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Celiac.com 02/13/2014 - A team of researchers recently set out to assess the validity and effectiveness of near-patient celiac immunological testing in dietician-led celiac disease follow-up clinics, and to compare the results against standard laboratory immunological techniques. The research team included D.A. George, L.L. Hui, D. Rattehalli, T. Lovatt, I. Perry, M. Green, K. Robinson, J.R.F. Walters, and M.J. Brookes. They are variously affiliated with the Department of Gastroenterology at New Cross Hospital in Wolverhampton, and the Department of Gastroenterology at Imperial College London, in London, UK. Each of the two phases of the study assessed the near-patient test and standard laboratory immunological techniques. In Phase 1, the team analyzed stored serum samples, while in Phase 2 they analyzed whole blood from patients attending the dietician-led celiac disease clinics. Between March 2010 and February 2011, the team recruited 50 patients from New Cross Hospital, Wolverhampton, and 30 from Imperial College London. All patients had a diagnosis of celiac disease for greater than 12 months, and attended dietician-led celiac disease clinics. During the study, the team took whole blood samples for routine analysis, along with regular capillary finger-prick blood samples. The team wanted to determine if the whole blood and serum near-patient test results correlated with outcomes of standard laboratory evaluation. The first phase of the study showed that the near-patient serum test had a sensitivity of 93.5% (95% CI 0.79% to 0.98%), and a specificity of 94.9% (0.83% to 0.99%), when compared with the standard laboratory ELISA. The second phase showed that whole blood measurements had a sensitivity of 77.8% (0.45% to 0.93%), and specificity of 100% (0.94% to 1%). The team concludes that the study results suggest a possible role for near-patient testing in celiac disease, but they suggest additional studies to corroborate and refine such a role. Disclosure: The team noted the receipt of a £2250 (approximately $3,750.00) bursary award from Dr. Falk Pharma and Core. Source: Frontline Gastroenterol. 2014;5(1):20-25.

Celiac.com 05/19/2016 - Using a prospective cohort study, a team of researchers recently set out to assess the outcomes of the latest celiac diagnosis guidelines from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN). The research team included Elisa Benelli, Valentina Carrato, Stefano Martelossi, Luca Ronfani, Tarcisio Not, and Alessandro Ventura. They are variously affiliated with the Department of Medical, Surgical and Health Sciences, University of Trieste in Trieste, Italy, and the Institute for Maternal and Child Health IRCCS 'Burlo Garofolo' in Trieste, Italy. The study was conducted at the Institute for Maternal and Child Health IRCCS Burlo Garofolo in Trieste, Italy. For the study, the team prospectively enrolled children diagnosed with celiac disease without a duodenal biopsy (group 1), following the last ESPGHAN and BSPGHAN guidelines, and children diagnosed with a duodenal biopsy, matched for sex, age and year of diagnosis (group 2). All of this was done over a 3-year period. The team made sure all patients were on a gluten-free diet (gluten-free diet) and then followed them for clinical conditions and laboratory testing at 6 months every year since diagnosis. The average follow up period was just under two years. Their analysis looked at resolution of symptoms, body mass index, levels of hemoglobin and anti-transglutaminase IgA, adherence to a gluten-free diet, quality of life, and supplementary post-diagnosis medical consultations. Out of 468 patients, the team found 51 patients (11%) who were diagnosed without a duodenal biopsy (group 1; median age 2.1 years), and matched those patients to 92 patients diagnosed with a biopsy (group 2; median age 2.4 years). At the end of follow-up the two groups showed statistically comparable clinical and nutritional status, anti-transglutaminase IgA antibody levels, quality of life, adherence to a gluten-free diet, and number of supplementary medical consultations. This study indicates that celiac disease can be reliably diagnosed without a duodenal biopsy in approximately 11% of cases. At least during a medium-term follow-up, this approach has no negative consequences relating to clinical remission, adherence to diet, and quality of life of children with celiac disease. Source: Arch Dis Child 2016;101:172-176. doi:10.1136/archdischild-2015-309259

Celiac.com 01/02/2013 - Doctors use capsule endoscopy to assess the small bowel in a number of intestinal diseases, including celiac disease. The main advantage of capsule endoscopy is that it allows for complete visualization of the intestinal mucosal surface. A team of researchers recently set out to investigate whether capsule endoscopy can predict the severity of celiac disease, and detect celiac disease complications. The research team included M. Barret, G. Malamut, G. Rahmi, E. Samaha, J. Edery, V. Verkarre, E. Macintyre, E. Lenain, G. Chatellier, N. Cerf-Bensussan, and C. Cellier. They are affiliated with the Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service d'Hépato-gastro-entérologie, and the Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, both in Paris, France. For their study, the team reviewed medical files for nine patients with symptomatic celiac disease, eleven patients with refractory celiac disease type I (RCDI), 18 patients with refractory celiac disease type II (RCDII), and 45 patients without celiac disease who received both capsule endoscopy and upper endoscopy or enteroscopy. To properly diagnose the type of celiac disease in the patients, the researchers used a centralized histological review, flow cytometry analysis of intraepithelial lymphocytes, and the analysis of T-cell receptor rearrangement by multiplex polymerase chain reaction. A total of 47 capsule endoscopies were administered for the 38 celiac patients: ten for the patients with symptomatic celiac disease; eleven for patients with RCDI; and 26 for RCDII patients. Another 47 capsule endoscopies were administered for the 45 non-celiac patients were retrospectively reviewed. They found that patients with celiac disease had more villous atrophy, and more numerous, or distally located ulcers than the control subjects. They also found that, in celiac disease patients, capsule endoscopy was of acceptable quality in 96% of cases and was complete in 62% of cases. Moreover, the concordance of capsule endoscopy with histology for villous atrophy was better than that of optic endoscopy (κ coefficient =0.45 vs. 0.24, P<0.001). Extensive mucosal damage on capsule endocscopy was associated with low serum albumin (P=0.003) and the RCDII form (P=0.02). The also detected three cases of overt lymphoma by capsule endoscopy during the follow-up. Overall, the results show that capsule endoscopy provides a sufficient match with histology and nutritional status in patients with symptomatic or refractory celiac disease. Lastly, capsule endoscopy may predict the type of RCD and enable the early detection of overt lymphoma. Source: Am J Gastroenterol. 2012 Oct;107(10):1546-53. doi: 10.1038/ajg.2012.199. Epub 2012 Sep 11.

Celiac.com 08/29/2007 - A study that appeared in the August issue of Journal of Clinical Gastroenterology, found that celiac disease and small intestinal bacterial growth both show increased levels of intraepithelial lymphocytes (IELs), especially gammadelta+ IELs. A sharp increase in gammadelta+ IELs has been noted in people with celiac disease, but little is known about the role of this particular class of IELs in other intestinal pathologies. A team of researchers led by J.M. Remes-Troche set out to assess the levels of IEls, especially of gammadelta+, in the duodenal mucosa biopsies from individuals w/ celiac disease and to compare them with those of patients with small intestinal bacterial overgrowth (SIBO), and irritable bowel syndrome (IBS). The study team looked at 12 individuals with untreated celiac disease, 8 patients with SIBO, and 10 patients with diarrhea-predominant IBS. All patients were given an upper-endoscopy for mucosal biopsy and jejunal aspirate. Intraepithelial cells were isolated from 2 small bowel biopsies, and labeled with monoclonal antibodies CD103-PE (phycoerythrin), CD3-FITC (fluoresecein isothio-cynate), celiac disease-7R-PE, CD45RO-APC (allophycocyanin), and TcR gammadelta-FITC. Researchers conducted flow cytometry analysis using a standard FACScan. Total IEL levels and subsequent levels were catalogued as percentages as follows: 16.7 +/- 6% for IBS patients; 25.7 +/- 17% for SIBO patients; and 26 +/- +/- 13% in celiac patients (P=0.2). Patients with SIBO & celiac disease showed significantly higher percentages of gammadelta+ IELs (14.6 +/- 8% and 15.7 +/- 13%) compared to IBS patients (4.1 +/- 2.5%, P<0.05). The results of the study indicate that gammadelta+ IELs might play a crucial role against intestinal bacterial infections. Journal of Clinical Gastroenterology. 2007 Aug;41(7):671-676 health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.

J Clin Gastroenterol. 2003 Nov-Dec;37(5):387-91 Tursi A, Brandimarte G, Giorgetti GM. Celiac.com 11/18/2003 - According to the results of an Italian study neither anti-transglutaminase (tTG) nor Anti-endomysium (EMA) antibody levels should be used to determine the state of recovery of gluten-free celiacs. The study looked at 42 consecutively biopsy and blood antibody diagnosed celiac disease patients who went on gluten-free diets, and were then evaluated at 6, 12, and 18 months using anti-transglutaminase (tTG) antibodies and EGDscopy (multiple bioptic samples). For comparison sorbitol H2-breath tests (H2-BT) and anti-endomysium (EMA) antibody tests were also carried out. The results: (A)nti-tTG and EMA were ineffective in assessing the histologic recovery at each follow-up visit (P = NS), while sorbitol H2-BT seems more effective than anti-tTG and EMA in this field (P These results indicate that the biopsy is still the best method to determine recovery from celiac disease, and surprisingly the non-invasive sorbitol H2-breath test was better than both anti-tTG and EMA serology testing in this regard.