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Showing results for tags 'adult'.
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Celiac.com 06/19/2024 - For adults with celiac disease, managing their condition often means adhering to a strict gluten-free diet. Research shows that is estimated that up to 50% of celiac disease patients have persistent symptoms while on the gluten-free diet. The most common reason for persistent symptoms is continuing to ingest gluten. However, researchers are exploring new treatments that might help. One such promising development is a clinical trial assessing the safety and efficacy of TPM502. Study Purpose The primary goal of this clinical trial is to evaluate the safety and pharmacodynamic effects of TPM502 in adults with celiac disease. Specifically, the trial aims to determine: Whether TPM502 is safe and well-tolerated To reveal whether TPM502 can induce modifications in parameters that suggest it may help induce tolerance to gluten. Study Design This is a multi-center, double-blind, randomized, placebo-controlled Phase 2a study to evaluate the safety, tolerability, and PD effects of two infusions of TPM502 in adult patients diagnosed with celiac disease. Participants in this study will undergo a one-day gluten challenge during both the screening phase and after the administration of TPM502 or a placebo. They will receive two infusions of TPM502 or a placebo, administered two weeks apart. This approach will help researchers assess the immediate effects of TPM502 on the body's response to gluten. Patient participation in the study comprises 3 phases: screening period, treatment period and follow-up period. Patients fulfilling the eligibility criteria will be randomized to receive two infusions of TMP502 (or placebo) at the same dose level. Patients will undergo a second GC one week after the second infusion of TPM502. The study includes 4 cohorts of patients, each cohort will receive escalating doses of TPM502 (or placebo). Upon completion of the 3rd cohort, a lower dose can be investigated, if deemed relevant. Inclusion Criteria To be eligible for the trial, participants must meet several criteria: A documented biopsy-confirmed diagnosis of celiac disease or significant markers like tissue transglutaminase levels above 10 times the upper limit of normal and positive IgA anti-endomysial antibody at the time of diagnosis. Normal levels of anti-tissue transglutaminase 2 antibodies at screening. Elevated serum IL-2 levels following the gluten challenge at screening Adherence to a gluten-free diet for at least six months. Well-controlled celiac disease with mild or no ongoing symptoms. HLA-DQ2.5 positivity. Exclusion Criteria Certain conditions will exclude potential participants from the study, including: Known or suspected refractory celiac disease. Severe symptoms following previous gluten challenges. HLA DQ8 positivity Active gastrointestinal diseases like gastroesophageal reflux disease, esophagitis, peptic ulcer, microscopic colitis, or irritable bowel syndrome that might interfere with symptom assessment. History of or active inflammatory bowel diseases like Crohn’s disease or ulcerative colitis. Known wheat allergy. Hypersensitivity to intravenous iron preparations or other components of TPM502 or the placebo. This trial represents a significant step forward in potentially expanding the treatment options available for individuals with celiac disease, offering hope for improved management of the condition beyond strict dietary restrictions. Read more at trials.celiac.org -
Celiac.com 04/27/2020 - Recent studies on celiac disease have reported changes in the gut microbiome. Researchers don't currently know if the change in the microbial makeup is the cause or a result of the disease, especially in cases of adult onset celiac disease. A team of researchers recently set out to compare of small gut and whole gut microbiota of first-degree relatives with adult celiac disease patients and controls. The research team included Rahul Bodkhe, Sudarshan A. Shetty, Dhiraj P. Dhotre, Anil K. Verma, Khushbo Bhatia, Asha Mishra, Gurvinder Kaur, Pranav Pande, Dhinoth K. Bangarusamy, Beena P. Santosh, Rajadurai C. Perumal, Vineet Ahuja, Yogesh S. Shouche, and Govind K. Makharia. They are variously affiliated with the National Centre for Microbial Resource, National Centre for Cell Science, Pune, India; the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India; the Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India; and AgriGenome Labs Pvt. Ltd., Kerala, India. First-degree relatives of celiac patients might offer researchers a chance to study gut microbiome in pre-disease state, since they are genetically prone toward celiac disease. 16S rRNA gene sequencing showed that ecosystem diversity was similar for the disease condition in celiacs, the pre-disease condition in first-degree relatives, and for control subjects. They did note differences in levels of amplicon sequence variant (ASV), indicating changes in specific ASVs between pre-disease and diseased condition. Duodenal biopsies showed greater differences in ASVs compared to fecal samples, which suggests more widespread disturbance to the microbiota in the diseased area. The duodenal microbiota of first-degree relatives was marked by large quantities of ASVs of the genera Parvimonas, Granulicatella, Gemella, Bifidobacterium, Anaerostipes, and Actinomyces. The duodenal microbiota of people with celiac disease contained more ASVs from genera Megasphaera and Helicobacter compared to the microbiota of first-degree relatives. Compared to control group microbiota, the fecal microbiota of both celiacs and first-degree relatives had lower amounts of ASVs classified as Akkermansia and Dorea. Moreover, functional metagenome projections showed reduced gluten degradation by celiac fecal microbiota as compared with first-degree relatives and control subjects. The data show clear differences in ASVs and suggests that celiac fecal microbiota have an impair ability to break down gluten compared to the fecal microbiota of first-degree relatives. More research is needed to examine strain levels and active functional microbiota profiles, in celiacs and first-degree relatives, in order to clarify role of gut microbiome in celiac disease development. Read more in Frontiers of Microbiology, 08 February 2019 -
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Celiac.com 10/28/2019 - Among other things, a recent study on nutrition and bone health in adults with probable undiagnosed, untreated celiac disease drives home the importance of early diagnosis and quick adoption of a gluten-free diet. The importance can be seen in the findings of a research team that recently looked at variations in nutritional intake of calcium, vitamin D, and phosphorus; their levels in the blood; and bone health in adults with and without likely, undiagnosed celiac disease. The research team included Lara H. Sattgast, Sina Gallo, Cara L. Frankenfeld, Alanna J. Moshfegh, and Margaret Slavin. They are variously affiliated with the Department of Nutrition & Food Studies, George Mason University, Fairfax, Virginia, USA; the Department of Global & Community Health, George Mason University, Fairfax, Virginia, USA; and the Food Survey celiac diseases Research Group, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland, USA. The team analyzed data from 48 adults with likely undiagnosed celiac disease and positive immunoglobulin A endomysial antibody tests, and 13,634 controls. The data came from What We Eat in America and the National Health and Nutrition Examination Survey 2009–2014, and included self-reported information on dietary and supplement intake from a single day of 24-hour recalls, serologic indicators, and dual x-ray absorptiometry images. The team's statistical analysis included multiple linear regression modeling controlled for age, sex, race/ethnicity, energy intake, and poverty income ratio. Rates of likely undiagnosed celiac disease were 1 in 285. Patients with likely celiac disease showed an average 251.6 mg higher daily total calcium intake, higher dairy consumption by 0.7 cups per day, and higher serum phosphorus levels. Probable celiac patients showed a substantially higher total dietary and supplement intake measured in calcium density and phosphorus density. The researchers saw no differences in serum calcium, vitamin D, or alkaline phosphatase levels between the groups. Patients with likely celiac disease were associated with lower femur bone mineral density (BMD) and a lower femoral neck BMD, but showed no difference in total spine BMD. This is one of the first studies to examine variations in nutritional intake of calcium, vitamin D, and phosphorus; their levels in the blood; and bone health in adults with and without likely, undiagnosed celiac disease. Adults with probable undiagnosed celiac disease had lower bone density than those without celiac disease, even though they reported higher calcium intake and nutritional density of calcium and phosphorus. Among other things, the variations in BMD in this study demonstrate the importance of early diagnosis and the rapid adoption of a gluten-free diet for patients with undiagnosed celiac disease. Read more in the J Am Coll Nutr. 2019 Jul 19:1-10. -
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Celiac.com 07/10/2019 - Fewer new celiac patients are being diagnosed with classical malabsorption problems. Has this fact had any impact on nutrient deficiency? A team of researchers recently set out to evaluate micronutrient deficiencies in a contemporary group of adult patients with newly diagnosed celiac disease. The research team included Adam C. Bledsoe MD; Katherine S. King MS; Joseph J. Larson BS; Melissa Snyder PhD; Imad Absah MD; Rok Seon Choung MD, PhD; and Joseph A.Murray MD. They are variously affiliated with the Division of Gastroenterology and Hepatology, the Division of Biomedical Statistics and Informatics, the Division of Clinical Biochemistry, and the Division of Pediatric Gastroenterology at the Mayo Clinic in Rochester, MN; and the Department of Pediatrics at the University of Southern Denmark, Odense. The team conducted a retrospective study of prospective adults newly diagnosed with celiac disease from January 1, 2000, through October 31, 2014, at Mayo Clinic. They collected micronutrient data levels of tissue transglutaminase IgA, 25-hydroxy vitamin D, albumin, copper, ferritin, serum folate vitamin B12, and zinc. The researchers used logistic regression to assess absolute number of deficiencies, and their connections with age, sex, body mass index, presenting symptoms, and tissue transglutaminase IgA. They then compared deficiencies with age- and sex-matched controls from the National Health and Nutrition Examination Survey. The team looked at a total of 196 women and 113 men with celiac disease. The team showed that about 25 percent of those patients showed weight loss, while nearly 60 percent showed zinc was deficient, compared with just with 33.2 percent of controls. Nearly 20 percent of patients showed low albumin compared with just 1.1 percent of controls. More than 6 percent of celiac patients showed low copper levels compared with 2.1 percent of control subjects. More than 5 percent of celiac patients showed low vitamin B12 levels, compared with 1.8 percent of control subjects. Low folate levels were found in nearly 4 percent of celiac patients compared with just 0.3 percent of control subjects. Meanwhile, ferritin was low in 30.8 percent of celiac patients, though no NHANES controls were available for comparison for ferritin. Adults with celiac disease often have micronutrient deficiencies, even though less of them show signs of classical malabsorption. This study supports testing celiac patients for micronutrient deficiencies at the time of diagnosis. Read more at ScienceDirect.com -
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Celiac.com 05/22/2019 - What are the risks for lymphoma and gastrointestinal cancer in patients 55 years and older with newly diagnosed adult-onset celiac disease? Researchers and clinicians have reported connections between celiac disease and the development of certain lymphoid and gastrointestinal (GI) cancers, but there just isn't much good data. Without good data, it's impossible to develop effective evidence-based follow-up protocols. In an effort to develop better information on the subject, a team of researchers recently set out to determine relative (RR) and absolute risks of lymphoma and GI carcinoma for newly diagnosed adult celiac patients. The research team included Tom van Gils, Petula Nijeboer, Lucy IH Overbeek, Michael Hauptmann, Daan AR Castelijn, Gerd Bouma, Chris JJ Mulder, Flora E van Leeuwen, and Daphne de Jong. They are variously affiliated with the Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands; the Foundation PALGA (The Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands), Houten, the Netherlands; the Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands; and the Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands. To assess RR with cases (lymphoma or GI carcinoma) and controls--melanoma or basal cell carcinoma diagnosed from 1994–2014, the team conducted a case-control design using the Dutch nationwide population-based pathology database (PALGA). Among this group, the team identified patients with prior histologically proven or simultaneously diagnosed with the malignancy. The team found celiac disease in a total of 349 of 301,425 cases (0.1%) and 282 of 576,971 (0.05%) control subjects. Adults diagnosed with celiac disease had a substantially higher risk of T-cell lymphoma, mainly enteropathy-associated T-cell lymphoma (EATL). Clinicians should look out for EATL (both intestinal and extra-intestinal) and small bowel adenocarcinoma in patients with celiac disease diagnosed at 50 years of age or later. Although most often synchronously diagnosed, risk of T-cell lymphoma 1 year or more after celiac disease diagnosis was still elevated at 12.7 (95% CI 7.6–21.3). Other celiac disease-associated malignancies were small bowel adenocarcinoma, with RR of 11.9 (95% CI 8.2–17.2), and esophageal squamous cell carcinoma (RR = 3.5 (95% CI 2.1–5.8)). Absolute risks of developing these cancers were relatively low. Celiac disease did not show any higher risk of developing other types of lymphomas and GI carcinomas. Read more in the United European Gastroenterology Journal -
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Celiac.com 01/07/2019 - Researchers have made progress in spotting celiac disease without biopsy in children with certain parameters. Can the same be done for adults? A team of researchers recently set out to evaluate the accuracy of serology-based criteria in adults with variable pre-test probabilities for celiac disease. The research team included V Fuchs, K Kurppa, H Huhtala, K Laurila, M Mäki, P Collin, T Salmi, L Luostarinen, P Saavalainen, and K Kaukinen. New criteria for diagnosing celiac disease in children allow doctors to forgo duodenal biopsies in children who have symptoms, positive blood tests, and celiac disease-associated genes. There’s currently no good data on whether such an approach might work for adults with certain clinical presentations of celiac disease. Three study cohorts included 421 adults with high-risk clinical celiac disease suspicion, 2,357 moderate-risk family members of celiac patients, and 2,722 low-risk individuals from the general population. The team collected blood tests and other physical patient data. Their "triple criteria" for celiac disease included transglutaminase 2 antibodies more than ten times the upper limit of normal, positive endomysium antibodies, and appropriate genetics, but required no symptoms. The diagnosis was made by grading the intestinal biopsies. In all, 274 patients were diagnosed with celiac disease. Of these, 59 high-risk subjects, 17 moderate-risk subjects, and 14 low-risk subjects fulfilled the "triple criteria.” All had histologically proven celiac disease, giving the criteria a positive predictive value of 100%. Altogether, 90 of the 274 newly diagnosed patients could have avoided biopsy. That’s one in three patients who could have avoided biopsy. In all, 37% of high-risk, 20% of moderate-risk, and 48% of low-risk patients could have avoided biopsy. Biopsies of "triple positive" subjects showed no histological findings other than celiac disease. The results of this study are exciting, because it shows that the “triple criteria” of transglutaminase 2 antibodies more than ten times the upper limit of normal, positive endomysium antibodies, and appropriate genetics, can be used by doctors to reliably diagnose celiac disease in adults without using biopsy. Implementing these three criteria as a screen would make diagnosing celiac disease easier in many cases, and will reduce the number of endoscopies by one-third. That’s a winning result all the way around. Source: Aliment Pharmacol Ther. 2018 Dec 27. doi: 10.1111/apt.15109. The researchers in this article are variously affiliated with the Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; the Tampere Center for Child Health Research, University of Tampere, and Department of Paediatrics, Tampere University Hospital, Tampere, Finland; the Tampere Faculty of Social Sciences, University of Tampere, Tampere, Finland; the Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; the Department of Dermatology, Tampere University Hospital, Tampere, Finland; the Department of Neurology, Päijät-Häme Central Hospital, Lahti, Finland; the Research Programs Unit, Immunobiology, and Haartman Institute, Department of Medical Genetics, University of Helsinki, Helsinki, Finland; the Department of Internal Medicine, Tampere University Hospital, Tampere, Finland. -
More than One in Ten US Adults Has a Food Allergy
Jefferson Adams posted an article in Latest Research
Celiac.com 01/21/2019 - A population-based survey study of more than 40,000 adults in the United States shows that just over one in ten people had an allergy to at least one food at the time of the survey. However, the same study reveals that nearly 20% of adults believed themselves to have a food allergy. Half of the adults with food allergies reacted to at least one food, while nearly 40% reported at least one food allergy-related emergency room visit in their lifetime. According to the US FDA, the most common food allergens are milk, peanuts, eggs, fish, crustacean shellfish, soy, tree nuts and wheat. How common are food allergies among adults in the United States? How severe are the symptoms, on average? Researchers Seek Accurate Estimates of Adults with Food Allergies A team of researchers recently set out to provide accurate estimates of the national distribution, severity, and factors associated with adult food allergies. The research team included Ruchi S. Gupta, MD, MPH; Christopher M. Warren, BA; Bridget M. Smith, PhD; et al Jialing Jiang, BA; Jesse A. Blumenstock, BS; Matthew M. Davis, MD, MAPP; Robert P. Schleimer, PhD; and Kari C. Nadeau, MD, PhD There have been numerous studies on food allergies in children, but very little is known about food allergy in adults. Food Allergy Can Start in Adulthood The team’s results indicate that more than 10% of US adults, more than 26 million people in all, are allergic to at least one food. That means that food allergies are both common and severe among adults in the United States. Moreover, food allergies often begin in adulthood, rather than in childhood, as is commonly believed. The team calls for greater scrutiny of adults with suspected food allergies, including proper testing and consultation to make sure patients are avoiding the correct foods, and not unnecessarily avoiding foods that are okay for them to eat. Source: JAMA Netw Open. 2019;2(1):e185630. doi:10.1001/jamanetworkopen.2018.5630 The researchers are variously affiliated with the Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois; the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles; the Center for Innovation for Complex Chronic Healthcare, Edward J. Hines Jr Veterans Affairs Hospital, Hines, Illinois; the Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine in Stanford, California. -
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Celiac.com 03/03/2017 - Previous studies have shown us that men are generally less troubled living with celiac disease than are women, but most studies of men with celiac disease have been mostly quantitative, and have a bio-medical emphasis. A team of researchers recently set out to explore the social experience of young men with screening-detected celiac disease and to highlight daily life situations five years after diagnosis. The research team included Ethel Kautto, Cecilia Olsson, Anneli Ivarsson, Phil Lyon, Agneta Hörnell, and Lena Alex. They are variously affiliated with the Department of Food and Nutrition and Umeå Center for Gender Studies, Umeå University, Sweden, the Department of Food and Nutrition, Umeå University, Sweden, the Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden, the School of Arts, Social Sciences and Management at Queen Margaret University, UK, and the Department of Nursing at Umeå University in Sweden. Using a large Swedish school-based celiac screening-study, the team arranged to interview seven young men, all of whom were diagnosed with celiac disease at 13 years-old. The semi-structured interviews were analyzed from a gender perspective which resulted in three themes. Those themes were of young adult men being subjected to changes, striving for normality and emphasizing commitment. Many of young men reported dissociating themselves from being seen as a person with a life-long chronic disease. The analysis also showed that the young men’s daily experiences of living with celiac disease largely depended on their use of characteristics known to be associated with masculinity: such as being self-assured, demanding, and behaving authoritatively. In food situations, where the young men had the ability to make use of such characteristics in their informal group, they experienced fewer negative aspects of the disease. If the young men did not hold a strong position in their informal group, their situation was insecure and vulnerable and this could lead to avoidance of contacts and social meal situations. So, basically, being relaxed and socially confident about eating gluten-free helps to ensure success with the diet. Source: International Journal of Celiac Disease Vol. 4, No. 4, 2016, pp 138-145. doi: 10.12691/ijcd-4-4-7 -
Celiac.com 11/14/2016 - Diagnosis of celiac disease is often delayed, sometimes into adulthood, but researchers don't have much good data on the possible consequences of such a delay. There's plenty of data to show that pediatric patients with celiac disease are often short in stature. However, there's very little data on physical features, including height, of adult patients with celiac disease. A team of researchers recently set out to evaluate whether patients suffering from celiac disease are shorter in comparison with the general population without celiac disease. The research team included Abbas Esmaeilzadeh, Azita Ganji, Ladan Goshayeshi, Kamran Ghafarzadegan, Mehdi Afzal Aghayee, Homan Mosanen Mozafari, Hassan Saadatniya, Abdolrasol Hayatbakhsh, and Vahid Ghavami Ghanbarabadi. The team also assessed likely correlations between demographic and physical features, main complains, serum anti tTG level, and intestinal pathology damage between short versus tall stature celiac patients. They conducted a retrospective cross-sectional study on 219 adult patients diagnosed with celiac disease in the Celiac Disease Center, between June 2008 and June 2014 in Mashhad, Iran. All patients were between 18 and 60 years of age. The team compared the height of the study subjects against a group of 657 age- and sex-matched control cases from the healthy population. They then then compared the likely influencing factors on height such as intestinal pathology, serum level of anti-tissue transglutaminase (anti-tTG), serum vitamin D, and hemoglobin level at the time of diagnosis in short versus tall stature patients with celiac disease. All 65 male and 154 female celiac patients were shorter than their counterparts in the general population "(males: 168.5±8.6 to 171.3±7.2 cm, p less than 0.01 and females: 154.8±10.58 to 157.8±7.2 cm, p less than 0.01). Spearman linear correlation showed height in patient with celiac disease was correlated with serum hemoglobin (p less than 0.001, r=0.285) and bone mineral density (p less than 0.001) and not with serum vitamin D levels (p =0.024, r=0.237), but was not correlated with anti-tTG serum levels (p=0.97)." Celiac patients with upper and lower quartile of height in men and women had no significant difference in the anti-tTG level and degree of duodenal pathology (Marsh grade). Shorter patients more commonly experienced anemia than taller patients. Adults with celiac disease are definitely shorter compared with healthy adults. There is a direct correlation between height and anemia and bone mineral density. This study really drives home the importance of early detection and treatment of celiac disease. Source: Middle East Journal of Digestive Diseases (MEJDD) 2016. 8(4):303-309. -
Celiac.com 08/08/2016 - Celiac-associated duodenal dysbiosis has not yet been clearly defined, and the mechanisms by which celiac-associated dysbiosis could concur to celiac disease development or exacerbation are unknown. To clarify the situation, a research team recently analyzed the duodenal microbiome of celiac patients. The research team included V D'Argenio, G Casaburi, V Precone, C Pagliuca, R Colicchio, D Sarnataro, V Discepolo, SM Kim, I Russo, G Del Vecchio Blanco, DS Horner, M Chiara, G Pesole, P Salvatore, G Monteleone, C Ciacci, GJ Caporaso, B Jabrì, F Salvatore, and L Sacchetti. They are variously affiliated with CEINGE-Biotecnologie Avanzate, Naples, Italy, the Department of Molecular Medicine and Medical Biotechnologies and the Department of Medical Translational Sciences and European Laboratory for the Investigation of Food Induced Diseases at the University of Naples Federico II, Naples, Italy, the Department of Medicine and the University of Chicago Celiac Disease Center, University of Chicago, Chicago, Illinois, USA, the Department of Medicine and Surgery, University of Salerno, Salerno, Italy, the Department of System Medicine, University of Rome Tor Vergata, Rome, Italy, the Department of Biosciences, University of Milan, Milan, Italy, the Institute of Biomembranes and Bioenergetics, National Research Council, Bari, Italy, the Department of Biochemistry and Molecular Biology, University of Bari A. Moro, Bari, Italy, the Northern Arizona University, Flagstaff, Arizona, USA, the IRCCS-Fondazione SDN, Naples, Italy. The team used DNA sequencing of 16S ribosomal RNA libraries to assess duodenal biopsy samples from 20 adult patients with active celiac disease, 6 celiac disease patients on a gluten-free diet, and 15 control subjects. They cultured, isolated and identified bacterial species by mass spectrometry. Isolated bacterial species were used to infect CaCo-2 cells, and to stimulate normal duodenal explants and cultured human and murine dendritic cells (DCs). They used immunofluorescence and ELISA to assess inflammatory markers and cytokines. Their findings showed that proteobacteria was the most abundant, and Firmicutes and Actinobacteria the least abundant, phyla in patients with active celiac disease. In patients with active celiac disease, bacteria of the Neisseria genus (Betaproteobacteria class) were substantially more abundant than it was in either of the other groups (P=0.03), with Neisseria flavescens being most prominent Neisseria species. Whole-genome sequencing of celiac disease-associated Neisseria flavescens and control-Nf showed genetic diversity of the iron acquisition systems, and of some hemoglobin-related genes. Neisseria flavescens was able to escape the lysosomal compartment in CaCo-2 cells and to induce an inflammatory response in DCs and in ex-vivo mucosal explants. Marked dysbiosis and the pronounced presence of a peculiar strain characterize the duodenal microbiome in active celiac disease patients. This suggests that celiac-associated Neisseria flavescens could contribute to the many inflammatory signals in celiac disease. Source: Am J Gastroenterol. 2016 Jun;111(6):879-90. doi: 10.1038/ajg.2016.95. Epub 2016 Apr 5.
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Celiac.com 09/15/2014 - Duodenal intraepithelial lymphocytosis (D-IEL) is an early marker for celiac disease, even though a majority of cases are due to non-celiac disease conditions. Researchers I. Aziz, T. Key, J.G. Goodwin, and D.S. Sanders wanted to identify the predictors of celiac disease in patients presenting with D-IEL. For their study, they reviewed 215 adults with D-IEL who had undergone prospective and systematic evaluation for celiac disease and other recognized associations. They confirmed celiac disease based on presence of HLA-DQ2 and/or DQ8, persistence or progression of D-IEL following a gluten challenge, and an improvement in symptoms with a gluten-free diet. To compare factors in celiac and non-celiac cases, and to determine their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), the team used binary logistic regression models, adjusted for age and sex. They diagnosed celiac disease in 48 cases (22%) and non-celiac in 167 cases (78%). They found no statistical difference between the celiac and non-celiac group in terms of baseline demographics, anemia, hematinics, or clinical symptoms, such as diarrhea, weight loss, abdominal pain. Compared with their non-celiac counterparts, celiac patients were significantly more likely to have a positive family history of celiac disease (21% vs. 3.6%, OR 6.73; PPV 62.5%, NPV 81%, specificity 96.4%), positive HLA-DQ status (100% vs. 49.1%; PPV 36.4%, NPV 100%, specificity 50.9%), and presence of endomysial antibody (EMA) (48% vs. 0%; PPV 100%, NPV 87%, specificity 100%); all P≤0.001. A total of 29.2% celiac and 83.2% non-celiac cases showed normal tissue transglutaminase antibody (TTG) levels (OR 0.084, P<0.001; PPV 9.2%). Between the groups, there was no difference in the prevalence of TTG levels 1 to 2×upper limit of normal (29.2% celiac vs. 14.4% non-celiac; PPV 33% to 38%). However, TTG levels between 3 and 20×ULN were much more common in the celiac group (33.3% vs. 2.4%, PPV 66.6% to 89%), whereas a TTG>20×ULN was exclusive to celiac disease (8.3%, P<0.001, PPV 100%). For patients with D-IEL, only a positive EMA or TTG greater than 20×ULN at the outset can yield an immediate celiac diagnosis. On their own, factors such as gastrointestinal symptoms, family history, anemia, or other celiac serology results do not reliably distinguish celiac from non-celiac patients. Source: J Clin Gastroenterol. 2014 Jul 10. -
Celiac.com 11/22/2009 - Celiac disease has been associated with numerous other auto-immune disorders. Recently, there appeared the case of a 40-yr-old competitive strongman with celiac disease, who responded to a gluten-free diet, but developed profound and generalized motor weakness with acetylcholine receptor antibody positive myasthenia gravis, a disorder reported to occur in about 1 in 5000 people. A team of researchers set out to further explore this possible relationship between myasthenia gravis and celiac disease via serological study. The research team was made up of Hugh J Freeman, Helen R Gillett, Peter M Gillett, Joel Oger of the Department of Medicine (Gastroenterology and Neurology) at Canada's University of British Columbia. The researchers performed celiac disease screens on frozen stored serum samples from 23 acetylcholine receptor antibody positive myasthenia gravis patients with no intestinal symptoms. They examined both endomysial and tissue transglutaminase antibodies. One in 23 samples (or, about 4.3%) tested positive for both IgA-endomysial and IgA tissue transglutaminase antibodies. Subsequent endoscopic study showed duodenal mucosal scalloping, while biopsies confirmed the histopathological changes of celiac disease. From this, they concluded that celiac disease and myasthenia gravis may occur together more often than is currently understood. Muscle weakness in celiac disease may be a sign of possible occult myasthenia gravis, even in the absence of intestinal symptoms. Source: World J Gastroenterol 2009 October 14; 15(38): 4741-4744
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Celiac.com 10/23/2013 - Celiac disease remains seriously under diagnosed in adults and, in many places, often takes years and even decades to diagnose. A team of researchers recently evaluated the usefulness of an on-site rapid fingertip whole blood point-of-care test (POCT) that would help primary workers to spot patients who might benefit from further diagnostic tests for celiac disease. The research team included Alina Popp, Mariana Jinga, Ciprian Jurcut, Vasile Balaban, Catalina Bardas, Kaija Laurila, Florina Vasilescu, Adina Ene, Ioana Anca and Markku Mäki. They are affiliated with the University of Medicine and Pharmacy “Carol Davila,” the Institute for Mother and Child Care “Alfred Rusescu,” Central University Emergency Military Hospital “Dr. Carol Davila,” Str. Mircea Vulcanescu, in Bucharest, Romania and with theTampere Center for Child Health Research, University of Tampere and Tampere University Hospital, in Tampere, Finland. Because celiac disease often runs in families, the team tested 148 healthy relatives of 70 Romanian index cases with biopsy-proven celiac disease, for a total of 87% of all first-degree family members, with a median age 36 years, for the presence of circulating autoantibodies. In addition to using the POCT to measures blood erythrocyte self-TG2-autoantibody complexes on site, the team took blood samples for later evaluation of serum IgA-class endomysial antibodies (EMA). The then tested all EMA-positive samples for transglutaminase 2 antibodies (TG2-IgA). They conducted blind analysis of all serological parameters in a centralized laboratory with no knowledge of the on site POCT result. The team recommended endoscopic small intestinal biopsies for all POCT- or EMA-test positive subjects. Overall, 12 of 148 (8%) first-degree relatives showed positive results for the POCT, and all twelve tested serum EMA-positive. Only one other test subject showed a positive EMA test result. All remaining 135 healthy first-degree relatives showed negative results for both POCT and EMA. Four subjects who tested positive for both POCT and EMA were negative for TG2-IgA. Ten out of thirteen of the antibody-positive subjects consented to endoscopy. In all, eight out of nine first-degree relatives with celiac-type mucosal lesions of grade Marsh 2 (n = 3) or Marsh 3 (n = 6) showed positive results with the POCT. The three POCT-positive subjects refused endoscopy tested positive for both EMA and TG2-IgA. The fingertip whole blood rapid POCT could be a simple and cheap way to spot biomarkers and promote further testing for faster diagnosis of celiac disease. The team is calling for further studies in adult case-finding in specialized outpatient clinics and in primary care. Source: BMC Gastroenterology 2013, 13:115. doi:10.1186/1471-230X-13-115
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Celiac.com 09/02/2013 - Most people with celiac disease are now diagnosed as adults, and many suffer from impaired bone mineralization. Researchers A.J Lucendo and A. García-Manzanares recently conducted a review of bone mineral density in patients with adult celiac disease. Their goal was to provide an updated discussion on the relationship between low bone mineral density (BMD), osteopenia and osteoporosis, and celiac disease. They conducted a search of relevant articles published in PubMed over the last 15 years. They also reviewed all sources cited in the article results to identify potential sources of information. They found that up to 75% of celiac patients can suffer from low BMD, which can occur at any age, independently of positive serological markers and presence of digestive symptoms. Patients with osteoporotic issues have significantly higher rates of celiac disease. The team proffers two theories which may explain the origins of low BMD in celiac patients. The first says that low BMD may result from malabsorption of micronutrients (including calcium and vitamin D) determined by villous atrophy, which has has been related to secondary hyperparathyroidism and incapacity to achieve the potential bone mass peak; The second theory says that low BMD may result from chronic inflammation, which was also related with RANKL secretion, osteoclasts activation and increased bone resorption. Whatever the cause of the low BMD, people with celiac disease have more than 40% higher rates of bone fractures compared to matched non-celiac individuals. Treatment of low BMD in celiac disease includes gluten-free diet, supplementation of calcium and vitamin D, and the use of biphosphonates, the effects of which on celiac disease have not been specifically studied. Up to 75% of people with celiac disease, and 40% of those diagnosed in adulthood show low BMD, along with increased risk of bone fractures. This information shows the potential importance of bone density scans for adults with celiac disease. Source: Rev Esp Enferm Dig. 2013 May;105(3):154-162. -
Dental Enamel Defects Indicate Adult Celiac Disease
Jefferson Adams posted an article in Latest Research
Celiac.com 08/23/2013 - Previous studies have noted the presence of dental enamel defects in people with celiac disease. A team of researchers recently set out to study the prevalence of dental enamel defects in adults with celiac disease, and to determine if there is in fact a connection between the grade of teeth lesion and clinical parameters present at the time of diagnosis of celiac disease. The research team included L.Trotta, F. Biagi, P.I. Bianchi, A. Marchese, C. Vattiato, D. Balduzzi, V. Collesano, and G.R. Corazza. They are affiliated with the Coeliac Centre/First Department of Internal Medicine at the Fondazione IRCCS Policlinico San Matteo at the University of Pavia in Italy. The team looked at 54 celiac disease patients who had undergone dental examination. The patients included 41 females and 13 males, with an average age of 37±13 years, and with an average age of 31±14years at the time of diagnosis. Symptoms leading to diagnosis were diarrhea/weight loss (32 pts.), anaemia (19 pts.), familiarity (3 pts.). None of the patients was diagnosed because of enamel defects. At the time of evaluation, all of the patients were following a gluten-free diet. The team classified enamel defects from grade 0 to 4 according to severity. They found dental enamel defects in 46 of the 54 patients (85.2%). They found grade 1 defects in 18 patients (33.3%), grade 2 defects in 16 patients (29.6%), grade 3 defects in 8 patients (14.8%), and grade 4 defects in 4 patients (7.4%). They also observed that grades 3 and 4 were more common in patients diagnosed with classical rather than non-classical coeliac disease (10/32 vs. 2/20). However, this was not statistically significant. From this study, the team concludes that enamel defects are common in adult celiac disease, and that the observation of enamel defects offers a way to diagnose celiac disease. Source: Eur J Intern Med. 2013 Apr 6. pii: S0953-6205(13)00091-5. doi: 10.1016/j.ejim.2013.03.007. [Epub ahead of print] -
Celiac.com 08/19/2013 - Data from blood studies suggest that about 1% or so of North Americans have celiac disease. However, there is no good screening data based on small intestinal biopsy performed during routine endoscopic evaluations. Researcher H.J Freeman recently set out to determine rates of detection of adult celiac disease via duodenal screening biopsies over a thirty year period. For his study, he looked at patients referred between January 1982 and December 2011 for evaluation of gastrointestinal symptoms that required elective investigative upper endoscopic assessment, and who underwent duodenal biopsies to determine whether changes of adult celiac disease were present. Freeman looked at a total of 9665 patients, including 4008 (41.5%) males and 5657 (68.5%) females, who underwent elective endoscopies and duodenal biopsies. Overall, 234 patients (2.4%) exhibited changes of celiac disease. That included 73 males (1.8%) and 161 females (2.8%). During the first 20 years, the number of biopsy-positive patients in five-year intervals progressively decreased, while, during the next 10 years, the number progressively increased. From this study, the team concludes that celiac disease is far more common in specialist practice than has been suggested in the evaluation of healthy populations using serological screening studies. Endoscopic duodenal biopsy is an important way to spot underlying celiac disease and should be routinely considered in all patients undergoing an elective endoscopic evaluation. They also note that the appearance of biopsy-defined celiac disease may be influenced by non-inherited factors, possibly environmental, which alter its detection over time. Source: Can J Gastroenterol. 2013 Jul;27(7):405-8.
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Celiac.com 07/12/2012 - A research team affiliated with the Department of Endocrinology and Nutrition at Complejo Hospitalario Mancha Centro in Alcázar de San Juan, Spain, recently set out to study how bone mineral density correlates with duodenal Marsh stage in newly diagnosed adult celiac patients. The team made up of A. García-Manzanares, J.M. Tenias, and A.J. Lucendo. For their study, the researchers wanted to estimate the rates of low bone mineral density (BMD) in adult celiac patients and to better understand nutritional and metabolic factors associated with osteoporosis and osteopenia. To do so, they recruited patients a consecutive group of 40 adults (36 females/4 males), between the ages of 18 and 68, who were newly diagnosed with celiac disease. Average patient age was 44.25 years. For each patient, the researchers conducted bone density scans on the left hip and lumbar spine using dual-energy X-ray absorptiometry. They also assessed nutritional parameters and conducted a hormone study to exclude secondary low BMD. Overall, at diagnosis 45% of patients showed low BMD at both hip and lumbar spine. Risk of hip fracture was generally low, but climbed into the mild range for patients with villous atrophy (p = 0.011). The team also found that major fracture risk varied according to Marsh stage (p = 0.015). They found significant differences in nutritional status between patients with and without duodenal villous atrophy. Marsh III stage patients showed substantially reduced body mass index and blood levels of pre-albumin, iron, vitamin D and folic acid. The team found no differences found in blood hormone levels between Marsh stages or BMDs. They found that the amount of bone mass loss in the lumbar spine was directly tied to Marsh stage. They found a parallel association between BMD and Marsh stage in the hip, but this was not statistically significant. Overall, results showed that duodenal villous atrophy, through malabsorption, was the main factor for low BMD in patients with adult-onset celiac disease. Source: Scand J Gastroenterol. 2012 May 16.
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Celiac.com 09/15/2010 - Until the present study, no clinical research had been published regarding the relative effects of clinical and psychosocial variables on outcome in celiac disease. A team of researchers examined psychosocial factors that may influence disease activity in celiac patients, such as relationships among demographics, psychosocial factors, and disease activity with health-related quality of life (HRQOL), health care utilization, and symptoms. The research team included Spencer D. Dorn, Lincoln Hernandez, Maria T. Minaya, Carolyn B. Morris, Yuming Hu, Suzanne Lewis, Jane Leserman, Shrikant I. Bangdiwala, Peter H. R. Green and Douglas A. Drossman of the Center for Functional GI and Motility Disorders at the University of North Carolina, Chapel Hill, USA. The team enrolled 101 adult patients with celiac disease with the goal of charting any relationships among demographics, psychosocial factors, and disease activity with health-related quality of life (HRQOL), health care utilization, and symptoms. All patients were newly referred to a tertiary care center with biopsy-proven celiac disease. The team examined: (a) demographic factors and diet status; ( disease measures (Marsh score, tissue transglutaminase antibody (tTG) level, weight change and additional blood studies); and © Psychosocial status (psychological distress, life stress, abuse history, and coping). They then conducted multivariate analyses to predict HRQOL, daily function, self-reported health, number of physician visits, and GI symptoms, such as pain and diarrhea. They found that patients with psychological distress and poor coping skills suffered from impaired HRQOL and daily function. Patients who reported poorer health generally showed poorer coping, longer symptom duration, lower education, and greater weight loss. Patients with poorer coping, abnormal tTG levels, and milder Marsh classification generally had more physician visits. Patients with higher psychological distress and greater weight loss also showed higher pain scores. Patients with greater psychological distress and poorer coping also showed higher rates of diarrhea. Their results show that among patients at celiac disease referral centers, psychosocial factors have a greater impact on health status and GI symptoms than does disease activity. Such factors should be considered as part of the patient's treatment and prognosis. Source: Dig Dis Sci. 2010 Jul 30. DOI: 10.1007/s10620-010-1342-y -
No Higher Rotavirus Risk for Adult Celiac Disease Patients
Jefferson Adams posted an article in Latest Research
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Celiac.com 09/03/2010 - Many patients who show up at hospitals and clinics with non-specific gastrointestinal symptoms have rotavirus infection A team of researchers recently studied a large cohort of adults with non-specific gastrointestinal complaints to see if people with celiac disease had any higher for rotavirus. The research team included Mohammad Rostami-Nejad, BS, Kamran Rostami, MD,PhD, Maryam Sanaei, MSc, Seyed R. Mohebbi, PhD, David Al-Dulaimi, MD, Ehsan Nazemalhosseini-Mojarad, MSc, Pekka Collin, MD, Chris J. Mulder, MD, PhD, Mohammad R. Zali, MD, FACG. They are associated variously with the Research Center of Gastroenterology and Liver Diseases at Shaheed Beheshti University in Tehran, Iran; the School of Medicine of the University of Birmingham, UK, the Department of Gastroenterology at Alexander Hospital in Redditch, UK; the Department of Gastroenterology and Alimentary Tract Surgery at Tampere University Hospital in Finland, and with the Department of Gastroenterology at VU University Medical Center in Amsterdam, The Netherlands. The team conducted the study at the Research Center of Gastroentrology and Liver Disease at Taleghani Hospital in Tehran, Iran. For their study, they randomly selected 5176 individuals living in Tehran, Iran between September 2006 and September 2007. Using a questionnaire, they found 670 case of GI symptoms, each of whom was invited for additional study, including stool sampling and blood tests. The researchers screened stool samples for rotavirus using amplification of specific gene (VP6), light microscopy and formalin-ether concentration methods. They also tested subjects for celiac disease including anti-transglutaminase (tTG) antibodies and total immunoglobulin A (IgA). The research team found the VP6 gene in 150 (22.3%) individuals. 22 subjects showed positive results for anti-tissue transglutaminase (tTG-IgA) (95% CI 2.3-5.1), while three patients who were IgA deficient tested positive for the IgGtTG antibody. Eight of 25 patients (32%) showed amplification of VP6 gene, and positive blood screens for celiac disease, while 142 of 645 with negative celiac blood tests (22%) showed amplification of VP6 gene. They found no statistically important difference between the two groups (p=0.2). Unlike earlier studies in children, this adult study shows that rates of active rotavirus infection were about the same for adults who tested positive for tTG antibody as they were for adults who tested negative for tTG antibody. Based on this study, there is no higher rotavirus risk for adults with celiac disease. Source: Saudi Med J 2010; Vol. 31 (8):891-4.
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