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Celiac.com 04/10/2013 - People with celiac disease or inflammatory bowel disease have higher rates of migraine headaches than their counterparts without those conditions, according to a new study. The research team included Alexandra K. Dimitrova MD, Ryan C. Ungaro MD, Benjamin Lebwohl MD, Suzanne K. Lewis MD, Christina A. Tennyson MD, Mark W. Green MD, Mark W. Babyatsky MD, and Peter H. Green MD. A team of researchers recently set out to assess the rates of migraine headaches in clinic and support group patients with celiac disease and inflammatory bowel disease (IBD) and to compare those with a sample group of healthy control subjects. A number of European studies have shown higher rates of migraine headaches in patients with celiac disease and IBD compared with control subjects. For the study, participants all answered a self-administered survey containing clinical, demographic, and dietary data, as well as questions about headache type and frequency. They also used both the ID-Migraine screening tool and the Headache Impact Test (HIT-6). The research team analyzed five hundred and two subjects who met exclusion criteria. Of these, 188 had celiac disease, 111 had IBD, 25 had gluten sensitivity (GS), and 178 healthy subjects served as controls. Thirty percent of celiac patients, 56% of gluten-sensitive patients, 23% of IBD patients, and 14% of control subjects reported chronic headaches (P < .0001). Using multivariate logistic regression, the team found that all subjects with celiac disease (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.78-8.10), GS (OR 9.53, 95% CI 3.24-28.09), and IBD (OR 2.66, 95%CI 1.08-6.54) had significantly higher rates of migraine headaches than did control subjects. Migraine rates were influenced by female sex (P = .01), depression, and anxiety (P = .0059) were independent predictors of migraine headaches, whereas age >65 was protective (P = .0345). When it came to grading their migraines, seventy-two percent of celiac disease subjects reported having migraine that were severe in impact, compared with 30% of IBD, 60% of GS, and 50% of C subjects (P = .0919). The number of years on gluten-free diet had no influence on the severity of migraines. Migraine headaches were more common in people with celiac disease and IBD patients than in control subjects. The team points out that future studies should screen migraine patients for celiac disease and assess the effects of gluten-free diet on celiac disease patients with migraines. Source: Headache: The Journal of Head and Face Pain. DOI: 10.1111/j.1526-4610.2012.02260.x -
Celiac.com 01/09/2012 - Women with celiac disease face a higher risk for depression than the general population, even once they have adopted a gluten-free diet, according to U.S. researchers. A team of researchers recently used a Web-mediated survey to assess a range of physical, behavioral and emotional experiences in 177 U.S. adult women, who reported a physician-provided diagnosis of celiac disease. The team was led by Josh Smyth, professor of biobehavioral health and medicine at Pennsylvania State University, and included members from Syracuse University and Drexel University. The survey gathered information about how closely people follow a gluten-free diet and assessed various symptoms of celiac disease from physical symptoms to the respondents' experience and management of stressful situations, along with charting symptoms of clinical depression and frequency of thoughts and behaviors associated with eating and body image. Perhaps unsurprisingly, many women with celiac disease suffer from disordered eating, given that the management of celiac disease requires careful attention to diet and food, Smyth said. "What we don't know is what leads to what and under what circumstances," Smyth said. "It's likely that the disease, stress, weight, shape and eating issues, and depression are interconnected." The findings are forthcoming in the journal of Chronic Illness. Source: http://www.upi.com/Health_News/2011/12/28/Celiac-ups-depression-risk-for-women/UPI-75401325131984/#ixzz1iQynze9k. -
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Celiac.com 10/15/2020 - A team of researchers recently conducted an analysis of US healthcare resource utilization (HRU) and costs between celiac patients and a group of matched control subjects. The research team included Katherine Cappell, PhD; Aliki Taylor MPH, PhD; Barbara H. Johnson MBA; Steve Gelwicks, MS; Song Wang, Song PhD; Michele Gerber, MPH, MD; Danial A. Leffler, Daniel MD. They are variously affiliated with the IBM Watson Health, Cambridge, Massachusetts, USA; Takeda Pharmaceuticals International, London, United Kingdom; Takeda Pharmaceuticals International Co, Cambridge, Massachusetts, USA; and the Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. For their study, the team used the MarketScam databases to isolate celiac patients with an endoscopic biopsy and two or more medical encounters with a celiac disease diagnosis between January 1, 2010, and October 1, 2015. As an index date, the team used the date of the first health claim with a celiac diagnosis on or after the endoscopic biopsy. They matched celiac disease cases 1:1 to with non-celiac patients on demographic characteristics and Deyo-Charlson Comorbidity Index score. The team compared clinical characteristics, all-cause, and celiac-related HRU, and price adjusted costs, between celiac patients and control subject during the one year before and two years after the index date, and matched 11,008 study subjects to 11,008 controls. Study subjects averaged about 40 years old, and just over 70% were women. The follow-up data showed that celiac patients had higher rates of all-cause and celiac-related HRU including inpatient admissions, emergency department visits, gastroenterologist visits, dietician visits, endoscopic biopsies, and gastroenterology imaging. Incremental all-cause costs were nearly $8,000 first year, and $4,000 second year, while celiac-related costs were nearly $3,000 and more than $900 for the same periods. This analysis shows that people with celiac disease face higher all-cause and celiac-related HRU costs, compared with matched non-celiac patients, and helps to quantify the extra financial challenges faced by people with celiac disease. Have you or a loved one faced higher health care costs due to celiac disease? Please share your story below. Read more at the American Journal of Gastroenterology -
Higher Suicide Rates in Celiac Disease Patients
Jefferson Adams posted an article in Depression and Celiac Disease
Celiac.com 10/03/2011 - A number of studies show that people with celiac disease have higher risk of depression and death from external causes, but there are no conclusive studies on death from suicide. A research team set out to more deeply examine the risk of suicide in people with celiac disease. The team included J. F. Ludvigsson, C. Sellgren, B. Runeson, N. Långström, and P. Lichtenstein. They are affiliated with the Department of Paediatrics at Örebro University Hospital in Sweden. The team examined suicide risk in individuals with celiac disease where the small intestinal biopsy showed no villous atrophy. For their study, the team collected biopsy data from all 28 clinical pathology departments in Sweden for 29,083 individuals diagnosed during 1969-2007 with celiac disease with Marsh 3 villous atrophy, with inflammation without villous atrophy (Marsh 1-2; n=13,263), or with positive celiac disease serology, but normal mucosa (Marsh 0, n=3719). The team used Cox regression to calculated hazard ratios for suicide as recorded in the Swedish Cause of Death Register. The team found that people with celiac disease have a higher risk for suicide compared to general population control subjects (HR=1.55; 95%CI=1.15-2.10; based on 54 completed suicides). The results showed that suicide was more common among those who suffered from inflammation (HR=1.96; 95%CI=1.39-2.77), but the team found no such increase in people who showed positive celiac disease serology, but normal mucosa. (HR=1.06; 95%CI=0.37-3.02). Overall, the team found a slightly higher risk of suicide in patients with celiac disease than in the general population. The increased risk is one that merits attention from doctors, when treating patients with celiac disease. Source: Dig Liver Dis. 2011 Aug;43(8):616-22. -
Celiac.com 01/28/2013 - Some case studies point to a connection between celiac disease and systemic lupus, but there hasn't been much in the way of population-based studies. Hoping to get data that would lead to a more solid answer, a research team recently set out to determine levels of systemic lupus erythematosus (SLE) in 29,000 patients with biopsy-verified celiac disease. The research team included J.F. Ludvigsson, A. Rubio-Tapia, V. Chowdhary, J. A. Murray, and J.F. Simard. They are affiliated with the Clinical Epidemiology Unit of Department of Medicine at Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden. For their study, the team compared the risk of SLE in 29,048 individuals with biopsy-verified celiac disease (villous atrophy, Marsh 3) from Sweden's 28 pathology departments with that in 144,352 matched individuals from the general population identified through the Swedish Total Population Register. For the study, the team defined SLE incidents as at least 2 records of SLE for any given patient in the Swedish Patient Register. They used Cox regression to estimate hazard ratios (HR). They found that 54 individuals with celiac disease also had an SLE incident. This amounted to a HR of 3.49 (95% CI 2.48-4.90), with an absolute risk of 17 cases per 100,000 person-years and an excess risk of 12 cases per 100,000 person-years. After five years, the HR for SLE was 2.54 (95% CI 1.57-4.10). Even though SLE incidents occurred mainly in female patients, the team found similar risk estimates in men and women. When they restricted the outcome to individuals who also had a dispensation for a medication used in SLE, the HR was 2.43 (95% CI 1.22-4.87). The HR for having 2 records of SLE diagnoses, out of which at least 1 had occurred in a department of rheumatology, nephrology/dialysis, internal medicine, or pediatrics, was 2.87 (95% CI 1.97-4.17). From this data, the team concludes that people with celiac disease faced a three-times higher risk of SLE compared to the general population. Although this elevated risk remained more than five years after celiac disease diagnosis, absolute risks were low. Source: J Rheumatol. 2012 Oct;39(10):1964-70. doi: 10.3899/jrheum.120493. Epub 2012 Aug 1. -
Celiac.com 09/09/2015 - Some researchers and clinicians suspect a connection between eosinophilic esophagitis (EoE) and celiac disease, but prior studies have shown conflicting results A team of researchers recently set out to determine the relationship between EoE and celiac disease among patients with concomitant esophageal and duodenal biopsies. The research team included Elizabeth T. Jensena, Swathi Eluria, Benjamin Lebwohl, Robert M. Gentab, and Evan S. Dellon. For their cross-sectional study, they team used data covering the period from January 2009 through June 2012 from a U.S. national pathology database. They defined esophageal eosinophilia as the presence of ≥15 eosinophils per high-power field. The crude and age and sex adjusted odds of esophageal eosinophilia for patients with active celiac disease were compared with those without celiac disease. Sensitivity analyses were performed by using more stringent case definitions and by estimating the associations between celiac disease and reflux esophagitis and celiac disease and Barrett’s esophagus. Out of 292,621 patients in the source population, the team looked at data from 88,517 patients with both esophageal and duodenal biopsies. Four thousand one hundred one (4.6%) met criteria for EoE, and 1203 (1.4%) met criteria for celiac disease. Patients with celiac disease had 26% higher odds of EoE than patients without celiac disease (adjusted odds ratio, 1.26; 95% confidence interval [CI], 0.98–1.60). The strength of the connection varied according to EoE case definition, but all definitions showed a weak positive association between the two conditions. Interestingly, this study showed no connection between celiac disease and reflux esophagitis (adjusted odds ratio 0.95; 95% CI, 0.85–1.07) or between celiac disease and Barrett’s esophagus (adjusted odds ratio 0.89; 95% CI, 0.69–1.14). Overall, this study showed only a weak increase in EoE in patients with celiac disease. The connection strengthened in direct relation to the strength of definitions of EoE, and was not seen with other esophageal conditions. Doctors should consider concomitant EoE in patients with celiac disease where clinical indications support it. Disclosures: Dellon reports receiving research funds from Meritage Pharma, consulting for Aptalis, Novartis, Receptos and Regeneron, and receiving an educational grant from Diagnovus. Source: Clinical Gastroenterology and Hepatology. doi:10.1016/j.cgh.2015.02.018. -
Celiac.com 06/29/2015 - Non-alcoholic fatty liver disease is a common cause of chronic liver disease. There's good data showing that celiac disease changes intestinal permeability, and that treatment with a gluten-free diet often causes weight gain, but so far there is scant documentation of non-alcoholic fatty liver disease in patients with celiac disease. A team of researchers recently set out to assess increased risk of non-alcoholic fatty liver disease following diagnosis of celiac disease. The research team include Norelle R. Reilly, Benjamin Lebwohl, Rolf Hultcrantz, Peter H.R. Green, and Jonas F. Ludvigsson. They are affiliated with the Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, and the Department of Pediatrics at Örebro University Hospital, Örebro University in Örebro, Sweden. The team assessed the for risk of non-alcoholic fatty liver disease diagnosed from 1997 to 2009 in 26,816 individuals with celiac disease to 130,051 matched reference individuals. The team excluded patients with any liver disease prior to celiac disease. They also excluded individuals with a lifetime diagnosis of alcohol-related disorder to minimize misclassification of non-alcoholic fatty liver disease. They used Cox regression estimated hazard ratios for non-alcoholic fatty liver disease. Their results showed that over 246,559 person-years of follow-up, 53 individuals with celiac disease had a diagnosis of non-alcoholic fatty liver disease (21/100,000 person-years). In comparison, in the reference group showed 85 individuals diagnosed with non-alcoholic fatty liver disease during 1,488,413 person-years (6/100,000 person-years). This corresponded to a hazard ratio of 2.8 in the celiac group (95% CI), with the highest risk estimates of 4.6 seen in children (95% CI). The risk increase in the first year after celiac disease diagnosis was 13.3 (95% CI), but remained significantly elevated at 2.5 even beyond 15 years after celiac diagnosis of celiac disease (95% CI). Individuals with celiac disease do have an increased risk of non-alcoholic fatty liver disease compared to the general population. Excess risks were highest in the first year after celiac disease diagnosis, but continued at least 15 years after celiac diagnosis. This much more comprehensive study provides much clearer and convincing data than any of the previous studies, and will likely serve as a baseline that clinicians have been lacking to this point. Source: Journal of Hepatology, June 2015Volume 62, Issue 6, Pages 1405–1411. DOI: http://dx.doi.org/10.1016/j.jhep.2015.01.013 -
Celiac.com 12/03/2014 - It is important for pregnant women seeking medical consultation to get good, evidence-based information. This is especially true for pregnant women with celiac disease, who might wonder whether they face an increased risk of adverse birth outcomes and pregnancy complications as a result of their disease. So, does celiac disease increase a woman’s risk for pregnancy complications and adverse birth outcomes? Until now, there hasn’t been much good, solid data to give women a clear answer. With that in mind, a research team in England recently conducted a population-based study on pregnancy outcomes and adverse birth conditions in women with celiac disease. The research team included Alyshah Abdul Sultan PhD, Laila J Tata PhD, Kate M. Fleming PhD, Colin J. Crooks PhD, Jonas F. Ludvigsson PhD, Nafeesa N. Dhalwani PhD, Lu Ban PhD, and Joe West PhD. They are variously affiliated with the Division of Epidemiology and Public Health, City Hospital Campus at the University of Nottingham, Nottingham, UK; the Department of Medical Epidemiology and Biostatistics at the Karolinska Institute in Stockholm, Sweden; and with the Department of Paediatrics at Örebro University Hospital in Örebro, Sweden. The team used linked primary care data from the Clinical Practice Research Datalink and secondary care Hospital Episode Statistics data to assess all singleton pregnancies between 1997 and 2012. They used logistic/multinomial regression to compare pregnancies of women with and without celiac disease for risks of pregnancy complications (antepartum and postpartum hemorrhage, pre-eclampsia, and mode of delivery), and for adverse birth outcomes (preterm birth, stillbirth, and low birth weight). They stratified risk levels based on whether women were diagnosed or undiagnosed before delivery. They found 363,930 pregnancies resulting in a live birth or stillbirth, 892 (0.25%) of which were among women with celiac disease. Women with diagnosed celiac disease showed no increased risk of pregnancy complications or adverse birth outcomes compared with women without celiac disease. However, pregnant women with diagnosed celiac disease did show a higher risk of postpartum hemorrhage and assisted delivery, with an adjusted odds ratio (aOR) of 1.34. Importantly, the team found no increased risk of any pregnancy complication among those with undiagnosed celiac disease. In all, they found just a 1% absolute excess risk of preterm birth and low birth weight among mothers with undiagnosed celiac disease, which corresponds to aOR=1.24 (95% confidence interval (CI)=0.82–1.87) and aOR=1.36 (95% CI=0.83–2.24), respectively. Overall, the results of this study offer some good news to pregnant women with celiac disease. Whether diagnosed or undiagnosed during pregnancy, celiac disease is not associated with a significantly higher risk of pregnancy complications and adverse birth outcomes. Source: Am J Gastroenterol. 2014;109:1653-1661. -
Celiac.com 05/11/2011 - People with multiple sclerosis and their first-generation relatives have higher rates of celiac disease than the general population, according to a report by a research team in Spain. For the study, a research team led by Dr. Luis Rodrigo of University Hospital, Central Asturias, Spain looked at rates of serological, genetic, and histological disease markers in 72 multiple sclerosis patients and 126 of their first-degree relatives. They then compared the results against data from 123 healthy control subjects. The team found rates of celiac disease among multiple sclerosis patients that are 5 to 10 times higher than rates for the general population worldwide, which average between 1% and 2%. The team found similar levels of HLA-DQ2 markers in both multiple sclerosis patients (29%) and controls (26%) (NS). They found eight multiple sclerosis patients (11.1%) who showed mild or moderate villous atrophy (Marsh III type) on duodenal biopsy. Results also showed that 26 of 126 first-degree relatives (32%) had celiac disease. Multiple Sclerosis patients also displayed increased frequency of circulating auto-antibodies such as anti-TPO in 19 (26%), ANA in 11 (15%) and AMA in 2 (3%). Source: BMC Neurology 2011, 11:31doi:10.1186/1471-2377-11-31
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Celiac.com 01/17/2018 - People with celiac disease face a higher risk of infections like tuberculosis, influenza, and pneumococcal pneumonia, but researchers don't know how this might apply to risk of Clostridium difficile infection in those patients. A team of researchers recently set out to identify celiac disease patients using biopsy data from all pathology departments in Sweden over the 39-year period covering July 1969 through February 2008. They compared the risk of Clostridium difficile infection, based on stratified Cox proportional hazards models, among patients with celiac disease versus a control group of patients without celiac disease--matched by age, sex, and calendar period. The research team included Benjamin Lebwohl MD, MS, Yael R Nobel MD, Peter H R Green MD, Martin J Blaser MD, and Jonas F Ludvigsson MD, PhD. They are variously affiliated with the Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, New York, USA; the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; the New York University Langone Medical Center, New York, New York, USA; the Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and with the Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden. In all, they isolated 28,339 celiac patients, along with 141,588 control subjects. None of the celiac patients or control subjects had any history of Clostridium difficile infection. Celiac patients showed a Clostridium difficile infection rate of 56 cases per 100,000 person-years, compared with a rate of 26 cases per 100,000 person-years among control subjects, yielding an overall hazard ratio (HR) of 2.01. Compared with control subjects, celiac patients in their first 12 months after diagnosis showed the highest risk. However, the risk remained high up to 5 years after celiac diagnosis. The researchers found antibiotic data for 251 of the 493 patients with Clostridium difficile infection; they found no significant differences in previous antibiotic use between patients with celiac disease and control subjects. This large population-based cohort study showed that celiac patients had substantially higher rates of Clostridium difficile infection than did control subjects. The results of this study match prior studies that confirm higher infection rates in celiac patients, and indicate that celiac patients may suffer from altered gut immunity and/or microbial composition. Source: The American Journal of Gastroenterology (2017) 112, 1878–1884 (2017). doi:10.1038/ajg.2017.400 -
Celiac.com 10/05/2017 - Recent data show that more adults with celiac disease may face a higher risk for cardiovascular disease compared with the general population. A team of researchers recently set out to investigate the association of with cardiovascular disease risk factors at late adolescence in a cross-sectional population-based study. The research team included Assa A, Frenkel-Nir Y, Tzur D, Katz LH, and Shamir R. They are variously affiliated with the Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petah-Tikva; the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, and with the Medical Corps of the Israeli Defense Force. The study group included 2,001,353 Jewish Israeli adolescents who underwent general health examinations from 1988 to 2015. The average participant age was 17.1 years of age. Additional participant information included demographic measures, blood pressure, resting heart rate, and risk factors associated with cardiovascular disease. The team identified a total of 10,566 cases of celiac disease. They conducted multivariate analysis that showed average diastolic blood pressure to be significantly lower in celiac patients; 72.0±8.7 in celiac men vs 70.4 ±â€Š8.5 in non-celiac men; and 70.0 ±â€Š8.3 in celiac women vs 69.0 ±â€Š8.2 in non-celiac women. There were no differences in systolic blood pressure, while resting heart rate was slightly higher in celiac patients, with an absolute difference of 0.4 beats per minute. The team saw no increase in blood pressure, or in rates of overweight and obesity among celiac patients. Patients with celiac disease far more likely to have non-insulin-dependent diabetes mellitus, hypercoagulability, and hyperlipidemia, than were non-celiacs. By age 17, people with celiac disease have a higher prevalence of risk factors for cardiovascular disease compared with the general population. There is, however, neither increase in blood pressure nor increase in overweight and obesity rates. Source: J Pediatr Gastroenterol Nutr. 2017 Aug;65(2):190-194. doi: 10.1097/MPG.0000000000001487. -
Celiac.com 05/01/2014 - While estimates indicate that about 1% of the world's population is affected by celiac disease, it is thought to be uncommon in both India and Asia. However, very little study has been done on celiac disease in Asian nations. A team of researchers recently set out to estimate rates of celiac disease in the Indian population. The research team included G.K. Makharia, A.K. Verma, R. Amarchand, S. Bhatnagar, P. Das, A. Goswami, V. Bhatia, V. Ahuja, S. Datta Gupta, and K. Anand. They are affiliated with the Department of Gastroenterology and Human Nutrition at the All India Institute of Medical Sciences in New Delhi, India. For their cross sectional study, the team estimated rates of celiac disease in urban and rural populations in the National Capital Region in Delhi, India. For their estimate, they made door-to-door visits with a structured questionnaire, collecting socio-demographic data, and screening for features of celiac disease, namely chronic or recurrent diarrhea and, anemia. In children, they included short stature, and failure to thrive/gain weight. All respondents who screened positive for any of the above factors, and 10% of screen negative individuals received blood tests for the anti-tissue transglutaminase antibody. Those with positive blood tests were invited to undergo further evaluation including endoscopic biopsy. Diagnosis for celiac disease was made on the basis of a positive blood test, the presence of villous atrophy and/or response to gluten free diet. Overall, the team had 10,488 participants, just over 50% of which were male. A total of 5622 participants (53.6%) showed positive first screens. Of those, 2167 (38.5%) received blood test. The team also blood tested an additional 712 (14%) negative first screens. The team found a total celiac disease blood screen rate of 1.44%, with 95% confidence interval [CI] 1.22 1.69, and a total celiac disease rate of 1.04%, with 95% CI 0.85 1.25. The prevalence of celiac disease in this north Indian community is slightly over one percent, which is about the same as many western nations, and higher than generally recognized in India. Source: J Gastroenterol Hepatol. 2011 May;26(5):894-900. doi: 10.1111/j.1440-1746.2010.06606.x.
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Celiac.com 04/13/2017 - A team of researchers recently set out to determine whether hospital admission for autoimmune disease is associated with an elevated risk of future admission for dementia. The research team included Clare J Wotton, and Michael J Goldacre, both affiliated with the Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK. The pair set up their retrospective, record-linkage cohort study using national hospital care and mortality administrative data from 1999–2012. From that patient data, they assembled a study group of people admitted to hospital with a range of autoimmune diseases, along with a control group, and followed forward in time to see if how many patients eventually developed dementia. Data revealed a total of 1,833,827 people admitted to hospital with an autoimmune disease. The number of patients for each autoimmune disease group ranged from 1,019 patients in the Goodpasture's syndrome group, to 316,043 people in the rheumatoid arthritis group. The researchers found that the rate ratio for dementia after admission for an autoimmune disease, compared with the control cohort, was 1.20 (95% CI 1.19 to 1.21). For patients whose dementia type was specified, the rate ratio ranged from 1.04 to 1.08 for Alzheimer's disease, and 1.26 to 1.31 for vascular dementia. Of the 25 autoimmune diseases studied, 18 showed significant positive associations with dementia, 14 of which were statistically significant. Significant associations include Addison's disease (1.48, 1.34 to 1.64), multiple sclerosis (1.97, 1.88 to 2.07), psoriasis (1.29, 1.25 to 1.34) and systemic lupus erythematosus (1.46, 1.32 to 1.61). The connections with vascular dementia may be one aspect of a wider connection between autoimmune diseases and vascular damage. Though findings were significant, effect sizes were small. Researchers advise clinicians to note the possibility of dementia in patients with autoimmune disease. The researchers are calling for further studies to assess their findings and to explore possible ways to reduce any increased risk. Source: BMJ -
Unvaccinated Celiac Patients Face Higher Pneumonia Risk
Jefferson Adams posted an article in Latest Research
Celiac.com 06/22/2016 - Doctors generally recommend that celiac disease patients receive pneumococcal vaccination, but little has been done to quantify risk levels. A team of researchers recently set out to quantify the risk of community-acquired pneumonia among patients with celiac disease, assessing whether vaccination against streptococcal pneumonia modified this risk. The research team included F. Zingone, A. Abdul Sultan, C. J. Crooks, L. J. Tata, C. Ciacci & J. West. They are variously affiliated with the Division of Epidemiology and PublicHealth, University of Nottingham, CityHospital, Nottingham, UK, and with the Coeliac center within the Department of Medicine and Surgery at the University of Salerno in Salerno, Italy. Their team identified all patients with celiac disease within the Clinical Practice Research Datalink linked with English Hospital Episodes Statistics between April 1997 and March 2011 and up to 10 controls per patient with celiac disease frequency matched in 10-year age bands. They calculated absolute rates of community-acquired pneumonia for patients with celiac disease compared to controls stratified by vaccination status and time of diagnosis using Cox regression in terms of adjusted hazard ratios (HR). They found 1,864 first community-acquired pneumonia events among the 101,755 control patients, and 179 among the 9,803 celiac patients. Overall, absolute rates of pneumonia were similar, with celiac patients at 3.42, and control subjects at 3.12 per 1000 person-years respectively (HR 1.07, 95% CI 0.91–1.24). However, they found a 28% increased risk of pneumonia in unvaccinated celiac disease subjects compared to unvaccinated control subjects (HR 1.28, 95% CI 1.02–1.60). Interestingly, this increased risk was limited to those younger than 65, was highest around the time of diagnosis and was maintained for more than 5 years after diagnosis. Only 26.6% underwent vaccination after their celiac disease diagnosis. Unvaccinated celiac patients under the age of 65 have an excess risk of community-acquired pneumonia that was not seen in vaccinated celiac patients. More patients with celiac disease need to be vaccinated to protect them from pneumonia. Source: Aliment Pharmacol Ther 2016; 44: 57–67. -
Celiac.com 01/08/2016 - Adults with both celiac disease and type 1 diabetes face an increased risk of developing thyroid disease, according to a new study. The study was done by researchers Matthew Kurien, Kaziwe Mollazadegan, David S. Sanders and Jonas F. Ludvigsson. They are variously affiliated with the Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, U.K., the Academic Unit of Gastroenterology at the University of Sheffield in Sheffield, U.K., the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet in Stockholm, Sweden, and the Department of Pediatrics of Örebro University Hospital at Örebro University in Örebro, Sweden. For their population-based cohort study, Dr. Kurien and colleagues analyzed data from Swedish National Patient Register between 1964 and 2009. Their team identified all 42,539 patients diagnosed with type 1 diabetes before age 31 years of age. They used small intestinal biopsy reports showing villous atrophy to identify 947 type 1 diabetes patients with celiac disease between 1969 and 2008 (55.1% women; mean age of celiac disease diagnosis, 12 years). The research team then selected up to five type 1 diabetes patients as controls for each patient with both type 1 diabetes and celiac disease, and matched them for age, sex and birth year. They selected 4,584 in all; 54.5% women. They then used Cox regression analysis to calculate hazard ratios for future thyroid disease, with celiac disease as a time-dependent variable. They found that, over an average 13 years of follow-up, 90 patients in the group with both type 1 diabetes and celiac disease developed autoimmune thyroid disease (either hypothyroid or hyperthyroid); with an average age at thyroid disease diagnosis of 25 years old. In total, nearly 11% of patients in the type 1 diabetes and celiac disease group were diagnosed with thyroid disease at some stage of life vs. 7.2% of patients with type 1 diabetes without celiac disease. Patients with both type 1 diabetes and celiac disease faced an increased risk for hypothyreosis (HR = 1.66; 95% CI, 1.3-2.12) and hyperthyreosis (HR = 1.71; 95% CI, 0.95-3.11). The RR for thyroid disease in patients with both type 1 diabetes and celiac disease was 1.67 (95% CI, 1.32-2.11). The team found the highest risk levels for thyroid disease in patients from 1964-1975, which they attributed to poor screening for thyroid disease in type 1 diabetes patients during that time. The researchers noted that the highest risks in patients with more than ten years of celiac disease, which suggests that long-term double autoimmunity is a risk factor for autoimmune thyroid disease. Source: Diabetes Care. 2015. doi:10.2337/dc15-2117.
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Celiac.com 02/23/2015 - There's an interesting article over at Mother Jones regarding the possible role that shorter rising times in most commercial bakeries might play in celiac disease and gluten-intolerance. In the article, author Tom Philpott interviews Stephen Jones, a wheat breeder at Washington State University, who points out that bread rising times in commercial bakeries has been cut from hours or even days down to just minutes, through the use of fast-acting yeasts and additives. What's more, Jones points out, commercial bakers add a lot of extra gluten to their products. Many supermarket sliced breads, especially whole-wheat breads include something called "vital wheat gluten" among the top four ingredients. Because whole-wheat flour has a lower gluten density than white flour, and to make the bread more soft and chewy, like white bread, commercial bakeries add extra gluten in the form of vital wheat gluten. So bakers are using more gluten and fermenting very rapidly, compared with traditional fermentation techniques that take up to 12 hours and more. By contrast, the team in Jones' laboratory, located in a rural stretch along Puget Sound has found that the longer the bread rises, the more the gluten proteins are broken down in the finished bread. It's certainly true that long fermentation reduces the amount of gluten in bread, and that long fermentation using strains of lactobacillus, as in many sourdough breads, breaks down even more of the gluten; in some cases, enough to be tolerated by people with celiac disease. Celiac.com has written about this in several articles on the future of long-fermentation sourdough, its tolerability and gut healing potential in people with celiac disease. However, Jones' notion that modern baking techniques, rather than modern wheat breeding techniques, are responsible for rising rates of celiac disease, and gluten-sensitivity remains unproven.
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Celiac.com 03/04/2015 - Women with infertility face higher rates of celiac disease, according to a recent data analysis. Until now, data connecting celiac disease and infertility has been contradictory. There are currently no recommendations regarding celiac disease screening in female patients with infertility. A research team recently conducted a meta-analysis to find out whether women with infertility have a higher risk for celiac disease. The team included Prashant Singh MBBS; Shubhangi Arora MBBS; Suman Lal MD; Tor A. Strand MD, PhD; and Govind K. Makharia MD, DM, DNB, MNAMS. To source information for their analysis, the team performed a literature search using the MeSH keywords "celiac disease," "gluten," and "infertility." They based celiac diagnosis on positive patient serology and biopsies showing villous atrophy. The team extracted celiac disease data in 3 groups of women with "all cause" infertility, unexplained infertility, and a group of control subjects. They then calculated pooled odds ratio (OR) and prevalence, with 95% confidence intervals (CI). Of 105 relevant studies, they included five studies for calculation of pooled odds ratio. Four additional studies, where data on controls were not available, were also considered for calculation of pooled rates of celiac disease. The analysis showed that women with infertility had 3.5 times higher odds of having celiac disease compared with the control group (OR=3.5; 95% CI, 1.3-9; P<0.01). Similarly, odds for celiac disease in women with "unexplained infertility" were 6 times greater than for control subjects (OR=6; 95% CI, 2.4-14.6). Of 884 women with infertility, 20 had celiac disease indicating a pooled prevalence of 2.3% (95% CI, 1.4-3.5). Of 623 women with "unexplained infertility," 20 had celiac disease. The pooled prevalence of celiac disease in women with unexplained infertility was 3.2% (95% CI, 2-4.9). Celiac disease is more common in women with what is called "all-cause" infertility and "unexplained" infertility, than in general population. Infertility and unexplained infertility can point to hidden celiac disease. Source: Journal of Clinical Gastroenterology. doi: 10.1097/MCG.0000000000000285 -
Celiac.com 02/02/2012 - A team of researchers recently conducted a prospective controlled study on a gluten-free diet and autoimmune thyroiditis in patients with celiac disease. The research team included S. Metso, H. Hyytiä-Ilmonen, K. Kaukinen, H. Huhtala, P. Jaatinen, J. Salmi, J. Taurio, and P. Collin. They are affiliated with the Department of Internal Medicine at Tampere University Hospital in Tampere, Finland. Prior to the study, there had been contradictory data regarding the ways in which early diagnosis and a gluten-free diet might slow the progression of associated autoimmune diseases in celiac disease. The research team investigated the course of autoimmune thyroid diseases in newly diagnosed celiac disease patients, both before and after gluten-free dietary treatment. For their study, the team examined twenty-seven adults with newly diagnosed celiac disease, both at the time of diagnosis and after one year on gluten-free diet. They also recorded and examined previously diagnosed and subclinical autoimmune thyroid diseases. The team used ultrasound to measure thyroid gland volume and echo-genicity. They also measured autoantibodies against celiac disease and thyroiditis, and conducted thyroid function tests. As a control group, they enrolled twenty-seven non-celiac subjects, all of whom followed a normal, gluten-containing diet. The data showed that, upon diagnosis, ten of 27 celiac disease patients had either manifest (n = 7) or subclinical (n = 3) thyroid diseases. Only three of 27 control subjects (10/27 vs. 3/27, p = 0.055) had thyroid disease. After treatment with a gluten-free diet, thyroid volume continued to decrease significantly in the patients with celiac disease compared with the control subjects, indicating the progression of thyroid gland atrophy regardless of the gluten-free diet. Overall, celiac patients faced a higher risk of thyroid autoimmune disorders than non-celiac control subjects. Moreover, a gluten-free diet did not seem to stop or reverse the progression of autoimmune disease after one year. Source: Scand J Gastroenterol. 2012 Jan;47(1):43-8. Epub 2011 Nov 30.
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Celiac.com 01/14/2015 - Recent epidemiological studies show that celiac disease rates are still underestimated, both in Europe and in Mediterranean regions. But how is better testing impacting higher celiac numbers in Europe? To get a clearer picture, a team of researchers recently set out to review the latest data on celiac rates and incidence in the European Union (EU) as of September 2014. The research team included E. Altobelli, R. Paduano, R. Petrocelli, and F. Di Orio. They are variously affiliated with the Department of Life, Health and Environmental Sciences at the University of L'Aquila in L'Aquila, Italy, and with ASREM in Molise, Italy. They assessed the celiac disease rates and cases by conducting a search of PubMed for papers in English using the key words "celiac disease", "celiac disease plus prevalence" (limits: 1990-2014), "incidence" (limits: 1970-2014), and "frequency", plus "in Europe". They conducted additional searches using the same key words plus the name of each European country. The team included only prevalence data obtained by serology using anti-gliadin antibodies (AGA), EMA test, tTG test, and/or duodenal biopsy, and only studies that were retrospective and prospective, such as population-based, cross-sectional, case-control and cohort studies. They found that the overall undiagnosed celiac population in EU is 0.5-1%, whereas the highest estimate reported in population-based studies is approximately 1%. Considering data from different periods, incidence seems to range from 0.1 to 3.7/1000 live births in the child population and from 1.3 to 39/100,000/year in the adult population. Interestingly, though perhaps unsurprisingly, the data show clear geographical variation in both cases and rates of celiac disease in various European countries. They note a rising occurrence of celiac disease in recent decades in European countries, due partly to the advent of improved serological testing (tTG + EMA) and partly to increased awareness of its clinical presentation. Source: Ann Ig. 2014 Nov-Dec;26(6):485-98. doi: 10.7416/ai.2014.2007.
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Celiac.com 09/01/2014 - At present, the number of reported celiac disease cases in China is extremely low, and celiac disease is considered to be rare in that country. To determine the accuracy of this perspective, a team of researchers recently set out to compile an accurate estimate of rates of celiac disease in China. The research team included Juanli Yuan, Jinyan Gao, Xin Li, Fahui Liu, Cisca Wijmenga, Hongbing Chen, and Luud J. W. J. Gilissen. They are variously affiliated with the State Key Laboratory of Food Science and Technology, the College of Pharmaceutical Sciences, and the School of Life Sciences and Food Engineering, at Nanchang University in Nanchang, China, the Department of Genetics at the University Medical Centre Groningen of University of Groningen in Groningen, The Netherlands, with the Sino-German Joint Research Institute, Nanchang University, Nanchang, Jiangxi, China, and with the Plant Research International at Wageningen University & Research Centre in Wageningen, The Netherlands. The team reviewed the literature for certain and possible cases of celiac disease, the predisposing HLA allele frequencies, and information on gluten exposure in China. For the review, the team used the MEDLINE database, Chinese full-text databases CNKI, CBM, VIP and WANFANG, and two HLA allele frequency net databases, along with the Chinese Statistics Yearbook databases. They performed meta-analysis by analyzing DQ2, DQ8 and DQB1*0201 gene frequencies, and heterogeneity, in populations from different geographic regions and ethnicities in China. They found that frequencies of the HLA-DQ2.5 and HLA-DQ8 haplotypes were 3.4% (95% confidence interval 1.3–5.5%) and 2.1% (0.1–4.1%), respectively. HLA-DQ2 and HLA-DQ8 antigen frequencies were 18.4% (15.0–21.7%) and 8.0% (4.5–11.4%), respectively. The frequency of the DQB1*0201 allele was 10.5% (9.3–11.6%), and the allele was more common in the northern Chinese than in the southern Chinese individuals. HLA haplotype data, in conjunction with increasing wheat consumption, strongly suggest that rates of celiac disease are far higher in China than currently reported. The researchers suggest that the Chinese government, medical and agricultural research institutions, and food industries work together to increase awareness about celiac disease to prevent it from growing into a medical and societal burden. Source: Open Original Shared Link -
Celiac.com 07/21/2014 - The presence of HLA haplotype DR3–DQ2 or DR4–DQ8 is associated with an increased risk of celiac disease. In addition, nearly all children with celiac disease have serum antibodies against tissue transglutaminase (tTG). A research team recently set out to determine the risk of celiac disease autoimmunity and celiac disease, by age and by halpotype, in children. The research team included Edwin Liu, M.D., Hye-Seung Lee, Ph.D., Carin A. Aronsson, M.Sc., William A. Hagopian, M.D., Ph.D., Sibylle Koletzko, M.D., Ph.D., Marian J. Rewers, M.D., M.P.H., George S. Eisenbarth, M.D., Ph.D., Polly J. Bingley, M.D., Ezio Bonifacio, Ph.D., Ville Simell, M.Sc., and Daniel Agardh, M.D., Ph.D. for the TEDDY Study Group. The team studied 6403 children with HLA haplotype DR3–DQ2 or DR4–DQ8 prospectively from birth in the United States, Finland, Germany, and Sweden. The study’s primary end point was the development of celiac disease autoimmunity, which the team defined as the presence of tTG antibodies on two consecutive tests at least 3 months apart. The secondary end point was the development of celiac disease itself, which they defined as either a diagnosis on biopsy or persistently high levels of tTG antibodies. The average follow-up was 5 years, with an overall range of 46 to 77 months. A total of 786 children (12%) developed celiac disease autoimmunity. A total of 350 children underwent biopsy, and 291 of those were diagnosed with celiac disease. Another 21 children did not undergo biopsy, but showed persistently high levels of tTG antibodies. For children with a single DR3–DQ2 haplotype, rates of celiac disease autoimmunity and celiac disease by the age of 5 years were 11% and 3%, respectively. For those with two copies (DR3–DQ2 homozygosity) rates of celiac disease autoimmunity and celiac disease by the age of 5 years were 26% and 11%, respectively. The adjusted hazard ratios for celiac disease autoimmunity were 2.09 (95% confidence interval [CI], 1.70 to 2.56) among children with one gene, and 5.70 (95% CI, 4.66 to 6.97) among children with both genes, as compared with children who had the lowest-risk genotypes (DR4–DQ8 heterozygotes or homozygotes). Living in Sweden was also independently associated with an increased risk of celiac disease autoimmunity (hazard ratio, 1.90; 95% CI, 1.61 to 2.25). Children with the HLA haplotype DR3–DQ2, especially homozygotes, were found to be at high risk for celiac disease autoimmunity and celiac disease early in childhood. People in Sweden face a higher risk for celiac disease autoimmunity and celiac disease than residents of other countries. These finding highlight the importance of studying environmental factors associated with celiac disease. Source: N Engl J Med 2014; 371:42-49July 3, 2014. DOI: 10.1056/NEJMoa1313977 -
Celiac.com 07/16/2014 - Information about the number of cases and and overall rates of celiac disease and dermatitis herpetiformis in the UK have not been well studied over time, either by region or by age. Yet, this type of information is essential for determining potential causes and quantifying the impact of these diseases. To provide this information, a team of researchers recently conducted a population-based study to assess incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades. The researchers included J. West, K.M. Fleming, L.J. Tata, T.R. Card, and C.J. Crooks. They are variously affiliated with the Division of Epidemiology and Public Health, City Hospital Campus, The University of Nottingham, the NIHR Biomedical Research Unit in Gastrointestinal and Liver Disease at Nottingham University Hospitals NHS Trust, and the Division of Epidemiology and Public Health at the City Hospital Campus of The University of Nottingham in Nottingham, UK. They used the Clinical Practice Research Datalink to identify patients with celiac disease or dermatitis herpetiformis between 1990 and 2011, and calculated incidence rates and prevalence by age, sex, year, and region of residence. They found a total of 9,087 incident cases of celiac disease and 809 incident cases of dermititis herpetiformis. From 1990 to 2011, the incidence rate of celiac disease rose from 5.2 per 100,000 (95% confidence interval (CI), 3.8-6.8) to 19.1 per 100,000 person-years (95% CI, 17.8-20.5; IRR, 3.6; 95% CI, 2.7-4.8). During that same period, incidence of dermatitis herpetiformis decreased from 1.8 per 100,000 to 0.8 per 100,000 person-years (average annual IRR, 0.96; 95% CI, 0.94-0.97). The absolute incidence of celiac disease per 100,000 person-years ranged from 22.3 in Northern Ireland to 10 in London. Celiac disease showed large regional variations in prevalence, while dermatitis herpetiformis did not. The team found a fourfold increase in the incidence of celiac disease in the United Kingdom over 22 years, with large regional variations in prevalence. This contrasted with a 4% annual decrease in the incidence of dermatitis herpetiformis, with minimal regional variations in prevalence. These contrasts could reflect differences in diagnosis between celiac disease (serological diagnosis and case finding) and dermatitis herpetiformis (symptomatic presentation) or the possibility that diagnosing and treating celiac disease prevents the development of dermatitis herpetiformis. Source: Am J Gastroenterol. 2014 May;109(5):757-68. doi: 10.1038/ajg.2014.55. Epub 2014 Mar 25.
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Celiac.com 03/27/2013 - Increased rates of celiac disease over the last fifty years are not linked to wheat breeding for higher gluten content, but are more likely a result of increased per capita consumption of wheat flour and vital glutens, says a scientist working with the US Department of Agriculture (USDA). The researcher, Donald D. Kasarda is affiliated with the Western Regional Research Center of the U.S. Department of Agriculture's Agricultural Research Service. Kasarda recently looked into one prominent theory that says that increased rates of celiac disease have been fueled by wheat breeding that has created higher gluten content in wheat varieties. His research article on the topic appears in the Journal of Agricultural and Food Chemistry. Kasarda says that, while increased consumption of wheat flour and vital wheat gluten may have contributed to the rise in celiac disease over the last decades, "wheat breeding for higher gluten content does not seem to be the basis." He notes that vital gluten is a wheat flour fraction used as an additive to improve characteristics like texture, and commonly featured in numerous and increasingly popular whole wheat products. However, he says that there is a lack of suitable data on the incidence of celiac disease by year to test this hypothesis. Part of his article features statistics on wheat flour consumption throughout the two centuries. He notes wheat flour consumption from all types of wheat hit an all-time high of 220 pounds per person (100kg) in 1900, declined steadily to a low of around 110 pounds per person (50kg) in 1970, then gradually rose to about 146 pounds per person (66kg) in 2000, and then decreased to about 134 pounds per person (61kg) in 2008. He goes on to point out that, even though consumption of wheat flour "seems to be decreasing slightly in recent years, there was an increase in the yearly consumption of wheat flour of about 35 lb (15.9kg) per person in the period from 1970 to 2000, which would correspond to an additional 2.9 lb (1.3kg) of gluten per person from that extra flour intake." Kasarda suggests that 'crude estimates' indicate that consumption of vital gluten has tripled since 1977. He finds this fact very interesting, because, he says, "it is in the time frame that fits with the predictions of an increase in celiac disease." However, he says that attributing an increase in the consumption of vital gluten directly to the rise of celiac disease remains challenging, partly because consumption of wheat flour increased far more significantly in the same time frame. Additionally, Kasarda says that there is no evidence that farmers have been breeding wheat to ensure higher protein and gluten content over the years. He points out that numerous studies have compared the protein contents of wheat varieties from the early part of the 20th century with those of recent varieties. These studies have all shown that, "when grown under comparable conditions, there was no difference in the protein contents," he said. One factor that remains unanswered is the relationship between higher rates of celiac disease and higher rates of diagnosis. That is, are more people developing celiac disease, or are more people simply with celiac disease getting diagnosed than in the past? It's likely that more and more people with celiac disease are being diagnosed, but it's unclear whether celiac disease rates are rising. There is just not enough evidence yet to provide a solid answer, although studies in the US and in Finland suggest that rates of celiac disease may be on the rise. Kasarda's article points out how much more research needs to be done. We need to determine if there is, in fact, a genuine rise in celiac disease rates and, if so, how such a rise might relate to gluten consumption. For now, though, there just isn't any solid evidence that wheat has any higher gluten levels than in the past, or that gluten consumption is driving an increase in celiac disease levels. What do you think? Have you heard this theory about modern wheat having higher gluten levels, or being substantially different than wheat in the past? Have you heard that such a difference may be driving higher rates of celiac disease? Please share your comments below. Source: J. Agric. Food Chem., 2013, 61 (6), pp 1155–1159. DOI: 10.1021/jf305122s
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