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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
Celiac.com - 06/24/2016 - What are the main factors facing children with celiac disease as they transition into teenagers and young adults? There isn't much good data on the transition and transfer of care in adolescents and teens with celiac disease. Recently, a team of 17 physicians from 10 countries, and two representatives from patient organizations examined the literature on transition from childhood to adulthood in celiac disease. Their The Prague consensus report looks to shine some light on the best options for providing optimal transition into adult healthcare for patients with celiac disease. The research team included Jonas F Ludvigsson, Lars Agreus, Carolina Ciacci, Sheila E Crowe, Marilyn G Geller, Peter H R Green, Ivor Hill, A Pali Hungin, Sibylle Koletzko, Tunde Koltai, Knut E A Lundin, M Luisa Mearin, Joseph A Murray, Norelle Reilly, Marjorie M Walker, David S Sanders, Raanan Shamir, Riccardo Troncone, and Steffen Husby. See the numerous author affiliations below. For their study, the team searched Medline (Ovid) and EMBASE for a period covering 1900 and September 2015. To assess evidence in retrieved reports, they used the Grading of Recommendation Assessment, Development and Evaluation method. The current consensus report aims to help healthcare personnel manage celiac disease in the adolescent and young adult, and provide optimal care and transition into adult healthcare for patients with this disease. In adolescence, patients with celiac disease should gradually assume exclusive responsibility for their care, although parental support is still important. Patients should talk with their doctors about dietary adherence and consequences of non-adherence during transition and beyond. In most adolescents and young adults, routine small intestinal biopsy is not needed to reconfirm a childhood diagnosis of celiac disease based on European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) or North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) criteria, However, a biopsy may be considered where pediatric diagnostic criteria have not been fulfilled, such as, in a patient without biopsy at diagnosis, when additional endomysium antibody tests have not been performed to confirm 10-fold positivity of tissue transglutaminase antibodies, or when a no biopsy strategy has been adopted in an asymptomatic child. Source: Gut doi:10.1136/gutjnl-2016-311574 The research team members are variously affiliated with the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, the Department of Paediatrics, Örebro University Hospital, Örebro, Sweden, the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK, the Division of Family Medicine, Karolinska Institutet, Sweden, the Department of Medicine and Surgery, University of Salerno, Salerno, Italy, the University of California, San Diego (UCSD), San Diego, California, USA, the Celiac Disease Foundation, Los Angeles, California, USA, the Celiac Disease Center at Columbia University, New York, New York, USA, the Division of Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA, the Primary Care and General Practice, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK, the Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany, with Hungary, representing the Association of European Coeliac Societies, (AOECS), with the Department of Gastroenterology and Centre for Immune Regulation, Oslo University Hospital Rikshospitalet, Oslo, Norway, the Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands, the Division of Gastroenterology and Hepatology, Department of Immunology Mayo Clinic, Rochester, Minnesota, USA, Columbia University Medical Center-Division of Paediatric Gastroenterology, New York, New York, USA, Anatomical Pathology, Faculty of Health and Medicine, University of Newcastle, School of Medicine & Public Health, Newcastle, Australia Academic Unit of Gastroenterology, Royal Hallamshire Hospital & University of Sheffield, Sheffield, UK, the Institute of Gastroenterology, Nutrition and Liver Diseases Schneider Children's Medical Center of Israel, Tel-Aviv University, Tel Aviv, Israel, the Department of Medical Translational Sciences & European Laboratory for the Investigation of Food Induced Diseases, University Federico II, Naples, Italy, and the Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark.
Am J Gastroenterol 2000;95:1742-1748. Celiac.com 09/20/2000 - A new study published in the July issue of the American Journal of Gastroenterology by Dr. Vincenzo Toscano and colleagues at the Universita La Sapienza in Rome indicates that adolescent patients with celiac disease have elevated levels of anti-thyroid and anti-pancreatic autoantibodies. The results indicate that gluten plays a key role in the observed autoimmunity, and may in some cases result in organ dysfunction. Previous studies have shown that antibodies directed against endocrine glands develop in a high proportion of patients who have celiac disease. In many cases a gluten-free diet is abandoned by many patients in adolescence, and the researchers studied such a group to determine whether anti-endocrine antibodies and endocrine function were affected by the presence or absence of gluten. Their study indicates that 9 of 44 celiac disease patients tested positive for at least one anti-thyroid autoantibody. The same numbers of patients tested positive for anti-pancreatic autoantibodies. Additionally, one patient was diabetic, two others exhibited preclinical hypothyroidism, and one had clinical hypothyroidism. Further, 10 of 19 patients on a diet containing gluten were positive for at least one antibody, in comparison with five of 25 patients on the gluten-free diet, and the distribution of autoantibodies was significantly different between the two groups. Dr. Toscanos team concludes that gluten consumption is associated with a high prevalence of anti-endocrine autoantibodies.