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Celiac.com 02/01/2016 - Among celiac researchers, there's been a good deal of professional curiosity about the clinical and immunological relevance of anti-neuronal antibodies in celiac disease with neurological manifestations. At present, doctors don't know very much about the clinical and immunological features in celiac disease patients with neurological problems, and many of them want to know more. Researchers estimate that about 10% of celiac disease patients have neurological issues, with the majority of those suffering from anti-neuronal antibodies (NA) to central nervous system (CNS) and/or anti-neuronal antibodies to the enteric nervous system (ENS). With that in mind, the question of the importance of such antibodies in celiac patients with neurological problems becomes important. To get a better picture of the issue, a team of researchers in Italy recently set out to assess rates of anti-neuronal antibodies, and to assess their correlation with neurological disorders and bowel habits in people with celiac disease. The research team included G. Caio, R. De Giorgio, A.Venturi, F. Giancola, R. Latorre E. Boschetti, M. Serra, E. Ruggeri, and U.Volta. They are all associated with the Department of Medical and Surgical Sciences, University of Bologna and St. Orsola-Malpighi Hospital, Bologna, Italy. For their study, the team investigated anti-neuronal antibodies to central nervous system and enteric nervous system in 106 celiac disease patients and in 60 controls with autoimmune disorders, using indirect immunofluorescence on rat and/or primate cerebellar cortex and intestinal (small and large bowel) sections. Their results showed that 21% of celiac patients were positive for IgG NA to central nervous system (titer 1:50 - 1:400); nearly half of those patients showed neurological dysfunction, compared with just 8% without. (P< 0.0001). Of the 26 celiacs (24%) with IgG anti-neuronal antibodies to enteric nervous system, 11 out of 12 with an antibody titer greater than 1:200 had severe constipation. Only one patient with cerebellar ataxia and intestinal sub-occlusion was positive for anti-neuronal antibodies to central nervous system and enteric nervous system. Anti-neuronal antibodies to central nervous system and enteric nervous system were found in 7% and 5% of controls, respectively. These results confirm that the presence of anti-neuronal antibodies to central nervous system can be regarded as a marker of neurological manifestations for people with celiac disease. High titer anti-neuronal antibodies to enteric nervous system are associated with severe constipation. The presence of anti-neuronal antibodies to central nervous system and enteric nervous system is a big red flag for an immune-mediated disease path that leads to central neural impairment, and gut dysfunction with associated constipation. Source: Gastroenterol Hepatol Bed Bench. 2015 Spring;8(2):146-52.
Celiac.com 07/15/2015 - Current celiac disease call for a follow-up biopsy taken 1 year after diagnosis to monitor gut recovery. Many celiac patients show incomplete gut recovery at that time, but there’s not much research to help doctors figure out how significant this might be. A team of researchers recently investigated associated factors and the significance of imperfect gut recovery in patients in whom the follow-up had been completed. The research team included Henna Pekki, Kalle Kurppa, Markku Mäki, Heini Huhtala, Harri Sievänen, Kaija Laurila, Pekka Collin and Katri Kaukinen. They are variously affiliated with the Medical School and the School of Health Sciences at the University of Tampere, the Tampere Center for Child Health Research at the University of Tampere and Tampere University Hospital in Tampere, Finland, the UKK Institute inTampere, Finland, the Department of Gastroenterology and Alimentary Tract Surgery, and the Department of Internal Medicine, Tampere University Hospital, Tampere, Finland. For their study, the team split 263 biopsy-proven celiac patients into two groups: one with histological recovery, and the other with incomplete recovery, after one year on gluten-free diet. The team measured serology, laboratory values, bone mineral density, and various clinical variables at diagnosis and after one year. They used validated questionnaires to assess gastrointestinal symptoms and quality of life, and also gathered further long-term follow-up data on mortality, malignancies, and other severe complications. The results showed that the incomplete recovery group had more severe mucosal damage (P=0.003), higher antibody values (P=0.017), and more signs of malabsorption at diagnosis (P<0.001). The data showed no difference in gender, symptoms or quality of life, family history of celiac disease, or co-morbidities. Follow-up showed a difference in antibodies (P=0.018) and femoral T-scores (P=0.024). Histologically recovered patients showed better gluten-free dietary adherence, although both groups reported close adherence to a gluten-free diet (97% for recovered group, versus 87% for the incomplete group (P<0.001). Interestingly, there was no difference in long-term outcomes between groups. Although, patients with more severe celiac disease in terms of histology, serology, and signs of malabsorption were more likely to show histological non-response. Patients who closely follow a gluten-free diet, incomplete villous recovery after 1 year does not affect the clinical response or long-term prognosis. Source: The American Journal of Gastroenterology , (2 June 2015). doi:10.1038/ajg.2015.155
Celiac.com 11/25/2008 - Celiac disease is one of the most under-diagnosed medical disorders, with 97% of all cases currently remaining undiagnosed. According to the National Institutes of Health, 3 million people in theUnited States with celiac disease, while only 140,000 have beendiagnosed. Celiac disease ismore than twice as common in people over 50 years of age. People with untreated celiac disease are at risk of developing anynumber of associated conditions, including gastrointestinal cancer atrates of 40 to 100 times those of the general population, in additionto osteoporosis, and a two-fold increase in the risk of fractures,including first-time hip fractures. Moreover, an unusually highpercentage of people with celiac disease suffer from the followingconditions: Anemia, Arthritis, Ataxia, Cancer—Non-Hodgkin’s Lymphoma, Cow's Milk Intolerance, Dermatitis, Diabetes-Type 1, Irritable Bowel Syndrome, Liver Disease, Migraine Headaches, Nerve Diseaseand/or Peripheral Neuropathy, Obesity, Osteoporosis,Osteomalacia/Low Bone Density, Pancreatic & Thyroid Disorders. According to a new study by doctors based in Sweden, people with celiac disease face a significantly higher risk of developing thyroid disorders, including hypothyroidism, hyperthyroidism and thyroiditis. The thyroid is a small, butterfly-shaped gland in the neck that creates the hormones that control human metabolism. People with under-active thyroid, called hypothyroidism, suffer symptoms such as fatigue, sensitivity to cold, dry skin and weight gain, while people with overactive thyroid, called hyperthyroidism, commonly suffer from symptoms such as excessive sweating, heat intolerance, and nervousness. However, mild cases of hypo- or hyperthyroidism commonly present no symptoms at all. Inflammation of the thyroid gland is called Thyroiditis. The research team, led by Dr. Peter Elfstrom at Orebro University Hospital, reviewed Swedish national health records covering the period from 1963 to 2003. The team compared rates of thyroid disease for 14,000 people with celiac disease against some 68,000 non-celiac control subjects matched for age and gender. The results showed that people with celiac disease are diagnosed with hypothyroidism more than four times as often as non-celiacs, with hyperthyroidism more than three times as often as non-celiacs, and with hyperthyroidism more than 3.6 times as often as non-celiacs. Moreover, the relationship works both ways: people with established hypothyroidism, hyperthyroidism and thyroiditis face much higher rates of celiac disease. These results held true even after the data were adjusted for potential confounders, including the presence of diabetes mellitus. The researchers theorize that the association between celiac disease and thyroid disease may be due to shared genetic or immunological traits. This is just the latest in a string of studies that drives home the importance of early testing for suspected celiac cases, as early discovery and treatment with a gluten free diet greatly reduces associated complications in celiac disease. Journal of Clinical Endocrinology and Metabolism, October 2008.
Celiac.com 08/02/2010 - Celiac crisis is a rare, poorly understood, but potentially deadly condition in which patients with celiac disease suffer from severe diarrhea and other serious metabolic changes. Celiac crisis is specifically defined as acute onset or rapid progression of gastrointestinal symptoms, together with signs or symptoms of dehydration or malnutrition that may be attributed to celiac disease, and which require hospitalization and/or supplemental nutrition. In an effort better understand celiac crisis, and to improve diagnosis techniques for the condition, a team of researchers reviewed cases of celiac crisis to identify presenting features, formulate diagnostic criteria, and develop treatment strategies. The research team included Shailaja Jamma, Alberto Rubio-Tapia, Ciaran P. Kelly, Joseph Murray, Robert Najarian, Sunil Sheth, Detlef Schuppan, Melinda Dennis, and Daniel A. Leffler. They are affiliated variously with the Celiac Center of the Beth Israel Deaconess Medical Center at Harvard Medical School, and with the Mayo Clinic. The team reviewed cases of biopsy-proven celiac disease, specifically defined as acute onset or rapid progression of gastrointestinal symptoms, together with signs or symptoms of dehydration or malnutrition that may be attributed to celiac disease, and which require hospitalization and/or parenteral nutrition. The team found twelve patients who met preset criteria for celiac crisis; eleven patients who developed celiac crisis before being diagnosed with celiac disease; eleven patients with increased titres of transglutaminase antibodies; and one patient with low levels of immunoglobulin A. Duodenal biopsy samples for all patients were consistent with a Marsh 3 score; 33% showed total villous atrophy. All patients showed signs or symptoms of severe dehydration, renal dysfunction, and electrolyte disturbances. All patients required hospitalization and intravenous fluids, six patients required corticosteroids, and five required parenteral nutrition. All patients showed positive response to treatment with a gluten-free diet. Even though celiac crisis is a rare condition that strikes adults, it is nonetheless serious and carries a high risk of death. In most cases, patients with the condition present clear signs and symptoms, such as severe unexplained diarrhea and malabsorption. Doctors should test such patients for celiac disease, and consider treatment with systemic steroids or oral budesonide, in addition to providing short-term nutritional support until the patients respond fully to a gluten-free diet. Source: Clin Gastroenterol Hepatol. 2010 Jul;8(7):587-90. Epub 2010 Apr 24. PMID: 20417725