products, you would complain and possibly shop somewhere else. You have a right to read about new things and be heard. Slippery Elm. It contains mucilage, which stimulates nerve endings in he gastrointestinal (GI) tract to increase its secretion of mucus. Mucus forms a barrier in the gut to protect it and promote healing. Deglycyrrhizinated licorice (DGL). DGL is a herb that is being used for more than 3,000 years in Marshmallow root is a multipurpose supplement that can be used for respiratory or digestive relief. Like slippery elm, it contains mucilage, which eases the inflammation in the stomach lining, heals ulcers and treats both diarrhea and constipation by creating a protective lining on the digestive tract. Bone Broth is very high in the anti-inflammatory amino-acids glycine and proline. The gelatin in bone broth protects and heals the mucosal lining of the digestive tract that may et disrupted by being glutened. Baking Soda Remember, be your own researcher and look into each of these before trying them.
  20. Celiac.com 08/08/2018 - A number of studies have cataloged the numerous challenges faced by adolescents with celiac disease attempting to comply with a gluten-free diet. A team of researchers recently set out to reevaluate gluten-free dietary compliance and the current clinical condition of 123 now teenage celiac patients, who were diagnosed in the first three years of life and were followed up for at least 10 years to determine whether a less strict approach to a gluten-free diet can actually increase gluten-free dietary compliance. The research team included M Mayer, L Greco, R Troncone, S Auricchio, and M N Marsh. They are variously affiliated with the University Department of Medicine, Hope Hospital, Salford, Manchester, UK. The team used computerized image analysis to assess mucosal structure and lymphocytes in small intestinal biopsy specimens obtained from 36 subjects. Of these adolescents with celiac disease, 65% were adhering to a strict gluten free diet, 11.4% followed a gluten-free diet with occasional gluten intake, while nearly 25% ate a gluten containing diet. Patients on a gluten containing diet had more frequent clinical gluten-related symptoms, while patients on a semi-strict diet did not. Occasional intake of small amounts (0-06-2 g/day) of gluten did not produce increased concentrations of anti-gliadin antibodies, but did result in a substantially greater crypt epithelial volume and expanded crypt intraepithelial lymphocyte numbers. So, could a semi-strict gluten-free diet benefit celiac teenagers who eat a gluten containing diet? These numbers suggest that a semi-strict gluten-free diet may be better than no gluten-free diet at all. Of course, the best choice would always be a 100% gluten-free diet. Source: Gut
  21. Celiac.com 08/07/2018 - A new drug designed to reduce symptoms of accidental gluten ingestion in celiac disease sufferers has yielded some encouraging data. The drug in question is a monoclonal antibody designed to reduce adverse reactions in celiacs who are accidentally exposed to gluten. The results, presented at Digestive Disease Week, held in Washington DC from 2–5 June 2018, suggest that monoclonal antibodies could provide protection for people with celiac disease. Celiac patients on a gluten-free diet who randomly received six injections of a monoclonal antibody, called AMG 714, over a ten-week period, enjoyed a substantial reduction in intestinal inflammation. Over a ten week study period, celiac patients on a gluten-free diet received six randomly assigned injections of either a placebo, or of AMG 714 at a dose of either 150mg or 300mg. Patients then underwent a dietary gluten challenge from week through until week twelve. As tested, the drug did not reduce damage to intestinal villi for either treatment group, which was the trial’s primary goal, but it did significantly reduce celiac-related inflammation and symptoms in response to gluten consumption. Patients receiving the highest dose of AMG 714 had no clinically active disease at week twelve of the study, and also had a significant improvement in self-reported outcomes, compared with the placebo group. No matter how diligently people with celiac disease follow a gluten-free diet, they can still suffer accidental gluten exposure ingestion. Treatments like AMG 714 could become important adjunct to gluten-free diet in for people with celiac disease, including non-responsive celiac disease. Read more in Pharmaceutical-journal.com
  22. 08/01/2018 - A federal appeals court has ordered a new trial for a terminated worker who sued a staffing company for allegedly violating the Americans with Disabilities Act by not accommodating her celiac disease. Laurie Peterson suffers from celiac disease, and worked as a staffing supervisor for Troy, Michigan-based Kelly Services Inc. until her termination in January 2014 according to court papers filed in Laurie Peterson v. Kelly Services Inc. Peterson had originally sued Kelly in U.S. District Court in Spokane, Washington, alleging failure to accommodate, discrimination and retaliation under the ADA. The original court issued a partial summary judgment granting Kelly’s motion on Ms. Peterson’s claims that the company had failed to accommodate her celiac disease and had fired her in retaliation for protected activity, but allowed related charges in the case to proceed. A jury later found that Kelly had not retaliated against Ms. Peterson. A three-judge panel of the 9th U.S. Circuit Court of Appeals recently issued a unanimous reversal of the district court’s original ruling. The panel wrote that the district court had “failed to construe the facts in the light most favorable to Peterson as the non-moving party as required on summary judgment.” The case originally arose out of Peterson’s work as interim district manager in fall 2013 while Kelly Services was looking for a new district manager. According to the complaint in the case, when the new district manager learned Ms. Peterson had celiac disease, he began treating her differently than other employees, including changing her work schedule. The change in work schedule allegedly caused Ms. Peterson stress and anxiety, which aggravated her celiac-related condition. Ms. Peterson sought to return to her previous 8 a.m. to 5 p.m. shift. According to the complaint, the district manager told Ms. Peterson to take unpaid leave under the Family Medical Leave Act instead of seeking an accommodation from the company. Peterson and the supervisor were later fired. In reversing the lower court and remanding for trial the claims decided on summary judgment, the court found that the district supervisor’s statement “is direct evidence of retaliatory intent.” The ruling added that the supervisor’s declaration “also raises a genuine issue of material fact as to whether Kelly Services engaged in the interactive process in good faith.” Ms. Peterson’s battle against Kelly Services, Inc., has important implications for how companies treat people with celiac disease under the ADA. To find out how the retrial turns out, keep an eye on Celiac.com Source: businessinsurance.com
  23. Celiac.com 07/26/2018 - Currently, the only medically proven treatment for celiac disease is a life-long gluten-free diet. That’s been true for many years, but that doesn’t stop people from making curious or questionable celiac disease claims. Today in the arena of likely bogus medical claims, we ask ourselves if long-distance energy channeling can help people with their celiac disease symptoms? The obvious answer is that it’s highly unlikely. According to the group's recent press release titled, Trivedi Global, Inc. and Su-Mei Liu Announce Research Results on the Impact of a Biofield Energy Treated Nutraceutical for Decreasing Inflammation and Autoimmune Disorders, such treatments do help. The company is called Trevedi Global, Inc., and claims that "tests" conducted in the research laboratory of Dabur Research Foundation, near New Delhi, India, show that just 5 minutes of Biofield Energy Treatment, conducted using the “healers' unique Biofield Energy Transmission process remotely to the test samples under laboratory conditions” improves celiac disease and numerous other conditions for people using nutraceutical supplements. Whatever their appeal may be, there’s reason to be skeptical of such claims. The press release claims that “Human Biofield Energy has subtle energy that…can be harnessed and transmitted by the gifted into living and non-living things via the process of a Biofield Energy Healing Treatment or Therapy.” Of course, this process involves paying money for both nutraceuticals and for the self-labeled “energy healers” working from a remote location. These “healers” then use their “unique” abilities to “channel energy” to the afflicted person for about five minutes. Again, as per the press release, these “healing” sessions were conducted by someone called “Sui-Me Liu as part of a group of 20 energy healers. Eighteen were remotely located in the U.S.A and two in Canada.” It goes on to add that “Lui, along with another 19 Biofield healers participating in this research never visited the laboratory in person, nor had any contact with the nutraceuticals samples.” The release calls Liu “an evidence-based energy healer, today announces research based on the impact of a biofield energy treated nutraceutical to improve overall immunity and to combat inflammation and autoimmune disorders.” Without addressing any alleged clinical significance the press release goes on to claim the following results: “Up to 260% increase overall immunity as seen by elevation of antibody levels" "Over 50% increase in delayed hypersensitivity reaction" "Over 30% decrease in uric acid levels" "Over 25% increase in blood cell counts” The press release claims that these “research findings suggest that the biofield energy treatment enhanced the nutraceutical's anti-inflammatory and immunomodulatory properties with a safe therapeutic index. Another promising indication for the supplement is improvement of overall health and quality of life.” So the company is basically selling their nutraceuticals as a cure-all that, coupled with remote energy channeling treatments, allegedly translates into improvements for people with celiac disease. They go on to claim that their product “can be used to combat autoimmune diseases and inflammatory disorders like Celiac Disease (gluten-sensitive enteropathy), Irritable Bowel Syndrome (IBS), Parkinson’s Disease, Graves’ Disease, chronic peptic ulcers, Hepatitis, Addison's Disease, Multiple Sclerosis (MS), Tuberculosis, Rheumatoid arthritis, Chronic periodontitis, Crohn's disease, Ulcerative colitis, Lupus, Vitiligo, Hashimoto Thyroiditis, Chronic sinusitis, Type 1 Diabetes, Asthma, Rheumatoid Arthritis, Sjogren Syndrome, Alopecia Areata, Dermatitis, Psoriasis, Fibromyalgia, Diverticulitis, Chronic Fatigue Syndrome, Alzheimer’s Disease, Atherosclerosis and more.” Aside from the addition of the strange energy channeling claim, the claims made by Trevedi Global about their nutraceuticals are pretty standard pseudo-medical hype. It’s common for companies to make vague, unsupported health claims while hawking products that are unlikely to have any impact at all upon particular health problems, including celiac disease, and any other serious disorder. So, take these claims, and any other claims such as this, with a grain of salt, and don’t give up your gluten-free diet just yet.
  24. Celiac.com 07/25/2018 - Several recent research articles have emphasized the connection between intestinal autoimmune diseases, such as Crohn's disease with dysbiosis or an imbalance in the microbiota composition in the gut. However, little is known about the role of the microbiota in autoimmune pathologies affecting other tissues than the intestine. A team of researchers recently set out to examine the role played by gut microbiota in the pathogenesis of non-intestinal autoimmune diseases, such as Grave's diseases, multiple sclerosis, Type-1 diabetes, systemic lupus erythematosus, psoriasis, schizophrenia, and autism spectrum disorders. They wanted to see if microbiota can influence and determine the function of cells of the immune system. In their report, the team discusses how metabolites derived from bacteria could be used as potential therapies for non-intestinal autoimmune diseases. The report was reviewed by Richard Eugene Frye of Phoenix Children's Hospital, United States, and Matej Oresic at the University of Turku in Finland. The report was edited by Marina I. Arleevskaya of Kazan State Medical Academy in Russia. The authors conclude: "The current evidence supports the notion that changes or alterations of the microbial species that form part of the intestinal microbiota will affect the balance of Tregs and Th17 cells at the intestine, which could modify the immune response of non-intestinal autoimmune diseases. The experimental evidence suggesting that the cytokines secreted from Treg and Th17 will determine and influence non-intestinal autoimmune responses. It could also be possible that cells of the immune system located at the intestine could to move other organs to establish or modify an autoimmune response. The major message of this review is that the abundant data support the notion that the intestine is a critical organ the appropriate immune balance and for the prevention of non-intestinal autoimmune diseases. The key point is that by modifying the intestinal microbiota of a patient that suffers non-intestinal autoimmune disease it might be possible to improve the outcome of such illness." For more on the role of microbiota in influencing immune cell function and promoting individual wellbeing, read the full report in Frontiers in Microbiology. The research team included Maria C. Opazo, Elizabeth M. Ortega-Rocha, Irenice Coronado-Arrázola, Laura C. Bonifaz, Helene Boudin, Michel Neunlist, Susan M. Bueno, Alexis M. Kalergis, and Claudia A. Riedel. They are variously affiliated with the Laboratorio de Biología Celular y Farmacología, Departamento de Ciencias Biológicas, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Universidad Andres Bello, Santiago, Chile; Facultad de Medicina, Millennium Institute on Immunology and Immunotherapy, Universidad Andres Bello, Santiago, Chile; Laboratorio de Inmunobiología, Facultad de Medicina, Departamento de Biología Celular y Tisular, Universidad Nacional Autónoma de México, Mexico City, Mexico; Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile; Unidad de Investigación Médica en Inmunoquímica Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Institut National de la Santé et de la Recherche Médicale U1235, Institut des Maladies de l'Appareil Digestif, Université de Nantes, Nantes, France; and the Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad, Metropolitana, Chile.
  25. Celiac.com 07/24/2018 - The UK is in the midst of a national evaluation and reshaping of gluten-free prescription practices for people with celiac disease. Meanwhile, local health authorities in Calderdale, UK, are catching heat for a plan to consult with local people on proposed prescription cuts for gluten-free foods, branded medications and over the counter supermarket items. Critics, including leading charity, Coeliac UK, strongly oppose cutting gluten-free prescriptions for patients in Calderdale and elsewhere. They say the plan is a pointless waste of time and money, as results are due in from a nationwide consultation. Chief executive Sarah Sleet described the move by the NHS Calderdale Clinical Commissioning Group (CCG) as a poor use of public money. The Commissioning Group claims that consulting with local people over the plans could save £800,000 a year, while Sleet warns that, if approved, the move will result in “health inequality.” The Commissioning Group is proposing to eliminate funding of certain gluten-free products on prescription, thus saving £120,000. The plan would affect all people who receive gluten-free foods on prescription. Coeliac UK contends that any reduction or elimination of gluten-free prescriptions will negatively impact the ability of celiac patients, to access needed gluten-free foods. The consultation exercise in Calderdale is slated to run through December 4. Meanwhile, Results are forthcoming from a recently concluded national consultation on gluten-free prescription practices in the UK. Stay tuned for more on what these decisions mean for UK residents living with celiac disease. See the CCG's online consultation survey.
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