Celiac disease (CD) is an autoimmune enteropathy with recognized extraintestinal manifestations. We describe a 55-year-old man with long-standing, well-controlled CD who developed progressive shortness of breath and cough. Imaging was indeterminate for usual interstitial pneumonia (UIP), and a surgical lung biopsy demonstrated a UIP pattern. Autoimmune serologies were negative, and no alternate etiologies for UIP were identified. With intermittent adherence to a gluten-free diet and medical management including nintedanib, his disease progressed, ultimately leading to lung transplantation. This case raises the possibility of an association between CD and UIP of uncertain aetiology and should prompt further discussion as the relationship remains unclear. To contextualize this observation, we conducted a systematic review of published case reports evaluating pulmonary manifestations of celiac disease.

Assessment of a standard dietitian evaluation in pediatric patients with celiac disease.

Celiac Disease as a Rare Cause of Chronic Diarrhea in a Patient After Heart Transplantation

Enteropathy in STAT3 GOF syndrome: Insights into the role of the JAK-STAT pathway.

Dysregulation of IL-10 Across Autoimmune and Allergic Conditions: A Tri-Disease Study of T1DM, Celiac Disease, and Asthma

Eosinophilic esophagitis (EoE) shares several risk factors with other autoimmune diseases, but population-based studies in this field are limited. Using the Swedish nationwide histopathology cohort Epidemiology Strengthened by histopathology Reports in Sweden (ESPRESSO), we identified all patients in Sweden with EoE and matched them by age, sex, county of residence and calendar year with up to 5 general population reference individuals. Using Cox regression modelling, we calculated hazard ratios (HRs) for future autoimmune disease as recorded in the National Patient Register. Using conditional logistic regression, we also calculated odds ratios (ORs) for autoimmune disease prior to EoE. We identified 1477 individuals with EoE and 6933 matched reference individuals from the general population. During a median follow-up of 8 years, 44 EoE patients (2.98%) and 113 reference individuals (1.63%) developed autoimmune disease with incidence rates of 3.54 and 1.93 per 1000 person-years, respectively. The adjusted HR for subsequent autoimmune disease was 1.83 (95% CI = 1.29-2.59) among patients with EoE compared to general population reference individuals. Excluding inflammatory bowel disease and celiac disease from our composite outcome, the adjusted HR for non-gastrointestinal autoimmunity was 1.45 (95% CI = 0.93-2.25). EoE was also associated with earlier autoimmune disease with 7.9% of EoE patients having a record of an autoimmune disease before EoE, as compared with 2.9% of reference individuals (OR = 2.92; 95% CI = 2.34-3.65). EoE was associated with both antecedent and subsequent autoimmune disease, which was strongly driven by gastrointestinal autoimmune conditions. While associations with non-gastrointestinal autoimmune diseases did not reach statistical significance in the present analysis, they warrant further investigation. Clinicians treating patients with EoE should be aware of the increased risk of concomitant or future autoimmunity.

MicroRNA155-3P and BACH2 are emerging biomarkers for diagnosis of Celiac Disease

Due to the patchy nature of mucosal involvement in Celiac disease (CD), histopathological changes may be confined to the duodenal bulb in some patients, leading to diagnostic challenges. This study aimed to investigate the frequency, as well as the clinical and serological characteristics, of ultra-short celiac disease (USCD) in children. Between February 2024 and March 2026, pediatric patients diagnosed with CD based on separate biopsy specimens obtained from the duodenal bulb and distal duodenum, each placed in separate containers, were enrolled in this study. The patients were classified into two groups: the USCD group and the classic CD group. Of the 78 patients included, 47 (60.25%) were female, and the overall mean age at diagnosis was 9.58 ± 4.21years. The median tissue transglutaminase IgA (tTG-IgA) level was 125.50 (IQR: 21.30-200.00) IU/L. Sixteen patients (20.51%) had histopathologically confirmed USCD. The median tTG-IgA level was significantly lower in the USCD group compared to the classic CD group (22.50 vs. 162.00IU/L; p < 0.05). Additionally, 87.50% of the patients in the USCD group lacked the classic gastrointestinal symptoms typically associated with malabsorption, presenting instead with isolated growth retardation. The rate of isolated duodenal bulb involvement in children was remarkably high (20.51%). Ultra-short celiac disease is more prevalent in pediatric patients presenting with fewer classic gastrointestinal findings and tTG-IgA levels below 10 × ULN. Therefore, it is critically important to obtain at least one biopsy specimen from the duodenal bulb and place it in a separate container. Missing bulb biopsies may result in a significant proportion of patients with isolated duodenal bulb involvement going undiagnosed. What is known • The frequency of ultra-short celiac disease (USCD) varies between 2.4% and 22.0% for more accurate differentiation • Intestinal biopsy remains mandatory to diagnose CD in patients with tTG-IgA levels below 10 times the upper limit of normal (10 × ULN) • Duodenal bulb biopsies are not routinely performed even in specialized centers during endoscopy What is new • The frequency of USCD in children with CD was found to be relatively high (20.51%) • Among patients with USCD, 75.00% exhibited tTG-IgA levels below 10 × ULN • Systematic duodenal bulb biopsy substantially enhances USCD detection in patients with low tTG-IgA levels; without it, approximately one in five patients may remain undiagnosed.

To assess whether autoimmune hypothyroidism (AH) or celiac disease (CD) influences diabetes progression among individuals who tested positive on a pooled screening assay for glutamic acid decarboxylase 65 and insulinoma-associated protein 2 autoantibodies (GADA/IA-2A). This retrospective cohort study used data from Maccabi Healthcare Services, Israel (2010-2024), and included 363 GADA/IA-2A-positive individuals without diabetes. In a 316-patient subcohort, individual GADA autoreactivity was assessed. The primary outcome was incident clinical diabetes. Cox regression estimated hazard ratios (HRs) for incident diabetes associated with AH, CD, and asthma (comparator), modelled as time-dependent covariates, adjusting for age, sex, socioeconomic status and baseline fasting plasma glucose. Over a median 5.8-year follow-up, 75 individuals (20.7%) developed clinical diabetes. Progression occurred in 35.8% of dysglyceamic versus 9.9% of normoglycemic individuals (p < 0.001). The prevalence of AH or CD was higher among progressors (21.3% vs. 10.4%; p = 0.01). Adjusted HRs (95% CI) were 2.55 (1.40-4.64) for the composite of AH or CD, 2.85 (1.00-8.15) for AH, and 2.41 (1.21-4.81) for CD. The HR for the composite association was 3.08 (1.36-3.96) in individuals aged < 18 years and 2.10 (0.86-5.12) in adults (p for interaction = 0.56). In a secondary analysis of the subcohort with individual GADA assessment (n = 316), further adjustment for GADA status attenuated the composite HR to 1.97 (1.06-3.65). Concurrent AH or CD is associated with accelerated diabetes progression in autoantibody-positive individuals. Although this partly reflects a shared polyautoimmune predisposition, both conditions may serve as accessible markers for risk stratification.

Alterations in gut microbiota have been reported in coeliac disease (CeD). However, longitudinal evidence distinguishing disease-related effects from diet-driven changes after gluten-free diet initiation remains scarce, particularly in pediatric cohorts. The present study aimed to evaluate time-dependent changes in selected intestinal microorganisms in children with CeD before and during adherence to a gluten-free diet and to compare these findings with those of healthy controls. Microbial DNA isolates from stool samples of pediatric patients with CeD (n = 24) and healthy children (n = 24) were analyzed by quantitative real-time PCR. Samples from CeD patients were categorized into four time points: pre-diet, 6-month, 1-year, and 2-year follow-up. The healthy controls were assessed once. The prevalence and microbial load of selected microorganisms were evaluated. Bifidobacterium spp. remained highly prevalent across all time points, although their abundance varied significantly over follow-up, with the lowest levels at one year and higher levels at two years, comparable to those in controls. The prevalence of Candida tropicalis increased significantly during dietary treatment, reaching levels similar to those of healthy children after two years. Saccharomyces cerevisiae showed a gradual rise in prevalence and abundance, whereas Methanobrevibacter smithii remained infrequent with low and fluctuating microbial load. The duration of adherence to a gluten-free diet appears to influence gut microbial profiles in pediatric CeD. The selected gut microbiota microorganisms' assessment may serve as a complementary tool for understanding intestinal adaptation during dietary treatment, however, its routine clinical application requires further validation.

Background Children and adolescents with type 1 diabetes mellitus (T1D) are at increased risk of developing additional autoimmune diseases. However, data on the frequency, spectrum, and timing of these comorbidities in long-term pediatric cohorts remain limited. This study aimed to evaluate the prevalence, clinical characteristics, and temporal relationships of autoimmune diseases in children and adolescents with T1D, as well as to identify factors associated with their occurrence. Methods This retrospective study included 639 children and adolescents with T1D who were followed at a tertiary pediatric endocrinology center between January 2004 and October 2018. Demographic, clinical, laboratory, and autoantibody data were reviewed. Autoimmune diseases were identified through routine annual screening and clinical follow-up. Temporal relationships between T1D and autoimmune disease diagnoses were analyzed. Multivariable logistic regression was used to assess factors associated with additional autoimmune diseases. Results At least one additional autoimmune disease was identified in 120 subjects with diabetes (18.8%). The most frequent comorbidities were autoimmune thyroiditis (AIT, 12.7%) and celiac disease (CD, 5.9%), followed by vitiligo (1.3%), autoimmune gastritis/pernicious anemia (0.15%), and autoimmune hepatitis (0.15%). Female sex was independently associated with the presence of additional autoimmune diseases (OR = 1.61, 95% CI 1.07–2.41, p = 0.022). Most autoimmune diseases were diagnosed either concurrently with or after T1D onset, clustering within the first two years. A moderate positive correlation was observed between age at diagnosis of T1D and age at diagnosis of AIT ( r = 0.586, p &amp;lt; 0.001), with older age at diagnosis of T1D associated with a shorter interval between T1D onset and the diagnosis of AIT. Similarly, age at diagnosis of T1D was strongly correlated with age at diagnosis of CD (ρ = 0.723, p &amp;lt; 0.001). Conclusion Autoimmune comorbidities, particularly AIT and CD, are common in pediatric T1D, with most diagnoses occurring within the first two years around diabetes onset. These findings support intensified and closer screening—especially during the early disease course and in female subjects with diabetes—to enable earlier detection and improved long-term management. This study provides valuable epidemiological data from Türkiye and contributes to global pediatric T1D literature.

This study aimed to evaluate sleep disturbances in children with coeliac disease (CD) and to investigate their associations with serologic activity and adherence to a gluten-free diet (GFD). This cross-sectional study included 203 children with biopsy-confirmed CD and 100 age- and sex-matched healthy controls. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children (SDSC). Dietary adherence was evaluated according to tissue transglutaminase IgA (tTG-IgA) levels. Children with CD had significantly higher total SDSC scores compared with healthy controls (38.24 ± 9.23 vs. 31.76 ± 3.75, p < 0.001). Subscale scores for difficulties initiating and maintaining sleep (DIMS), daytime sleepiness (DOES) and sleep-wake transition disorders (SWTD) were also significantly higher in the CD group (all p < 0.001). Children with poor GFD adherence demonstrated significantly higher total SDSC scores and higher DIMS, DOES and night-time awakening scores compared with those showing good dietary adherence. tTG-IgA levels showed weak but statistically significant positive correlations with total SDSC scores, DIMS and DOES scores. ROC analysis demonstrated an association between higher SDSC total scores and elevated serologic activity (AUC = 0.84). Children with CD demonstrated higher sleep disturbance scores compared with healthy peers, particularly in domains related to sleep initiation and daytime functioning. Poor dietary adherence and higher serologic activity were associated with increased sleep disturbance severity. Further longitudinal studies are needed to clarify the clinical significance and long-term implications of these findings.

Despite a strict gluten-free diet (GFD), many patients with celiac disease (CD) continue to experience symptoms and nutrient deficiencies. Prebiotics, non-digestible substrates that foster beneficial bacteria and short-chain fatty acid (SCFA) production, may offer adjunctive benefits, though their role in CD remains unclear. We aimed to determine the clinical efficacy, safety, and nutritional outcomes of prebiotics in CD. Following PRISMA guidelines, we systematically searched PubMed, Embase, Web of Science, and CENTRAL through May 2025 for clinical studies evaluating the effects of prebiotics in CD, derived from either supplements or foods naturally abundant in prebiotics. Eligible trials and observational studies were assessed using Cochrane RoB 2.0 or Newcastle-Ottawa tools, and data were synthesized narratively. Twelve studies (1,066 participants) were included. Oligofructose-enriched inulin (Synergy 1) increased fecal SCFAs by 31%, Bifidobacterium abundance, osteocalcin, and serum vitamins D and E. It also reduced hepcidin by 61% without gastrointestinal intolerance. Oats (50-70 g/day) for up to 24 months maintained histologic remission, negative serology, and improved dietary iron, fiber, thiamin, and zinc intake without worsening hemoglobin or ferritin status. Quinoa modestly lowered cholesterol, and amaranth enhanced growth and corrected trace element deficiencies in children. No study reported serious adverse events; adherence improved when prebiotics diversified the GFD. Prebiotics appear safe and may enhance microbiota composition, nutrient absorption, and barrier integrity without compromising mucosal healing. Larger standardized randomized trials are needed to confirm these findings.

Globally, there are differences in the way oats are regulated-particularly regarding the food labeling when oats are called gluten-free, with the potential to impact people who have celiac disease or related conditions. The potential cross-contact of oats with wheat, rye, and barley during processing is a concern for people with gluten-related disorders. This study examined selected international regulations governing gluten-free foods, the regulatory treatment of oats, and the requirements for declaring oats as an ingredient on gluten-free food labels. A comparative review of key regulatory frameworks was undertaken, including the World Health Organization and Food and Agriculture Organization-Codex Alimentarius Standard, and regulations from the United Kingdom (UK), the European Union (EU), the United States, Canada, and Australia and New Zealand (ANZ). All of the listed jurisdictions, with the exception of ANZ, define gluten-free foods as foods containing less than 20 mg gluten/kg food (20 ppm) (in the United States), or less than or equal to 20 ppm. In ANZ, a gluten-free food must not contain detectable gluten or oats, which prohibits oats from being labeled as gluten-free. The United States alone classifies oats as not containing gluten. The regulations of many countries are based on the premise that oats processed with minimizing of gluten cross-contact are safe for most individuals with celiac disease, but stipulate that oats are only permitted to be labeled gluten-free if they contain <20 ppm (in the United States) or ≤20 ppm gluten (in the remaining listed jurisdictions with the exception of ANZ). The current ANZ labeling regulations are not aligned with other international regulations, and emerging clinical evidence suggests it may be timely and impactful to re-evaluate the regulatory definitions of oats, such that individuals can safely identify products suitable for their medical requirements.

A predisposing effect of HLA class II genes in celiac disease by skewing the naive CD4+ T cell receptor repertoire

Celiac disease (CD) is a systemic autoimmune disorder requiring lifelong gluten exclusion, which may inadvertently foster disordered eating patterns. This study examined orthorexic traits in patients with CD and explored its association with anxiety and depressive symptoms. A cross-sectional study included 156 biopsy-confirmed patients with CD and 182 controls. Assessments included the Orthorexia Nervosa Inventory (ONI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Of the 338 participants, 255 were female (75.4%). ONI total score and all ONI subscale scores (behaviors, emotions, and impairments) were significantly higher in the CD group. Similarly, BDI and BAI scores were significantly higher in the CD group. ONI total scores showed a significant positive correlation with BDI (r = 0.38; p < 0.001) and BAI scores (r = 0.42; p < 0.001). In hierarchical regression analyses, CD status emerged as the strongest predictor of orthorexic traits, while anxiety symptoms and age remained significant independent predictors. Orthorexic traits were significantly higher in individuals with CD and were associated with increased psychological distress. These findings suggest that the rigid dietary requirements of CD management may be associated with orthorexic tendencies in some individuals, highlighting the importance of integrating nutritional and psychological support into routine clinical follow-up.

Disturbances in the female reproductive system are known extraintestinal manifestations of celiac disease (CD). However, the reliability of the existing literature is limited by small study populations and heterogeneous study designs. This study is the first systematic review and meta-analysis to synthesize all available evidence and provide a comprehensive evaluation of the association between CD and female menstrual and hormonal parameters. A systematic literature search was conducted in PubMed, Scopus, and Cochrane Central databases using keywords related to CD, menstrual characteristics, and hormonal markers. Studies published until August 2025 were included. Our analysis demonstrated a significantly higher mean age at menarche in girls with CD compared with controls [pooled mean difference (MD): 0.64years, 95% confidence interval (CI): 0.32 to 0.95, p = 0.0007), as well as an increased risk of abnormal uterine bleeding [pooled odds ratio (OR): 2.11, 95% CI: 1.23 to 3.63, p < 0.05] and amenorrhea (pooled OR: 4.03, 95% CI: 1.11 to 14.65, p = 0.0394). Menopausal age was not found to be earlier in women with CD (pooled MD: -1.31years, 95% CI: -3.02 to 0.40, p = 0.1053). Adherence to a gluten-free diet was not associated with age at menarche when adherent and non-adherent patients were compared (pooled MD: 0.56years, 95% CI: -0.72 to 1.83, p = 0.260). Furthermore, none of the evaluated biochemical hormonal markers (FSH, LH, estradiol, prolactin, and AMH) differed significantly between women with CD and controls. This systematic review and meta-analysis reinforces the existing evidence that CD may adversely affect several aspects of menstrual health in women without significantly impacting biochemical hormonal markers.

Exocrine pancreatic insufficiency (EPI) is a clinically significant disorder characterized by inadequate secretion or activity of pancreatic digestive enzymes, leading to maldigestion, malabsorption, and adverse nutritional and metabolic consequences. The causes of EPI can be divided into loss of pancreatic parenchyma, inhibition or inactivation of pancreatic secretion, and postcibal pancreatic asynchrony. Although most associated with intrinsic pancreatic diseases such as cystic fibrosis, chronic pancreatitis or pancreatic cancer, EPI is increasingly recognized in a range of other conditions including diabetes, inflammatory bowel disease, celiac disease, hypersecretory states, gastrointestinal surgeries, small intestinal bacterial overgrowth, drug side effects and aging. This narrative review summarizes the diagnosis and treatment of EPI along with a focused review of the pathophysiology, clinical consequences, diagnostic approaches, and treatment principles of EPI for a variety of conditions.

Celiac disease plasma cells recognize the active form of transglutaminase 2 with and without bound substrate.

Predictive capacity of anti-tissue-transglutaminase IgA antibodies to identify intestinal villous atrophy in persons with celiac disease. An observational study at a referral center in Mexico City.