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Celiac.com 02/08/2016 - When doctors talk about non-celiac gluten sensitivity (NCGS), they are usually talking about people who have gastrointestinal symptoms without enteropathy, and for whom a gluten-free diet (GFD) provides some relief of symptoms. However, doctors don't currently know very much about the pathophysiology of NCGS, its connection to neurological manifestations, or if it is in any way different from the manifestations seen in patients celiac disease. To address this issue, a team of researchers recently set out to take a closer look at the clinical and immunological characteristics of patients presenting with neurological manifestations with celiac disease and those with NCGS. The research team included Marios Hadjivassiliou, Dasappaiah G Rao, Richard A Grìnewald, Daniel P Aeschlimann, Ptolemaios G Sarrigiannis, Nigel Hoggard, Pascale Aeschlimann, Peter D Mooney and David S Sanders. The team compared clinical, neurophysiological, and imaging data from celiac disease patients and NCGS patients who presented with neurological dysfunction, and who had regular assessment and follow up over a 20-year period. The study included 562 out of total 700 patients. The team excluded patients who had no bowel biopsy to confirm celiac disease, no HLA type available, and/or failed to adhere to GFD. All patients presented with neurological dysfunction and had circulating anti-gliadin antibodies. The most common neurological problems were cerebellar ataxia, peripheral neuropathy, and encephalopathy. Out of 562 patients, 228 (41%) had evidence of enteropathy (Group 1, celiac disease) and 334 (59%) did not (Group 2, NCGS). There was a greater proportion of patients with encephalopathy in Group 1 and with a greater proportion of neuropathy in Group 2. The severity of ataxia was about the same between the two groups. Patients in Group 1 showed more severe neuropathy. Patients from both groups responded well to a gluten-free diet. Anti-tissue transglutaminase (TG2) antibodies were found in 91% of patients in Group 1 and in 29% of patients in Group 2. Researchers saw no difference between those patients in Group 2 with HLA-DQ2/DQ8 and those without, or between those with positive TG2 compared to those with negative TG2 antibodies. Both groups showed similar serological positivity for TG6 antibodies, at 67% and 60%, respectively. The results of this study show that patients with celiac disease and NCGS have similar neurological manifestations, which respond well to a gluten-free diet. This suggests that the two conditions share common pathophysiological mechanisms. Source: The American Journal of Gastroenterology , (2 February 2016). doi:10.1038/ajg.2015.434
Celiac.com 02/06/2013 - Villous atrophy (VA) in the small intestine is one of the prime features of celiac disease, and has been associated with increased mortality, but it is unknown if mortality is influenced by mucosal recovery. To better understand the relationship between mucosal healing and mortality in celiac disease, a research team set out to determine whether persistent villous atrophy is associated with mortality in celiac disease patients. The research team included B. Lebwohl, F. Granath, A. Ekbom, S.M. Montgomery, J.A. Murray, A. Rubio-Tapia, P.H. Green, and J.F. Ludvigsson. They are variously affiliated with the Celiac Disease Center at the Department of Medicine of Columbia University College of Physicians and Surgeons in New York, NY, the Clinical Epidemiology Unit at the Department of Medicine of Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden. The team used biopsy reports from every pathology department (n = 28) in Sweden to identified 7,648 individuals with celiac disease, which they defined as the presence of villous atrophy, and who had undergone a follow-up biopsy within 5 years of diagnosis. They used Cox regression to assess mortality according to follow-up biopsy. Celiac patients were 28.4 years of age, on average, and 63% were female. The average follow-up after diagnosis was 11.5 years. Overall, patients who underwent follow-up biopsy had lower mortality rates than those who did not undergo follow-up biopsy (Hazard Ratio 0.88, 95% CI: 0.80-0.96). Of the 7648 patients who underwent follow-up biopsy, 3317 (43%) showed persistent villous atrophy. In all, 606 (8%) patients died. However, patients with persistent villous atrophy died at about the same rates as those with mucosal healing (HR: 1.01; 95% CI: 0.86-1.19). Also, children with persistent villous atrophy showed no increase in mortality (HR: 1.09 95% CI: 0.37-3.16) or adults (HR 1.00 95% CI: 0.85-1.18), including adults older than age 50 years (HR: 0.96 95% CI: 0.80-1.14). Mortality rates for celiac patients with persistent villous atrophy are about the same as for celiac patients with healthy guts. So, persistent villous atrophy is not tied to higher mortality for celiac disease patients. That means that even though a follow-up biopsy will help doctors to spot refractory disease in symptomatic patients, persistent villous atrophy is not useful in predicting future mortality. Source: Aliment Pharmacol Ther. 2013 Feb;37(3):332-9. doi: 10.1111/apt.12164.
Celiac.com 04/08/2011 - A medical research team recently conducted an epidemiological review of celiac disease in Iran. The team included M. Rostami Nejad, K. Rostami, M. H. Emami, M. R. Zali, and R. Malekzadeh. They are associated variously with the Research Institute for Gastroenterology and Liver Diseases at Shahid Beheshti University of Medical Science, with the Digestive Disease Research Center,Tehran University of Medical Sciences, both in Tehran, Iran, with the Poursina Hakim Research Institute (PHRI), Isfahan University of MedicalSciences (IUMS), Isfahan, Iran, and with the School of Medicine, University of Birmingham, United Kingdom. Celiac disease has been traditionally believed to be a chronic enteropathy, almost exclusively affecting people of European origin. The use of new, simple, very sensitive and specific serological tests has revealed shown that celiac disease is as common in Middle Eastern countries as in Europe, Australia and New Zealand, where wheat is a major dietary staple. Celiac disease was presumed to be rare in Iran because of low awareness and a low index of suspicion. However new epidemiological data show that celiac disease is a common disorder in Middle Eastern countries, particularly Iran. In fact, studies have shown Iran to have high rates of celiac disease, in both the general population and the at-risk groups, i.e. patients with type 1 diabetes or irritable bowel syndrome (IBS). In developing countries, doing blood tests on at-risk groups is necessary for early identification of celiac patients. Clinical studies show that patients in the middle east present with non-specific symptoms or a lack of symptoms as often as in Europe. Since wheat is a major component of the Iranian diet and exposure to wheat proteins induces some degree of immune tolerance, leading to milder symptoms that may be mistaken with other GI disorders. Getting patients on a gluten free diet is a major challenge for both patients and clinicians in Iran, mainly because commercial gluten-free products are simply not available. Since it is possible that there is some variable frequency celiac disease in different parts of Iran, as is the case for India, the study team suggests the need for a more uniformly designed evaluation of celiac disease for the entire country, a mapping of HLA DQ in the same areas, together with a gluten consumption assessment. Celiac disease rates are quite low in some areas of Iran, such as Shiraz Province, while a summary of the reviewed studies suggests a prevalence of 1% in the remaining areas of Iran, a rate similar to that found in Western European countries. SOURCE: Middle East Journal of Digestive Diseases/ Vol.3/ No.1/ March 2011
Celiac.com 03/12/2010 - A team of researchers recently noted similar presentations of celiac disease in both elder and younger patients.The research team included Rupa Mukherjee, Ikenna Egbuna, Pardeep Brar, Lincoln Hernandez, Donald J. McMahon, Elizabeth J. Shane, Govind Bhagat, and Peter H. R. Green. They are affiliated variously with the Division of Digestive and Liver Diseases, the Division of Endocrinology, Department of Medicine, and the Department of Pathology at the Columbia University College of Physicians and Surgeons in New York, and with Columbia University Medical Center's Celiac Disease Center. It is well known that celiac disease can affect individuals of all ages. However, there have been few studies to focus solely on how celiac disease presents among elderly people. To get a better understanding of how celiac disease presents in the elderly, a research team recently set out to compare aspects of celiac disease from elderly populations with a population of young adults with celiac disease. The first step was to assemble two groups of patients, an elderly cohort over 65-years old, and a young adult cohort aged 18–30 years, with biopsy-confirmed celiac disease. They did this by reviewing a tertiary center database of celiac disease patients with celiac disease, which provided data on symptom duration, clinical presentation, small intestinal pathology, associated conditions, and the presence of bone disease. The team reviewed data on 149 young adult and 125 elderly patients with celiac disease; The elderly subjects comprised 12.4% of the patient database. Both groups showed similar duration of symptoms before diagnosis, with young adults at 5.8 ± 12 years and elderly at 6.14 ± 12.6 years, respectively (p = 0.119). The presenting symptoms were also basically the same for both groups, with diarrhea being the main presenting symptom in 49% of young adults and 50% of the elderly (p = 0.921). Both groups showed similar rates of autoimmune disease, with 19% of young adult and 26% of elderly patients having relevant autoimmune conditions (p = 0.133). Both groups showed similar presence of villous atrophy and rates of bone disease, while the elderly group showed higher rates of thyroid disease and neuropathy (p = 0.037 and p = 0.023, respectively). The team expressed surprise that, both clinically and histologically, celiac disease seems to present similarly in elderly and young adult patients. They note that since the exact causes for celiac disease at any given age remain unclear and warrant further study. Source: Dig Dis Sci DOI 10.1007/s10620-010-1142-4.