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Found 6 results

  1. Celiac.com 11/24/2014 - Following a strict gluten-free diet is the only way to treat celiac disease. However, researchers have been lacking clear agreement on how and when to assess gluten-free dietary adherence in celiac patients or how to determine its effectiveness on villous atrophy. To address this reality, a team of researches conducted a prospective study to determine patient adherence to a gluten-free diet, and its effect on histological recovery after 1-year of gluten-free diet. The research team included G. Galli, G. Esposito, E. Lahner, E. Pilozzi, V. D. Corleto, E. Di Giulio, M. A. Aloe Spiriti, and B. Annibale. They are variously affiliated with the Department of Digestive and Liver Disease, the Department of Haematology, the Department of Pathology, and the Department of Digestive Endoscopy at Sant'Andrea Hospital Sapienza University Rome in Rome, Italy, and with the Centro Ricerche S. Pietro, Ospedale S. Pietro in Rome, Italy. Between 2009 and 2012, the researchers enrolled 65 consecutive newly-diagnosed adult patients (median age 38 years, 18–70) with biopsy-proven atrophic celiac disease. The researchers assessed patients after one year of gluten-free diet, using duodenal histology, serological assays, symptom reports and a dietary interview based on a validated questionnaire. They defined complete histological recovery as the absence of villous atrophy and ≤30/100 intraepithelial lymphocytes. The team found that 81.5% of patients showed adequate gluten-free diet adherence (ADA), whereas 18.5% had inadequate adherence (IADA). Overall, 66% of ADA patients achieved complete histological recovery, but no IADA patients recovered (P < 0.00001). Interestingly, ADA patients who achieved complete histological recovery showed about the same antibody seroconversion and symptoms as those who achieved partial histological recovery with P = 0.309 and P = 0.197, respectively. Multivariate analysis showed that, for ADA patients with incomplete histological recovery, Marsh 3C was still a risk factor (OR 8.74, 95% CI: 1.87–40.83). This study shows that 66% of adult celiac patients who successfully follow a gluten-free diet can make a complete histological recovery after 1-year. However, patients with severe histological damage at diagnosis who successfully follow a gluten-free diet remain at risk for incomplete histological recovery 1 year later. Lastly, patients who do not follow a gluten-free diet have no hope of making a full histological recovery. For clinicians and doctors, this data should serve as a guideline for determining gluten-free diet adherence in celiac patients, and determining the level of patient recovery. For celiac patients, the data should serve to demonstrate the importance of following a strict gluten-free diet. Source: Alimentary Pharmacology & Therapeutics 2014; 40(6):639-647.
  2. Celiac.com 11/03/2016 - Refractory celiac disease type II (RCDII) often transforms into an enteropathy-associated T-cell lymphoma (EATL), a serious condition that requires intensive treatment. Current treatment strategies for RCDII include cladribine(2-CdA) and autologous stem cell transplantation (auSCT). A team of researchers recently set out to assess long-term survival in refractory celiac disease type II, and to define clear prognostic criteria for EATL development comparing two treatment strategies. They also wanted to evaluate histological response as prognostic factor. The research team included P Nijeboer, RLJ van Wanrooij, T van Gils, NJ Wierdsma, GJ Tack, BI Witte, HJ Bontkes, O Visser, CJJ Mulder, and G Bouma. They are variously affiliated with the Department of Gastroenterology, the Department of Nutrition and Dietetics, the Department of Epidemiology and Biostatistics, the Department of Pathology, and the Department of Haematology at VU University Medical Centre in Amsterdam, The Netherlands. For their study, they retrospectively analyzed 45 patients. All patients received 2-CdA, after which they were either closely monitored (monotherapy, n=30) or received a step-up approach, including auSCT (step-up therapy, n=15). Ten patients (22%) developed EATL, nine of whom had received monotherapy. Absence of histological remission after monotherapy was associated with EATL development (p=0.010). A total of 20 patients (44%) died, with an average survival of 84 months. Overall survival (OS) in the monotherapy group was far better in those with complete histological remission compared to those with without histological remission. The monotherapy patients, who achieved complete histological remission, showed comparable EATL occurrence and OS as compared to the step-up therapy group (p=0.80 and p=0.14 respectively). Histological response is an accurate parameter to evaluate the effect of 2-CdA therapy and this parameter should be leading in the decisions whether or not to perform a step-up treatment approach in RCDII. Source: United European Gastroenterology Journal, April 2016; DOI: 10.1177/2050640616646529
  3. Celiac.com 08/10/2012 - A diagnosis of Celiac disease is measured mainly by an adverse response to gluten, yet there is very little in the way of data regarding gluten challenge in adults on a gluten-free diet. A research team recently studied the kinetics of histological, serological, and symptomatic responses to gluten challenge in adults with celiac disease. The research team included D. Leffler, D. Schuppan, K. Pallav, R. Najarian, J.D. Goldsmith, J. Hansen, T. Kabbani T, M. Dennis, and C.P. Kelly. They are affiliated with Beth Israel Deaconess Medical Center in Boston, Massachusetts. For their study, the team wanted to address a lack of data regarding the kinetics of responses to gluten, which causes assessment issues in clinical practice and research when gluten-challenge is performed. For their study, the researchers recruited twenty adults with biopsy-proven coeliac disease. For each participant, the team conducted two run-in visits followed by a 14-day gluten-challenge at a randomly assigned dose of 3 or 7.5 g of gluten/day. Patients visited study team doctors at 3, 7, 14 and 28 days after the start of their gluten challenge. The researchers performed duodenal biopsy during the run-in and at days 3 and 14 of gluten challenge. The team used two pathologists to measure villous height to crypt depth ratio (Vh:celiac disease) and intraepithelial lymphocyte (IEL) count/100 enterocytes. Upon each visit, the team also assessed antibodies to tissue transglutaminase and deamidated gliadin peptides, lactulose to mannitol ratio (LAMA) and any physical symptoms. Compared to the initial data, results after 14 days showed substantially lower Vh:celiac disease (2.2-1.1, p Interestingly, gastrointestinal symptoms increased significantly after three days, but had returned to baseline by day 28. There were no differences between the higher and lower gluten doses. The team concludes by noting that a 14-day gluten challenge at or above 3 g of gluten/day triggers cellular, tissue, and blood changes in most adults with celiac disease. These findings will help researchers create more accurate clinical trials, and show that many individuals will meet celiac diagnostic criteria after a basic 2-week gluten challenge. Source: Gut. 2012 May 22.
  4. Celiac.com 07/28/2010 - Most people with celiac disease keep themselves healthy by following a gluten free diet. More and more, doctors are recognizing the importance of confirming gut recovery through follow-up evaluation. Still, among clinicians, there is currently no standard for follow-up confirmation of gut healing in celiac disease treatment. Many guidelines recommend an initial follow-up biopsy at 4-6 months after the patient begins a gluten-free diet. However, the use of biopsy to confirm gut healing is still controversial, as it can yield enormously variable results. A group of researchers recently set out to establish the amount of time it takes for full gut recovery in patients with celiac disease. The research team was made up of J.M. Hutchinson, N.P. West, G.G. Robins and P.D. Howdle. They are variously affiliated with the Sections of Medicine, Surgery and Anesthesia, the Section of Pathology & Tumour Biology at the Leeds Institute of Molecular Medicine in Leeds, and with the Department of Gastroenterology of the York Foundation Hospitals Trust, York, UK. The team enrolled patients who attended a specialty celiac disease clinic prior to March 2009, and recorded various clinicopathological information into a database. The team reviewed histopathology reports for all duodenal biopsies, and scored each biopsy for histopathology based on a modified Marsh grade. The team indexed and performed at least one biopsy on two hundred and eighty-four patients. The team found marked gut improvement in two-hundred and twenty-seven patients (80%), and a complete return to normal histology in 100 patients (35%). Average recovery time was 1.9 years, with a range of 1.0–4.8 years. Patients with less serious celiac disease at the start showed a better overall response (r = 0.281, P < 0.0001), while older patients recovered more quickly (r = –0.200, P = 0.001). Patients who best followed a gluten-free diet showed the best biopsy scores (r = –0.134, P = 0.040) and the greatest degree of histological recovery (r = 0.161, P = 0.014). Current guidelines for treatment of celiac disease recommend timing repeat biopsy 4-6 months after commencing a gluten free diet. These results shows histological recovery generally takes longer than traditionally thought, and that doctors looking to conduct such follow-ups might do well to factor in the patient’s age at diagnosis, the initial disease score, as well as the level of compliance with a gluten free diet. Source: QJM 2010 103(7):511-517
  5. Scand J Gastroenterol. 2003 Jul;38(7):727-31. Effectiveness of the sorbitol H2 breath test in detecting histological damage among relatives of coeliacs. Tursi A, Brandimarte G, Giorgetti GM, Inchingolo celiac disease. Dept. of Emergency, L. Bonomo Hospital, Andria (BA), Italy. Celiac.com 08/07/2003 - An Italian study conducted by Dr. L. Bonomo and colleagues and published in the July 2003 edition of Scandinavian Journal of Gastroenterology concludes that A significant proportion of coeliacs may be missed if relatives are screened by serology only, while the efficacy of sorbitol H2-BT in screening relatives is confirmed. This study confirms that neither a breath test nor serology can replace intestinal biopsy, which remains the gold standard for the diagnosis of celiac disease, thus confirming the continued importance of performing biopsies for diagnosing celiac disease. The studys goal was to determine the diagnostic capabilities of serological tests (antigliadin (AGA), antiendomysium (EMA) and anti-tissue transglutaminase (anti-tTG)) and sorbitol H2 breath test (H2-BT) in the detection of celiac disease in first-degree relatives. The study screened 111 first-degree relatives of 37 celiac families using both test methods to determine candidates for small bowel biopsy. First-degree relatives with abnormal test results underwent a small bowel biopsy, as did those with negative serological and H2 breath test results who had clinical complaints or suspected that they may have celiac disease. The biopsy results were expressed using the Marsh classification system, and celiac disease was diagnosed in 49 of the 111 screened relatives of celiacs, or in 44.14%. A breakdown of the results is as follows: 5 showed Marsh IIIc, 8 Marsh IIIb, 16 Marsh IIIa, 13 Marsh II and 7 Marsh I lesions. 19 relatives showed the classical form of celiac disease, 20 showed the sub-clinical form, and 10 showed the silent form. The serological test results indicated an overall positivity of only 36.73%, with strong positive results only in those with severe intestinal damage and Marsh IIIb-c lesions. The sorbitol H2-BT breath test results showed an overall positivity of 83.67%, and showed strong positivity in patients with slight histological damage (Marsh I-IIIa).
  6. AU- Fallstrom SP; Kristiansson B; Ryd W JN- Acta Pathol Microbiol Scand [A]; 89 (6) p431-8 PY- Nov 1981 AB- Eighty-one children aged 4-18 months with unsatisfactory weight gain were investigated for organic diseases; the investigation included small-intestinal biopsy. Sixteen had total villous atrophy, in most cases due to gluten intolerance. Transient disease, e.g. cows milk protein intolerance, was probable in 7 children with subtotal atrophy. In 18 children the only abnormal finding was an increased number of inflammatory cells in the mucosa, a finding which was probably of no clinical significance. Planimetric measurement showed good agreement between the mucosal surface/volume ratio and an ordinary histological grouping of the mucosa. A significant correlation was found between the rate of weight gain during the period preceding investigation and mucosal surface/volume ratio.
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