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Celiac.com 06/08/2007 - This study shows that celiac disease is as common among British Columbians with Type 1 diabetes as it is in Europeans with Type 1 Diabetes. The research team was made up of doctors P.M. Gillett, H.R. Gillett, D.M. Israel, D.L. Metzger, L. Stewart, J-P. Chanoine, H.J. Freeman. The team looked at 233 children with Type1 diabetes. In a blind study, the children were screened for celiac disease using immunoglublin A endomysium antibody (EmA), and the Immunoglublin A tissue transglutaminase. Children with positive results were offered small bowel biopsies. For those confirmed with celiac disease, doctors recommended a gluten-free diet. British Columbians with Type 1 Diabetes Get Celiac Disease at Rates Comparable to their European Counterparts Nineteen children tested positive for EmA and showed elevated tTG levels. Of the 18 patients who agreed to biopsies, one was normal, three showed normal morphology with elevated Intraepithelial lymphocyte counts, and 14 biopsies showed morphological changes consistent with celiac disease. 9 of the 19 children who tested positive for EmA were asymptomatic. Seven patients showed only mildly elevated tTG levels. Of this second group, five refused biopsy and two showed normal biopsies. In addition to the four known cases, the doctors uncovered at least 14 new cases of celiac disease. The total rate of biopsy confirmed celiac disease was 18 out of 233, or 7.7%. The doctors concluded that these results confirm that celiac disease is prevalent in pediatric type 1 diabetes. The doctors say the study reinforces the importance of celiac screening for children with type 1 diabetes, and also the advisability of keeping an eye on tTg serology as part of determining the effects of and compliance to a gluten-free diet. Participating Facilities 1. Division of Pediatric Gastroenterology at British Columbias Childrens Hospital Vancouver, British Columbia. 2. Division of Endocrinology, British Columbias Childrens Hospital, Vancouver, British Columbia. 3. Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia Journal of Pediatric Gastroenterology & Nutrition: Volume 29(4)October 1999p 495. About the Author: Jefferson Adams is a freelance health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
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Celiac.com 10/30/2007 - Many studies over the years have supported the idea that celiac disease is a permanent condition, and that those who strayed from the strict gluten-free diet that forms the core of celiac treatment risked relapsing and suffering the telltale intestinal damage associated with celiac disease. However, it was generally assumed that symptoms of celiac disease and associated intestinal degradation occurred within two years of reintroducing gluten back into the diet. The medical journal GUT recently published a paper by Matysiak-Budnik et al. concerning the natural history of celiac disease, which indicates that classic celiac damage to the intestinal lining may take years or decades to develop in some cases. A team of researchers looked at 61 adults who had been diagnosed with celiac disease as children, and who felt themselves to be asymptomatic for anywhere from 3 to 21 years, with a group average of 11 years. An exam revealed that 48 of the 61 test subjects indeed showed villous atrophy with crypt hypoplasia. The 13 other patients showed no celiac-associated intestinal damage. Strangely, 2 of the 13 patients with no signs of damage had showed such damage a short time after gluten was reintroduced into their diets, only to return to normal as they continued to consume gluten. From this, the researchers concluded that some people might actually become truly latent and tolerate gluten with no adverse effects. It’s also possible that such people actually still have celiac disease and that the intestinal damage has yet to recur, as villous atrophy occurs only at the tail end of celiac disease. In fact, delayed relapse of celiac disease after gluten reintroduction supports the notion that people with normal mucosa may in fact have celiac disease. Still, it is highly uncommon for patients with celiac disease to show no clinical symptoms on a long-term gluten-inclusive diet. The level of celiac disease+ intraepithelial lymphocytes has proven to be more useful than mucosal Marsh Type 1 lymphocytes in revealing early developing celiac disease in such cases and in general. Reliable diagnosis of celiac disease is important, as untreated celiac disease carries a broad range of associated risks including markedly higher rates of certain cancers. A recent study also suggests celiac disease may also adversely impact both the peripheral the central nervous systems. However, regarding the 13 asymptomatic patients, the original diagnosis of celiac would seem to be accurate in each case, as each had celiac-type HLA, either HLA DQ2 or DQ8, and their follow-up exam results showed that 5 of those patients had positive serum antibody results and higher densities of small bowel mucosa celiac disease+ and CD3+ intraepithelial lymphocytes than did the non-celiac control groups. Two of the 13 patients developed symptoms of a relapse during the follow-up. The study team concluded that the “2 year rule” for reintroducing gluten is invalid and supports the view that celiac disease exists beyond villous atrophy. As villous atrophy of the small intestine is only one manifestation of genetic gluten intolerance, and that the present diagnostic guidelines based on mucosal damage and ignoring early developing celiac disease and dermatitis herpetiformis is only one incarnation of celiac disease. GUT 2007; 56:1339-1340 Katri Kaukinen, Pekka Collin, Medical School, University of Tampere and Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland Markku Ma¨ki, Medical School, University of Tampere and Department of Paediatrics, Tampere University Hospital, Tampere, Finland
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Celiac.com 09/10/2007 - Nuvelo has announced Phase 1 trials of NU206 (R-spondin1) gastrointestinal growth factor product on cancer patients who are receiving radiation or chemotherapy treatment for cancer. NU206 is a recombinant, secreted protein that early animal studies show to act as a highly specific stimulator of the gastrointestinal (GI) epithelial cells. Preclinical studies suggest NU206 promotes growth and regeneration of gastrointestinal tissues in animal models of radiation and chemotherapy treatment for cancer, as well as in animal models of inflammatory bowel disease and short bowel syndrome. They expect to follow shortly thereafter with trials on patients with IBD. Mice deficient in IL-10 with drug-inducted colitis serve as research models for human IBD. Studies on such mice show that R-spondin1 substantially prevents mucosal damage and restored mucosal integrity. The implications for repairing and preventing mucosal damage in celiac disease are obvious. In addition to restoring other normal mucosal functions, rapid mucosal repair in celiacs through the use of NU206 therapy would provide relief from the problems caused by increased intestinal permeability. Gastroenterology. 2007 April; 132(4) pgs 1331-1343 health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
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Celiac.com 05/27/2008 - People with celiac disease know all too well that the only effective treatment at present is faithfully following a gluten-free diet. There’s been a lot of talk about various therapies and enzyme treatments that would allow people with celiac disease to return to a normal diet. Talk to anyone who suffers from celiac disease and they’ll likely have a personal horror story about a time when they had an unhappy episode of cross-contamination. So, the idea of a drug that would prevent such symptoms is appealing, and the goal, desirable. The chief cause of recurring symptoms in celiac disease is accidental gluten exposure, usually through cross-contamination. Cross-contamination doesn’t always mean food. Gluten is a common ingredient in many medicines and vitamins, and exposure in celiacs can cause diarrhea, weight loss, abdominal pain, anemia and oral ulcerations in the short-term, and myriad other problems in the long-run. The drug AT-1001 is a good example of how the realities are playing out on the front-lines of science. AT-1001 is an enzyme therapy that has promised some degree of protection from gluten exposure in people with celiac disease. A team of researches recently set out to assess the effectiveness of AT-1001 in preventing gluten from crossing the gut barrier by reversing the defective barrier mechanism. This required evaluating intestinal permeability between those exposed to gluten after taking AT-1001, those exposed without AT-1001, and control groups. The of intestinal function is done by gauging the absorption rates of various sugars. Early testing of AT-1001 showed some progress and a significant rate of protection of celiac patients exposed to wheat proteins. The research team looked at 86 subjects with celiac disease. The patients were divided into three groups. The first group was given placebo AT-1011 and challenged with gluten, the second group was given either active or placebo AT-1001, while the third group was given gluten and active AT-1001. After the first week, all subjects showed improvement, possibly due to closer adherence to a gluten-free diet. At three weeks, those given AT-1001 showed substantial improvement over the group given gluten and placebo AT-1001, including reduced intestinal permeability and fewer symptoms of gluten toxicity. The problem is that while AT-1001 shows a degree of promise, the results are so far underwhelming. The research team noted that the degree of improvement did not match the primary study. The results are, however, strong enough to encourage researchers to conduct a larger trial of AT-1001, which is currently underway. It’s important to remember that celiac disease is an immune disorder and no immune disorder has ever been fully cured. So, the idea of people with celiac disease being able to take a pill and head out for a night of pizza and beer without the standard celiac-related reactions is far-fetched at best. At best, such drugs would likely help to prevent cross-contamination, rather than conveying immunity to gluten proteins. Until then, stay tuned…best of luck with the gluten-free diet! Presented by Dr. Leffler at the 2009 Digestive Disease Week on Tuesday, May 20 at 10:45 a.m. Pacific Time in room 10, San Diego Convention Center.
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Study Shows Reasons for Success or Failure in Gluten-Free Diet
Jefferson Adams posted an article in Latest Research
Celiac.com 11/15/2007 - There’s a large body of evidence pointing to the importance of a life-long gluten-free diet for people with celiac disease. However, following a gluten-free diet is not always easy. Studies show that only 50% to 75% of all celiac patients are successful in faithfully following their gluten-free diets. But until now, very little has been published that indicates why this might be, or offers evidence as to the best way to succeed in faithfully maintaining a gluten-free diet. Recently, a team of doctors led by Dr. Daniel Leffler conducted a study of the factors that are most important in increasing the success rates for people trying to maintain a gluten-free diet. Dr. Leffler is a clinical fellow in gastroenterology at Boston’s Beth Israel Deaconess Medical Center. Dr. Leffler presented the results of that study recently at the 2007 American College of Gastroenterology’s Annual Scientific Meeting and Postgraduate Course. The results of the study indicate that support groups seem to have an important role to play. A team of doctors, dietitians, psychologists, and patients created a study questionnaire that included 155 questions designed to measure ten areas important to success in living with celiac disease, including the burden of the disease, knowledge specific to celiac, health care access, mood and stress factors, perceptions about adherence, reasons for adherence, social support, symptoms. Participants of the study were all found through biopsy to have celiac disease. A professional nutritionist assessed each of the participants for dietary adherence. Of the 154 participants, 76% were Caucasian women. Nearly 70% had at least a college-level education. The average age was 50, and they had followed gluten-free diets for an average of 5 years. Concerns over cost and changes in stress levels and shifts in mood were among the reasons that contributed not following a gluten-free diet. Being a member of a celiac support group (P=.008), the ease of eating gluten-free while traveling (P=.012), or while attending social functions were important factors in successfully following the gluten-free diet. Demographic factors like age, sex, and age at diagnosis had no bearing on successfully remaining on a gluten-free diet. -
Celiac.com 10/30/2007 - A recent study published in the August issue of American Journal of Gastroenterology suggest that villous atrophy in suspected cases of celiac disease can be reliably detected by video capsule enteroscopy (VCE). Reliable diagnosis presently demands the identification of tell-tale lesions in the mucosa of the small bowel. Accomplishing such identification requires an endoscopy of the upper gastrointestinal tract, and multiple duodenal biopsies. A team of Italian researchers evaluated the effectiveness of Video Capsule Enteroscopy against the standard endoscopy of the upper GI with biopsies of the second portion of the duodenum in patients suspected of having celiac disease. The research team included Emanuele Rondonotti, M.D.; Cristiano Spada, M.D.; David Cave, M.D.; Marco Pennazio, M.D.; Maria E. Riccioni, M.D.; Italo De Vitis, M.D.; David Schneider, M.D.; Tatiana Sprujevnik, M.D.; Federica Villa, M.D.; Jennifer Langelier, M.D.; Arrigo Arrigoni, M.D.; Guido Costamagna, M.D.; Roberto de Franchis, M.D. The research team tested a total of 43 patients. In 41 patients, VCE reached the ileocecal valve during the reading time. 32 patients were found to exhibit diagnostic histology. Of those, 28 were diagnosed with celiac disease using capsule enteroscopy, for a total sensitivity of 87.5%. Overall, for diagnosing celiac disease, VCE was shown to be 90.9% specific, 96.5% predictive, 71.4% negative predictive, with positive and negative likelihood ratios of 9.6% and 0.14% respectively. Four patients showed normal VCE findings, but were still diagnosed with celiac disease. Of these patients, three had Marsh grade III lesions, and one had Marsh grade I lesions. The ability of VCE to offer high-quality images of small bowel mucosa including high-resolution of the individual villi led the team to conclude the VCE may offer an effective alternative to duodenal biopsy among some patients. As VCE is also far less invasive than the endoscopy/biopsy approach, it may also generate greater patient acceptance. Also, unlike conventional endoscopy/biopsy, VCE offers exploration of the entire small intestine, and may lead to the discovery of damaged villi beyond those areas accessible via endoscopy. Because of the small number of the test subjects, the results, though encouraging, invite a larger and more comprehensive study before VCE becomes an acceptable alternative to conventional endoscopy/biopsy method for diagnosing celiac disease. American Journal of Gastroenterology 2007; 102(8): 1624-1631
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Celiac.com 09/28/2007 - Celiac disease is one of the most common lifelong disorders in western countries. However, most cases in North America remain currently undiagnosed, mostly because they present unusual symptoms and because of the low number of doctors who have a sound awareness of celiac disease. In a large European survey, the ratio between diagnosed and undiagnosed cases, found by mass serological screening, was as high as 1 to 7 , an effect termed the ‘celiac iceberg’. In addition to having chronic symptoms that might otherwise respond to a gluten-free diet, undiagnosed patients are exposed to the risk of long-term complications of celiac disease, such as anemia, infertility, osteoporosis, or cancer, particularly an intestinal lymphoma. Celiac Disease is diagnosed by confirming the presence of intestinal damage to the small intestine through a biopsy, along with a clinical response to the gluten-free diet. However, serological markers, e.g., the IgA class anti-tissue transglutaminase (tTG) antibodies, are useful screening tests. The sensitivity and the specificity of the IgA anti-tTG test are 94% and 97%, respectively. To address the large number of undiagnosed cases, a team of researchers recently set out to assess whether an active case-finding strategy in primary care could lead to increased frequency of celiac disease diagnosis, and to assess the most common clinical manifestations of the condition. The team was made up of Carlo Catassi, M.D., M.P.H.; Deborah Kryszak, B.S.; Otto Louis-Jacques, M.D.; Donald R. Duerksen, M.D.; Ivor Hill, M.D.; Sheila E. Crowe, M.D.; Andrew R. Brown, M.D.; Nicholas J. Procaccini, M.D.; Brigid A Wonderly, R.N.; Paul Hartley, M.D.; James Moreci, M.D.; Nathan Bennett, M.D.; Karoly Horvath, M.D., Ph.D.; Margaret Burk, R.N.; Alessio Fasano, M.D. 737 women and 239 men, with a median age of 54.3 years, who attended one of the practices participated in a multi-center, prospective study involving adult subjects during the years 2002-2004. All individuals with celiac-associated symptoms or conditions were tested for immunoglobulin A anti-transglutaminase (tTG) antibodies. Those with elevated anti-tTG were then tested for IgA antiendomysial antibodies (EMA). All who were positive for EMA were advised to undergo an intestinal biopsy and HLA typing. 30 out of 976 study subjects showed a positive anti-tTG test (3.07%, 95% CI 1.98-4.16). 22 patients,18 women, 4 men, were diagnosed with celiac disease. In these 22 cases the most common reasons for screening for celiac disease was: bloating (12/22), thyroid disease (11/22), irritable bowel syndrome (7/22), unexplained chronic diarrhea (6/22), chronic fatigue (5/22), and constipation (4/22). The prevalence of celiac disease in the serologically screened sample was 2.25% (95% CI 1.32-3.18). The diagnostic rate was low at baseline (0.27 cases per thousand visits, 95% CI 0.13-0.41) and rose sharply to 11.6 per thousand visits (95% CI 6.8-16.4, P This study shows that the diagnosis rate for celiac disease can be significantly increased through the implementation of a strategy of active case-finding. Am J Gastroenterol. 2007;102(7):1454-1460.
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