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Found 30 results

  1. Celiac.com 02/19/2018 - It's very important that people with celiac disease maintain a gluten-free diet. Still, there has been some data to suggest that some people with celiac disease may be "hyper vigilant" in their approach to a gluten-free diet, and that such extreme vigilance can cause them stress and reduce their overall quality of life. Can a more relaxed approach improve quality of life for some people with the disease? A team of researchers recently set out to determine whether "extreme vigilance" to a strict gluten-free diet may increase symptoms such as anxiety and fatigue, and therefore, lower quality of life (QOL). The research team included Randi L. Wolf, Benjamin Lebwohl, Anne R. Lee, Patricia Zybert, Norelle R. Reilly, Jennifer Cadenhead, Chelsea Amengual, and Peter H. R. Green. They are variously affiliated with the Department of Health and Behavior Studies, Program in Nutrition, Teachers College Columbia University New York USA, the Department of Medicine, Celiac Disease Center Columbia University Medical Center, Harkness Pavilion New York, USA. The team assessed the influence of QOL with energy levels and adherence to, and knowledge about, a gluten-free diet. For their cross-sectional prospective study, the team looked at 80 teenagers and adults, all with biopsy-confirmed celiac disease, living in a major metropolitan area. They assessed QOL using celiac disease-specific metrics. The team based dietary vigilance on 24-hour recalls and an interview. They based knowledge on a food label quiz. They used open-ended questions to describe facilitators and barriers to following a gluten-free diet. Overall, extremely vigilant adults had greater knowledge, but significantly lower QOL scores than their more relaxed counterparts. Both teens and adults who reported lower energy levels had much lower overall QOL scores than those with higher energy levels. To maintain a strict gluten-free diet, hyper-vigilant celiacs were more likely to avoid eating out, to cook at home, and to use internet sites and apps. For hyper vigilant eaters, eating out was especially challenging. Being hyper-vigilant about maintaining a strict gluten-free diet can cause stress and adverse effects in both teens and adults with celiac disease. Doctors may want to look toward balancing advocacy of a gluten-free diet with promoting social and emotional well-being for celiac patients. In some cases, allowing a more relaxed approach may increase well-being and, thus, make dietary adherence easier. Obviously, people would need to tailor any relaxation in their gluten-free vigilance to make sure they weren't suffering preventable symptoms or doing themselves any harm. Source: Dig Dis Sci (2018)
  2. Celiac.com 08/18/2017 - In a recent issue of Journal of Gluten Sensitivity, we announced a research study/survey for adults who are 18 or older and living the "gluten-free" lifestyle in a household with other adults over 18. Click here to read the Survey Overview Article. The survey is a research study conducted by Jean Duane, PhD Student at the University of Denver. It will focus on family interactions when dealing with dietary restrictions, with the potential to increase family members' compliance. It will seek to gain insight on the perceived impact one adult's food restrictions cause in a household when cohabitating with other adults. This study has social significance because family unity in the future may rely on developing strategies for compliance to address this emerging social problem. Please consider participating in this survey if you are an adult living the gluten-free lifestyle who cohabitates with another adult who may or may not have food restrictions. Your responses will be kept confidential. The survey should take around 10 minutes to complete and a compilation of the results will be published in an upcoming issue of the Journal of Gluten Sensitivities on Celiac.com. As a "thank you" for participating in this survey, your name will be entered into a drawing. Four lucky winners will receive a $25 Amazon.com gift card. If you are interested in participating in a more in-depth interview to discuss your coping strategies, successes and struggles, you will be prompted at the end of the survey to provide contact information. Jean Duane will contact you and schedule a mutually agreeable time for the interview. To take the survey, please click here: NOTE: SURVEY CLOSED AS OF 9/18/2017.
  3. Celiac.com 04/21/2017 - Adults who have gluten sensitivities cohabitating with non-gluten sensitive adults may have a lot of unanswered questions that need to be asked. Dramatic changes in one family member's diet can have profound effects on a household (Bacigalupe & Plocha, 2015). Numerous studies document how parents and children handle everyday living when the child has food intolerances, but very few studies focus on adults living with food sensitivities. Wouldn't you like to know how other adults with food sensitivities adapt and manage over the long haul? Questions like: Does the person with the sensitivity live in fear of cross-contamination? Does the household employ methods to ensure s/he is safe? If so, what are those methods? Do the non-sensitive members of the household feel resentment? Or have they grown weary of compliance over the long haul? How adherent is the sensitive adult? Is it worth a little risk for a little pleasure once in a while? What do these cohabitating adults do to exist gracefully? These questions will be asked in a forthcoming study (on Celiac.com), and the results will be shared with viewers/readers. Food allergies affect 15 million Americans (FARE, 2015), which means that adults with food sensitivities have gone from being rare to more commonplace as the population ages (Norling, 2012). Dietary restrictions due to disease will soon become common in many households and this can be problematic because severe dietary constraints are positively associated with diminished family social activities (Komulainen, 2010). Studies indicate that adults cohabitating, when one has food sensitivities and others do not, could potentially result in problems between members of the household creating feelings of uncertainty and potentially less adherence to the diet. Regimented dietary requirements affect the quality of life when virtually every bite of food must be scrutinized before consumption. For some households, compliance may fall on the shoulders of the person who cooks. The cook in the household, caregivers, and everyone sharing the same kitchen, must be actively involved in protecting the person with the sensitivities keeping gluten-containing crumbs off the counter, out of condiment jars, thoroughly cleaning utensils, etc. (Crowley, 2012; Bollinger, 2005; Merras-Salmino et al., 2014). Of course, those living with sensitivities know there is a lot more to staying "clean and safe." Family members who share a home with someone with pervasive food sensitivities must express empathy to ensure harmony and compliance (Komulainen, 2010). However, compliance comes with a price -- every meal must be planned and cooked using alternative ingredients to avoid accidental ingestion. This takes diligence, education and ability to accomplish meal after meal (Jackson et al., 1985) especially when allergies are to ubiquitous foods such as dairy, soy, gluten or corn. Dietary restrictions can cause misgivings on the part of the other family members, who may feel deprived of their favorite foods, compromised with recipe adaptations, or forced to unwillingly comply with the other person's diet. On the contrary, the person with food sensitivity may feel pressure not to comply with the diet in order to conform to the other adult's culinary demands. In the Jackson et al. study, forty percent of people with Celiac disease did not comply with the diet because it was too difficult (1985). The relationship between the cohabitating adults may be further complicated as trust issues develop between the sensitive adult and the cook, if the sensitive adult suspects foods that make them sick are creeping into their diet. Other food-sensitive adults report non-adherence because it is "too much trouble" and causes "social isolation" (Coulson, 2007). Non-adherence for those with sensitivities can lead to reactions, anaphylactic shock and even to death (Lee et al., 2003). Even those who do not react immediately risk long-term illness with non-compliance. In my twelve years experience working with people in this arena, I have observed that dietary adherence in the household seems to go through phases. The first phase is what I'm calling the "transition" stage when a person is newly diagnosed, and everyone in the household is learning the new rules. The second stage is the "status quo" stage where cohabitants understand, and hopefully comply. Finally, the third stage is what I'm terming as 'turbulent' when other adult household inhabitants are feeling weary of compliance, may have doubts about the other's sensitivities, or even rebel. This stage may be triggered by an event that disrupts the "status quo", such as a holiday where traditional foods are expected, and where their gluten-free substitutions may not be as satisfying to the other household members. It may be triggered when the food sensitive adult decides they may be reacting to different foods than they thought before, and want to experiment with dietary changes. Dynamics between cohabitants may become turbulent during these times. After the event, the household adjusts back to equilibrium until the next triggering event, which throws them into a different part of this phase-cycle, where they may cheerfully welcome a "transition," or react with "turbulence." This cyclical pattern seems to continue as cohabitants move in and out of phases as life-events occur. One of the goals of this survey will be to determine the validity of this cycle. I also want to test the hypothesis that a component of household compliance may also be associated with the status of the adult who has the dietary restrictions – whether the head of the home enjoys full household compliance, or if a subordinate adult must comply while others are eating the foods s/he are sensitive to. Another factor that may affect compliance is how the sensitive adult was initially diagnosed. Did a medical doctor conduct tests? Or did they read an article, and notice that they had symptoms consistent with gluten sensitivity and decide to go "gluten free?" Does the diagnostic process affect the compliance of the other adult members of the household? There are many factors that need to be assessed in order to help those of us who have food sensitivities who are living with other adults. This survey/study will focus on family interactions when dealing with dietary restrictions, with the potential to increase family member's compliance. It will seek to gain insight on the impact food restrictions for one adult has on the rest of the family. This study has social significance because family unity in the future may rely on developing constructs for compliance to address this emerging social problem. I'll collect data for this study and then share it with Celiac.com and the Journal of Gluten Sensitivity readers in order to create awareness by thoroughly examining the lifestyle of food sensitive people, shedding light on how social influences affect dietary adherence. As a PhD student at the University of Denver, and an adult with Celiac disease and a lifetime of other food allergies, living with another adult who has no food sensitivities, I know first-hand that it takes cooperation and commitment from everyone to ensure my health. I hope the study can help others improve their quality of life with the insight gained from conducting this study. I'll be launching this study on Celiac.com. Thank you to Scott Adams for allowing this study to be conducted on Celiac.com.
  4. Celiac.com 07/08/2016 - If their symptoms don't get worse, many patients diagnosed with celiac disease as children do not pursue follow-up care as adults, according to data presented at Digestive Disease Week 2016. There's been some really good stuff coming out of Digestive Disease Week 2016 in San Diego. One example is a talk given by Norelle Reilly, MD, from the division of pediatric gastroenterology and the Celiac Disease Center at Columbia University Medical Center in New York City. According to data presented by Dr. Reilly many patients diagnosed with celiac disease as children do not pursue follow-up gastroenterology care as adults, unless symptoms worsen. Reilly and colleagues sent a 33-question survey to nearly 8,000 recipients via the medical center's proprietary distribution list and received 98 qualified responses. According to Reilly, 37% of respondents said they were not seeking ongoing care for celiac disease. These respondents reported an average of 2 to 5 years, and sometimes as many as 10 years, between doctor visits for their celiac disease. Compare that with an average of six months between doctor visits for people who were getting regular care. Large numbers of patients diagnosed with celiac disease in childhood do not seek follow-up care as adults, especially those diagnosed earlier in childhood, who may have fewer ongoing symptoms, Reilly said. She ended her talk by asking "providers caring for children and adolescents with celiac disease [to] educate early as to the importance of ongoing care, emphasize the importance of follow-up and the reasons for follow-up, particularly with patients who lack symptoms and may not seek care otherwise and to provide a referral, and formally transition the patient to adult care to improve compliance." Reference: Reilly N, et al. Abstract #35. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego. Read more at Helio.com.
  5. Celiac.com 06/01/2016 - People with potential celiac disease (PCD) have blood and genetic markers for celiac disease, but show little or no damage to the small intestinal mucosa. A research team recently conducted a prospective study to learn more about how the disease progresses in these individuals. The research team included U Volta, G Caio, F Giancola, KJ Rhoden, E Ruggeri, E Boschetti, V Stanghellini, and R De Giorgio. They are all affiliated with the departments of Medical and Surgical Sciences and Digestive System, Centro di Ricerca Biomedica Applicata at the University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy. For their study the team collected data from 59 women and 18 men, averaging 33 years of age. The patients were all diagnosed with potential celiac disease, based on blood tests and HLA type, at Bologna University in Italy from 2004 through 2013. All patients had either slight inflammation of the small intestinal mucosa, or normal mucosa. The team assessed clinical, laboratory, and histologic parameters at diagnosis and during a 3-year follow-up period. Forty-six female and 15 male patients, with an average age of 36 years, showed intestinal and extra-intestinal symptoms, whereas the remaining 13 female and 3 male patients, averaging 21 years of age, showed no symptoms at diagnosis. All subjects tested positive for immunoglobulin A endomysial antibody and tissue transglutaminase antibody, except for 1 patient with immunoglobulin A deficiency; 95% of patients carried the HLA-DQ2 gene. Duodenal biopsies showed that 26% of patients had a Marsh score of 0, while 74% had a Marsh score of 1. Thirty-six percent of symptomatic patients had autoimmune disorders, and 41% had antinuclear antibodies, compared to just 5% and 12% asymptomatic patients, respectively. Symptomatic patients were generally older at diagnosis (P < .05). Gluten-free diet led to significant clinical improvement in all 61 symptomatic patients. The 16 asymptomatic patients continued on gluten-containing diets, and only 1 developed mucosal flattening; levels of anti-endomysial and tissue transglutaminase antibodies fluctuated in 5 of these patients or became undetectable. This 3-year study of adults with potential celiac disease shows that most do have symptoms, which improved on gluten-free diet. However, asymptomatic adults with potential celiac disease do not tend to develop villous atrophy, and so do not require treatment with a gluten-free diet. Source: Clin Gastroenterol Hepatol. 2016 May;14(5):686-693.e1. doi: 10.1016/j.cgh.2015.10.024. Epub 2015 Oct 30.
  6. Celiac.com 03/02/2016 - A team of researchers recently completed the first extensive study comparing gene expression in children and adults with celiac disease, and found some key differences between the two groups. The research team included V. Pascual, L. M. Medrano , N. López-Palacios, A. Bodas, B. Dema, M. Fernández-Arquero, B. González-Pérez, I. Salazar, and C. Núñez. They are variously affiliated with Servicio de Pediatría, Servicio de Aparato Digestivo, and Servicio de Inmunología Clínica at the Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain, and with the Departamento de Producción Animal, Facultad de Veterinaria, and the Departamento de Estadística e Investigación Operativa I, Facultad de Matemáticas, Universidad Complutense de Madrid in Madrid, Spain. For their study, the team collected 19 duodenal biopsies of children and adults with celiac disease and compared the expression of 38 selected genes between each other, and in 13 non-celiac disease control subjects matched by age. The team used a Baysian methodology to analyze the differences of gene expression between groups. They found that, compared to controls, children and adults with celiac disease all had seven genes with a similarly altered expression. These were C2orf74, CCR6, FASLG, JAK2, IL23A, TAGAP and UBE2L3. The team found differences in 13 genes, six of which were altered only in adults (IL1RL1, celiac disease28, STAT3, TMEM187, VAMP3 and ZFP36L1) and two only in children (TNFSF18 and ICOSLG); while four genes show a significantly higher alteration in adults (CCR4, IL6, IL18RAP and PLEK) and one in children (C1orf106). Between the two groups, the team found significant differences in the expression level of several genes, most notably the higher alteration seen in adults. The team is calling for further research to assess possible genetic influences behind the changes, along with the specific physical consequences of the reported differences. Source: PLOS.ORG. Published: February 9, 2016. DOI: 10.1371/journal.pone.0146276
  7. Celiac.com 01/08/2016 - Adults with both celiac disease and type 1 diabetes face an increased risk of developing thyroid disease, according to a new study. The study was done by researchers Matthew Kurien, Kaziwe Mollazadegan, David S. Sanders and Jonas F. Ludvigsson. They are variously affiliated with the Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, U.K., the Academic Unit of Gastroenterology at the University of Sheffield in Sheffield, U.K., the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet in Stockholm, Sweden, and the Department of Pediatrics of Örebro University Hospital at Örebro University in Örebro, Sweden. For their population-based cohort study, Dr. Kurien and colleagues analyzed data from Swedish National Patient Register between 1964 and 2009. Their team identified all 42,539 patients diagnosed with type 1 diabetes before age 31 years of age. They used small intestinal biopsy reports showing villous atrophy to identify 947 type 1 diabetes patients with celiac disease between 1969 and 2008 (55.1% women; mean age of celiac disease diagnosis, 12 years). The research team then selected up to five type 1 diabetes patients as controls for each patient with both type 1 diabetes and celiac disease, and matched them for age, sex and birth year. They selected 4,584 in all; 54.5% women. They then used Cox regression analysis to calculate hazard ratios for future thyroid disease, with celiac disease as a time-dependent variable. They found that, over an average 13 years of follow-up, 90 patients in the group with both type 1 diabetes and celiac disease developed autoimmune thyroid disease (either hypothyroid or hyperthyroid); with an average age at thyroid disease diagnosis of 25 years old. In total, nearly 11% of patients in the type 1 diabetes and celiac disease group were diagnosed with thyroid disease at some stage of life vs. 7.2% of patients with type 1 diabetes without celiac disease. Patients with both type 1 diabetes and celiac disease faced an increased risk for hypothyreosis (HR = 1.66; 95% CI, 1.3-2.12) and hyperthyreosis (HR = 1.71; 95% CI, 0.95-3.11). The RR for thyroid disease in patients with both type 1 diabetes and celiac disease was 1.67 (95% CI, 1.32-2.11). The team found the highest risk levels for thyroid disease in patients from 1964-1975, which they attributed to poor screening for thyroid disease in type 1 diabetes patients during that time. The researchers noted that the highest risks in patients with more than ten years of celiac disease, which suggests that long-term double autoimmunity is a risk factor for autoimmune thyroid disease. Source: Diabetes Care. 2015. doi:10.2337/dc15-2117.
  8. Celiac.com 06/24/2015 - The Danish National Patient Registry records about 50 cases of celiac disease per 100,000 persons. This is much lower than the celiac rates reported in other Nordic countries, and many doctors have suspected that the condition is being under-diagnosed. So, how common is under-diagnosis of celiac disease? A team of researchers recently set out to answer that question by conducting a population-based study of Danish adults. The research team included A. Horwitz, T. Skaaby, L.L. Kårhus, P. Schwarz, T. Jørgensen, J.J. Rumessen, and A. Linneberg. They are affiliated with the Research Centre for Prevention and Health, The Capital Region at the University of Copenhagen in Copenhagen, Denmark. They screened a total of 2,297 adults aged 24-76 years living in the southwestern part of Copenhagen for celiac disease via immunoglobulin (Ig)A and IgG antibodies to transglutaminases and deamidated gliadin. They invited IgA/IgG-positive participants to a have a clinical evaluation, including biopsies, by a gastroenterologist. Of 56 invited participants, 40 underwent a full clinical evaluation, 8 of whom were diagnosed with celiac disease. Experts considered 2 of the 16 persons who declined the clinical evaluation to be likely positive for celiac disease. None of the above 56 participants had a known history of celiac disease or a recorded diagnosis of celiac disease in National Patient Registry. By combining the 8 cases of biopsy-proven celiac disease, the 2 cases of probable celiac disease, and 1 registry-recorded case of celiac disease, the team calculated 11 celiac cases out of 2,297 study participants. From this number, the team estimated celiac disease rates to be 479 per 100,000 persons, for the general population (95% CI: 197-761). This figure is 10 times higher than the registry-based prevalence of celiac disease. Of 11 participants diagnosed with celiac disease in our screening study, 10 were unaware of the diagnosis prior to the study. Thus, the team suggests that celiac disease is profoundly under-diagnosed in Danish adults. Source: Scand J Gastroenterol. 2015 Jul;50(7):824-31. doi: 10.3109/00365521.2015.101057.
  9. Celiac.com 07/13/2010 - More and more, researchers are showing connections between inflammatory diseases, like celiac disease, and complex disorders, such as anxiety and depression. There's also a good amount of anecdotal evidence to suggest that people with celiac disease have higher rates of anxiety and depression than the general population. A study of the German population is the first to show that female adults following a gluten-free diet for celiac disease show higher levels of anxiety than do members of the general population. The researchers are recommending that female celiacs on a gluten-free diet be screened for anxiety. The researchers included W. Häuser, K. H. Janke, B. Klump, M. Gregor, and A. Hinz of the Department of Internal Medicine I of the Klinikum Saarbrücken, Winterberg in Saarbrücken, Germany. The team set out to examine levels of depression and anxiety between adults with celiac disease following a gluten-free diet (GFD), and in control subjects drawn from the general population. For their study, the team used the Hospital Anxiety and Depression Scale to measure levels of anxiety, depression, and likely anxiety or depressive disorder, in 441 adult patients with celiac disease recruited by the German Celiac Society. They then conducted the same assessments on 235 comparable patients with inflammatory bowel disease (IBD), either in remission or with slight disease activity. They did the same for the cross-sample control group of 441 adults from the general population. The team used regression analysis to test possible demographic and disease-related predictors of anxiety and depression in celiac disease. Demographic predictors included age, sex, social class, and family status. Disease-related predictors included latency to diagnosis, duration of GFD, compliance with GFD, thyroid disease. The team found that female gender (P = 0.01) was the main predictor (R(2) = 0.07) of anxiety levels in patients with celiac disease. Female patients had a higher risk for a probable anxiety disorder (OR = 3.6, 95% CI: 1.3-9.4, P = 0.01) Patients who lived alone (OR = 0.5, 95% CI: 0.2-0.9, P = 0.05) enjoyed a lower risk of anxiety disorder. None of the demographic and medical variables for which the team screened predicted either depression levels or risk for a probable depressive disorders. Patients with celiac disease showed anxiety levels of 6.6 +/- 3.4, and those with IBD, anxiety levels of 6.9 +/- 3.7, both higher than the general population's level of 4.6 +/- 3.3 - (both P < 0.001). Depression levels were similar for people with celiac disease (4.2 +/- 3.4), IBD (4.6 +/- 3.4) and the general population (4.2 +/- 3.8) (P = 0.3). Rates of likely anxiety disorders in people with celiac disease were 16.8%, and 14.0% for IBD, both higher than the rates of 5.7% in the general population (P < 0.001). All three groups showed similar rates of probable depressive disorder (P = 0.1). Their results provide strong indications that adult women with celiac disease on a gluten-free diet suffer higher rates of anxiety than persons of the general population. They encourage clinicians to provide anxiety screens for adult women with celiac disease on a gluten-free diet. Source: World J Gastroenterol. 2010 Jun 14;16(22):2780-7. PMID 20533598
  10. Celiac.com 04/22/2010 - Restless leg syndrome (RLS) is a common neurological condition, with generally unknown causes, that is sometimes associated with specific disorders such as iron deficiency. Even though celiac disease is an autoimmune condition, people with celiac disease often suffer from associated malabsorption-related iron deficiency anemia and peripheral neuropathy. A team of researchers recently set out to assess rates of restless leg syndrome in adults with celiac disease. The team included Marcello Moccia, MS, Maria Teresa Pellecchia, MD, PhD, Roberto Erro, MD, Fabiana Zingone, MD, Sara Marelli, MD, Damiano Giuseppe Barone, MD, Carolina Ciacci, MD, Luigi Ferini Strambi, MD, and Paolo Barone, MD, PhD. They are variously associated with the Department of Systematic Pathology, the Department of Neurological Sciences at University Federico II and IDC Hermitage Capodimonte, Naples, Italy, and the Sleep Disorders Center, University Vita-Salute San Raffaele, Milan, Italy. For their study, the team enrolled 100 adult patients for features of celiac disease, iron metabolism, clinical and neurological conditions, and enrolled another 100 people from the general population as control subjects. These subjects were matched for age and sex. To determine the presence of restless leg syndrome in celiac disease patients and controls, the team applied the four essential diagnostic criteria of the International restless leg syndrome Study Group, in addition to conducting a neurological examination. They gauged restless leg syndrome severity using the International restless leg syndrome Study Group rating scale. The results showed a 31% prevalence of restless leg syndrome among subjects with celiac disease, which was much higher than the 4% prevalence in the control population (P < 0.001). The average restless leg syndrome severity among celiac disease patients was moderate (17 ± 6.5). In the subjects with celiac disease, the team saw no significant correlation between restless leg syndrome and either gluten-free diet or iron metabolism; even though the celiac patients with restless leg syndrome showed significantly lower hemoglobin levels than celiac patients without restless leg syndrome (P = 0.003). They also found no connection between restless leg syndrome and other possible causes of secondary restless leg syndrome, including signs of peripheral neuropathy, pregnancy, end-stage renal disease, and pharmacological treatments. Their study increases the number of neurological disorders associated with celiac disease, and supports screening all celiac disease patients for restless leg syndrome. SOURCE: Movement Disorders; 13 Apr 2010 DOI 10.1002/mds.22903
  11. Celiac.com 12/23/2013 - Symptoms of celiac disease negatively impact the social activities and emotional states of some patients. A team of researchers recently set out to assess rates of altered eating behavior in celiac patients. The research team included V. Passananti, M. Siniscalchi, F. Zingone, C. Bucci, R. Tortora, P. Iovino, and C. Ciacci. They are variously affiliated with the Department of Clinical and Experimental Medicine at University Federico II of Naples, Italy, and with the Department of Medicine and Surgery, University of Salerno, Baronissi Campus, in Salerno, Italy. The researchers evaluated 100 celiac adults and 100 control subjects of statistically similar gender, age, and physical activity. The researchers had both celiac patients and control subjects complete a dietary interview and the Binge Eating Staircases, Eating Disorder Inventory (EDI-2), Eating Attitudes Test, Zung Self-Rating Depression Scale, State Trait Anxiety Inventory Forma Y (STAI-Y1 and STAI-Y2), and Symptom Check List (SCL-90). The results showed that, compared with the control group, celiac patients had higher STAI-Y1 and STAI-Y2, Somatization, Interpersonal, Sensitivity, and Anxiety scores of the SLC-90. EDI-2 differed in pulse thinness, social insecurity, perfectionism, inadequacy, aceticisms, and interpersonal diffidences between celiac disease patients and healthy female controls, whilst only in interceptive awareness between celiac disease patients and healthy male controls. Celiac patients with gastrointestinal symptoms showed dependently higher EAT-26 scores. The EAT26 showed a connection between indices of diet-related disorders in both celiac disease, and the feminine gender after controlling for anxiety and depression. Eating disorders appear to be more frequent in young celiac women than in celiac men and in healthy control subjects. Overall, these results indicate that pathological eating behavior in celiac adults may be due to celiac disease itself, rather than the gastrointestinal related symptoms or psychological factors. Source: Gastroenterology Research and Practice Volume 2013 (2013), Article ID 491657
  12. Celiac.com 07/25/2013 - Numerous studies have shown that people with immune-mediated disorders can suffer from accelerated progression of atherosclerosis and increased cardiovascular risk, but few studies have been done for people with celiac disease. A team of researchers recently looked at young adults with celiac disease to see what, if any, added risk they may have for developing atherosclerosis. The research team included S. De Marchi, G. Chiarioni, M. Prior, and E. Arosio. They are variously affiliated with the Department of Medicine,and the Division of Vascular Rehabilitation in the Department of Medicine at the University of Verona in Verona, Italy, and with the Division of Gastroenterology and Hepatology, Center for Functional GI and Motility Disorders at the University of North Carolina in Chapel Hill, North Carolina. The team wanted to assess instrumental and biochemical signs of atherosclerosis risk in 20 adults at first diagnosis of celiac disease and again after 6–8 months of gluten-free diet with mucosal recovery. They used twenty-two healthy members of the hospital staff as matched controls. For their study, the team analyzed total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, homocysteine, C-reactive protein, folate and vitamin B12. They also conducted ultrasound measurement of carotid intima-media thickness (IMT) and endothelium-dependent dilatation at diagnosis and after gluten withdrawal. The team found average total and HDL-cholesterol (HDL-C) to be within the normal range, at baseline, while average LDL-cholesterol concentration was slightly higher. Diet was tied to increment in total and HDL-C (68.2 ± 17.4 vs. 51.4 ± 18.6 mg/dL; P < 0.001). Meanwhile, total/HDL-C ratio was substantially improved (3.05 ± 0.71 vs. 3.77 ± 0.92; P < 0.02). Overall plasma homocysteine was elevated and not changed by diet, while C-reactive protein dropped significantly with diet (1.073 ± 0.51 vs. 1.92 ± 1.38 mg/dL; P < 0.05). At baseline, celiacs showed increased IMT (0.082 ± 0.011 vs. 0.058 ± 0.012 cm; P < 0.005), with decreased endothelium-dependent dilatation (9.3 ± 1.3 vs. 11.2 ± 1.2%; P < 0.05). A gluten-free diet returned both of those factors to normal. According to these results, vascular impairment and unfavorable biochemical risk pattern increase the potential for young adults with celiac disease to develop early atherosclerosis. This increased risk may be largely due to chronic inflammation. The good news is that adopting a gluten-free diet seems to return the body to a healthy mucosal state and returns the body to the normal risk levels of a healthy non-celiac person. Source: Alimentary Pharmacology & Therapeutics - Volume 38, Issue 2, pages 162–169, July 2013. DOI: 10.1111/apt.12360
  13. Celiac.com 05/13/2013 - Intestinal absorption capacity is currently regarded as the best way to assess overall digestive intestinal function. Earlier reference values for intestinal function in healthy Dutch adults were based on a study that was conducted in an inpatient metabolic unit setting in a relatively small series. A team of researchers recently used bomb calorimetry to measure normative values of intestinal absorption in healthy ambulant adults. The research team included N. J. Wierdsma, J. H. C. Peters, M. A. E. van Bokhorst-de van der Schueren, C. J. J. Mulder, I. Metgod & A. A. van Bodegraven They are variously affiliated with the Department of Nutrition and Dietetics, the Department of Gastroenterology, Small Bowel Unit, and the Department of Clinical Chemical Laboratory at VU University Medical Centre in Amsterdam, and the Department of Gastroenterology and Hepatology of Red Cross Hospital in Beverwijk, The Netherlands. The present study aimed to readdress and describe the intestinal absorption capacity of healthy adults, who were consuming their usual (Western European) food and beverage diet, in a standard ambulatory setting. The researchers evaluated twenty-three healthy subjects, ranging form 22–60 years old, using a 4-day nutritional diary to determine levels of nutritional intake (energy and macronutrients). They then collected fecal samples over three days to measure mean fecal losses of energy (by bomb calorimetry), fat, protein and carbohydrate. Finally, they calculated intestinal absorption capacity by determining the differences between intake and losses. They found that average (SD) daily feces production was 141 grams, of which, 49 grams (29%) was dry weight, Overall, the samples contained 891 (276) kJ [10.7 (1.3) kJ g1 wet feces; 22.6 (2.5) kJ g1 dry feces], 5.2 (2.2) g fat, 10.0 (3.8) g protein and 29.7 (11.7) g carbohydrates. Mean (SD) intestinal absorption capacity of healthy subjects was 89.4% (3.8%) for energy, 92.5% (3.7%) for fat, 86.9% (6.4%) for protein and 87.3% (6.6%) for carbohydrates. They found that average intestinal energy absorption was approximately 90%. These data serve as normative values for both stool nutrient composition and intestinal energy and macronutrient absorption in healthy adults on a regular Dutch diet in an ambulatory setting. Source: J Hum Nutr Diet. doi:10.1111/jhn.12113
  14. Celiac.com 05/08/2013 - A team of researchers recently set out to test determine if an interactive online intervention might help to improve gluten free diet adherence in adults with celiac disease. The research team included Kirby Sainsbury BA/BEd, DCP (candidate), Barbara Mullan PhD and Louise Sharpe PhD. They are affiliated with the School of Psychology, and the Clinical Psychology Unit at the University of Sydney in Sydney, New South Wales, Australia For their controlled trial, the researchers recruited 189 adults with biopsy-confirmed celiac disease. They randomly assigned 101 adults to receive the intervention, and 88 adults to a wait-list control condition. They retrieved post-intervention data for 70 intervention subjects and 64 wait-list participants, along with three month follow-up data for 46 of 50 who completed the intervention period. The team first measured overall gluten-free diet adherence, then measured gluten-free diet knowledge, quality of life and psychological symptoms. The researchers based their results on intention-to-treat analysis, which bases their calculations on initial treatment assignment and not on the treatment eventually received. ITT analysis helps avoid various misleading factors that can color intervention research, such as non-random attrition of participants from the study or crossover. Overall, the intervention group showed strong improvement in gluten-free diet adherence, and gluten-free diet knowledge following the treatment period compared to the wait-list control group. However, changes in knowledge had no effect on adherence. These improvements continued through the 3-month’ follow-up period. The results show that the online intervention program helped improve adherence to a gluten-free diet for people with celiac disease. Such a program can be developed into a valuable resource for celiacs who are struggling with gluten-free diet adherence. Source: Am J Gastroenterol advance online publication 5 March 2013;
  15. Celiac.com 08/18/2010 - The importance of an accurate celiac disease diagnosis is becoming increasinglymore evident to health practitioners and the general public worldwide. While the outcomes of undiagnosed celiac disease are still unclear,current studies are attempting to find an answer. Between 1995 and 2001, serum samples were obtained from 16,886 Olmsted County, Minnesota citizens 50 years of age or older with unknown celiac status. Out of 16,847 adults studied, 129 cases were discovered to have undiagnosed celiac disease. 127 undiagnosed celiacs and 254 unmatched controls were then submitted for a systematic evaluation in search of over 100 possibly coexisting ailments. The scientists found that while celiac disease has been associated with an elevated risk for cancer, this study found no significant risk increase for cancer in undiagnosed celiacs compared to the control group. Researchers also found that those patients with undiagnosed celiac disease displayed an increased rate of osteoporosis and hypothyroidism. Furthermore, undiagnosed celiacs were also found to typically have a lower body mass index, and lower levels of ferritin and cholesterol, and to be less prone to arthritis and have a reduced rate of glucose intolerance. The correlation between lower arthritis and glucose intolerance in undiagnosed celiacs is speculated to be a result of a lower body mass index. In conclusion, researchers were not able to determine a connection between undiagnosed celiac in older adults and comorbidity. In fact, except for impaired bone health, most undiagnosed celiacs in this study displayed little comorbidity and they did not have increased mortality rates when compared to the control group. Researchers of this study therefore concluded that there may be advantages and disadvantages to being an older undiagnosed celiac. Source: Gastroentrology doi:10.1053/j.gastro.2010.05.041
  16. Celiac.com 04/01/2013 - There haven't been many studies that evaluate the usefulness of capsule endoscopy in equivocal celiac disease. A team of researchers recently set out to conduct an evaluation of capsule endoscopy in adult celiac disease, and to assess its potential role in equivocal cases of celiac disease compared with patients with biopsy-proven and serology-proven celiac disease who have persisting symptoms. The research team included M. Kurien, K.E. Evans, I. Aziz, R. Sidhu, K. Drew, T.L. Rogers, M.E. McAlindon, and D.S.Sanders. They are affiliated with the Department of Gastroenterology at Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust in Sheffield, South Yorkshire, United Kingdom. To determine the use of capsule endoscopy in patients with equivocal celiac disease, compared to patients with biopsy-proven and serology-proven celiac disease who have ongoing symptoms. To do this, the team conduced a prospective cohort study of 62 patients with equivocal celiac disease and 69 patients with non-responsive celiac disease. They measured outcome according to the diagnostic yield of capsule endoscopy in equivocal cases and accuracy of mucosal abnormality detection in patients with non-responsive celiac disease. They found that the 62 cases of equivocal celiac disease could be divided into two subgroups: group A, with 32 cases of antibody-negative villous atrophy, and group B with 30 cases of Marsh 1-2 changes. In group A, using capsule endoscopy, the team was able to diagnose celiac disease or Crohn's disease in 9 of 32 patients (28%), compared with just 2 of the 30 patients in group B (7%; P = .044). In patients with persistent celiac disease symptoms, the team made significant capsule endoscopy findings in 8 of 69 patients (12%), including 2 cases of enteropathy-associated lymphoma, 4 cases of type 1 refractory celiac disease, 1 polypoidal mass histologically confirmed to be a fibroepithelial polyp, and 1 case of ulcerative jejunitis. This outcome was significantly lower than the diagnostic yield of capsule endoscopy in antibody-negative villous atrophy (P = .048). It is important to remember that this study was restricted to a single clinic. That said, this is the first time that researchers have used capsule endoscopy to systematically evaluate equivocal celiac disease. Because the diagnostic rates for capsule endoscopy in patients with antibody-negative villous atrophy are better than that of capsule endoscopy in patients with celiac disease with persisting symptoms, the researchers are encouraging the use of capsule endoscopy in equivocal cases, especially in cases where patients antibody-negative villous atrophy. Source: Gastrointest Endosc. 2013 Feb;77(2):227-32. doi: 10.1016/j.gie.2012.09.031.
  17. Celiac.com 08/06/2012 - Celiac disease seems to be on the rise in the United States, with recent population-based data suggest a sharp increase in rates over the last several decades. A number of researchers hypothesize that such a rise might be due in part to disease triggers including inter-current illnesses, such as gastroenteritis, surgeries, and trauma. But just how common is celiac disease among the healthy adult population, and what, if any, do prior illnesses have to do with it? To get a better idea of actual rates and connections, a team of researchers recently conducted a study regarding the incidence and risk of celiac disease in healthy U.S. adults. The research team included Mark S. Riddle, Joseph A. Murray and Chad K. Porter. For their study, they turned to data from active duty US military personnel, a largely healthy population with excellent medical diagnostic coding. The data offered a unique opportunity to spot trends in celiac disease and deployment-related risk factors. The team used electronic medical encounter data, from 1999–2008, on active duty US military personnel. In all, they reviewed data for over 13.7 million person-years, to conduct a matched, nested case–control study describing the epidemiology and risk determinants of celiac disease (based on ≥2 ICD-9 medical encounters). Using this data, they were able to estimate incidence and duration of celiac-related medical care, and to employ conditional logistic regression to evaluate celiac disease risk following infectious gastroenteritis (IGE) up to 3 years before celiac diagnosis, while controlling for other risk factors. They found a total of 455 incident cases of celiac disease, which they then age, gender, and time matched to 1,820 control subjects. They found that, from 1999 to 2008, cases of celiac disease increased five-fold from 1.3 per 100,000 to 6.5 per 100,000, with the highest rates of increase among those over 34 years of age. The average annual increase was 0.8 cases per 100,000. They found a total of 172 episodes of IGE, 60.5% of which were viral in nature. Using multivariate models, they found a strong association between IGE and celiac disease was found (Odds ratio (OR): 2.06, 95% confidence interval (CI) 1.43, 2.97). Risk generally increased with temporal proximity to, and non-viral etiology of, exposure. Other notable risk factors for celiac disease in multivariate models were Caucasian race (OR: 3.1, P). Rates of celiac disease in the US military are rising, particularly among those in the fourth and fifth decades of life and the rates seem higher than other population-based estimates. The team noted a connection between prior IGE and risk of celiac disease, but they noted that they could not rule out possible IGE misclassification, and called for further study to better determine any links between pathogen-specific exposure to celiac disease, anti-gluten antibody development or symptom onset. Source: The American Journal of Gastroenterology , (15 May 2012) doi:10.1038/ajg.2012.130
  18. Celiac.com 08/02/2010 - Celiac crisis is a rare, poorly understood, but potentially deadly condition in which patients with celiac disease suffer from severe diarrhea and other serious metabolic changes. Celiac crisis is specifically defined as acute onset or rapid progression of gastrointestinal symptoms, together with signs or symptoms of dehydration or malnutrition that may be attributed to celiac disease, and which require hospitalization and/or supplemental nutrition. In an effort better understand celiac crisis, and to improve diagnosis techniques for the condition, a team of researchers reviewed cases of celiac crisis to identify presenting features, formulate diagnostic criteria, and develop treatment strategies. The research team included Shailaja Jamma, Alberto Rubio-Tapia, Ciaran P. Kelly, Joseph Murray, Robert Najarian, Sunil Sheth, Detlef Schuppan, Melinda Dennis, and Daniel A. Leffler. They are affiliated variously with the Celiac Center of the Beth Israel Deaconess Medical Center at Harvard Medical School, and with the Mayo Clinic. The team reviewed cases of biopsy-proven celiac disease, specifically defined as acute onset or rapid progression of gastrointestinal symptoms, together with signs or symptoms of dehydration or malnutrition that may be attributed to celiac disease, and which require hospitalization and/or parenteral nutrition. The team found twelve patients who met preset criteria for celiac crisis; eleven patients who developed celiac crisis before being diagnosed with celiac disease; eleven patients with increased titres of transglutaminase antibodies; and one patient with low levels of immunoglobulin A. Duodenal biopsy samples for all patients were consistent with a Marsh 3 score; 33% showed total villous atrophy. All patients showed signs or symptoms of severe dehydration, renal dysfunction, and electrolyte disturbances. All patients required hospitalization and intravenous fluids, six patients required corticosteroids, and five required parenteral nutrition. All patients showed positive response to treatment with a gluten-free diet. Even though celiac crisis is a rare condition that strikes adults, it is nonetheless serious and carries a high risk of death. In most cases, patients with the condition present clear signs and symptoms, such as severe unexplained diarrhea and malabsorption. Doctors should test such patients for celiac disease, and consider treatment with systemic steroids or oral budesonide, in addition to providing short-term nutritional support until the patients respond fully to a gluten-free diet. Source: Clin Gastroenterol Hepatol. 2010 Jul;8(7):587-90. Epub 2010 Apr 24. PMID: 20417725
  19. Celiac.com 08/10/2012 - A diagnosis of Celiac disease is measured mainly by an adverse response to gluten, yet there is very little in the way of data regarding gluten challenge in adults on a gluten-free diet. A research team recently studied the kinetics of histological, serological, and symptomatic responses to gluten challenge in adults with celiac disease. The research team included D. Leffler, D. Schuppan, K. Pallav, R. Najarian, J.D. Goldsmith, J. Hansen, T. Kabbani T, M. Dennis, and C.P. Kelly. They are affiliated with Beth Israel Deaconess Medical Center in Boston, Massachusetts. For their study, the team wanted to address a lack of data regarding the kinetics of responses to gluten, which causes assessment issues in clinical practice and research when gluten-challenge is performed. For their study, the researchers recruited twenty adults with biopsy-proven coeliac disease. For each participant, the team conducted two run-in visits followed by a 14-day gluten-challenge at a randomly assigned dose of 3 or 7.5 g of gluten/day. Patients visited study team doctors at 3, 7, 14 and 28 days after the start of their gluten challenge. The researchers performed duodenal biopsy during the run-in and at days 3 and 14 of gluten challenge. The team used two pathologists to measure villous height to crypt depth ratio (Vh:celiac disease) and intraepithelial lymphocyte (IEL) count/100 enterocytes. Upon each visit, the team also assessed antibodies to tissue transglutaminase and deamidated gliadin peptides, lactulose to mannitol ratio (LAMA) and any physical symptoms. Compared to the initial data, results after 14 days showed substantially lower Vh:celiac disease (2.2-1.1, p Interestingly, gastrointestinal symptoms increased significantly after three days, but had returned to baseline by day 28. There were no differences between the higher and lower gluten doses. The team concludes by noting that a 14-day gluten challenge at or above 3 g of gluten/day triggers cellular, tissue, and blood changes in most adults with celiac disease. These findings will help researchers create more accurate clinical trials, and show that many individuals will meet celiac diagnostic criteria after a basic 2-week gluten challenge. Source: Gut. 2012 May 22.
  20. Celiac.com 05/23/2012 - We know from past studies that the intestinal bacteria communities of children with celiac disease differ greatly from those of healthy children, but there has been little work done to draw such a correlation with adult celiac disease sufferers. Intestinal bacteria could potentially serve as a convenient way of indexing the severity of a patient's celiac disease, but research in adults is limited. A recent study remedies this, showing that adults with celiac disease do, in fact, have different intestinal bacteria from healthy adults, which may lead to a way of testing for the severity of one's disorder based on fecal bacteria tests. Ten untreated celiac disease patients, eleven treated celiac disease patients (those on gluten-free diets for at least two years) and eleven healthy adults were tested for intestinal bacteria in fecal samples. The healthy adults were tested once under normal gluten diet conditions, and additionally, ten of them were tested again after one week of gluten-free dieting. Testing showed that untreated celiac disease patients had much more Bifidobacterium bifidum in their intestinal microbial communities than those of healthy adults. Treated celiac disease patients showed decreased levels of Bifidobacterium bifidum, as well as a reduction in the diversity of Lactobacillus and Bifidobacterium. These results most closely resembled those achieved by healthy adults. It would seem, then, that a gluten-free diet helps to balance and normalize intestinal bacteria populations. While a portion of the treated celiac disease patients displayed restored, normal intestinal bacteria, there were still differences in the presence of short-chain fatty acids. Such SCFAs would appear to correlate with celiac disease, regardless of the diet taken: healthy adults, both on gluten-free diets and on normal diets had significantly fewer SCFAs than both treated and untreated celiac disease patients. Gluten-free, healthy adults had the fewest, but treated celiac disease patients actually had the highest. We can take from this study that gluten-free diets help to lower both the presence and diversity of bacteria associated with celiac disease. A gluten-free diet does not 'fix' the presence of short-chain fatty acids in the intestines though, even though it is not entirely clear what these acids signal as to the health of the individual. Source: http://www.ncbi.nlm.nih.gov/pubmed/22542995
  21. Celiac.com 06/30/2008 - In the crypts of the small bowel, there is a group of small, granular epithelial cells, called Paneth cells, which play an important part in innate immune system. There has been some controversy about what role Paneth cells might play in complicating celiac disease, so team of Italian researchers set out to examine the distribution, proliferation, and function of paneth cells in adults with uncomplicated and complicated celiac disease. The research team was made up of P. Biancheri , Cdel V. Blanco, L. Cantoro, M. De Vincenzi, A. Di Sabatino, W. Dhaliwal, E. Miceli, R. Salerno, A. Vanoli, T.T. Macdonald, and G.R. Corazza. The team is affiliated with the Celiac Specialty Center at the First Department of Medicine at University of Pavia in Pavia, Italy. Seeking to better understand the function and the numbers of Paneth cell adults with celiac disease (celiac disease), the team measured Paneth cells and human alpha-defensin (HD)-5 and HD-6 in 28 adults with uncomplicated celiac disease, 8 patients with complicated celiac disease (3 with ulcerative jejunoileitis, 2 with refractory sprue, and 3 with enteropathy-associated T-cell lymphoma), and 14 control subjects. Subjects with uncomplicated untreated and treated celiac disease showed similar numbers of Paneth cells, with similar cell proliferation, compared to the control group, while subjects with complicated celiac disease showed much fewer Paneth. Subjects with uncomplicated untreated celiac disease, and those with treated celiac disease showed similar levels of mucosal HD-5 and HD-6 compared to the control group, while cells taken from the biopsies of subjects with treated celiac disease and challenged with gliadin proteins showed no change in mucosal HD-5 and HD-6 transcripts. Furthermore, those subjects with uncomplicated celiac disease showed no reduction in mucosal Paneth cell numbers and alpha-defensins. Clearly, a small study such as this will not tell us exactly how a reduction in the numbers of Paneth cells might complicate celiac disease, but since the role of Paneth cells is so vital to healthy innate immune function, it does point to the need for further examination. Am J Clin Pathol. 2008 Jul;130(1):34-42.
  22. Celiac.com 01/04/2012 - A number of cases have led researchers to suspect a connection between eosinophilic esophagitis and celiac disease in children. A research team sought to confirm this association in children, and determine whether it extends into adulthood. To do this, they reviewed data from a group of celiac disease patients to learn the number of patients who also had a diagnoses of eosinophilic esophagitis. The team included Jennifer S. Thompson, MD, Benjamin Lebwohl, MD, MS, Norelle Rizkalla Reilly, MD, Nicholas J. Talley, MD, PhD, Govind Bhagat, MD, and Peter HR. Green, MD. For their study, they reviewed histopathology reports of esophageal biopsies to identify all cases of increased esophageal eosinophilia. The team defined cases of eosinophilic esophagitis as those where biopsies showed Z15 eosinophils per high power field and, which also included associated symptoms. Using published US population-derived incidence data as a reference, they formulated age- and sex-adjusted standardized incidence ratios with corresponding 95% confidence intervals (CI). In all, the team found 4 children and 10 adults with eosinophilic esophagitis, which makes eosinophilic esophagitis more common in people with celiac disease than in the general population. Standardized incidence ratio was 35.6 (95% CI, 9.3-79.0) for children, and 13.1 (95% CI, 6.2-22.5) for adults. Overall, age-adjusted and sex-adjusted standardized incidence ratio was 16.0 (95% CI, 8.7-25.5). This study found higher rates of eosinophilic esophagitis in patients with celiac disease than in the general population. The researchers advise doctors to consider the possibility of eosinophilic esophagitis for celiac disease patients who suffer ongoing esophageal problems. Source: J Clin Gastroenterol. 2012 Jan;46(1):e6-e11.
  23. Celiac.com 02/23/2011 - In most adults with celiac disease, clinical symptoms disappear with a gluten-free diet. However, the exact effects of a gluten-free diet on rates of mucosal recovery in adults with celiac disease is less certain. A group of clinicians recently set out to assess rates of mucosal recovery under a gluten-free diet in adults with celiac disease, and to gauge the clinical prospects of ongoing mucosal damage in celiac patients who follow a gluten-free diet. The study group included Alberto Rubio-Tapia, MD; Mussarat W. Rahim, MBBS; Jacalyn A. See, MS, RD, LD; Brian D. Lahr, MS; Tsung-Teh Wu, MD; and Joseph A. Murray, MD. Each patient in the study had biopsy-proven celiac disease, and was assessed at the Mayo Clinic. Also, each patient received duodenal biopsies at diagnosis. After beginning a gluten-free diet, each patient had at least one follow-up intestinal biopsy to assess mucosal recovery. The study team focused on mucosal recovery and overall mortality. Of 381 adult patients with biopsy-proven celiac disease, a total of 241 (175 women - 73%) had both a diagnostic and follow-up biopsy available for re-review. Using the Kaplan–Meier rate of confirmed mucosal recovery to assess these 241 patients, the study group found that 34% of the patients enjoyed mucosal recovery at 2 years after diagnosis (95% with a confidence interval (CI): 27–40 % ), and 66% of patients enjoyed mucosal recovery at 5 years (95% CI: 58–74 % ). More than 80% of patients showed some clinical response to the gluten-free diet, but clinical response was not a reliable marker of mucosal recovery ( P = 0.7). Serological response was, by far, the best marker for confirmed mucosal recovery ( P = 0.01). Patients who complied poorly with a gluten-free diet ( P < 0.01), those with severe celiac disease defined by diarrhea and weight loss ( P < 0.001), and those with total villous atrophy at diagnosis ( P < 0.001) had high rates of persistent mucosal damage. With adjustments for gender and age, patients who experienced confirmed mucosal recovery had lower mortality rates overall (hazard ratio = 0.13, 95 % CI: 0.02 – 1.06, P = 0.06). One of the most important findings from this study was that a large number of adults with celiac disease have no mucosal recovery, even after treatment with a gluten free diet. Compared to those patients who suffered persistent damage, patients who experienced confirmed mucosal recovery had lower rates of mortality independent of age and gender. The group notes that systematic follow-up via intestinal biopsy may be advisable for adults with celiac disease. Source: Am J Gastroenterol. 9 February 2010; doi: 10.1038/ajg.2010.10
  24. Celiac.com 04/16/2010 - In most adults with celiac disease, clinical symptoms disappear with a gluten-free diet. However, the exact effects of a gluten-free diet on rates of mucosal recovery in adults with celiac disease is less certain. A group of clinicians recently set out to estimate the rate of mucosal recovery under a gluten-free diet in adult subjects with celiac disease, and to gauge the clinical prospects of ongoing mucosal damage in celiac patients following a gluten-free diet. The study group included: Alberto Rubio-Tapia, MD; Mussarat W. Rahim, MBBS; Jacalyn A. See , MS , RD, LD; Brian D. Lahr , MS; Tsung-Teh Wu, MD; and Joseph A. Murray, MD. Each patient in the study had biopsy-proven celiac disease, and was assessed at the Mayo Clinic. Also, each patient received duodenal biopsies at diagnosis. After beginning a gluten-free diet, each patient had at least one follow-up intestinal biopsy to assess mucosal recovery. The study team focused on mucosal recovery and overall mortality. Of 381 adult patients with biopsy-proven celiac disease, a total of 241 (175 women - 73%) had both a diagnostic and follow-up biopsy available for re-review. Using the Kaplan–Meier rate of confirmed mucosal recovery on these 241 patients, the study group found that 34% of patients enjoyed mucosal recovery at 2 years following diagnosis (95% with a confidence interval (CI): 27–40 % ), and 66% of patients enjoyed mucosal recovery at 5 years (95% CI: 58–74 % ). More than 80% of patients showed some clinical response to the gluten-free diet, but clinical response was not a reliable marker of mucosal recovery ( P = 0.7). Serological response was, by far, the best marker for confirmed mucosal recovery ( P = 0.01). Patients who complied poorly with a gluten-free diet ( P < 0.01), those with severe celiac disease defined by diarrhea and weight loss ( P < 0.001), and those with total villous atrophy at diagnosis ( P < 0.001) had high rates of persistent mucosal damage. With adjustments for gender and age, patients who experienced confirmed mucosal recovery had lower mortality rates overall (hazard ratio = 0.13, 95 % CI: 0.02 – 1.06, P = 0.06). One of the most important findings from this study was that a large number of adults with celiac disease see no mucosal recovery, even after treatment with a GFD. Compared to those patients who suffered persistent damage, patients who experienced confirmed mucosal recovery had lower rates of mortality independent of age and gender. The group notes that systematic follow-up via intestinal biopsies may be advisable in patients diagnosed with celiac disease as adults. SOURCE: Am J Gastroenterol. 9 February 2010; doi: 10.1038/ajg.2010.10
  25. Please note that this study has no biopsy confirmation, so it can only be called gluten intolerance statistics. Its findings indicate that gluten intolerance may be relatively common in the general population. AU - Arnason JA ; Gudjonsson H ; Freysdottir J ; Jonsdottir I ; Valdimarsson H TI - Do Adults with High Gliadin Antibody Concentrations have Subclinical Gluten Intolerance? LA - Eng AD - Department of Immunology, National University Hospital, Reykjavik, Iceland. SO - Gut 1992 Feb;33(2):194-7 AB - Gliadin antibodies of the IgG and IgA isotopes and IgG subclasses were measured in 200 adults who were randomly selected from the Icelandic National Register. Those with the highest gliadin antibody concentrations were invited with negative controls to participate in a clinical evaluation. Neither the study subjects nor the physicians who recorded and evaluated the clinical findings were aware of the antibody levels. Significantly higher proportion of the gliadin antibody positive individuals reported unexplained attacks of diarrhea (p = 0.03), and IgA gliadin antibodies were associated with increased prevalence of chronic fatigue (p = 0.0037). The gliadin antibody positive group also showed significantly decreased transferrin saturation, mean corpuscular volume and mean corpuscular hemoglobin compared with the gliadin antibody negative controls. Serum folic acid concentrations were significantly lower in the IgA gliadin antibody positive individuals. On blind global assessment, 15 of the 48 participants were thought to have clinical and laboratory features that are compatible with gluten sensitive enteropathy, and 14 of these were in the gliadin antibody positive group (p = 0.013). Complaints that have not been associated with gluten intolerance had similar prevalence in both groups with the exception of persistent or recurrent headaches that were more common in the gliadin antibody positive group. These findings raise the possibility that a sub-clinical form of gluten intolerance may be relatively common. The following chart summarizes the study: No. Randomly Selected for Study No. Selected w/ High Gliadin No. w/ Gluten Sensitive Enteropathy No. w/ GSE & High Gliadin 200 ( = 100%) 48 ( = 24%) 15 ( = 7.5%) 14 ( = 7%)
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