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Celiac.com 05/21/2022 - “My daughter has celiac disease. I do the best I can to provide her with gluten-free food, but I don’t know everything that has gluten in it. I give her these pills from the health food store, because they say they block gluten. I want to make sure she is healthy. Am I giving her enough of these pills?” What Is The Antidote To Questionable Information? We all know the saying, “if something sounds too good to be true, it probably is.” When this question was asked by a participant at one of our education presentations, we informed her that while research was underway, at this time no pill could block gluten. We said that if and when such a discovery was made, it would be scientifically validated and widely available. We offered her assistance with her questions about the gluten-free diet. Many people who live with more commonly known medical conditions like cancer, heart disease, and diabetes have numerous ways to verify the accuracy of the health information they acquire, including a simple call to their doctor’s office. So what happens when the patient knows more than the doctor? Many celiacs face this scenario, and are not always certain how to verify information they hear about celiac disease in a support group meeting, in a newsletter or even in the doctor’s office. How can celiacs learn if the medical or dietary information they’ve acquired is “too good to be true?” A healthy dose of skepticism is the antidote to the information about celiac disease that seems too good to be true. Awareness Is a Double-Edged Sword Awareness of celiac disease has led to a greater appreciation of the needs of people on a gluten-free diet, as well as the importance of correctly diagnosing the condition in a timely manner. This is a very positive development, as it will encourage physicians to become more knowledgeable and diagnose more people. However, the heightened interest in celiac disease has also lead to the increased dissemination of inaccurate information which could dissuade symptomatic people from receiving the highest standard of medical care for diagnosing celiac disease and the most up-to-date information on the gluten-free diet. Of course, we’d all prefer a world with a greater level of awareness about celiac disease. But it can be helpful to understand how this would bring about more opportunities for misinformation as well. Vital Signs: Evaluating Information about Celiac Disease We already understand how important it is to be skeptical about much information in our daily lives, and it is important to apply this skepticism to celiac disease as well. There are many questions you can ask about the information you’ve learned in order to authenticate its source and verify its content. Consider the Source: Speaker Who is delivering the information? What interests do they represent (who pays their salary)? Are they presenting information that is representative of their expertise? Do they share information about their conflicts of interest (an individual who works for a testing company that is speaking about testing for celiac disease, for example)? Is the person honest about what they know and don’t know? Does the individual presentation that has been scientifically valuated (evaluated and published in a peer-reviewed medical journal) or do they present information that is based on clinical experience and individual judgment? Are they telling you which are which? Consider the Source: Published Article/Website Where does the article appear—is it a support group newsletter, your local newspaper or the New England Journal of Medicine? Is it an editorial, which expresses an opinion or an article which presents factual information from a third party’s point of view? What type of review process did the article go through before it was published? Is the medical journal article a research study, a case report, or an editorial? A research study goes through the highest level of scrutiny. Was the study well designed— prospective, controlled for bias, and an adequate number of patients? Is the website a .com, representing a commercial interest, a .edu, representing a university, or a .org, representing a non-profit? Is the site sponsored by a commercial interest? Do they present information in a way that is consistent with the guidelines on evaluating an article or speaker? Is the information presented an interpretation of the original source material, or the original material itself? Consider the Source: Media Television and radio stories on any type of medical topic are usually to report some type of breakthrough or discovery. Interviews with patients will often depict extremes, either the most desperate situation or a “miracle” recovery. Accuracy, while important, is seldom achieved in a 30 second television story or a 60 second radio spot. Consider Content and Context Is there an established, credible resource you can use to verify the content of the information you’ve received? Is the resource unrelated to the source of your information? Was the information presented in a way that you felt less than capable, afraid or anxious? Was the information presented in the context of selling a product or a service, or to encourage you to take a particular course of action? Consider Uncertainty When a patient is evaluated or diagnosed with a medical condition, it is often difficult to realize that treatment decisions have to be made without perfect information. The level of uncertainty during this process can vary. For instance, a knowledgeable physician knows that there is a high degree of certainty when a patient has a negative tTG test that it is accurate and the patient requires no further evaluation for celiac disease. However, the same physician understands that a positive tTG test result does not bring that same high degree of certainty—that there is less than a 50% chance of the patient actually having celiac disease. However, this probability is high enough to suspect celiac disease and perform an endoscopy. For a person diagnosed with celiac disease, evaluating the gluten content of foods can be an uncertain process. While there are numerous resources available, and a new food labeling law that will take effect in a year, there is still uncertainty. Food lists change after they are printed, what happens in a restaurant kitchen may not be related to the in-depth instruction that a patron provided about his/her meal, and celiac legends about foods that are safe or unsafe abound on list servs and in support groups. Check, Check, Double Check Verifying the quality of the information you receive about celiac disease is not unlike verifying the gluten-free status of your meals; double checking ingredients, or information is always important. Most of the time, you’ll find that the people, companies and organizations that serve the celiac community are doing so with the highest level of professionalism and personal integrity. But it’s always good to make sure. A little bit of gluten, like a little bit of bad information, can be detrimental to your health.
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Celiac.com 06/11/2020 - Who should get screened for celiac disease? Traditionally, doctors test for celiac disease, based on the following factors: Signs and symptoms of malabsorption, including chronic diarrhea with weight loss, steatorrhea, abdominal pain after eating, and bloating, or: Laboratory evidence of malabsorption, particularly in people who have a first-degree family member with a confirmed celiac disease diagnosis. This includes associated nutritional deficiencies, or: A personal history of an autoimmune disease, or an IgA deficiency, or: Biopsy-proven DH, iron-deficiency anemia refractory to oral supplementation, or hypertransaminasemia with no other origins. So who, exactly, should be screened for celiac disease? Celiac Disease Screening Recommendations per Organization: The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Recommends celiac disease screening in asymptomatic children who have conditions associated with celiac disease, including type 1 diabetes mellitus, autoimmune thyroiditis, Down syndrome, Turner syndrome, Williams syndrome, selective IgA deficiency, and first-degree relatives of celiac patients. It recommends testing asymptomatic children who are at risk beginning around age 3 years, provided they have had an adequate gluten-containing diet for at least 1 year before testing. It recommends that asymptomatic persons with negative serology who are at risk be considered for repeat testing. The American College of Gastroenterology Recommends that asymptomatic persons with a first-degree relative who has a confirmed diagnosis of celiac disease be considered for testing. Patients with type 1 diabetes mellitus should be tested for celiac disease if there are any digestive symptoms, signs, or laboratory evidence suggestive of celiac disease. The U.K. National Institute for Health and Care Excellence Recommends offering serologic testing for celiac disease to persons with a first-degree relative with celiac disease or persons with type 1 diabetes mellitus or autoimmune thyroid disease upon diagnosis. They also recommend considering serologic celiac testing for persons with metabolic bone disorder (reduced bone mineral density or osteomalacia), unexplained neurologic symptoms (particularly peripheral neuropathy or ataxia), unexplained sub-fertility or recurrent miscarriage, persistently elevated liver enzymes with unknown cause, dental enamel defects, Down syndrome, or Turner syndrome. Based on more recent study data, many doctors are beginning to do celiac screening in patients with: Anemia A 2014 study showed that celiac disease is common in people with unexplained autism. The study team recommends celiac screening for anyone with unexplained iron-deficient anemia. Autism People with autism have celiac disease at rates almost 20 times higher than in those without autism, reported lead investigator Daniel Karb, MD, a second-year resident at University Hospitals Case Medical Center in Cleveland. As such, many doctors now recommend celiac screening for people with autism. Autoimmune Disorders Researchers urge primary care doctors to adopt a practice of celiac screening for all people with elevated risk factors, including people with a family history of celiac disease, people with Addison’s disease Down Syndrome type 1 diabetes, thyroiditis, Turner syndrome, and type 1 diabetes. The team also called for screening of patients with short stature, iron deficiency anemia, and high transaminase levels. First-degree Relatives of Celiacs A Mayo Clinic team found celiac disease in 160 of 360 first-degree relatives of celiac patients, while 62% of those relatives found to have celiac were women. Most doctors now recommend testing first degree relatives of celiac disease patients. IgA Deficiency The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends testing for celiac disease in asymptomatic children who have conditions associated with celiac disease, including selective IgA deficiency. Unexplained Neuropathy Patients with unexplained neuropathy, or small fiber neuropathy should be screened for celiac disease and gluten-sensitivity, according to researchers. Consider Celiac Screening for Top Physical Complaints People with any one or more of the Ten Most Common Complaints of Celiac Patients, might want to consider the possibility of celiac disease, look for any other celiac-related symptoms, and consult a doctor if they suspect celiac disease. The ten most common physical complaints of people who have celiac disease are: Osteopenia/Osteoporosis; Anemia; Cryptogenic hypertransaminasemia; Diarrhea; Bloating; Aphthous stomatitis; Alternating bowel habit; Constipation; Gastroesophageal reflux disease and Recurrent miscarriages. Most People with Celiac Disease Show No Symptoms Remember that most people who are diagnosed with celiac disease show no symptoms at the time of their diagnosis. What's Involved in Celiac Disease Screening? Find out what's involved in screening and testing for celiac disease.
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Celiac.com 10/09/2019 - The American Gastroenterological Association's new guidelines for evaluating chronic diarrhea in clinical practices offer recommendations on the best laboratory tests for excluding other diagnoses when patients have possible functional diarrhea or diarrhea-predominant irritable bowel syndrome. When evaluating patients with chronic watery diarrhea, "it is important for health care providers to determine whether it is being caused by organic disease or a functional disorder, such as functional diarrhea or irritable bowel syndrome with diarrhea,” says Walter Smalley, MD, MPH, of the Veterans Affairs Tennessee Valley Healthcare System and Vanderbilt University School of Medicine. Celiac disease would be another factor to check, and the new AGA guidelines include a recommendation to test for IgA tissue transglutaminase, along with a second test for detecting celiac disease via IGA deficiency. The AGA recommended the following seven steps to guide laboratory testing in patients with chronic diarrhea: Test for markers of inflammatory conditions — such as IBD — like fecal calprotectin or fecal lactoferrin. The AGA suggests against using erythrocyte sedimentation rate or C-reactive protein to screen for IBD. Screen for Giardia. Screen for O&P or parasites, other than Giardia, only in patients with a travel history in high-risk areas. Test for celiac disease with IgA tissue transglutaminase and a second test to detect celiac disease in the setting of IGA deficiency. Screen for bile acid diarrhea. The AGA made no recommendation on the use of currently available serological tests for the diagnosis of IBS. The new AGA guidelines are aimed at patients with a working immune system, who suffer watery diarrhea for at least 4 weeks. Patients with bloody diarrhea, diarrhea with signs of poor fat absorption, features of alarm systems like weight loss, anemia and hypoalbuminemia, family history of inflammatory bowel disease, colon cancer or celiac disease, and patients who have traveled to areas where diarrhea-related diseases are coming are excluded from the guidelines. Read more in Gastroenterology. 2019. doi:10.1053/j.gastro.2019.07.004.
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Celiac.com 07/05/2016 - Principal Investigator: Amrit P.S. Narula M.D, F.A.C.P, F.A.C.G, F.A.C.N., A.G.A.F Study Coordinator: Alicia Mercuri, PA-C Background Research estimates that approximately 18 million Americans have gluten sensitivity. That is six times more than patients confirmed with celiac disease. Non-celiac gluten sensitivity is defined as those individuals who cannot tolerate gluten in the diet and experience the same symptoms attributed to celiac disease, but lack antibodies and intestinal damage as seen in celiac disease. A dietary supplement called ZyGluten was developed from in vitro studies, not in vivo. The primary aim in its development was a supplement which, if taken at the beginning of a meal, would hydrolyze gluten concentration in ingested food. Foods tested included McDonald's hamburger, white sliced bread, a plain bagel, macaroni and cheese, spaghetti, a muffin, and frozen pizza. The amount of gluten was measured at 0, 30 and 60 minutes after the introduction of ZyGluten. In all samples, gluten measured at the end of 60 minutes was less than 20 ppm. ZyGluten is a compound of amylases, proteases, and lipase enzymes with probiotics, specifically Lactococcus lactis and Lactococcus cremoris. It is derived from plant and microbial sources. Inclusion Criteria Ages 18-80 years Physician diagnosed gluten sensitivity by history and experienced symptoms of gluten sensitivity for at least 1 month prior to involvement Willing to take supplement twice daily for 2 weeks Sign informed consent Exclusion criteria Active Inflammatory Disease Celiac disease confirmed by antibodies and duodenal biopsy Peptic ulcer disease Lactose intolerance Pregnant or lactating women Received any experimental drug within 30 days of enrollment Methods 27 patients, all of whom met the inclusion criteria, were selected to take 2 capsules of ZyGlutens before 2 major meals of the day for 2 weeks. 23 patients were female and 4 were male, with ages ranging from 25-77. The following symptoms were assessed at baseline, week 1, and week 2 which was the conclusion of the study: Abdominal pain Diarrhea Constipation Headaches Joint pain Fatigue The severity of symptoms was measured as mild, moderate, or severe, and none if symptoms were absent. All patients were contacted by phone within 48 hours of start of the trial to assess for any adverse effects. Following parameters were checked at baseline, week 1, and week 2: Weight Height Blood pressure Pulse rate Respiration rate Patients were not charged or reimbursed for their participation in the study. Results The following number of patients (27) had these symptoms at baseline: None Mild Moderate Severe Abdominal Pain/Cramping 1 1 16 9 Bloating/Distention 0 3 9 15 Diarrhea 10 4 2 11 Constipation 16 2 3 6 Headaches 11 5 7 4 Joint Pains 12 2 9 4 Fatigue 3 4 5 15 The following number of patients (23) had these symptoms at week 1: None Mild Moderate Severe Abdominal pain/Cramping 10 7 4 2 Bloating/Distention 9 10 1 3 Diarrhea 16 5 2 0 Constipation 20 1 1 1 Headaches 17 2 3 1 Joint Pains 14 2 4 3 Fatigue 7 8 3 5 The following number of patients (23) had these symptoms at week 2: None Mild Moderate Severe Abdominal Pain/Cramping 15 4 2 2 Bloating/Distention 14 6 1 2 Diarrhea 21 1 1 0 Constipation 21 1 0 1 Headaches 16 5 1 1 Joint Pains 17 3 2 1 Fatigue 10 7 1 5 The following number of patients rated their symptom improvement as: No improvement: 0 Improved: 4 Markedly improved: 19 Adverse Effects No patients reported any adverse effects. Participants Twenty-seven participants were enrolled in the study. Two patients withdrew from the study; one of which had a scheduling conflict with follow-up visits and one stopped taking the medication due to increased sleepiness after two pills. Two patients were lost to follow-up. These four patients were excluded from analysis. Conclusion In conclusion, ZyGluten study is a 2 week open labeled trial. Our outcome so far has shown to be extremely efficacious with no significant side effects. There was no significant difference found in patients who complained of headaches or joint pain. The majority of the patients found significant improvement in their symptoms of abdominal pain, bloating, changes in bowel habits, and fatigue. In fact, 83% of patients rated that their symptoms markedly improved, and 17% rated an improvement in their symptoms. Patient Testimonials *The medication was known by patients as ‘Gluten Buster' during the clinical trial. "Medication has given me more freedom. I am no longer afraid to eat, especially away from home. I am very pleased with the medication".-MF "My symptoms have improved. I would like to keep taking this if I can, especially since it's natural, to see how long I can go without an endoscopy".-MH "I feel that this pill has made a tremendous improvement in my condition". –BW "Bloating is gone. Stools seem to be more formed. Feeling good". –PS "It's wonderful to not be limited in what I can eat. It's great not to have the symptoms of pain, etc. when eating gluten foods". –JH "Great for bloating".-JF "Very little of passing gas. I feel good". -PW "Bloating is a lot better". -LW "I have not had any cramping or urgency to have a BM after a meal. My bowel movements are now normal. I have had no GI distress since on the meds". –KY "Gluten Buster has been a miracle pill. After so many years of having bowel problems, I never knew what it was like to have a regular bowel movement. I have had no problems with digestive system since I starting taking these pills". -JM "Medication was very helpful". –KO "My experience with the Gluten Buster that Dr. Narula has given me to take has been simply amazing. It has made my quality of life so much better. He is an amazing doctor to help those that otherwise thought there was no hope! I feel great"!-CM "Seems a little bit better. Still have IBS. Still have a lot of gas and bloating."-AM "It has been helping to go to the bathroom. The weight is going up and the stomach is going down a little bit".-SH "Before taking the medicine, mornings were hard because of bloating and diarrhea. Now I feel great in the morning".-GK "Gluten Buster is a life changer. Will definitely go on it when available in market." -MC "It is helping with bloating and gas. Has improved all of my GI symptoms. Overall, I can eat anything, including French fries and food I could not eat before (Super Pill)". -MK "I feel it has improved. Still have bloating, but eating regular food. Diarrhea has improved, no pain in stomach or abdomen". -BS "I feel 10x better than I did before starting the medication. No stomach cramps of bloating, I only have a BM twice/day. Feel great!" -JB "I am doing 100% better now since I have been taking the Gluten Buster meds". - JZ "Passing more gas, feeling better". -ML "I'm feeling better. I'm eating anything I want, not sticking with gluten free food. If it's due to taking the Gluten Buster, then I would still take it". -BS "It has made a big difference in bloating and abdominal pain. I would like to continue taking it". -JP "My stomach feels fantastic when I take the product. This should be available for all people with gluten sensitivity. This would be a great idea for Shark Tank. It needs to be available to the masses! I don't know how my stomach will survive without it, especially at the holidays". -LT References Am J Gastroenterol. 2011 Mar;106(3):508-14; quiz 515. doi: 10.1038/ajg.2010.487. Epub 2011 Jan 11. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Biesiekierski JR1, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. The Oslo definitions for celiac disease and related terms. Jonas F Ludvigsson,1,2 Daniel A Leffler,3 Julio C Bai,4 Federico Biagi,5 Alessio Fasano,6 Peter H R Green,7 Marios Hadjivassiliou,8 Katri Kaukinen,9 Ciaran P Kelly,3 Jonathan N Leonard,10 Knut Erik Aslaksen Lundin,11 Joseph A Murray,12 David S Sanders,13,14 Marjorie M Walker,14 Fabiana Zingone,15 Carolina Ciacci16 Food Allergy - An Overview (PDF|1 MB). DHHS. NIH. National Institute of Allergy and Infectious Diseases. Gastroenterol Hepatol. 2014 Jun-Jul;37(6):362-71. doi: 10.1016/j.gastrohep.2014.01.005. Epub 2014 Mar 22. [Non-celiac gluten sensitivity: a critical review of current evidence]. [Article in Spanish] Molina-Infante J1, Santolaria S2, Montoro M2, Esteve M3, Fernández-Bañares F3. Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. Jessica R Biesiekierski, Evan D Newnham, Peter M Irving, Jacqueline S Barrett, Melissa Haines, James D Doecke, Susan J Shepherd, Jane G Muir and Peter R Gibson. Nutrients. 2013 Sep 26;5(10):3839-53. doi: 10.3390/nu5103839. Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. Catassi C1, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A, Castillejo G, Ciacci C, Cristofori F, Dolinsek J, Francavilla R, Elli L, Green P, Holtmeier W, Koehler P, Koletzko S, Meinhold C, Sanders D, Schumann M, Schuppan D, Ullrich R, Vécsei A, Volta U, Zevallos V, Sapone A, Fasano A. BMC Med. 2014 May 23;12:86. doi: 10.1186/1741-7015-12-86. Non-celiac gluten sensitivity - why worry? Lundin KE. BMC Med. 2014 May 23;12:85. doi: 10.1186/1741-7015-12-85. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. Volta U1, Bardella MT, Calabrò Neurogastroenterol Motil. 2013 Nov;25(11):864-71. doi: 10.1111/nmo.12216. Epub 2013 Aug 12. Non-celiac gluten sensitivity: clinical relevance and recommendations for future research. Mooney PD1, Aziz I, Sanders DS. World J Gastroenterol. 2014 Jul 21;20(27):8837-45. doi: 10.3748/wjg.v20.i27.8837. Irritable bowel syndrome and food interaction. Cuomo R, Andreozzi P, Zito FP, Passananti V, De Carlo G, Sarnelli G. Expert Rev Gastroenterol Hepatol. 2012;6(1):43-55. Problems of an Emerging Condition Separate From Celiac Disease. Amy C Brown Dig Dis Sci. 1999 Jul;44(7):1317-21. Pancreatic supplements reduce symptomatic response of healthy subjects to a high fat meal. Suarez F1, Levitt MD, Adshead J, Barkin JS.
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Celiac.com 07/09/2015 - Children presenting for rheumatology evaluation have undiagnosed celiac disease at double the rates of the general population, says the latest study. However, current clinical guidelines do not consider patients with rheumatic conditions to be at high risk for celiac disease despite numerous reported associations between the two in adults and children. A team of researchers set out to assess the prevalence of celiac disease among kids receiving a rheumatology evaluation. The research team included Yekaterina Sherman, BA, Rose Karanicolas, MD, Brittany DiMarco, BA, Nancy Pan, MD, Alexa B. Adams, MD, Laura V. Barinstein, MD, L. Nandini Moorthy, MD, and Thomas J. A. Lehman, MD. They are variously affiliated with the Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York; the Division of Rheumatology, Mount Sinai Medical Center, New York, New York; and the Division of Pediatric Rheumatology, Robert Wood Johnson Medical School in New Brunswick, New Jersey. The team conducted celiac disease screenings on a total of 2,125 patients presenting for initial evaluation by the Division of Pediatric Rheumatology at the Hospital for Special Surgery between June 2006 and December 201, as a part of the standard initial serologic evaluation. The team then reviewed the charts at the end of this period. From this information, the team diagnosed celiac disease in a total of 36 patients (30 girls, 6 boys, mean age 9.4 ± 4.3 years, range 2–16 years), after serologic testing and evaluation by pediatric gastroenterology. Eight additional patients with known celiac disease diagnoses presented during this time period. The total prevalence of celiac disease over this 6.5-year period was 2.0%. The most commonly reported complaints among patients diagnosed with celiac disease were myalgias, arthralgias, and skin rash. Less frequently, patients reported gastrointestinal complaints including abdominal pain, nausea, and diarrhea. All patients reported improvement or complete resolution of their musculoskeletal symptoms after beginning a gluten-free diet. In this study, the team found 36 new cases of celiac disease among children presenting for rheumatology evaluation, for an overall prevalence rate of 2.0%. The majority of patients who ultimately received a diagnosis of celiac disease presented with extra-intestinal manifestations. These results underscore the importance of celiac disease screening in children receiving a rheumatology evaluation. Source: http://pediatrics.aappublications.org/content/early/2015/06/09/peds.2014-2379.abstract
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Evaluation of IVE/MTX-ASCT treatment for cases of EATL
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Celiac.com 06/14/2010 - Enteropathy associated T-cell lymphoma (EATL) is a rare type of for which there are currently no standardized diagnostic or treatment protocols. A team of researchers recently evaluated enteropathy-associated T-cell lymphoma and compared standard therapies with a novel regimen including autologous stem cell transplantation The research team included Michal Sieniawski, Nithia Angamuthu, Kathryn Boyd, Richard Chasty, John Davies, Peter Forsyth, Fergus Jack, Simon Lyons, Philip Mounter, Paul Revell, Stephen J. Proctor, and Anne L. Lennard. The team describe EATL in a population-based setting and evaluates a new treatment with aggressive chemotherapy and autologous stem cell transplantation (ASCT). In 1979, the Scotland and Newcastle Lymphoma Group began to collect data on all patients newly diagnosed with lymphoma in the Northern Region of England and Scotland. The research team reviewed the records of patients diagnosed with EATL from 1994 and 1998. 54 patients had features of EATL. The overall annual rate was 0.14/100,000. Doctors treated 35 patients with systemic chemotherapy (mainly anthracycline-based chemotherapy) and with surgery. They treated 19 patients with surgery alone. Patients showed a median progression-free survival (PFS) of 3.4 months and overall survival (OS) of 7.1 months. Starting in 1998 patients eligible for intensive treatment received the novel regimen IVE/MTX (ifosfamide, vincristine, etoposide/methotrexate)–ASCT, with a total 26 patients included. PFS and OS at the five year mark were 52% and 60%, respectively, a substantial improvement over the historical group treated with anthracycline-based chemotherapy (P .01 and P .003, respectively). In contrast to the poor outcomes when treated with conventional therapies, the IVE/MTX-ASCT regimen offers acceptable toxicity and significantly improved outcome for cases of EATL. Researchers are affiliated variously with the Department of Haematological Sciences, Newcastle University, Newcastle upon Tyne; the Department of Haematology, Craigavon Area Hospital, Portadown; the Department of Haematology, University Hospital of North Staffordshire, Stoke on Trent; the Department of Haematology, Western General Hospital, Edinburgh; the Department of Haematology, Raigmore Hospital, Inverness; the Department of Haematology, Harbour Hospital, Poole; the Department of Haematology, Sunderland Royal Hospital, Sunderland; the Department of Haematology, University Hospital of North Tees, Stockton on Tees; and the Department of Haematology, Staffordshire General Hospital, Stafford, United Kingdom Source: Blood, 6 May 2010, Vol. 115, No. 18, pp. 3664-3670. DOI 10.1182/blood-2009-07-231324.-
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Celiac Study: Non-invasive Intestinal Evaluation Shows Promise
Jefferson Adams posted an article in Latest Research
Celiac.com 05/21/2009 - To better diagnose celiac disease, assess intestinal damage, and monitor treatment over the long-term, doctors are looking to develop a whole new set of non-invasive evaluation tools. One of the tools currently of interest are fatty acid binding proteins (FABPs), these are small cytosolic proteins found in enterocytes (tall columnar cells and responsible for the final digestion and absorption of nutrients, electrolytes and water). FABPs are reliable indicators of intestinal mucosal damage, and are potentially useful for non-invasive assessment of intestinal damage in celiac patients. A team of researchers in the Institute of Nutrition and Toxicology Research at Maastricht University, as well as the departments of Surgery, Pediatrics and Internal Medicine at University Hospital Maastricht, recently set out to assess the potential use of FABPs in non-invasive assessment of intestinal damage in celiac disease. The study team was made up of J. P. Derikx, A. C. Vreugdenhil, A. M. Van den Neucker, J.Grootjans J, A. A. van Bijnen, J.G. Damoiseaux, L. W. van Heurn, E. Heineman, and W. A. Buurman. They began by examining the distribution and microscopic localization of FABPs in healthy human intestinal tissue. They then checked circulating levels of intestinal (I)-FABP and liver (L)-FABP in 26 healthy control subjects, and in 13 patients with biopsy-proven celiac disease, both before and after initiating a gluten-free diet. Ten celiac subjects underwent reevaluation within a year beginning a gluten-free diet. They found that I-FABP and L-FABP are common in the small intestine, particularly in the jejunum. FABPs also show up in cells on the upper part of the villi, the part that is first to be damaged in celiac disease. They also found that people with untreated, biopsy-proven celiac disease have substantially higher circulating levels of FABPs as compared with healthy control subjects (I-FABP: 784.7 pg/mL vs. 172.7 pg/mL, P<0.001; L-FABP: 48.4 ng/mL vs. 10.4 ng/mL, P<0.001). These levels return to normal when patients adopt a gluten-free diet. According to the team, the monitoring of FABP circulating levels shows strong promise as a non-invasive means of diagnosing and assessing intestinal damage in celiac disease, as well as in long-term non-invasive monitoring of treatment and gluten-free diet compliance. Journal of Clinical Gastroenterology. 2009 Apr 6.-
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TI- Proba prowokacyjna u dzieci z nietolerancja biaLek mleka krowiego i glutenu: ocena reakcji klinicznych i zmian w bLonie sluzowej jelita cienkiego. AU- Kaczmarski M CS- Kliniki Chorob Zakaznych Dzieci AM w BiaLymstoku. JN- Pol Tyg Lek; 45 (8-9) p161-5 PY- Feb 19-26 1990 AB- Provocation test (re-introduction of the noxious protein) was carried out in two groups of patients: (a) with intolerance to the cow-milk proteins (41 children) treated with milk-free diet for 6-24 months, and ( with gluten intolerance (26 children) treated with gluten-free diet for 6-36 months. The following parameters were compared: type and frequency of the clinical symptoms seen in these patients prior to the introduction of allergen-free diet. Moreover, the type of observed morphological changes in the small intestine mucosa following provocation test were analyzed in the groups of 7 patients. A two-year elimination of milk from the diet produces milk tolerance in about 61% patients; clinical symptoms in the remaining children are diversified. Re-introduction of gluten with the diet (provocation test) produces recurrence of gluten intolerance in 96% of children treated with gluten-free diet for 2-3 years. Recurrence of the disease was accompanied by the atrophy of the intestinal villi.
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