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Celiac.com 11/17/2016 - Studies in small groups of patients indicated that splenic volume may be decreased in patients with celiac disease, refractory celiac disease (RCD) type II and enteropathy-associated T-cell lymphoma (EATL). A team of researchers recently set out to assess splenic volume in a large group of uncomplicated celiac disease, RCD II and EATL patients and in healthy controls. The research team included Tom van Gils, Petula Nijeboer, Jan Hein TM van Waesberghe, Veerle MH Coupé, Kiki Janssen, Jessy A Zegers, Shaikh A. Nurmohamed, Georg Kraal, Sabine CI Jiskoot, Gerd Bouma, Chris JJ Mulder. They are variously affiliated with the Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, the Department of Radiology, the Department of Epidemiology and Biostatistics, the Department of Nephrology, the Department of Molecular Cell Biology and Immunology at VU University Medical Center, Amsterdam, The Netherlands, and with the Department of Radiology, St Jansdal, Harderwijk, The Netherlands. For their retrospective cohort they included 77 patients with uncomplicated celiac disease (of whom 39 in remission), 29 patients with RCD II, 24 patients with EATL, and 12 patients with both RCD II and EATL. The control group included 149 healthy living kidney donors. The team used computed tomography to determine splenic volume. The median splenic volume in the uncomplicated celiac disease group was significantly larger than in controls (202 cm3 (interquartile range (IQR): 154–275) versus 183 cm3 (IQR: 140–232), p = 0.02). After correction for body surface area, age and gender, the ratio of splenic volume in uncomplicated celiac disease versus controls was 1.28 (95% confidence interval: 1.20–1.36; p less than 0.001). On average, RCD II patients showed smaller splenic volume (118 cm3 (IQR 83–181)) than the median splenic volume in the control group (p less than 0.001). These results show wide variation in splenic volume among patients. In uncomplicated celiac disease, splenic volume is typically enlarged. Lower splenic volume in RCD II patients may be clinically relevant, given the the compromised immune conditions of these patients. Source: United European Gastroenterology Journal August 17, 2016 2050640616663571. doi: 10.1177/2050640616663571
Celiac.com 01/15/2014 - Complicated celiac disease is uncommon, but patients have high death rates, say a team of researchers, who recently set out to better understand the epidemiology of complications in patients with celiac disease. The research team included F. Biagi, P. Gobbi, A. Marchese, E. Borsotti, F. Zingone, C. Ciacci, U. Volta, G. Caio, A. Carroccio, G. Ambrosiano, P. Mansueto, 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 conducted a retrospective multi-center case-control study based on collection of clinical and laboratory data. They looked at incidence of complicated celiac disease among celiac patients directly diagnosed in four Italian centers. Their study did not include patients referred to these centers after being diagnosed with celiac disease and/or complicated celiac disease at other facilities. Between January of 1999 and October 2011, the team followed-up on 1840 adult celiac patients, for a total of 7364.3 person-years. They found that fourteen patients developed complications to they celiac disease. Five patients died by the end of the observation period in October 2011, making the rates of complicated celiac disease nine cases out of 1835 celiac patients (1/204, 0.49%, 95% CI 0.2-0.9%). The annual rates of complicated celiac disease in the study period was 14 out of 7364 celiac patients, or about 0.2%, 95% CI 0.1-0.31%. Although complications tend to occur soon after the diagnosis of celiac disease, Kaplan-Meier curve analysis showed that they can actually occur at any time after the diagnosis of celiac disease. Overall, complications of celiac disease in this study group were quite rare, but those patients with complications faced very high mortality rates. Source: "Dig Liver Dis. 2013 Nov 19. pii: S1590-8658(13)00624-5. doi: 10.1016/j.dld.2013.10.010.
Celiac.com 07/08/2013 - Right now, the only way for doctors to distinguish between the complicated and uncomplicated forms of celiac disease is to use invasive methods. In an effort to find a way other than these invasive methods to distinguish between uncomplicated and complicated forms of celiac disease, a research team set out to study serum parameters in the spectrum of celiac disease The research team included Greetje J Tack, Roy LJ van Wanrooij, B Mary E Von Blomberg, Hedayat Amini, Veerle MH Coupe, Petra Bonnet, Chris JJ Mulder, and Marco WJ Schreurs. They are variously affiliated with the Departments of Epidemiology and Biostatistics, Gastroenterology and Hepatology, and Pathology of VU University Medical Centre in Amsterdam, The Netherlands, and with the Department of Immunology, Erasmus MC at theUniversity Medical Centre in Rotterdam, The Netherlands. The team's cohort study looked at the possible use of new testing methods, including IL-6, IL-8, IL-17, IL-22, sCD25, sCD27, granzyme-B, sMICA and sCTLA-4 in patients diagnosed with active celiac disease, celiac disease following a gluten-free diet, Refractory celiac disease (RCD) types I and II, and enteropathy associated T-cell lymphoma (EATL). The results showed elevated levels of the pro-inflammatory IL-8, IL-17 and sCD25 in both active celiac disease and RCDI-II. In addition, patients with RCDII showed higher serum levels of soluble granzyme-B and IL-6 compared with active celiac disease patients. They did not find any differences between RCDI and active celiac disease, or between RCDI and RCDII. However, they did find that EATL patients had higher IL-6 levels compared with all other groups. This study document a specific series of serum parameters that show that RCDII and EATL have distinct immunological features compared with uncomplicated celiac disease and RCDI. This new method of distinguishing uncomplicated and complicated forms of celiac disease might promote the development of non-invasive procedures in the future. Source: BMC Gastroenterology 2012, 12:159. doi:10.1186/1471-230X-12-159.
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.