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Celiac.com 04/24/2013 - Doctors classify refractory celiac disease (RCD) depending on the presence or absence of monoclonal expansions of intraepithelial lymphocytes (IELs) with an aberrant immunophenotype. A team of researchers recently set out to determine whether IEL parameters have any connection with mortality and morbidity in cases of refractory celiac disease. The research team included C. Arguelles-Grande, P. Brar, P. H. Green, and G. Bhagat. They are variously affiliated with the Celiac Disease Center, and the Departments of Medicine, Pathology and Cell Biology, at Columbia University Medical Center in New York, NY. The team used immunohistochemistry to assess IEL phenotype and polymerase chain reaction to determine T-cell receptor (TCR) gene rearrangement in 67 patients with RCD type I, and six patients with RCD type II. They considered a monoclonal TCR gene rearrangement and presence of greater than 50% CD3 CD8 IELs to be abnormal. They used Kaplan-Meier and Cox proportional hazard analyses to determine the time to worsening of clinical symptoms and the predictors of worsening. The team found 30 patients with less than 50% CD3 CD8 IELs, and eight with monoclonal TCR rearrangements. Three patients died and 40 suffered clinical worsening despite treatment. Estimated 5-year survival rates were 100% in patients with greater than 50% CD3 CD8 IELs and polyclonal TCR, but just 88% in patients with less than 50% CD3 CD8 IELs and 50% in patients with monoclonal TCR. All patients with monoclonal TCR gene rearrangement with less than 50% CD3 CD8 IELs showed shorter average time to clinical worsening of symptoms (11 mo), when compared to patients with less than 50% CD3 CD8 IELs alone (21 mo), polyclonal TCR (38 mo), or greater than 50% CD3 CD8 IELs alone (66 mo). After the team adjusted for age and gender, they found that the presence of less than 50% CD3 CD8 IELs was the only factor associated with increased risk for clinical worsening, despite negative celiac blood screens (hazard ratio=4.879; 95% confidence interval, 1.785-13.336; P=0.002). This means that RCD patients with <50% CD3 CD8 IELs are at risk for clinical worsening, and that RCD patients who also show monoclonal TCR gene rearrangement have higher mortality rates. Overall, the assessment of IEL phenotype and TCR gene rearrangement can provide important information regarding morbidity and risk of death in cases of RCD. Source: J Clin Gastroenterol. 2013 Mar 6.
Celiac.com 03/01/2012 - Currently, the best way to assess whether patients with celiac disease are actually maintaining a strict gluten-free diet is to have trained experts conduct a dietary interview. These interviews can vary in complexity, depending on the nature and number of the questions, and on the amount of medical expertise required to score the responses. A team of researchers has developed a way to score gluten-free dietary adherence based on answers to four quick and easy questions that can be assessed by non-expert personnel. The researchers recently set out to test the reliability of their questionnaire in a new group of patients. The research team includes F. Biagi, P.I. Bianchi, A. Marchese, L. Trotta, C. Vattiato, D. Balduzzi, G. Brusco, A. Andrealli, F. Cisarò, M. Astegiano, S. Pellegrino, G. Magazzù, C. Klersy, and G.R. Corazza. They are affiliated with the Coeliac Centre/First Department of Internal Medicine of the Fondazione IRCCS Policlinico San Matteo at the University of Pavia in Pavia, Italy. The scoring for the quiz is set up to verify adherence to a gluten-free diet. The questionnaire has a five-level score. From March 2008 to January 2011, the team surveyed 141 celiac disease patients who were undergoing re-evaluation. Each patient was following on a gluten-free diet. The team then compared survey scores with levels of both villous atrophy and endomysial antibodies (EMA). Patients with persistence of either villous atrophy (Fisher's exact, P < 0·001; test for trend, P < 0·001) or positive EMA (Fisher's exact, P = 0·001; test for trend, P = 0·018) showed the lowest scores, which indicates poor compliance with a gluten-free diet. Given that the celiac patients have been well instructed on what a gluten-free diet means and on how to follow it, our questionnaire is a reliable and simple method to verify compliance to a gluten-free diet. The team did not share in the study abstract the exact questions included in the survey, so stay tuned to find out the exact questions the team is testing. Source: Br J Nutr. 2012 Feb 10:1-5.
For 100 units of whole grain wheat, about 70 units of white flour results from the milling process. The rest is separately sold as wheat bran or wheat germ. Those 70 units of flour are about 10%- 15% protein, thus about 7 to 10 units of protein for 100 units of whole wheat. The protein is about 80% gluten, thus about 6 to 8 units of gluten for 100 units of whole wheat. Since one typically sees wheat flour as an ingredient, applying the 70% factor implies 8 to 12 units of gluten per 100 units of wheat flour.