Glycine receptor antibodies and coeliac disease-related neurological dysfunction

The role of capsule endoscopy in patients with nonresponsive celiac disease

A Child With Refractory Coeliac Disease

Gluten-Free Diet: Imprudent Dietary Advice for the General Population?

Association of celiac disease and intestinal lymphomas and other cancers

Suspected Nonceliac Gluten Sensitivity Confirmed in FewPatients After Gluten Challenge in Double-Blind, Placebo-Controlled Trials.

Celiac Disease: From Pathogenesis to Novel Therapies

Whole-Genome Analysis and HLA Genotyping of Enteropathy-Type T-Cell Lymphoma Reveals 2 Distinct Lymphoma Subtypes

Mesalamine for Refractory Celiac Disease

Follow-up of patients with celiac disease: Achieving compliance with treatment

Food, the Immune System, and the Gastrointestinal Tract

First Case of Refractory Celiac Disease and Ulcerative Jejunitis in a Child Revealed By Capsule Endoscopy

BACKGROUND AND OBJECTIVES:Celiac disease (CD) is an immune-mediated enteropathy, induced by gluten in genetically susceptible individuals. The objective of this study was to describe the clinical pattern of CD in children from the western region of Saudi Arabia.DESIGN AND SETTING:Retrospective, hospital-based.PATIENTS AND METHODS:This study included children with a biopsy-proven diagnosis of CD made between September 2002 and July 2007. Children were admitted to the endoscopy unit for a small-bowel biopsy if they had gastrointestinal symptoms suggestive of CD or if they were positive for a CD-antibody screen performed for the high-risk groups.RESULTS:Eighty children were identified with a diagnosis of CD. Their mean (SD) age was 9.6 (4.9) years (range, 0.5-18 years). There were 44 (55%) female patients. Forty-one (51%) patients were detected during screening of high-risk groups, while 39 (49%) patients had classical symptoms of malabsorption. The screening also detected asymptomatic patients. Of 65 patients tested, 11 (17%) had elevated liver function tests, which reverted to normal after introduction of a gluten-free diet (GFD) except in one case. Seventy-three (91%) patients were positive for anti-tissue transglutaminase antibodies, 18 (23%), for IgG anti-gliadin antibodies; and 46 (58%), for IgA anti-gliadin antibodies. Forty-one (56%) patients showed good adherence to GFD as assessed by dietary history and the decline in anti-tTG level.CONCLUSION:CD may present with classical symptoms or be identified through screening programs. Growth and laboratory abnormalities usually improve after introduction of a GFD. Adherence to a GFD remains a problem; therefore, thorough assessment and counseling at the time of diagnosis and ongoing care are crucial.

IntroductionAlthough coeliac disease (CD) is classically associated with malabsorption and the attendant complications arising from it, population studies have shown that patients with celiac disease (CD) are at increased risk...

There are too many papers published regarding the definition, diagnosis and treatment of celiac disease (CD). All we know that CD is a major health care issue affecting people in any ages, and increased wheat consumption may have had an effect on CD prevalence, which was reported worldwide prevalence of approximately 1% [1]. Most of the celiac patients report long gastrointestinal symptoms such as abdominal pain, tenderness, or irregular bowel habits like constipation or diarrhea or alternating bowel movements. Very often they consult a number of physicians, seeking to reach a CD diagnosis but they are considered to be simply suffering from irritable bowel syndrome (IBS) [2]. According to ACG clinical guidelines, in individuals over the age of 2 years, anti-tissue transglutaminase (TTG) immunoglobulin A (IgA) antibody is strongly recommended and preferred for celiac disease diagnosis. But in children younger than 2 years, the IgA TTG test should be used combined with DGP (IgA and IgG) [3]. Currently, the only safe and effective treatment is a strict gluten-free diet (GFD) accompany with nutritional support, which improves the health and quality of life in the vast majority of patients [4]. There is no doubt that GFD so effective in symptomatic CD patients, and reduce the risk of malignancies such as osteoporosis, refractory CD and small intestinal lymphoma [5]. On the other hands, a consistent percentage of the general population consider themselves to be suffering from troubles caused by wheat and/or gluten ingestion, even if they do not have celiac disease or wheat allergy (WA), as they test negative both for CD serology and histopathology and for IgE-mediated assays. Most patients report both gastrointestinal and non-gastrointestinal symptoms, all agreeing, however, about the reduction of symptoms on a gluten-free diet. This clinical condition has been recently named Non-Celiac Gluten Sensitivity (NCGS) [6]. We talk about NCGS when CD serology, duodenal histology and IgE-based assays are negative (Table 1).

Management of Celiac Disease: Beyond the Gluten-Free Diet