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Celiac.com 04/28/2022 - Some studies have indicated that celiac disease patients may not fully respond to hepatitis B virus (HBV) vaccination, and may therefore be at greater risk of developing HBV infection. However, the data are far from conclusive. Also, there's not been much study on the risk of HBV infection in celiac disease patients. To get a clearer picture of the issue, a team of researchers recently set out to assess the response to hepatitis B virus (HBV) vaccination and the risk of HBV infection in celiac disease patients. The research team included Nawras Habash; Rok Seon Choung; Robert M Jacobson; Joseph A. Murray; and Imad Absah. They are variously affiliated with the Division of Pediatric Gastroenterology and Hepatology; the Division of Community Pediatric and Adolescent Medicine, Division of Pediatric Infectious Diseases; the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. For their cross-sectional study, the team used data from the National Health and Nutrition Examination Survey (NHANES) database, from 2009–2014, to assess the rate of HBV vaccination, immune response, and HBV infection risk in patients with and without celiac disease. The team calculated the rate of HBV infection via retrospective analysis of two groups of patients. The first visited the Mayo Clinic from 1998–2021, while the second was a stable longitudinally observed cohort, the Rochester Epidemiology Project (REP), from 2010–2020. Based on the NHANES data, the rate of HBV infection in the United States was 0.33%. Of 93 patients with celiac disease, 46 (49%) were vaccinated for HBV and of the remaining 19,422 without celiac disease, 10,228 (53%) were vaccinated. Twenty-two (48%) vaccinated patients with celiac disease had HBV immunity, while 4,405 (43.07%) of vaccinated patients without celiac disease had HBV immunity, which was not significantly different. NHANES data showed no cases of HBV infection in celiac patients. During the study period, the team found just over 3,500 patients with celiac disease who were seen at Mayo Clinic, and nearly four thousand patients with celiac disease in the REP database. Of those patients with celiac disease, only four (0.11%) at Mayo Clinic and nine (0.23%) of the REP patients had HBV infection. These data show that the rate of HBV vaccination and immunity was similar for individuals with and without celiac disease. Overall, they showed no greater risk of HBV infection for celiac disease patients. Based on these results, HBV screening and HBV revaccination to increase immunity is not required for people with celiac disease. Read more in the Journal of Pediatric Gastroenterology and Nutrition: March 2022 - Volume 74 - Issue 3 - p 328-332 -
Celiac.com 03/18/2024 - A recent study aimed to uncover the prevalence of celiac disease among individuals with systemic lupus erythematosus, shedding light on potential connections between the two conditions. Researchers conducted a thorough investigation, reviewing 14 studies that met their inclusion criteria. They analyzed data from over 1200 patients with systemic lupus erythematosus to determine the prevalence of biopsy-verified celiac disease and serological markers indicative of celiac disease. The research team included Adonis Sotoodeh, Madeleine Nguyen Hoang, Karin Hellgren, and Anders Forss. They are variously affiliated with the Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Gastroenterology Unit, Department of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; and the Department of Medicine, Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden. Serological Markers for Celiac Disease in Those with Systemic Lupus Erythematosus was 3.7% Surprisingly, the study found that the prevalence of biopsy-verified celiac disease in patients with systemic lupus erythematosus was comparable to that of the general population, at 0.7%. However, the prevalence of serological markers for celiac disease was slightly higher, at 3.7%. Despite these findings, the researchers did not identify any significant associations between the prevalence of celiac disease in individuals with systemic lupus erythematosus and various study characteristics or demographics. Based on these results, the researchers concluded that routine screening for celiac disease may not be necessary for all patients with systemic lupus erythematosus. However, they suggested that individual screening could be considered in cases where there is clinical suspicion or additional risk factors for celiac disease. While further research is needed to fully understand the connection between these two conditions, this study provides important guidance for healthcare professionals in managing patients with systemic lupus erythematosus, who may also be at risk for celiac disease. Read more in Lupus Science & Medicine at the BMJ -
09/18/2023 - Vomiting and nausea are considered common symptoms related to gluten ingestion in treated celiac disease. However, the overall rates and associated factors of these symptoms after chronic gluten exposure, and acute re-exposure during gluten challenge, remain poorly understood. A team of researchers recently set out to explore the rates and factors associated with vomiting and nausea in individuals with celiac disease, both at the time of diagnosis and during gluten challenges. The research team included Iida Ahonen, Pilvi Laurikka, Sara Koskimaa, Heini Huhtala, Katri Lindfors, Katri Kaukinen, Kalle Kurppa, and Laura Kivelä. They are variously affiliated with the Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; the Department of Internal Medicine, Tampere University Hospital, Tampere, Finland; the Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland; the Faculty of Social Sciences, Tampere University, Tampere, Finland; and the University Consortium of Seinäjoki, Seinäjoki, Finland. For their study, the researchers collected medical data from 815 adult celiac disease patients at the time of their diagnosis, and an additional 74 patients underwent a three-day gluten challenge. Here are the team's key findings: At The Time of Celiac Disease Diagnosis About one in three patients presented with vomiting at the time of their celiac disease diagnosis. These patients were less likely to have been identified through screening, and more likely to experience various other symptoms. Specifically, patients who suffered from vomiting had about a 20% higher occurrence of abdominal pain, diarrhea, and weight loss, along with a nearly 30% higher rates of childhood symptoms, compared to those without vomiting. During a Gluten Challenge During the short-term gluten challenge, nearly 20% of patients experienced vomiting/nausea. Interestingly, those who consumed gluten-free oats less frequently were about 30% more likely to experience these symptoms. There were no significant differences between the two groups in terms of other clinical-demographic characteristics, duration of a gluten-free diet, or other symptoms. Literature Review The study also conducted a literature review, which revealed a wide range in the prevalence of vomiting/nausea in celiac disease patients, both at diagnosis (ranging from 3% to 46%), and during gluten challenges (ranging from 13% to 61%). Overall, vomiting and nausea appear to be relatively specific symptoms associated with gluten ingestion in individuals with treated celiac disease. At diagnosis, those experiencing vomiting tended to have a higher rates of other gastrointestinal symptoms and an earlier onset of symptoms in childhood. During a gluten challenge, reduced consumption of gluten-free oats was linked to a higher likelihood of vomiting/nausea. The prevalence of these symptoms varied widely in the existing literature. This research provides valuable insights into the presentation of symptoms in celiac disease patients, shedding light on factors associated with vomiting and nausea both at diagnosis and during gluten challenges. Read more at bmcgastroenterology.com -
Celiac.com 10/12/2023 - Celiac disease is a chronic, inflammatory disease triggered by the consumption of gluten-containing foods. Early diagnosis and proper management with a gluten-free diet can reduce its impact on patients' quality of life. People with a family history of celiac disease are at a higher risk, making it crucial to actively identify cases within this group. A new study conducted by a team of researchers in Australia offers new insight into rates of celiac disease, particularly among first-degree relatives of individuals with the condition. The research team included Richard Muir, Anuj Sehgal, Jason A Tye‐Din and A James M Daveson. They are variously affiliated with The Wesley Hospital, Brisbane, QLD; St Andrew's War Memorial Hospital, Brisbane, QLD; the Wesley Research Institute, Brisbane, QLD; The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC; The Royal Melbourne Hospital, Melbourne, VIC; and The University of Queensland, Brisbane, QLD. Celiac Disease Affects Approximately 1.4% of People Globally Their research found that celiac disease affects approximately 1.4% of both the global and Australian populations. The study, conducted at the Wesley Research Institute in Brisbane, targeted first-degree relatives of individuals already diagnosed with celiac disease. These relatives were invited to participate in the research, and the study involved genetic testing for celiac disease risk alleles (HLA‐DQ2/8/7 polymerase chain reaction genotyping) and serological tests to detect specific antibodies related to celiac disease. Key findings from the study include: High Celiac Disease Susceptibility Among the participants, 86% had celiac disease susceptibility haplotypes, with 50% of children and 53% of adults carrying high-risk celiac-associated genotypes. Serology Results Sixteen individuals with susceptibility haplotypes tested positive for serological markers associated with celiac disease. Biopsy Confirmation Small bowel biopsies were performed on individuals with positive serological results, confirming celiac disease in seven children and two adults who had high-risk alleles. Celiac Disease Prevalence Among Child First-Degree Relatives Between 11% and 14% Among child first-degree relatives, the estimated rates of celiac disease was 11%, rising to 14% among those with celiac disease susceptibility haplotypes. In contrast, only 1.4% of adult first-degree relatives were confirmed to have celiac disease. These findings highlight the importance of active case finding, especially among first-degree relatives of individuals diagnosed with celiac disease. Such screening can lead to early diagnosis and timely intervention, improving the quality of life and health for celiacs. However, the study also acknowledges limitations, including the fact that not all individuals with positive serological results underwent small bowel biopsies. Additionally, the research was conducted at a single center, and a non-first-degree relatives group was not included for comparison. Overall, the study's results support international guidelines recommending active case finding among first-degree relatives of individuals with celiac disease. Read more in The Medical Journal Of Australia -
12/06/2021 - Celiac disease is an auto-immune disease that can manifest in numerous ways. A team of researchers recently set out to assess rates of gastrointestinal (GI) and extra-intestinal symptoms of celiac patients, especially headache and migraine, and compare those to a healthy control group. The team compared one thousand celiac subjects, with migraine and non-migrainous headache, registered at their celiac center, against a healthy control group, for headache parameters, in terms of GI and extra-intestinal symptoms. Overall, celiac subjects experienced higher rates of headache than control subjects, with the greatest prevalence in female celiacs. Celiac subjects also showed higher rates of migraine than controls, especially females. In fact 80% of females with celiac disease experienced migraine, and without aura nearly three-quarters of the time. The most common GI symptoms in celiac subjects with headache were abdominal pain, diarrhea, and constipation, which were all more prevalent in celiac subjects with migraine. Conversely, celiac subjects with migraine saw lower rates of type 1 diabetes mellitus than celiac subjects with non-migrainous headache. Multivariate logistic regression analysis showed that being female, and having celiac disease were independent predictors of headache, whereas patients over 60 years old saw some protective effects. Celiac subjects have higher rates of headache, especially migraine, than healthy control subjects. Moreover, celiac subjects with migraine more commonly experience abdominal pain, diarrhea, and constipation than celiac subjects with non-migrainous headaches. Because of this, the team recommends celiac screening for patients with migraine and simultaneous GI symptoms. Read more at PLOS ONE The research team included Mohammad M. Fanaeian, Nazanin Alibeik, Azita Ganji, Hafez Fakheri, Golnaz Ekhlasi, and Bijan Shahbazkhani. They are variously affiliated with the Division of Gastroenterology and Liver Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences inTehran, Iran; the Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran; the Department of Gastroenterology and Hepatology, Mashhad University of Medical Sciences, Mashahd, Iran; the Gut and Liver Research Center, Non-communicable Disease Institue at Mazandaran University of Medical Sciences in Sari, Iran; and the Digestive Disease Research Institute at Shariati Hospital, Tehran University of Medical Sciences in Tehran, Iran. -
Celiac.com 07/17/2023 - Celiac disease has been associated with higher levels of anxiety, but study evidence is scant. A team of researchers recently set out to measure the frequency of anxiety and depressive symptoms in Jordanian patients with celiac disease. The Research Team The research team included Sara Haj Ali, Rahaf Alqurneh, Awni Abu Sneineh, Bandar Ghazal, Lana Agraib, Layali Abbasi, Sufian Rifaei, and Tarek Mazzawi. They are variously affiliated with the department of Medicine, Al-Balqa Applied University, Al-Salt, JOR; the department Gastroenterology and Hepatology, University of Jordan, Amman, JOR; and the department of Food Science and Nutrition, Jerash University, Jerash, JOR. Celiac disease is a condition where the immune system reacts to gluten, causing intestinal problems and other symptoms. Researchers conducted a study to understand the frequency of anxiety and depressive symptoms in Jordanian patients with celiac disease. Anxiety and Depressive Symptom Questionnaire The study involved sending a questionnaire electronically to celiac disease patients through WhatsApp. The questionnaire asked about demographics, disease-related information, and assessed anxiety and depressive symptoms using validated scales. A total of 133 patients participated in the study, mostly females with an average age of 33.9 years. About one-third of the patients were not following a gluten-free diet, and more than half were experiencing symptoms at the time of the study. 83% Report Depressive Symptoms The prevalence of anxiety and depressive symptoms among the participants was found to be high, with 85% reporting anxiety symptoms and nearly 83% reporting depressive symptoms. There were no significant correlations found between the variables and the presence of anxiety or depressive symptoms. These findings highlight the significant proportion of Jordanian celiac disease patients who experience anxiety and depressive symptoms. Considering the potential impact on their quality of life, it is important for healthcare providers to screen celiac disease patients for psychiatric comorbidities and refer them for further evaluation if needed. This can help improve their overall well-being and provide appropriate support. Read more at Cureus. 2023 Jun; 15(6): e39842 -
Celiac.com 06/27/2023 - Some individuals with celiac disease experience liver complications such as elevated liver enzymes, liver cirrhosis, and autoimmune hepatitis. A group of researchers conducted a systematic review with meta-analyses to determine the combined prevalence of celiac disease in patients with different liver conditions. Here's what they found. The research team included Yoosuf, Shakira MD; Singh, Prashant MD; Khaitan, Ashank MBBS; Strand, Tor A. MD; Ahuja, Vineet MD, DM; and Makharia, Govind K. MD, DM, DNB. They are variously affiliated with the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India; the Chettinad Hospital and Research Institute, Chennai, Tamilnadu, India; the Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA; the Department of Global Public Health, Innlandet Hospital Trust, Lillehammer, Norway. Medical Databases Searched for Relevant Liver and Celiac Diesase Studies They searched medical databases for relevant studies up to January 2022. Studies that performed serological tests and/or intestinal biopsy for celiac disease on patients with cryptogenic cirrhosis, all-cause cirrhosis, cryptogenic hypertransaminasemia (elevated liver enzymes), and all-cause hypertransaminasemia were included. The researchers calculated the pooled estimates of seroprevalence (presence of celiac antibodies in the blood) and the rates of biopsy-confirmed celiac disease in these four groups. Out of the many articles screened, 20 articles were included in the final analysis for cryptogenic cirrhosis, all-cause cirrhosis, and cryptogenic hypertransaminasemia. However, for all-cause hypertransaminasemia, a qualitative review of four studies was conducted due to significant differences in the studies. Patients with Cryptogenic Cirrhosis ~5% and Cryptogenic Hypertransaminasemia 6% The results showed that the pooled prevalence of biopsy-confirmed celiac disease in patients with cryptogenic cirrhosis was approximately 5%. For all-cause cirrhosis, the prevalence was less than 1%. In the case of cryptogenic hypertransaminasemia, the pooled prevalence of biopsy-confirmed celiac disease was nearly 6%. These findings suggest that approximately 1 in 20 patients with cryptogenic cirrhosis or cryptogenic hypertransaminasemia have celiac disease. Therefore, individuals with these liver conditions should be considered high-risk groups for celiac disease and may benefit from screening. Although the prevalence of celiac disease in individuals with all-cause cirrhosis is similar to the general population, it may still be worth conducting celiac screening the, because the liver damage in these cases has the potential for reversal. Read more in The American Journal of Gastroenterology 118(5):p 820-832, May 2023. -
Celiac.com 04/26/2023 - Celiac disease is a common chronic disorder, but there's a lack of information on its current prevalence and detection rate. To get a better picture of the actual situation on the ground, a research team conducted a mass screening of school-ages children in Italy to assess the prevalence and detection rate of celiac disease among school-age children in Italy using a multi-center mass screening approach. The team included Elena Lionetti, Dorina Pjetraj a, Simona Gatti a, Giulia Catassi, Antonella Bellantoni c, Massimo Boffardi, Mara Cananzi, Mauro Cinquetti j, Ruggiero Francavilla, Basilio Malamisura, Monica Montuori, Gianvincenzo Zuccotti, Fernanda Cristofori, Paola Gaio, Tiziana Passaro, Francesca Penagini, Alessandra Testa, Chiara Maria Trovato, and Carlo Catassi. Nearly 6,000 children were eligible for the study, 4.438 participated and nearly 2,000 showed predisposing haplotypes for celiac disease. The team used HLA-DQ2 and -DQ8 determination on a drop of blood and total serum IgA and IgA anti-transglutaminase to determine the diagnosis of celiac disease, as per the European guidelines. The overall prevalence of celiac disease was 1.65%, with only 40% of children diagnosed prior to the school screening. Interestingly, symptoms of celiac disease were as common in celiac children as in control subjects. The study revealed that the rate of celiac disease in school-age Italian children was one of the highest in the world, and without a mass screening strategy, 60% of celiac patients remain currently undiagnosed in Italy. This highlights the importance of mass screening strategies and early detection of celiac disease to reduce the burden of the disease and its associated complications. The study also showed that determination of HLA predisposing genotypes is an easy and fast first-level screening test for celiac disease, which can be used to identify children who require further diagnostic testing. Read more in Science Direct The researchers are variously affiliated with the Division of Pediatrics and Center for Celiac Research, DISCO Department, Marche Polytechnic University, Ancona, Italy; the Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza-University of Rome, Rome, Italy; the Department of Pediatrics, Bianchi-Melacrino Morelli Hospital in Reggio Calabria, Italy; the Pediatric Unit and Center for Celiac Disease - University Hospital of Salerno, Campus of Cava de' Tirreni, Italy; the Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Dpt. of Women's and Children's Health, University Hospital of Padova, Italy; the Pediatric Section, Department of Interdisciplinary Medicine, University of Bari, Italy; the Department of Pediatrics, Vittore Buzzi Children's Hospital at University of Milan, Italy; the Clinical Biochemistry Unit, National Research Council, Reggio Calabria, Italy; the Hepatology Gastroenterology and Nutrition Unit, "Bambino Gesù" Children Hospital in Rome, Italy; and the Department of Pediatrics, "G. Fracastoro" Hospital in Verona, Italy. -
Celiac.com 01/30/2023 - To spot regional differences in celiac disease autoimmunity and overall celiac incidence for children born between 2004 and 2010, a team of researchers with The Environmental Determinants of Diabetes in the Young (TEDDY) recently set out to follow an HLA-risk selected group of celiac patients using a uniform protocol. The team evaluated children from six different regions within Europe and the United States. The research team included Marisa, Stahl MD; Qian, Li PhD; Kristian, Lynch PhD; Sibylle, Koletzko MD, PhD; Pooja, Mehta MD; Loren, Gragert PhD; Jill M, Norris PhD; Carin, Andrén Aronsson PhD; Katri, Lindfors PhD; Kalle, Kurppa MD, PhD; Jorma, Ilonen MD, PhD; Jeffrey, Krischer PhD; Beena, Alkolkar PhD; Annette-G, Ziegler MD; Jorma, Toppari MD, PhD; Marian, Rewers MD, PhD; Daniel, Agardh MD, PhD; William, Hagopian MD, PhD; Edwin, Liu MD; and the TEDDY Study Group. Prospective Study of Nearly 7,000 Patients The team prospectively enrolled from birth nearly seven thousand patients with DQ2.5 and/or DQ8.1 in Georgia, Washington, Colorado, Finland, Germany, and Sweden. They regularly screened the children for tissue transglutaminase antibodies (tTGA), and then assessed them for celiac disease follow-up based on clinical need. The team then estimated population-specific figures by weighting the total study-specific incidence with the population-specific haplogenotype frequencies derived from the sites' ample stem cell registries. Research Findings Individual haplogenotype risks for celiac disease autoimmunity and celiac disease varied by region. In some regions, the overall numbers of celiac disease are high. For example, the team found a celiac incidence of nearly 2.5% by age 10 in Colorado children. Adjusted for HLA, sex, and family history, Colorado children had a 2.5-fold higher risk of celiac disease compared to children in Washington state. Celiac rates by age 10 years were highest for Swedish children, at 3%. Their data show that cumulative incidence of celiac disease varies significantly by region, which indicates variable environmental, genetic, and epigenetic factors even within the United States. Such high regional case numbers supports the use of low threshold for celiac screening, along with more research into the reasons for the region-specific differences in celiac disease case numbers. Read more in the American Journal of Gastroenterology The researchers in this study are variously affiliated with theDigestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; the Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, United States; the Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, United States; the Department of Pediatrics, Dr von Hauner Kinderspital, LMU Klinikum, Munich, Germany; the Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland; the Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA, United States; the Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; the Department of Clinical Sciences, Malmo, Lund University, Malmo, Sweden; the Celiac Disease Research Center, Tampere University and Tampere University Hospital; the Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital; the Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland; the Department of Pediatrics, Turku University Hospital, Turku, Finland; the National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States; the Forschergruppe Diabetes e.V. and Institute of Diabetes Research, Helmholtz Zentrum, Munich, Germany; the Institute of Biomedicine, Centre for Integrative Physiology and Pharmacology, Univeristy of Turku, Turku, Finland; the Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; the Diabetes and Celiac Disease, Lund University, Malmo, Sweden; and the Department of Diabetes, Pacific Northwest Research Institute, Seattle, WA, United States. -
Celiac.com 02/03/2023 - Multiple sclerosis is a chronic autoimmune disease of the central nervous system that affects individuals worldwide. People with multiple sclerosis often have other autoimmune diseases such as hypothyroidism, inflammatory bowel disease, rheumatoid arthritis, and diabetes, which suggests that there may be common genetic or environmental exposures between multiple sclerosis and other autoimmune diseases. Epidemiological studies have also shown that individuals with one autoimmune disease have an increased susceptibility to developing another autoimmune disease. Celiac disease is an autoimmune gluten-sensitive enteropathy that results in small intestinal lesions and malabsorption in affected individuals. Celiac disease develops based on genetic factors and mucosal immune response. Almost all individuals with celiac disease have HLA DR3-DQ2 and/or the DR4-DQ8. These HLA class II haplotypes have a strong association with multiple sclerosis. celiac disease is also associated with neurological manifestations and diseases such as ataxia, epilepsy, neuropathy, and multiple sclerosis. However, the exact relationship between celiac disease and multiple sclerosis is not well understood. In order to evaluate the prevalence of celiac disease in multiple sclerosis cases, two researchers conducted a systematic review and meta-analysis using PubMed, Scopus, EMBASE, Web of Science, and Google Scholar. The search included all relevant studies published up to October 2022. The researchers independently searched all databases and also references of included studies. They included cross-sectional studies/case, articles which had been published in the English language, and studies in which the diagnostic criteria were biopsy of the duodenum. They excluded letters to editors, case reports, and RCT studies. They found a total of 1,113 articles by literature search, and after deleting duplicates, 519 remained. Sixteen articles remained for meta-analysis. A total of 31,418 patients were evaluated and the total number of possible/confirmed cases was 124. Studies were published between 2004 and 2020, and the most published studies were from Italy. Five studies provided information regarding controls. The pooled rates of this systematic review showed that celiac disease is not common in multiple sclerosis cases. However, the study did have some limitations. There were studies that used serologic evaluation for celiac disease diagnosis which were excluded. Additionally, there were no reports from some countries, and the control groups were different; as in some studies, the control group was healthy subjects, and in others, the control group was patients with other diseases except multiple sclerosis. The study authors suggest that larger multicenter studies from numerous countries are needed to fully understand the relationship between celiac disease and multiple sclerosis. It is important to note that while the rates of celiac disease in multiple sclerosis patients may be low, patients with multiple sclerosis still suffer from a wide range of gastrointestinal manifestations such as dysphagia, constipation, and/or fecal incontinence. Dyspeptic symptoms and associated pain are also common in multiple sclerosis cases, which can negatively affect quality of life and interfere with daily activities. Because of this, it's important for doctors to be aware of the potential for these symptoms in multiple sclerosis patients, and to consider a range of possible causes. Read more in the American Journal of Gastroenterology -
Celiac.com 06/28/2021 - There is a growing body of data to suggest the intestinal action of SARS-CoV-2, with ciliated cells and intestinal enterocytes serving as target cells, due to high expression of ACE2 and TMPRSS2, could possibly trigger celiac disease in predisposed individuals. Indeed, COVID-19 promotes a “cytokine storm” in the intestinal mucosa, triggering epithelial damage that increases barrier permeability, permitting gliadin to "leak" into the intestinal lamina. However, the possible impact of the SARS-CoV-2 infection, and the resulting disease, on celiac disease rates remains unknown, with no data currently available on the development of systemic disorder, or on long-term outcomes. A team of researchers recently set out to highlight the potential risk of a rise in celiac disease rates among genetically predisposed subjects following SARS-CoV-2 infection, based on several factors which could promote the development of celiac disease. The research team included Chiara Maria Trovato, Monica Montuori, Nicoletta Pietropaoli, and Salvatore Oliva. They are variously affiliated with the Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy; and the Hepatology Gastroenterology and Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy. The team used current medical literature to help them hypothesize the role of COVID-19 as a possible trigger for celiac disease development in predisposed individuals. They suggest that genetically predisposed people could be more likely to develop celiac disease following SARS-CoV-2 infection, making COVID-19 a potential driver of increased celiac disease cases in the future. An unexpected rise in celiac cases among genetically predisposed individuals in the wake of the COVID-19 pandemic would support the team's hypothesis. Time will tell if they are right. Stay tuned for more stories regarding COVID-19, celiac disease, and related topics. Read more in the International Journal of Clinical Practice -
Celiac.com 11/07/2022 - A team of researchers recently set out to investigate why certain at-risk individuals develop celiac disease. They especially wanted to look at the risk levels early on that might influence levels of celiac disease later on in childhood. The research team included Michael Boechler MD; Apryl Susi MS; Elizabeth Hisle-Gorman MSW PhD; Philip L. Rogers; and Cade M. Nylund MD. They are variously affiliated with the Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, and the Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD. For their retrospective cohort study, the team used the Military Healthcare System (MHS) database, the team found children born between October 1, 2001- September 30, 2013. The team examined the connections between patients who received either proton pump inhibitors (PPI), histamine-2 receptor antagonist (H2RA), or antibiotic prescriptions in the first six months of life, and who also had a celiac disease diagnosis in early childhood. They then searched outpatient prescription records for antibiotic, PPI, and H2RA prescriptions in the first 6 months of life. They used ICD-9 codes to identify children who made outpatient visits for celiac disease, and Cox proportional hazards regression to calculate the hazard ratio (HR) for the development of celiac disease based on medication exposure. Nearly one-million children met inclusion criteria, from which the researchers uncovered just over 1,700 cases of celiac disease. Average follow-up time for patients in this group was about 4.5 years. The data show that PPI’s, H2RA’s, and antibiotics were all associated with an increased hazard of celiac disease. Children who receive antibiotics, PPI’s and H2RA’s in the first 6 months of life face an increased risk for developing celiac disease. The data reinforce the notion that controllable factors, such as the use of drugs to treat conditions in infancy, could help to lower the childhood risk of celiac disease for many people worldwide. Read more in The Journal of Pediatrics -
Celiac.com 09/19/2022 - A team of researchers recently set out to calculate rates of non-coeliac gluten sensitivity (NCGS) in a group of fibromyalgia patients, to evaluate their clinical response to a six-week gluten-free diet, any improvement in symptoms, rates of diet responders who did not meet non-coeliac gluten sensitivity diagnostic criteria, and any baseline characteristics associated with diet response and diagnostic criteria fulfillment. The research team included Miriam Almirall, Francesc Casellas, Joan Dot, Inés de Torres, Hegoi Segurola, Sara Marsal. They are variously affiliated with the Department of Pathology, Department of Endoscopy, Department of Rheumatology, and the Nutritional Support Unit ant the Hospital Universitari Vall d’Hebron, Barcelona, Spain; the Rheumatology Research Group, Vall d’Hebron Research Institute; the Digestive System Research Unit Gastroenterology; and the Department of Morphological Sciences, Autonomous University of Barcelona. The team carried out an uncontrolled prospective experimental study in a group of patients with fibromyalgia from a specialized hospital ward. The team analyzed the percentage of patients who met the Salerno Experts’ Criteria, responded to a gluten-free diet, improved their symptomatology and baseline characteristics, and met diagnostic criteria. In all, the team found a non-coeliac gluten sensitivity rate of about 6% in 142 patients. About 22% of those showed an improvement in intestinal symptoms on a gluten-free diet. In total, 74.2% of the responders did not fulfil the Salerno Experts’ Criteria. The presence of diarrhea and intraepithelial lymphocytosis and lower levels of anxiety were predictive factors of gluten-free diet response. No predictive factors of non-coeliac gluten sensitivity criteria fulfilment were found due to the low number of discriminators between gluten and placebo. These results show that patients with fibromyalgia have non-coeliac gluten sensitivity at rates similar to the general population. That means a gluten-free diet won't be appropriate for all patients with fibromyalgia. However, it could be useful for patients with diarrhea or intraepithelial lymphocytosis, at least to assess any improvement in intestinal symptoms. Read more in Rheumatology -
Celiac.com 05/30/2022 - A recent Italian study published in Pediatric Rheumatology indicates that juvenile idiopathic arthritis patients have higher rates of celiac disease, which suggests that celiac screening would be beneficial for IA sufferers, especially those with a family history of autoimmunity. Since many autoimmune disorders share similar immune triggers, mechanics and contributing factors, including genetics and environment, understanding the connections, along with the factors associated with an increased susceptibility, could help researchers and clinicians to design better case-finding strategies for certain at-risk populations. For their retrospective study, the team gathered information, including age at diagnosis, family history, other autoimmune disorders, juvenile idiopathic arthritis subtype, and medications, from a Southern Italian group of patients with juvenile idiopathic arthritis who were admitted to the Pediatric Rheumatology Unit between January 2001 and June 2019 who underwent celiac disease screening. Using the data, they were able to assess clinical features and disease course, along with associated risk factors when juvenile idiopathic arthritis and celiac disease happen together. The team evaluated juvenile idiopathic arthritis patients every 3 to 6 months and adjusted treatment in response to adverse events and disease effects. The team's analysis is limited in part by small sample size of patients with both juvenile idiopathic arthritis and celiac disease, and because patients with juvenile idiopathic arthritis and celiac disease had longer follow-up periods than patients with juvenile idiopathic arthritis alone. However, since most celiac disease diagnosis occurred within 12 months of juvenile idiopathic arthritis onset, the team believes this does not influence bias. The team concluded that: They also added that the "results highlight the importance of celiac disease screening in pediatric juvenile idiopathic arthritis patients." These results are also significant for juvenile idiopathic arthritis patients who also have celiac disease, as juvenile idiopathic arthritis looks to be more aggressive in those patients, who often need step-up therapy. They note that these patients might benefit from an early introduction of a biologic drug, but more study is needed to know for sure. They plan future studies to test whether first-line genetic testing followed by celiac disease-specific serological screening will produce better results than first-line serological screening. Stay tuned for more on this and related stories. Read more in Rheumatology Network -
Celiac.com 05/02/2022 - Patients with chronic illnesses often suffer from sexual function. Many patients with chronic gastrointestinal and liver disorders also suffer from sexual dysfunction, but little study has been done on celiac patients, even though celiac disease is a highly common gastroenterological disorder that can cause multiple nutrient deficiencies. A team of researchers recently set out to investigate the sexual function incidence and the risk factors for sexual dysfunction in both male and female celiac disease patients. For their cross-sectional observational study, the team anonymously included two hundred and eighty-four patients, with 170 females, and 114 males. The team evaluated female sexual function through the Female Sexual Function Index questionnaire. They used the International Index of Erectile Function-5 questionnaire to assess male sexual function. They also recorded clinical-demographic information for both groups. To figure out overall rates and assessment of sexual dysfunction in this group of celiac disease patients. They then compared differences in the patient-reported outcomes among the different subgroups, looking for clinical-demographic predictors of sexual dysfunction. Half of the women's group had a total score compatible with sexual dysfunction: nearly half showed low desire, half showed inability to obtain orgasm, nearly eighty percent showed arousal disorder, two-thirds reported lubrication disorder, and a whopping 94.70%, showed sexual discomfort during intercourse. Meanwhile, more than sixty percent of the men's group showed scores marking erectile function, with seven percent of those showing mild erectile dysfunction, more than twenty percent mild to moderate erectile dysfunction, and just under three percent showing severe erectile dysfunction. In both male and female patient groups, sexual dysfunction was also associated with altered body mass index. Most celiac disease patients suffer from sexual dysfunction. Early age at the time of diagnosis was a major predictor of sexual dysfunction in male celiac patients. That is, the younger the patient at celiac diagnosis, the greater the likelihood that the patient will later suffer sexual dysfunction. Because of this the research team recommends assessment of sexual function as part of initial celiac disease patient assessment, to ensure prompt diagnosis and treatment for any dysfunction. Read more in Andrology The research team included Lorenzo Romano, Raffaele Pellegrino, Carmine Sciorio, Biagio Barone, Antonietta Gerarda Gravina, Antonio Santonastaso, Caterina Mucherino, Silvia Astretto, Luigi Napolitano, Achille Aveta,Savio Domenico Pandolfo, Davide Loizzo, Francesco Del Giudice, Matteo Ferro, Ciro Imbimbo, Marco Romano, and Felice Crocetto. They are variously affiliated with the Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy; the Hepato-Gastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy; the Urology Unit, ASST “Alessandro Manzoni” Hospital, Lecco, Italy; the Gastroenterology Unit, “Sant'Anna and San Sebastiano” Hospital, Caserta, Italy; the Division of Urology, Department of Surgery, VCU Health, Richmond, Virginia, USA; the Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Bari, Italy; the Department of Maternal-Infant and Urological Sciences, Policlinico “Umberto I” Hospital, University of Rome “La Sapienza”, Rome, Italy; and the Department of Urology, Stanford Medical Center, Stanford, California, USA. -
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Celiac.com 03/31/2022 - A number of studies have associated celiac disease with increased mortality rates, partly due to celiac-related cancers. However, most studies assessing cancer risk used data from celiac patients diagnosed in an era before celiac disease diagnosis rates and access to gluten-free food become more common. What can we learn from a study of celiac patients diagnosed more recently? A team of researchers conducted a population-based study to assess cancer risk in celiac disease. The research team included Benjamin Lebwohl; Peter H.R. Green; Louise Emilsson; Karl Mårild; Jonas Söderling; Bjorn Roelstraete; and Jonas F. Ludvigsson. Defining celiac disease as duodenal/jejunal villus atrophy, and using the Epidemiology Strengthened by histoPathology Reports in Sweden cohort, the team gathered data on all celiac patients in Sweden. The team matched each patient to five or fewer controls by age, sex, and county. They then employed a stratified Cox proportional hazards model, and tracked patients from diagnosis until the first instance of cancer, or to December 31, 2016. After looking at nearly fifty thousand patients with celiac disease, the team found that nearly sixty-five percent were diagnosed since 2000. After an average follow-up of nearly twelve years, the rate of cancer was 6.5 and 5.7 per 1000 person-years in celiac disease patients and control subjects, respectively. The overall risk of cancer rose only in the first year after celiac disease diagnosis and not subsequently, although the risks for hematologic, lymphoproliferative, hepatobiliary, and pancreatic cancers continued. People over sixty showed the highest risk, while those diagnosed before age 40 showed no increase in cancer risk. The cancer risk was similar among those diagnosed with celiac disease before or after the year 2000. Bad news/Good news The bad news is that the team did find that celiac patients have an elevated risk of developing cancer. The good news is that the increased risk is found in people diagnosed with celiac disease after age 40, but it is mainly a factor within the first year of celiac diagnosis, and limited to certain gastrointestinal and hematologic cancers. However, this study is good news for anyone with celiac disease who might be worried about having an overall higher risk of cancer, as that does no seem to be the case, at least going by this data. Stay tuned for more on this and related stories. Read more in Clinical Gastroenterology & Hepatology The researchers are variously affiliated with the Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York; the Department of Epidemiology, Mailman School of Public Health, Columbia University in New York, USA; School of Medical Science, University of Örebro, Örebro, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Värmlands Nysäter Health Care Center and Centre for Clinical Research, County Council of Värmland, Sweden; the Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway; the Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Queen Silvia Children’s Hospital, Gothenburg, Sweden; and the Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. -
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Celiac.com 01/03/2022 - Studies looking at rates of celiac disease in people with autoimmune hepatitis (AIH) have shown wide ranging results. A team of researchers recently set out to examine the rates of celiac disease in individuals with autoimmune hepatitis. For their systematic review and meta-analysis the team used two professional librarians to conduct a search of PubMed, EMBASE, Cochrane and Web of Science Core Collection up to 7 February 2020. Search terms included 'celiac disease', 'celiac', 'transglutaminases', 'gluten', 'gliadin', 'EMA', 'TTG' and 'villous' combined with 'autoimmune', 'hepatitis', 'ANA', 'SMA' and 'LKM'. This search yielded 2,419 unique publications. A systematic review based on the PRISMA guidelines resulted in 31 articles eligible for full text review. They found fifteen relevant articles, eight of which they included in their main analysis. The team used a fixed-effect inverse variance-weighted model, and calculated heterogeneity. The team's main analysis included 567 autoimmune hepatitis patients from eight studies. Twenty three of those patients showed biopsy-verified celiac disease equivalent to Marsh III. The pooled rate of celiac disease in autoimmune hepatitis patients 3.5%, which is more than triple the 1% celiac disease rates in most general populations. When also including the fifteen studies on 1,817 people where celiac disease had been diagnosed through positive serology without biopsy, the pooled rate of celiac disease was just under 3%. The team's results show high rates of celiac disease in people with autoimmune hepatitis compared to the general population. As such, they are recommending that physicians consider celiac disease screening for patients with autoimmune hepatitis. Read more in Liver International. 2021;44(11):2693-2702. The research team included Linnea Haggård; Ida Glimberg; Benjamin Lebwohl; Rajani Sharma; Elizabeth C. Verna; Peter H. R. Green; and Jonas F. Ludvigsson. They are variously affiliated with the Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the School of Medical Sciences, Örebro University, Örebro, Sweden; the Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA; the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; the Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY, USA; the Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; the Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; and the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK. -
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Celiac.com 10/18/2021 - Researchers and clinicians have promoted family screening as a way to reduce the significant under-diagnosis of celiac disease. However, good data for calculating the exact risk of the disease in relatives, and the effects of individual patient- and relative-related factors, remains scarce. A team of researchers recently set out to investigate the individual risk of celiac disease among relatives of celiac patients. The research team included Saana Paavola, Katri Lindfors, Laura Kivelä, Juliana Cerqueira, Heini Huhtala, Päivi Saavalainen, Riku Tauschi, Katri Kaukinen, and Kalle Kurppa. They are variously affiliated with the Faculty of Medicine and Health Technology at the University of Tampere and Tampere University Hospital in Tampere, Finland; the Faculty of Social Sciences at the University of Tampere in Tampere, Finland; the Translational Immunology Research Program, and Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland; and the University Consortium of Seinäjoki, Seinäjoki, Finland. The team assessed nearly three-thousand relatives of 624 index patients for evidence of prior celiac disease, or else screened for the disease. For each subject, the team was able to determine the celiac-associated human leucocyte antigen (HLA) genotype. They then used logistic regression to assess the connection between individual factors and new screening positivity. They found 229 previously diagnosed non-index relatives with celiac disease and 2,714 non-affected (2,067 first-degree, 647 more distant) relatives. Of these 2,714 relatives, 129 (nearly 5%) screened positive, with 5.1% of first-degree, 3.6% of second-degree, and 3.5% of more distant relatives. The combined rate of the previously diagnosed and now detected cases in relatives was just over 12%, and was evenly divided at about 6% for both clinically detected and screen-detected. Univariate analysis showed the main risk factors associated with screening positivity to be: under age 18 years at diagnosis, age 41–60 years, being a sibling, and having the high-risk genotype (3.22, 2.01–5.15 DQ2.5/2.5 or DQ2.5/2.2 vs other risk alleles) in relatives. Multivariable analysis showed that only high-risk HLA remained significant. From this study, the team concludes that unrecognized celiac disease is common for at-risk relatives, and also in relatives beyond first-degree, even where active case-finding prevails. By far, the most important predictor for screening positivity was the presence of the high-risk HLA genotype: 3.22, 2.01–5.15 DQ2.5/2.5 or DQ2.5/2.2. Read more in Aliment Pharmacol Ther. 2021;54(6):805-813. -
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