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Celiac.com 12/23/2024 - Celiac disease is an autoimmune disorder that affects the small intestine, making it difficult for the body to absorb essential nutrients. This condition can occur globally, especially in individuals with other autoimmune diseases like Type 1 diabetes. In West Africa, however, there has been little research on celiac disease’s prevalence in populations with Type 1 diabetes, which prompted this study to investigate its occurrence among Nigerian children and adolescents with diabetes. Study Objectives and Design The study aimed to explore how frequently celiac disease autoimmunity occurs in Nigerian children and adolescents diagnosed with Type 1 diabetes. Researchers examined over 100 young patients from pediatric endocrinology clinics across Nigeria, gathering data on socio-demographic factors and clinical details like symptom history and overall health. To detect celiac disease autoimmunity, the study screened for specific antibodies in blood samples. Those with elevated antibody levels were encouraged to undergo an endoscopy and a biopsy to confirm a celiac disease diagnosis. Key Findings on Celiac Disease Autoimmunity Among the participants with Type 1 diabetes, around 6% showed signs of celiac disease autoimmunity based on elevated antibody levels. All cases occurred in females, primarily between ages 3 and 12. Most of the affected children experienced gastrointestinal symptoms, including nausea, vomiting, diarrhea, and bloating, which are typical symptoms of celiac disease. A notable finding was that children diagnosed with Type 1 diabetes before age 10 were more likely to have celiac disease autoimmunity compared to those diagnosed later. Regional and Gender-Based Patterns This study highlighted potential regional trends, finding that most children with celiac disease autoimmunity were from northern Nigeria, which borders regions in North Africa where celiac disease is more prevalent. This geographical proximity may play a role in increased autoimmune conditions due to genetic similarities and environmental factors. Additionally, the study confirmed that celiac disease autoimmunity appears more frequently in females, consistent with broader findings in autoimmune research. Challenges and Diagnostic Limitations Although antibody tests are useful in suggesting celiac disease autoimmunity, a duodenal biopsy is necessary to confirm the diagnosis. However, due to limited healthcare resources in Nigeria, most children with high antibody levels couldn’t complete a biopsy. Given the expense and accessibility issues related to this procedure, the study relied on combined antibody testing to improve diagnostic accuracy. Despite these constraints, researchers could identify patterns and suggest that screening programs might help to better understand the prevalence of celiac disease among high-risk groups in Nigeria. Comparisons with Other Regions The study’s findings align with similar research in Europe and the Middle East, where celiac disease occurs in approximately 5% of children with Type 1 diabetes. However, in certain African and Middle Eastern countries, the prevalence is often higher, likely due to genetic and dietary factors, as well as varying diagnostic practices. For example, countries like Egypt and Morocco report higher prevalence rates in children with diabetes than observed in Nigeria, which could be due to regional differences in food consumption, healthcare access, or population genetics. Implications for Health Practices in Nigeria This study brings attention to the potential for undiagnosed celiac disease in the general Nigerian population, especially among children with Type 1 diabetes. For individuals with both diabetes and celiac disease, untreated symptoms can lead to poor nutrient absorption, impacting their diabetes management and overall health. Diagnosing and managing celiac disease in young diabetic patients could improve their quality of life and reduce health risks related to nutrient deficiencies. Why These Findings Matter for Children with Type 1 Diabetes For healthcare providers, this research underscores the importance of routine screening for celiac disease in children and adolescents diagnosed with Type 1 diabetes. Early detection can help families and medical teams address dietary adjustments, specifically a gluten-free diet, to prevent complications and manage symptoms effectively. This study encourages proactive healthcare approaches, particularly for those at higher risk, and emphasizes the need for accessible diagnostic tools. By raising awareness and improving screening practices, the healthcare community can work to address the significant but often overlooked burden of celiac disease. Read more at: bmcgastroenterol.biomedcentral.com Watch the video version of this article:
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Celiac.com 08/19/2024 - Erectile dysfunction is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual performance. It affects a significant portion of the male population, with prevalence rates varying globally but generally high. Research has shown a strong link between erectile dysfunction and several chronic health conditions, including gastrointestinal diseases. However, establishing a clear causal relationship has been challenging. Research Design This study used Mendelian randomization to investigate the potential causal links between various chronic gastrointestinal diseases and erectile dysfunction. Mendelian randomization leverages genetic variants as instrumental variables to infer causality, minimizing confounding factors and reverse causation that often plague observational studies. Data on chronic gastrointestinal diseases, such as Crohn's disease, inflammatory bowel disease, ulcerative colitis, liver cirrhosis, and colorectal cancer, were sourced from large public datasets. Erectile dysfunction data were obtained from three distinct sources, including the FinnGen study and the UK Biobank. The genetic correlations between these diseases and erectile dysfunction were explored using linkage disequilibrium score regression. Mendelian randomization analysis followed, along with meta-analysis to determine the ultimate causal effect. Genetic Correlation Findings The study found significant genetic correlations between Crohn's disease and erectile dysfunction. Inflammatory bowel disease and ulcerative colitis showed potential genetic correlations with erectile dysfunction, while liver cirrhosis exhibited a negative genetic correlation. These findings suggest a genetic link between these gastrointestinal conditions and erectile dysfunction, warranting further investigation. Causal Relationship Findings The Mendelian randomization analysis revealed significant causal relationships between inflammatory bowel disease and Crohn's disease with erectile dysfunction. Colorectal cancer also demonstrated a potential causal effect on erectile dysfunction. These results were consistent across multiple analyses, strengthening the evidence for these associations. Conclusion The study underscores the importance of considering gastrointestinal health when addressing erectile dysfunction. Chronic gastrointestinal diseases can impact sexual function through various mechanisms, including inflammation, psychological stress, and hormonal changes. The findings highlight the need for comprehensive care in patients with these conditions, addressing both their gastrointestinal and sexual health. This study provides robust evidence supporting a causal relationship between chronic gastrointestinal diseases and erectile dysfunction. For patients with celiac disease, understanding these links can be particularly meaningful. It emphasizes the need for healthcare providers to consider and address potential sexual health issues in patients with chronic gastrointestinal diseases, ultimately aiming for improved overall health and quality of life. Read more at: frontiersin.org
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Celiac.com 03/08/2018 - A team of researchers recently set out to study delays in diagnosing patients who have biopsy-proven celiac disease with gastrointestinal complaints, compared to those without non-gastrointestinal complaints. The research team included Marco A. Paez, MD, Anna Maria Gramelspacher, MD, James Sinacore, PhD, Laura Winterfield, MD, and Mukund Venu, MD. They are variously affiliated with the Division of Gastroenterology, Department of Medicine, Howard College of Medicine, Washington, DC; the Department of Medicine, the Department of Public Health Sciences, the Division of Gastroenterology, and the Department of Medicine at Loyola University Medical Center in Maywood, Illinois. The research team first conducted a medical chart review of 687 adult patients diagnosed with celiac disease. All patients they studied had biopsy-proven celiac disease and were grouped according to presence or absence of gastrointestinal symptoms before diagnosis. The team found 101 biopsy-proven celiac patients that met their study criteria. The groups were roughly equal in size, with 52 patients showing gastrointestinal symptoms before diagnosis, and 49 with no gastrointestinal symptoms. The results for the groups were starkly different. Statistical analysis revealed an average diagnosis delay of 2.3 months for the group with gastrointestinal symptoms, while the group that showed no symptoms showed an average delay of 42 months. That’s a difference of nearly 3½ years. Nearly half of the patients with non-gastrointestinal symptoms had abnormal thyroid-stimulating hormone, as opposed to 15.5% in the gastrointestinal symptom group (P = .004). Nearly 70% of patients without gastrointestinal symptoms had anemia, compared with just 11.5% of the group with gastrointestinal symptoms. Also, nearly 70% of patients in the non-gastrointestinal symptom group showed abnormal bone density scans, compared with 41% in the gastrointestinal symptom group. The team saw no sex differences on chi-squared analysis between the 2 groups. Although there is growing awareness of celiac disease, the delay in diagnosis for patients without gastrointestinal symptoms remains prolonged, with an average delay of 3.5 years for celiac diagnosis, compared with just over two months for those with symptoms. Clearly, more needs to be done with regard to diagnosing celiac disease in patients who show no symptoms. On the upside, researchers are currently working on ways to better diagnose celiac disease via faster, more accurate tests, even in patients who have already gone gluten-free. Source: amjmed.com
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Hey Guys, I'll post the question first in case you don't have time to read my story. Does/can gluten expose cause burning pain in the gut area? It seems when I MIGHT have a gluten exposure I get a "flare" of burning pain in my gut - mostly my left upper area. If I KNOW I've eaten gluten I get the burning plus the awful cramps and like I have constipation and diarrhea at the same time, my joints hurt like crazy and feel a little dizzy and this goes on strong for at least two days and takes what seems two to three weeks to go away. Backstory: My gut has been sick for 5 years. My gastro doc ran the basic tests (colonoscopy, endoscopy with all the biopsies, etc.) and my GP ran all the other stuff (CT scan, Echo of gallbladder, bloodwork). ALL normal except slight gastritis in stomach and a few diverticuli along my colon. Gastro doc said I have classic IBS. I have seriously tried every single diet change on the planet to heal up, and some have been quite extreme. The ONE thing I found for sure is that if I go strict without gluten and dairy for, say, 3 weeks, and then eat gluten again I get sicker than a dog. Now, during all my tests, my gastro doc biopsied me for celiac but at the time I didn't KNOW he was going to test me for it and HE didn't know I wasn't eating gluten. When he told me the celiac came back negative I said that was good because I hadn't been eating gluten for awhile anyway. The gasto doc was shocked and said the NEGATIVE results could totally be wrong. He told me to "Go eat all the bread that God made and come see me so we can redo the test". I took some gluten afterwards and immediately got sick. I didn't go back to my gastro doc because I wasn't about to continue to eat the gluten for 2 weeks. My GP doc says he wants to diagnose me with celiac just based on my symptoms alone. Now, the burning pain in my left upper side is so awful. Like a 6 or 7 on my pain scale.. and I've birthed 6 children with no meds. It used to come and go and now it's mostly here. I try hard to stay away from gluten but since the pandemic have been eating out "gluten free" and I think I get exposed. Yet, I'm still not sure if I am even celiac! I read somewhere that if a person is highly sensitive to gluten that an exposure can make them sick for up to a year? Now my GP doc wants to run more tests to see if I have other issues. My main question is whether gluten exposure can cause this type of burning pain? Has anyone else experienced this? Thanks, Missi
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Probiotics May Reduce GI Symptoms in Celiac Disease Patients
Scott Adams posted an article in Latest Research
Celiac.com 11/02/2020 - Many people with celiac disease experience persistent symptoms despite adhering to the gluten-free diet. Different studies have assessed the use of probiotics as an adjuvant treatment for celiac disease. A team of researchers recently set out to to evaluate the efficacy of probiotics in improving gastrointestinal (GI) symptoms and quality of life (QOL) in patients with celiac disease, and used EMBASE, MEDLINE, CINAHL, Web of Science, CENTRAL, and DARE databases to search for randomized controlled trials (RCTs) evaluating probiotics compared with placebo for treating celiac disease, before February 2019. The researchers collected data on GI symptoms, QOL, adverse events, serum tumor necrosis factor-α, intestinal permeability, and microbiota composition. After examining 2,831 records, they found seven articles describing 6 RCTs, totaling 5,279 participants, that met their eligibility criteria for quantitative analysis. Probiotic use increased Bifidobacteria an average of 0.85 log colony-forming units (CFU) per gram. When measured by the GI Symptoms Rating Scale, which measures average difference symptom reduction, probiotics reduced GI symptoms. However, there was no difference in GI symptoms after probiotics when different questionnaires were pooled. There was just not enough data on tumor necrosis factor-a levels or QOL for probiotics compared with placebo. Meanwhile, the team saw no difference in adverse events between probiotics and placebo. Because the overall certainty of the evidence ranged from very low to low, the best the team can say is that probiotics MAY be helpful to celiac patients. The team is calling for high-quality clinical trials to increase the certainty of the data in this matter. Do you have celiac disease, and take probitiotics to help your gut health? Do they help? Share your experience in our comments section. Read more in Am J Gastroenterol. 2020 Oct;115(10):1584-1595. The research team included Caroline L Seiler, Michel Kiflen, Juan Pablo Stefanolo, Julio César Bai, Premysl Bercik, Ciaran P Kelly, Elena F Verdu, Paul Moayyedi, Maria Ines Pinto-Sanchez. They are variously affiliated with the Department of Medicine, Farncombe Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; the Population Health Research Institute, Genetic and Molecular Epidemiology Laboratory, Hamilton, Ontario, Canada; the Hospital de Gastroenterologia Dr C B Udaondo, Buenos Aires, Argentina; and the Celiac Center Beth Israel Deaconess Medical Center and Celiac Research Program, Harvard Medical School, Boston, Massachusetts, USA.- 14 comments
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Celiac.com 08/28/2019 - Do people who avoid gluten for lifestyle reasons actually have some sort of underlying health or medical condition that makes a gluten-free diet beneficial? Or, a simpler way to put the question: Who benefits from a gluten-free diet, and who does not? A team of researchers recently set out to see if people without celiac disease or gluten-intolerance, who eat a gluten-free diet, are gaining any benefit. The research team included Iain David Croall, Imran Aziz, Nick Trott, Paola Tosi, Nigel Hoggard, and David S. Sanders. They are variously affiliated with the Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom; the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; and the University of Reading, School of Agriculture Policy and Development, Reading, United Kingdom. Although the gluten-free diet is necessary for people with celiac disease, non-celiac gluten sensitivity (NCGS), and other types of clinical gluten sensitivity, the scientific consensus is that gluten is safe for most people. Still, numerous celebrity and athlete endorsements of the gluten-free diet have promoted an image of gluten as “unhealthy,” leading numerous people to adopt the gluten-free diet as a lifestyle choice. American market research found that nearly half of all gluten-free food consumers do not have celiac disease or gluten-sensitivity, while nearly two-thirds believe that gluten-free food is generally healthier. This trend is partly responsible for the explosive growth in the worldwide gluten-free industry, which is projected to see revenues of about $4.7 billion in 2020. The researchers feel that the perception of the gluten-free diet as a "fad" has harmed people with celiac disease and gluten intolerance. They feel that clarifying exactly who will benefit from a gluten-free diet, and who will not, will help to inform the public and clinicians on these issues. For this reason, the team conducted that first double-blind randomized controlled trial (DRCT) of gluten in healthy control subjects, under the assumption that the gluten would not cause symptoms in people without gluten sensitivity. Volunteers attended 2 study sessions, and were then educated by a dietitian about a gluten-free diet and asked to follow a supported gluten-free diet for for 2 weeks. The researchers then measured gluten-free diet adherence using the Biagi score. For their study, the research team recruited unpaid adult volunteers with no diagnosed gluten-related disorders, who followed gluten-containing diets. The study aimed to recruit 30 subjects to divide into 2 groups. No previous data in healthy individuals are available, but NCGS DRCTs have reported gastrointestinal symptom changes induced by gluten, which would carry 89.2% power if observed within a group of n = 15. Volunteers received blood screens for celiac disease antibodies. The trial was supported by the personal research funds of Professor Sanders, and sought ethical approval from the Yorkshire and Humber Research. The results of the study show that gluten does not cause gastrointestinal symptoms in healthy people. Basically, people who eat gluten-free absent some clear medical benefit may be falling victim to public misconception of gluten, and likely gaining no health benefit from eating gluten-free. Read more at Science Direct.com
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Celiac.com 08/19/2019 - Most gluten-free celiac patients will experience gastrointestinal symptoms within hours of gluten exposure. A number of studies have shown a connection between cytokines and adverse gluten-reactions. A team of researchers recently set out to examine systemic cytokine profiles and their connection to acute symptoms in celiac disease patients after reactivation of gluten immunity. To do this, the team carried out a series of multiplex cytokine measurements in celiac disease patients after a gluten challenge, both orally, and by injection. The research team included Gautam Goel, Jason A. Tye-Din, Shuo-Wang Qiao, Amy K. Russell, Toufic Mayassi, Cezary Ciszewski, Vikas K. Sarna, Suyue Wang, Kaela E. Goldstein, John L. Dzuris, Leslie J. Williams, Ramnik J. Xavier, Knut E. A. Lundin, Bana Jabri, Ludvig M. Sollid, and Robert P. Anderson. Patients receiving gluten by injection showed at least 15 elevated plasma cytokines, with IL-2, IL-8, and IL-10 being most common, with changes 272-fold, 11-fold, and 1.2-fold, respectively. IL-2 and IL-8 were the only cytokines elevated at 2 hours, prior to symptom onset. After gluten ingestion, IL-2 was the earliest and most prominent cytokine, with a 15-fold change after 4 hours. Supported by studies of patient-derived gluten-specific T cell clones and primary lymphocytes, the team's observations indicate that celiac-associated gastrointestinal symptoms are likely caused by rapid reactivation of gluten-specific CD4+ T cells by gluten. This research may lead to new ways to diagnose and treat those with celiac disease. Stay tuned for more on this and related stories. Read more at: Science Advances 07 Aug 2019:Vol. 5, no. 8. DOI: 10.1126/sciadv.aaw7756 The researchers in this study are variously affiliated with the Division of Gastroenterology and Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA, USA; Immunology Division, The Walter and Eliza Hall Institute, Parkville, VIC, Australia; the Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia; the Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, VIC, Australia; the Centre for Food and Allergy Research, Murdoch Children’s Research Institute, Parkville, VIC, Australia; the Department of Immunology and KG Jebsen Coeliac Disease Research Centre, University of Oslo and Oslo University Hospital-Rikshospitalet, Oslo, Norway; the Department of Pediatrics, Department of Medicine, University of Chicago, Chicago, IL, USA; ImmusanT Inc., Cambridge, MA, USA; and the Department of Gastroenterology and KG Jebsen Coeliac Disease Research Centre, University of Oslo and Oslo University Hospital-Rikshospitalet, Oslo, Norway.
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Celiac.com 05/02/2019 - Both gastrointestinal and mental disorders can occur alongside other disorders, and both can be triggered by early adversity, such as parental deprivation. Interactions between the brain and bacteria that live in the gut microbiome potentially influence interactions between adversity, gastrointestinal issues and anxiety. These connections have been well-studied in animals, but very little study has been done during human development. What can we learn about mood and gastrointestinal distress in children exposed to adversity? A team of researchers recently set out to explore adversity–gastrointestinal–anxiety associations in youth who were raised with their biological parents, or were exposed to early adverse care giving experiences, such as institutional or foster care followed by international adoption. The research team included Bridget L. Callaghan, Andrea Fields, Dylan G. Gee, Laurel Gabard-Durnam, Christina Caldera, Kathryn L. Humphreys, Bonnie Goff, Jessica Flannery, Eva H. Telzer, Mor Shapiro and Nim Tottenham. To assess connections between adversity, gastrointestinal issues, and anxiety, the team assessed data from a 344 youth, aged from 3–18 years old, who were raised with biological parents, or else exposed to early adverse care giving experiences, such as institutional or foster care followed by international adoption. In Study 1, we demonstrated that previous adverse care experiences were associated with increased incidence of gastrointestinal symptoms in youth. Gastrointestinal symptoms were also associated with concurrent and future anxiety (measured across 5 years), and those gastrointestinal symptoms mediated the adversity–anxiety association at Time 1. Study 2 comprised a sub-sample of children who provided both stool samples and functional magnetic resonance imaging of the brain, and served as a “proof-of-principle." The data from study 2 showed that adversity was tied to changes in both alpha and beta diversity of microbial communities, and both adversity-associated and adversity-independent bacteria level correlated with prefrontal cortex activation to emotional faces. Read more about the implications of these data for supporting youth mental health at Cambridge.org The researchers are variously affiliated with the Department of Psychology, Columbia University in New York, NY; the Department of Psychiatry, Melbourne University, Melbourne, Australia; the Department of Psychology, Yale University in New Haven, CT; Harvard Medical School, Boston, MA, USA; the Semel Institute for Neuroscience and Human Behavior at the University of California Los Angeles in Los Angeles; the Department of Psychology and Human Development at Vanderbilt University in Nashville, TN, USA; the Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA; the Department of Psychology at the University of Oregon in Eugene, OR; the Department of Psychology and Neuroscience at the University of North Carolina, Chapel Hill, in Chapel Hill, NC; and the David Geffen School of Medicine, University of California, Los Angeles in Los Angeles, CA.
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Celiac.com 04/09/2019 - Epithelial barrier loss is a key factor in many intestinal and systemic diseases. Myosin light chain kinase (MLCK) is a key effector of barrier dysfunction, and a target for a potential treatment, but enzymatic inhibition has unacceptable toxicity. A team of researchers recently demonstrated that a unique domain within the MLCK splice variant MLCK1 directs perijunctional actomyosin ring (PAMR) recruitment. The research team included W. Vallen Graham, Weiqi He, Amanda M. Marchiando, Juanmin Zha, Gurminder Singh, Hua-Shan Li, Amlan Biswas, Ma. Lora Drizella M. Ong, Zhi-Hui Jiang, Wangsun Choi, Harmon Zuccola, Yitang Wang, James Griffith, Jingshing Wu, Harry J. Rosenberg, Yingmin Wang, Scott B. Snapper, David Ostrov, Stephen C. Meredith, Lawrence W. Miller and Jerrold R. Turner. Using the domain structure and multiple screens, they revealed a domain-binding small molecule (divertin) that blocks MLCK1 recruitment without inhibiting enzymatic function. Divertin blocks acute, tumor necrosis factor (TNF)-induced MLCK1 recruitment, in addition to downstream myosin light chain (MLC) phosphorylation, barrier loss, and diarrhea, both in vitro and in vivo. The potentially exciting part is that, under experimental inflammatory bowel disease conditions, divertin corrects barrier dysfunction, and prevents disease development and progression. Beyond applications of divertin in gastrointestinal disease, this general approach to enzymatic inhibition by preventing access to specific sub-cellular sites offers a new model for safe and precise targeting of specific properties of enzymes with numerous functions. The development of a safe way to inhibit MLCK1 enzyme action, and which could potentially correct gut barrier dysfunction, and prevent the development and progression of inflammatory bowel disease is exciting news. Read more in Nature Medicine The researchers are variously affiliated with the Department of Pathology, University of Chicago, Chicago, IL, USA; the Laboratory of Chemical Biology & Signal Transduction, The Rockefeller University, New York, NY, USA; Jiangsu Key Laboratory of Neuropsychiatric Diseases and Cambridge-Suda Genomic Resource Center, Soochow University, and Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China; the Laboratory of Mucosal Barrier Pathobiology, Department of Pathology and the Division of Gastroenterology, Hepatology and Nutrition at Boston Children’s Hospital and Harvard Medical School in Boston, MA, USA; the Department of Pathology, Immunology and Laboratory Medicine, University of Florida, College of Medicine, Gainesville, FL, USA, the Department of Chemistry, University of Illinois at Chicago, Chicago, IL, USA, and Vertex Pharmaceuticals, Boston, MA, USA.
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Celiac.com 04/10/2018 - Celiac disease is a multi-system disorder with manifestations that may result in psychiatric disorders. Does that mean that celiac disease patients are more likely to take psychotropic drugs than other gastrointestinal patients? A team of researchers recently set out to assess the prevalence of medication use to treat psychiatric disorders in celiac disease patients compared to other gastrointestinal patients. The research team included Haley M. Zylberberg, Jonas F. Ludvigsson, Peter H. R. Green, and Benjamin Lebwohl. They are variously affiliated with the Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA; the Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden; the Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA; and with the Celiac Disease Center at Columbia University in New York, NY, USA. For their cross-sectional study, the team compiled data on patients undergoing esophago-gastroduodenoscopy over 9-years at a celiac disease referral center. They then compared rates of psychotropic medication use among 1,293 celiac disease patients to a control group of 1,401 patients with abdominal pain or reflux. Average patient age was 48.4 years, nearly 70% were female, and 22.7% used some sort of psychotropic medication. Overall, the team found no difference between rates of psychotropic medication use among celiac disease patients compared to control subjects. However, they did find that people with celiac disease were more likely to use antidepressants. This was confirmed using both univariate and multivariate analysis. Psychotropic medication use was not connected with either the duration or mode of presentation of celiac disease. So, even though the data show that celiac disease patients may use more antidepressants, they use psychotropic medications at similar rates as those with other gastrointestinal diseases. From these data, the study team suggests that researchers should try to assess whether people with celiac disease suffer from mood disorders that are not treated with medications. Source: BMC Psychiatry. 2018; 18: 76. Published online 2018 Mar 27. doi: 10.1186/s12888-018-1668-0
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Celiac.com 06/17/2013 - To investigate the prevalence of human leukocyte antigen (HLA) DQ2/8 alleles in Southern Italians with liver and gastrointestinal (GI) diseases outside of celiac disease, a team of researchers recently looked at human leukocyte antigen DQ2/8 prevalence in non-celiac patients with gastrointestinal diseases. The research team included Daniel DiGiacomo, Antonella Santonicola, Fabiana Zingone, Edoardo Troncone, Maria Cristina Caria, Patrizia Borgheresi, Gianpaolo Parrilli, and Carolina Ciacci. They are variously affiliated with the Gastrointestinal Unit of University Federico â…¡ in Naples, Italy, the Department of Medicine, Celiac Disease Center of Columbia University in New York, in the United States, The Celiac Center of Loreto Crispi Hospital in Naples, Italy, the Celiac Center, Gastrointestinal Unit in San Giovanni di Dio e Ruggi d’Aragona Hospital at the University of Salerno, and the Department of Medicine and Surgery, Campus di Baronissi at the University of Salerno Medical School in Baronissi, Italy. The team assessed HLA DQ2/8 status in 443 patients from three ambulatory gastroenterology clinics in Southern Italy. The clinics were located at the University of Federico â…¡ and Loreto Crispi Hospital in Naples, and Ruggi D’Aragona Hospital in Salerno. The team grouped patients according disease status for pre-post transplant liver disease, esophageal/gastric organic and functional diseases, irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), along with DQ2/8 alleles, which correspond to a celiac disease genetic risk scale. They then compared allele frequencies in the test subjects with healthy Italian control subjects. Out of 443 subjects, the team found that 196 subjects (44.2%), tested positive for DQ2/8. The average age of DQ2/8 positive subjects was 56 years, and 42.6% were female. Overall, the team found that 86/188 (45.7%) patients with liver disease were HLA DQ2/8 positive, 39/73 (53.4%) with functional upper GI diseases and 19/41 (46.3%) with organic upper GI diseases were positive. Moreover, 38/105 (36.2%) patients with IBS and 14/36 (38.9%) with IBD were HLA DQ2/8 positive (P = 0.21). Additionally, people with functional upper GI diseases disorders had rates of DQ2/8 positivity that were nearly double those of healthy control subjects. Those with liver disease had rates of DQ2/8 positivity that were 1.3 percent higher than controls, though this rate is not statistically significant. People with IBS and IBD had a lower rates of DQ2/8 positivity compared to healthy controls. Compared to general population estimates, the percentage of individuals who were HLA DQ2/8 positive is higher in those with liver/upper functional GI disease and lower in IBS/IBD. Source: World J Gastroenterol 2013 April 28; 19(16): 2507-2513. ISSN 1007-9327 (print) ISSN 2219-2840 (online). doi:10.3748/wjg.v19.i16.2507
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Celiac.com 03/25/2013 - More and more, research is showing that celiac disease may have a variety of different clinical presentations. A team of researchers recently used data from Italy, Romania and Iran to explore rates of gastrointestinal and non-gastrointestinal symptoms in patients with celiac disease. The research team included M.J. Ehsani-Ardakani, M. Rostami Nejad, V. Villanacci, U. Volta, S. Manenti, G. Caio, P. Giovenali, G. Becheanu, M. Diculescu, S. Pellegrino, G. Magazzù, G. Casella, C. Di Bella, N. Decarli, M. Biancalani, G. Bassotti, S. Hogg-Kollars, M.R. Zali, K. Rostami. They are affiliated with the Gastroenterology and Liver Diseases Research Center at Shahid Beheshti University of Medical Sciences in Tehran, Iran. For their retrospective cross-sectional study, the team used data gathered Iran, Romania and Italy from May 2009 - May 2011. The study included only cases of celiac disease confirmed by endoscopy, small bowel biopsy and positive serology. The team collected data on gastrointestinal symptoms such as abdominal pain, diarrhea, constipation, nausea and vomiting, weight loss and flatulence, as well as additional signs and symptoms of iron deficiency anemia (IDA), osteoporosis, hypertransaminasemia, and other related abnormalities. The study included 323 women and 127 men with confirmed celiac disease. Average patient age at diagnosis was 34.2 ± 16.47. A total of 157 patients (34.9%) reported at least one gastrointestinal symptom. Most of those patients reported diarrhea (13.6%), or dyspepsia and constipation (4.0%). 168 patients (37.3%) reported non-gastrointestinal symptoms, most commonly anemia (20.7%) and osteopenia (6%). The data showed statistically significant differences between the majority of symptoms, compared with the reported clinical symptoms from different countries. The study showed that European patients commonly complained of upper abdominal disorders, such as abdominal pain and dyspepsia, while Iranian patients commonly complained of the more classic celiac symptoms of diarrhea and bloating. Anemia was the most common non-gastrointestinal complaint for both Iranian and Italian patients, but was significantly higher in Iranian patients. Source: Arch Iran Med. 2013 Feb;16(2):78-82. doi: 013162/AIM.006.
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Celiac.com 12/15/2011 - Until now, studies have only shown a connection between celiac disease and functional gastrointestinal disorders in adults. No solid information exists regarding children. Due to the fact that gluten-induced gut inflammation is reversible by dietary manipulation, celiac disease may offer a useful model for examining the role of inflammatory triggers in various functional gastrointestinal disorders. Gut inflammation is a well-known cause of functional and structural changes in the central nervous system. Researchers suspect that the culprit is an abnormal afferent input from the gut. Psychological factors may play a role in triggering overt symptoms. A research team recently set out to examine connections between childhood celiac disease and functional gastrointestinal disorder in children meeting Rome III criteria. The team included R. Turco, G. Boccia, E. Miele; E. Giannetti, R. Buonavolontà, P. Quitadamo, R. Auricchio, and A. Staiano. Their goal was to assess the prevalence of functional gastrointestinal disorders at one year, along with the role of psychological aspects on the development of functional gastrointestinal disorders in celiac disease children. For the study, the team enrolled a group of 36 boys and 64 girls (Total = 100 children) with celiac disease, and followed them for one year. They also assembled a control group of 56 children, 25 boys and 31 girls. The team had all children and/or their parents complete validated questionnaires for GI symptoms, depression, and anxiety. The team then compared GI symptoms at diagnosis and after 1 year of gluten-free diet. The team was able to follow up on 82 of the patients with celiac disease who followed a gluten-free diet for at least one year. Of those, 23 patients (28%) met Rome III criteria for functional gastrointestinal disorders compared with 5 of 56 (8.9%) patients from the control group (P = 0.008; χ2 = 6.8; OR: 3.97; 95% CI: 1.40–11.21). Most of those children who met Rome III criteria for functional gastrointestinal disorders after one year on a gluten-free diet complained of GI symptoms alone; 21 of 52 children (40.3%) overall. Children with celiac disease with FGDIs showed substantially higher levels of anxiety and depression compared to control subjects, and to celiac disease children without functional gastrointestinal disorders (P = 0.02). The study shows that children with celiac disease, who follow a gluten-free diet for a year, have much higher rates of functional GI symptoms than do non-celiac control subjects. The risk may be due to residual chronic inflammation, and/or to psychological factors, but further study is needed to make that determination. Source: Alimentary Pharmacology & Therapeutics. 2011;34(7):783-789.
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Celiac.com 02/15/2012 - At the American College of Gastroenterology (ACG) 2011 Annual Scientific Meeting held in Washington, DC, Caris Diagnostics, a leader in anatomic pathology services, presented 15 abstracts highlighting new findings that reflect and expand Caris' commitment to gastrointestinal disease research. Highlights from the presentation include two studies, in particular. The first study, "High Prevalence of Celiac Disease in Women With Young Onset Collagenous Colitis," found that young women with collagenous colitis are eight times more likely than the general population to have celiac disease. That study was authored by Ahmed Bedeir, MD, Bhaskar Ganguly, and Mukunda Ray, MD, PhD. As Dr. Bedeir's finding is gleaned from the largest series of young patients with collagenous colitis ever reported, the study team recommends that women age 40 or younger who have a diagnosis of collagenous colitis also undergo an EGD with duodenal biopsies to exclude concurrent celiac disease. The second study, "Seasonal Patterns in Eosinophilic Esophagitis: An Analysis by Month of Diagnosis and Month of Birth," showed that, contrary to previous suggestions derived from smaller series, there was no evidence of monthly or seasonal variation even within known regions with diverse climates among our 10,000 patients with eosinophilic esophagitis. That study was authored by Jennifer M. Hurrell, DO, Amnon Sonnenberg, MD, and Robert M. Genta, MD, FACG. Regarding Caris' commitment to gastrointestinal disease research, Richard H. Lash, MD, Chief Medical Officer for Caris says that the "establishment of the Caris Research Institute as a structure for promoting and carrying out research has again generated a strong presence at the annual ACG meeting in Washington, D.C," adding that Caris remains "committed to leveraging our tremendous database and academic talent to answer important questions in the field of gastroenterology and are honored to have the opportunity to present our findings at ACG 2011." Source: http://www.carislifesciences.com/news/caris-diagnostics-presents-research-at-2011-annual-meeting-of-the-american-college-of-gastroenterology/
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Celiac.com 01/18/2012 - A number of small studies have shown a connection between celiac disease and various gastrointestinal (GI) cancers, but the results haven't been corroborated by larger studies, or by blood and biopsy analysis of large populations. That means that researchers just haven't been able to say with certainty what the results of those smaller studies might mean about cancer risks for the larger population. Recently, a clinical team set out to assess GI cancer risks for a larger population. The study team included Peter Elfström, Fredrik Granath, Weimin Ye, and Jonas F. Ludvigsson. They assessed risk GI cancers by using data from large groups of patients with either celiac disease, inflammation, or latent celiac disease. They assessed data from 28,882 patients with celiac disease, all with villous atrophy, and Marsh scores of 3. They also assessed data for 12,680 patients with inflammation, all with Marsh scores of 1–2. They evaluated biopsy samples at 28 different pathology centers. They assessed a third group of 3705 patients with latent celiac disease, that is, with normal mucosa, but positive blood tests. The team then compared the results against data from an age- and sex-matched population. They found that 372 of the patients with celiac disease developed incident GI cancers, while 347 patients with inflammation, and 38 with latent celiac disease developed GI cancers. That means that the first year after diagnosis and initial biopsy, celiac disease carried a 5.95-times greater risk of incident GI cancer, with a 95% confidence interval [CI], 4.64–7.64). The hazard ratio for inflammation was 9.13 (95% CI, 7.19–11.6) and for latent celiac disease was 8.10 (95% CI, 4.69–14.0). After the first year, patients showed no significant increase in GI cancer risk. The HR for celiac disease was 1.07 (95% CI, 0.93–1.23), for inflammation it was 1.16 (95% CI, 0.98–1.37). HR for latent celiac disease it was 0.96 (95% CI, 0.56–1.66). The absolute risk for any GI cancer in people with celiac disease was 101/100,000 person-years, with an excess risk of 2/100,000 person-years. The results carried some relatively good news. That is, even though celiac disease, inflammation, and latent disease all increase a person's risk for GI cancers in the first year after diagnosis, there is no increase in risk beyond the first year. Source: Clinical Gastroenterology and Hepatology. Volume 10, Issue 1 , Pages 30-36, January 2012
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Celiac.com 11/28/2011 - Celiac disease often results in "leaky" intestinal mucosa. This development may involve changes in hydrophobicity of the mucus surface barrier along with changes of the epithelial barrier. A team of researchers recently compared bio-physical aspects of gastrointestinal mucosa of celiac patients with control subjects, along with the effects of gluten free diet on each group. The research team included Stefania Bertolazzi, Francesco Lanzarotto, Barbara Zanini, Chiara Ricci, Vincenzo Villanacci, and Alberto Lanzini. The team set out to compare duodenal hydrophobicity as an index of mucus barrier integrity in 38 patients studied before and 68 patients during gluten-free diet, and in 90 control subjects. They also checked for regional differences of hydrophobicity in the gastro-intestinal tract. The team gauged hydrophobicity by measuring the contact angle (CA) (Rame Hart 100/10 goniometer) created by a single drop of water applied to intestinal mucosal biopsies. Once the team pooled the results and evaluated the control groups, patients with histologically normal duodenal biopsies showed significantly higher CA (620 + 90) than patients with biopsies showing Marsh 1-2 (580 + 100; p<0.02) and Marsh 3 lesions (570+ 100; p<0.02). Among the control group, the action sequence of hydrofobicity along the gastrointestinal tract follows the pattern: gastric antrum> corpus> rectum> duodenum> oesophagus> ileum. From these results, the team concludes that people with celiac disease experience reduced hydrophobicity of duodenal mucous layer, and a reduced ability to repel luminal contents. This may may contribute to the increased intestinal permeability seen in celiac disease. This change in hydrofobicity corresponds to the severity of the mucosal lesions in the patient, and is not completely reversed by gluten-free diet. Source: BMC Gastroenterology 2011, 11:119 doi:10.1186/1471-230X-11-119
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Psoriasis, Liver, and the Gastrointestinal Tract
Jefferson Adams posted an article in Psoriasis and Celiac Disease
Celiac.com 04/12/2010 - A team of researchers recently set out to look at connections between psoriasis, the liver, and the gastrointestinal tract. The team was made up of Paolo Gisondi, Micol Del Giglio, Alessandra Cozzi & Giampiero Girolomoni. They are associated with the Section of Dermatology and Venereology of the Department of Medicine, at the University of Verona, Italy. Psoriasis is a common chronic inflammatory, immune-mediated skin disease that is often tied to other disorders, including psoriatic arthropathy, chronic inflammatory bowel diseases, and cardio-metabolic disorders. Additionally, about 50% of all patients patients with psoriasis suffer from non-alcoholic fatty liver disease, from 0.2–4.3% suffer from celiac disease, and about one half of one percent suffer from Crohn's disease. These associated conditions may have some common genetic traits, as well as common inflammatory pathways, and their presence offers important implications in the global approach to treating psoriasis. In particular, common systemic antipsoriatic drugs might have a negative affect on associated cardio-metabolic conditions and nonalcoholic fatty liver disease, and may have important interactions with drugs commonly used to treat psoriasis. Moreover, the team emphasizes the importance of encouraging psoriasis patients to drastically improve their modifiable cardiovascular and liver risk factors, especially obesity, alcohol and smoking intake, because improvements could have positive impact on both the psoriasis and the patient's general well-being. Source: Dermatologic Therapy, Volume 23 Issue 2, Pages 155 - 159 - DOI: 10.1111/j.1529-8019.2010.01310.x- 1 comment
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Celiac.com 09/12/2011 - Exogenous enzymes are enzymes that are created outside of the body. Doctors use exogenous enzymes, usually orally, to treat several diseases, such as pancreatic insufficiency and lactose intolerance. Because these enzymes are protein-based, they can be inactivated and/or digested in the gastrointestinal (GI) tract. A research team recently established a convenient fluorescence-based test to measure the activity of therapeutic enzymes live and in real time in the GI tract. The research team included Gregor Fuhrmann and Jean-Christophe Leroux. They are affiliated with the Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences in Zurich, Switzerland. To establish proof of their principle, the team applied their assay to proline-specific endopeptidases (PEPs), a group of enzymes recently proposed as adjuvant therapy for celiac disease, which is a very common immunogenetic enteropathy. To do so, they took a short PEP-specific peptide sequence from larger immunotoxic sequences of gluten. They then labeled each sequence with a fluorescent dye and a corresponding quencher. Once the enzyme sequence split, they dequenched the fluorescence emission and then used an live imaging system to detect the result. The team then evaluated PEPs originating from Flavobacterium meningosepticum (FM) and Myxococcus xanthus (MX) after oral administration in rats. While MX PEP could not split the peptide in the stomach, FM PEP showed significant gastric activity reaching 40–60% of the maximal live signal intensity. However, both enzymes produced similar fluorescence signals in the small intestine. Using an antacid significantly enhanced MX PEP’s gastric activity due to increased pH and/or inhibition of stomach proteases. By using this simple method, the team was able to observe differences in the live performance of PEPs, which could not be identified under laboratory conditions. This imaging method could be used for live study other oral enzymes and may prove useful in improving current treatments. Source: PNAS 108:9032-9037. DOI:10.1073/pnas.1100285108
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Celiac.com 07/02/2010 - Serological screening of healthy volunteers from around the world estimates that the prevalence for celiac disease is approximately 0.5%- 1% of the total population. However, a recent meta-analysis denotes that the actual ratio of known or undiagnosed celiac cases is closer to 1 in 7 people. Due to knowledge of celiac, acute clinical suspicion, and increased endoscopy accessibility some areas have reported celiac prevalence as high as 5.2%; suggesting that there is a considerable gap in effectively detecting new cases of celiac disease. Researchers further investigated the statistics on celiac disease prevalence by evaluating the incidence of celiac disease among “adult out-patients biopsied during upper endoscopy with typical and atypical symptoms”. One hundred and fifty out-patients including 94 women and 56 men with a median age of 45, were enrolled for the study between January 2007 and December 2008. There is no current standard classification for endoscopic lesions found from celiac disease. As such, this study used a method of classification where-as patients were labeled as; normal, mild, moderate, or severe. To detect villous atrophy, biopsy's were taken from patients that were only presenting endoscopic appearances, which are indicative of celiac disease. Results which had t-TGA levels greater than 24 U/mL were considered positive for celiac disease. Patients were also positively diagnosed as celiac if they exhibited some degree of histological abnormality. Of the hundred and fifty subjects studied, twelve were diagnosed positively for celiac disease, and nine of them were women. The most commonly exhibited gastrointestinal pathology diagnosed in the study, was gatroduodenitis peptic ulcer. All of the subjects that had biopsy proven t-TGA, had positive antibodies, and the values of t-TGA increased depending on the intensity of the mucosal lesions. Additionally, all subjects were assessed for the existence of gastrointestinal and extra-intestinal symptoms. Typical gastrointestinal symptoms of celiac include diarrhea, anemia and weight loss, as evident in 58.32% of the subjects studied, while atypical symptoms were present in 25% of the test subjects. 41.66% of the subjects had iron deficiency anemia(IDA), 8.33% had osteopenia, 16.66% had hypocalcaemiaia and hypomagnesaemia. Additionally, extra-intestinal symptoms associated with gastrointestinal manifestations were found in 16.66% of the subjects that had astenia, and in 41.55% of the subjects with weight loss. Almost every celiac case observed demonstrated symptoms that progressively increased in severity. No differences were observed among patients in the control group, and in the celiac patients with regard to gastrointestinal problems and discomforts. However, IDA was observed most frequently in patients with celiac disease than in the control group. All patients that were diagnosed were recommended to strictly adhere to a gluten-free diet. One person refused to comply with the diet, but the other 90% followed the diet for one year. Of the patients following a gluten-free diet, a total histological response was observed. Severity of mucosal lesions decreased in 70% of the subjects, and all subjects were asymptomatic after one year on a gluten-free diet. The final incidence of celiac disease in the study was 6%. Screening studies such as these, demonstrate that the prevalence of celiac disease is increasing. When duodenal biopsy was preformed in patients during routine upper gastrointestinal endoscopy, the incidence of celiac disease was observed at rates as high as 12%. Additionally, when clinical presentations of symptoms like diarrhea, anemia, and weight loss are used as screening criteria for celiac, increased rates of celiac disease diagnosis' were evident. Strict adherence to a completely gluten-free diet is still the only cure for celiac disease. Increased doctor and patient awareness of celiac, as well as an increase in celiac screening (especially for patients with typical celiac symptoms or atypical symptoms untreated by standard methods) is still needed to avoid more cases of undiagnosed celiac disease, and to eliminate unnecessary suffering for those misdiagnosed or undiagnosed. Source: Journal of Experimental Medical & Surgical Research, Year XVII · Nr.1/2010 · Pag.23 -27
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More and more people with celiac disease present atypical symptoms that are clinically indistinguishable from other gastrointestinal disorders. A new study shows that upwards of 4% of people with generalized gastrointestinal complaints show elevated celiac disease antibodies when screened. A team of researchers recently set out to assess rates of celiac disease in patients with gastrointestinal symptoms, and to catalog the common manifestations of atypical expressions of celiac disease. The research team was made up of Mohammad Rostami Nejad, Kamran Rostami, Mohamad Amin Pourhoseingholi, Ehsan Nazemalhosseini Mojarad, Manijeh Habibi, Hossein Dabiri, and Mohammad Reza Zali. The team designed and executed a cross sectional study that included 5,176 individuals chosen randomly from self-referred patients within a primary care setting in Tehran province from 2006-2007. In all, 670 of the 5176, or 13% of patients self-referred to a general practitioner suffered from gastrointestinal complaints. All 670 subjects with gastrointestinal symptoms underwent celiac blood tests, including total immunoglobulin A (IgA) and anti-tissue transglutaminase (tTG) antibodies. Individuals showing IgA deficiency underwent screening for IgG tTG. Of the 670 investigated for gastrointestinal complaints, a total of 22 patients, 17 women and 5 men, showed positive anti-tTG results (95% CI: 1.70-4.30). Another 8/670 showed IgA deficiency, with 3 of those 8 subjects showing positive IgG tTG. Dyspepsia (indigestion) was the chief complaint in 25 patients withpositive blood tests and cases that were analogous to the rest of thesubjects. In all, 3.3% of serologically screened samples excluding IgA-deficient showed celiac disease antibodies, compared to 3.7% of those IgA-deficient subjects with positive tTG-IgG. Generalized gastrointestinal complaints are a common indication of atypical celiac disease. This study points to high rates of celiac disease antibodies among patients with generalized gastrointestinal symptoms (3.7%). Clinicians and patients will benefit from greater vigilance regarding atypical presentation of celiac disease and its association with generalized gastrointestinal symptoms. Source: Journal of Gastrointestinal Liver Disease - September 2009 Vol.18 No 3, 285-291
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