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Showing results for tags 'small bowel'.
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Celiac.com 01/23/2025 - This study explored how a gluten-free diet influences gut function and microbiome composition in individuals newly diagnosed with celiac disease over a one-year period. Celiac disease, an autoimmune disorder triggered by gluten, primarily damages the small intestine, leading to digestive issues, nutrient malabsorption, and changes in gut health. The primary treatment for celiac disease is a strict gluten-free diet, but its broader effects on the gut environment and microbiome were not fully understood until now. To investigate these impacts, researchers compared individuals with newly diagnosed celiac disease to healthy volunteers who did not follow a gluten-free diet. How the Study Was Conducted The study involved two groups: 36 newly diagnosed celiac disease patients and 36 healthy individuals matched by age and gender. Before starting their gluten-free diet, the celiac group underwent tests to assess their gut function, such as small bowel water content, colon volume, and whole gut transit time (the time it takes for food to move through the digestive tract). Stool samples were collected for microbiome analysis, which determined the types of bacteria present and their functions. These tests were repeated after one year of following a gluten-free diet. Healthy participants provided a baseline for comparison and were tested over the same period without dietary changes. Researchers also evaluated gastrointestinal symptoms, general wellbeing, and psychological factors to understand the diet's broader impacts on quality of life. Key Findings: Gut Function Changes Small Bowel Water Content At the start of the study, individuals with celiac disease had significantly higher small bowel water content than the healthy group. This increase likely reflects damage caused by celiac disease, such as poor nutrient absorption and excessive fluid secretion in the small intestine. Although there was improvement after one year on a gluten-free diet, the levels did not fully return to those seen in the healthy group. Gut Transit Time Whole gut transit time, which measures how quickly food moves through the digestive system, was much slower in celiac patients at the start of the study. After following a gluten-free diet for a year, there was some improvement, but transit time remained slower compared to the healthy group. This delay in gut movement may be due to inflammation, malabsorption, and other gut function disruptions caused by celiac disease. Colon Volume Unlike small bowel water content and transit time, colon volume did not show significant differences between the two groups at the start of the study or after one year. This indicates that the gluten-free diet had a more noticeable effect on small intestinal function than on the large intestine. Gut Microbiome: Changes in Bacterial Composition Differences in Microbiome Before the Gluten-Free Diet At the start of the study, the gut microbiome of celiac patients showed higher levels of certain bacteria, such as Escherichia coli, Enterobacter, and Peptostreptococcus. These bacteria are associated with increased protein breakdown, which may reflect the malabsorption of nutrients in the damaged intestine. In contrast, beneficial bacteria like Bifidobacteria, known for supporting gut health, were less abundant in celiac patients. Impact of a Gluten-Free Diet on Microbiome After one year of following a gluten-free diet, significant changes occurred in the gut microbiome. The gluten-free diet reduced the levels of Bifidobacteria even further. This decline is likely due to the removal of dietary fibers, such as resistant starch and arabinoxylan, which are found in gluten-containing foods like wheat. These fibers are important for feeding Bifidobacteria and maintaining a healthy gut environment. Additionally, a bacterium called Blautia wexlerae increased after the gluten-free diet. Changes in gut bacterial species were also linked to gut function, such as transit time and colonic volume, showing that the diet indirectly influenced the microbiome by altering the gut environment. Carbohydrate Metabolism Changes The gluten-free diet significantly altered the gut microbiome's ability to break down certain carbohydrates. Enzymes responsible for digesting resistant starch and arabinoxylan decreased after the gluten-free diet. This shift reflects the reduced intake of wheat-based fibers, which may contribute to further disruptions in the gut microbiome. Quality of Life and Symptoms At the start of the study, patients with celiac disease reported significantly worse gastrointestinal symptoms and overall wellbeing compared to the healthy group. Symptoms such as abdominal pain, bloating, and nausea were more common in the celiac group. After one year on a gluten-free diet, patients experienced significant improvements in their symptoms and general wellbeing. However, their quality of life and symptoms did not fully return to the levels reported by healthy individuals. Why This Study Matters for Celiac Disease Patients This study highlights the complex relationship between celiac disease, gut function, and the gut microbiome. While a gluten-free diet remains the cornerstone of celiac disease management, the findings suggest that it does not fully reverse the damage caused to gut function or restore a balanced microbiome. The reduction in beneficial bacteria like Bifidobacteria and the altered carbohydrate metabolism highlight potential downsides of the gluten-free diet. For individuals with celiac disease, this research provides insight into why symptoms may persist even after strict adherence to a gluten-free diet. It also emphasizes the need for further strategies to support gut health, such as including prebiotic or fiber-rich foods that feed beneficial bacteria or developing targeted probiotics to restore balance in the gut microbiome. Conclusion The gluten-free diet improves symptoms and partially restores gut function in celiac disease patients, but it also causes significant changes to the gut microbiome. Understanding these effects opens the door for new treatments aimed at improving gut health alongside dietary management. For those with celiac disease, this research underscores the importance of ongoing care and potential future therapies to address the gut's long-term health. Read more at: biorxiv.org Watch the video version of this article:
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Celiac.com 9/26/2019 - Small bowel adenocarcinoma is a rare abnormal tissue growth, that can happen alone, or can also be the result of predisposing conditions, including hereditary syndromes and immune-mediated intestinal disorders, such as celiac disease. However, researchers still don't know very much about small bowel adenocarcinoma in the context of celiac disease. To get some answers, a research team recently set out to show the main clinical features, diagnostic procedures and management options of small bowel adenocarcinoma cases detected in a large cohort of celiac patients diagnosed in a single tertiary care center. The research team included Giacomo Caio, Umberto Volta, Francesco Ursini, Roberto Manfredini, and Roberto De Giorgio. They are variously affiliated with the Department of Medical Sciences, University of Ferrara, St. Anna Hospital in Ferrara, Italy; the Mucosal Immunology and Biology Research Center and Celiac Center, Massachusetts General Hospital- Harvard Medical School, Boston, MA, USA; the Department of Medical and Surgical Sciences, University of Bologna in Bologna, Italy; and the Department of Medical Sciences, University of Ferrara, St. Anna Hospital, Ferrara, Italy. The team retrospectively reviewed all small bowel adenocarcinoma cases from a group of 770 celiac disease patients of the Celiac Disease Referral Center at the University Hospital in Bologna, Italy from January 1995 to December 2014. The group included nearly 600 females, spanned 18 to 80 years of age, and averaged 36 years old at diagnosis. A total of five of the 770 celiac disease patients developed small bowel adenocarcinoma. All were female, and about 53 years old on average, though the individuals ranged from 38 to 72 years old. The small bowel adenocarcinoma was diagnosed along with the celiac disease in three cases. It was localized to the jejunum in four cases, and to the duodenum in one case. The clinical presentation of small bowel adenocarcinoma was characterized by intestinal sub-occlusion in two cases, while the main presentation in the other three cases were iron deficiency anaemia, abdominal pain and acute intestinal obstruction, respectively. All the patients underwent surgery, while three patients with advanced stage neoplasia also received chemotherapy. The overall survival rate at 5 years was 80% for the group. The observed celiac disease-related small bowel adenocarcinoma cases were marked by a younger age of onset, were mainly female, and faced better odds of survival, compared with sporadic, Crohn- and hereditary syndrome-related small bowel adenocarcinoma. Read more in BMC Gastroenterology volume 19, Article number: 45 (2019)
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Celiac.com 08/10/2020 - Small bowel cancers are on the rise. Research has shown some possible connections with celiac disease, but there have not been any detailed large group studies. To better understand the connections between celiac disease and small bowel cancers, a team of researchers recently set out to conduct a large group study. The UK and Swedish based team turned to the nationwide ESPRESSO cohort study to gather data on everyone diagnosed for celiac disease from 1965 through 2017 at any of the twenty-eight pathology centers in Sweden. They defined celiac disease as duodenal or jejunal villous atrophy, with a stage 3 Marsh score, and matched celiac patients with up five control subjects randomly chosen from the general population. They used stratified Cox regression to calculate hazard ratios for small bowel adenocarcinoma, adenomas and carcinoids. Over an average follow up of 11 years, they matched nearly 50,000 celiac patients with about 240,000 controls. Overall, for about every 3,000 patients with celiac disease followed for 10 years, they found one extra case of small bowel adenocarcinoma. They observed an inverse relationship between mucosal healing and risk of future small bowel adenocarcinoma, though this was not statistically significant. Their analysis showed the absolute risk of small bowel adenocarcinoma is low in people with celiac disease. However, even though the absolute risk is low, the team found that risks are still much higher than non-celiacs for small bowel adenocarcinoma and adenomas, but not for carcinoids. The good news is that the overall risks of developing small bowel adenocarcinoma remain low in people with celiac disease. The bad news is that the risk is still many time greater than it is for people without celiac disease. Read more in Gastroenterology The research team included Louise Emilsson, Carol Semrad, Benjamin Lebwohl, Peter Hr Green, and Jonas F Ludvigsson. They are variously affiliated with the Department of General Practice & Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Faculty of Medicine and Health, Örebro University, SE 701 82, Örebro, Sweden; Vårdcentralen Årjäng and Centre for Clinical Research, County Council of Värmland, Värmland, Sweden; the University of Chicago Medicine, Chicago, IL, USA; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA; the Department of Paediatrics at Örebro University Hospital, Örebro, Sweden; and the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
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Celiac.com 05/07/2020 - Seronegative villous atrophy (SNVA), raised intraepithelial lymphocytes (IELs) and crypt hyperplasia on duodenal histology can be caused by celiac disease or by drugs or infections. A team of researchers recently set out to assess the role of small-bowel capsule endoscopy (SBCE) in these patients and to determine SBCE findings at diagnosis can predict disease outcome. The research team included Stefania Chetcuti Zammit, Annalisa Schiepatti, Imran Aziz, Matthew Kurien, David S. Sanders, and Reena Sidhu. They are variously affiliated with the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK, and the Academic Unit of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield. The team assessed 177 patients with SNVA, IELs +/-crypt hyperplasia on duodenal histology. These patients all had an equivocal diagnosis of celiac disease. About one in three patients had a positive SBCE. Most patients had disease affecting the proximal third of the small bowel. All patients in the SNVA-celiac disease group who later developed poor outcomes had a positive SBCE. These patients also showed much more widespread small bowel disease than those with no adverse incidents. More-extensive small bowel disease on SBCE was associated with a higher SNVA-related deaths in patients with SNVA-UO and SNVA-celiac disease. Interestingly, severity of gut damage did not correlate with mortality, meaning that it's possible to recover and become healthy. Overall, the team found that positive SBCE at diagnosis corresponds to a worse celiac disease outcome. Crucially, widespread disease in these patients is associated with poor survival rates. Spotting and aggressively treating patients with extensive disease at diagnosis can improve outcomes for many of these patients. Read more at: Gastrointestinal Endoscopy
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Celiac.com 03/11/2020 - Researchers don't have a very good understanding about the connection between symptoms, blood tests, and the results of small bowel capsule endoscopy (SBCE) in celiac patients. Better understanding such connections will help to figure out whether symptoms and blood tests can determine the severity and extent of disease using SBCE. A team of researchers recently set out determine if symptoms and blood tests can determine the severity and extent of disease using SBCE. The team included Stefania Chetcuti Zammit, David S. Sanders and Reena Sidhu, of the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. The research team enrolled newly diagnosed celiac patients, and noted Information on SBCE, along with symptoms and indications upon presentation, blood test results, and levels of disease histology in the duodenum. A total of 60 newly diagnosed celiac patients were included, who averaged about 45 years of age. Older patients and those with iron deficiency anemia showed more small bowel involvement. Nearly 40% of patients with weight loss had small bowel involvement beyond the duodenum, compared to those without. Patients with iron deficient anemia and weight loss were much older at the time of diagnosis. There was no significant association between blood antibodies and amount of small bowel mucosa damage. Patients with higher Marsh scores on duodenal histology showed more widespread small bowel involvement. This is the largest assessment of SBCE in newly diagnosed celiac disease so far conducted. The data reveal that older patients showed more widespread celiac disease on SBCE upon diagnosis. Aside from weight loss and iron deficiency anaemia, symptoms and blood test results were independent of the team's findings. Read more in the Eur J Gastroenterol Hepatol 31: 1496–1501
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Celiac.com 02/10/2020 - There are no articles in the medical literature about the role of repeat small bowel capsule endoscopy (SBCE) in patients with refractory celiac disease (RCD) following treatment with steroids and/or immunosuppressants. A team of researchers recently set out to compare the findings on SBCEs from a group of 23 patients with histologically proven RCD against the results of 48 patients with uncomplicated celiac disease. All patients had concurrent duodenal histology and serology taken at the time of SBCE. The team included Stefania Chetcuti Zammit, David S. Sanders, Simon S. Cross, and Reena Sidhu. They are variously associated with Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield; and the Academic Unit of Pathology, Department of Neuroscience, Faculty of Medicine, Dentistry & Health, The University of Sheffield, Sheffield, UK. SBCE revealed refractory celiac disease patients to have greater mucosal involvement than patients with uncomplicated celiac disease. After steroid and/or immunosuppressant treatment, refractory celiac disease patients showed an improvement in the extent of affected small bowel mucosa. Statistically, both histology and serology were the same for first and second SBCE in refractory celiac disease patients. The study data indicates that SBCE is useful in documenting the degree of mucosal involvement in refractory celiac disease patients. The team notes that this is the first study to demonstrate the value of a second look SBCE to assess the degree of improvement in celiac disease in the small bowel following treatment. However, more study is needed to more firmly establish these results. Read more in J Gastrointestin Liver Dis, March 2019 Vol. 28 No 1: 15-22
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