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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. -
Can New Terms Improve Outcomes for Sub-clinical Celiac Disease and Gluten Sensitivity?
Jefferson Adams posted an article in Celiac Disease & Gluten Intolerance Research
Celiac.com 08/01/2011 - Over the last two decades, there has been a marked increase in the prevalence of celiac disease, especially the sub-clinical celiac disease forms and non-celiac gluten sensitivity. Most people with celiac disease now present atypical or non-classical symptoms. However, even with improved evaluation methods, clinicians may often face variable histological and clinical presentations of celiac disease, and they may be confused by diagnostic models in the current guidelines. A team of researchers recently set out to reassess sub-clinical celiac disease and gluten sensitivity. The study team included Mohammad Rostami Nejad, Sabine Hogg- Kollars, Sauid Ishaq, Kamran Rostami They are affiliated variously with the Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran, School of Immunity and Infection, University of Birmingham, and the Dudley Group of Hospital NHS Foundation Trust, both in the UK. Improved celiac evaluation methods, and the discovery such conditions as non-celiac gluten sensitivity have them recommending that clinicians use the term 'sub-clinical' in place of 'silent,' and 'atypical' in place of 'potential/latent,' as a way to better understand clinical atypical celiac disease. Although terminologies like 'latent,' 'silent' and 'potential' do reflect certain observable aspects of clinical and pathological celiac disease, they also cause some confusion between clinicians and patients, in part because the definitions are still somewhat vague and subjective. The researchers point out that 'silent' celiac disease is not actually silent after all. Rather, patients show signs of celiac disease with no significant symptoms. Meanwhile, the terms 'potential' and 'latent' are defined differently across numerous studies. The researchers point out the widening spectrum of gluten related disorders, and note that these common systemic disorders have numerous causes with a variety of symptoms and complications inside and outside the small bowel. They conclude that the body of evidence supports decreasing the treatment threshold in people with atypical celiac disease and gluten sensitivity. Since long-term complications of sub-clinical celiac disease remain unknown, they say, it is appropriate to diagnose such patients as early as possible, and to treat them with a gluten-free diet. Source: Gastroenterology and Hepatology From Bed to Bench. 2011;4(3): 102-108 -
Collagenous Sprue Patients Achieving Relatively Good Clinical Outcomes
Jefferson Adams posted an article in Refractory Celiac Disease & Collagenous Sprue
Celiac.com 12/07/2009 - Collagenous sprue is associated with high morbidity, but the etiology of this condition is poorly understood. There is little data concerning the pathological and clinical manifestations of patients with collagenous sprue. The research team set out shed some light on the etiology, disease manifestations and outcomes of collagenous sprue. A team of researchers recently undertook a clinico-pathological study of 19 patients with collagenous sprue and found that the condition does not always end badly for the patient. The research team was made up of Efsevia Vakiani, Carolina Arguelles-Grande, Mahesh M Mansukhani, Suzanne K Lewis, Heidrun Rotterdam, Peter H Green and Govind Bhagat. They are associated with either the Department of Pathology at New York's Memorial Sloan-Kettering Cancer Center, or with Columbia University's Department of Medicine or of Pathology. The team searched their departmental database covering the periods from 1999–2008 to identify cases of collagenous sprue and to gather clinical and lab data. The team evaluated small bowel histology, including thickness of sub-epithelial collagen, intra-epithelial lymphocyte phenotype and results of T-cell clonality assays. The found nineteen patients (15 women, 4 men, age 22–80 years, mean 57 years). Seventeen (89%) suffered from celiac disease and two from unclassified sprue. 9 of 17 (53%) celiac disease patients had refractory disease; 5 of 15 (33%) presented atypically without diarrhea, including 2 of 6 (33%) with active (untreated) celiac disease, and 3 of 9 (33%) with refractory celiac disease. They found autoimmune disorders in 12 of 19 (63%) patients and microscopic colitis (n¼7), lymphocytic gastritis (n¼2) or collagenous gastritis (n¼2) in nine patients. Thickness of subepithelial collagen increase varied from mild (n¼6), moderate (n¼10), or marked (n¼3), and villous atrophy from total (n¼13) to subtotal (n¼6). In no case did they find phenotypically aberrant intraepithelial lymphocytes. The only patient with refractory celiac disease type II showed a dominant T-cell clone with polymerase chain reaction analysis. 7 of 11 (64%) patients showed histological improvement. Overall, 8 of 19 (42%) responded favorably to a gluten-free diet, including 2 of 9 (22%) with refractory celiac disease. 10 of the 19 patients responded to immuno-modulatory therapy, including 6 of 9 (67%) with refractory celiac disease. Only one patient died from the effects of refractory celiac disease. No patient developed lymphoma. The vast majority of patients with collagenous sprue did have celiac disease. Even though numerous patients required immuno-modulatory therapy to control symptoms, many responded to gluten-free diet alone. The researchers conclude that most collagenous sprue patients have relatively good clinical outcomes. Source: Modern Pathology 23 October 2009; doi:10.1038/modpathol.2009.151 -
Untreated Celiac Disease Linked To Poor Birth Outcomes
Scott Adams posted an article in Conferences, Publicity, Pregnancy, Church, Bread Machines, Distillation & Beer
Am J Gastroenterol 1999;94:2435-2440. (Celiac.com 04/10/2000) A study by Danish researchers that was published in the September issue of the American Journal of Gastroenterology concludes that treating women who have celiac disease before they become pregnant improves their birth outcomes. According to Dr. Bente Norgard and colleagues of the University of Aarhus, Denmark, Our study emphasizes the importance of encouraging fertile women to maintain a gluten-free diet once they have been diagnosed, because the time of establishing the diagnosis and subsequent treatment is the major predictor for a favorable birth outcome. The Danish team examined the outcomes of 211 newborns from 127 women with celiac disease, and compared them to 1,260 births to women without celiac disease, from data collected between 1977 and 1992 by the Danish Medical Birth Registry. Their results showed that birth outcomes were worse in women with untreated celiac disease than in women who had been hospitalized for celiac disease, and that the risk of low birth weight and intrauterine growth retardation were increased 2.6 and 3.4 fold respectively when compared to the infants born to women with celiac disease and no prior hospitalization for the disease. These same risks were not increased in women with celiac disease who had prior hospitalization for it. According to Dr. Norgard, Our results emphasize the importance of clinical awareness of this chronic disease. Their conclusion is that untreated celiac disease is a major risk factor for poor birth outcomes, and that the treatment of celiac disease in women is important in the prevention of fetal growth retardation.