Celiac Population Research Articles

Evaluation of a Modified Italian European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire for Individuals with Celiac Disease

BackgroundTo date, it is unclear whether individuals with celiac disease following a gluten-free (GF) diet for several years have adequate intake of all recommended nutrients. Lack of a food frequency questionnaire (FFQ) for individuals with celiac disease could be partly responsible for this still-debated issue. ObjectiveThe aim of the study is to evaluate the performance of a modified European Prospective Investigation into Cancer and Nutrition (EPIC) FFQ in estimating nutrient and food intake in a celiac population. DesignIn a cross-sectional study, the dietary habits of individuals with celiac disease were reported using a modified Italian EPIC FFQ and were compared to a 7-day weighed food record as a reference method. Participants/settingA total of 200 individuals with histologically confirmed celiac disease were enrolled in the study between October 2012 and August 2014 at the Center for Prevention and Diagnosis of Celiac Disease (Milan, Italy). Main outcome measuresNutrient and food category intake were calculated by 7-day weighed food record using an Italian food database integrated with the nutrient composition of 60 GF foods and the modified EPIC FFQ, in which 24 foods were substituted with GF foods comparable for energy and carbohydrate content. Statistical analyses performedAn evaluation of the modified FFQ compared to 7-day weighed food record in assessing the reported intake of nutrient and food groups was conducted using Spearman’s correlation coefficients and weighted κ. ResultsOne hundred individuals completed the study. The Spearman's correlation coefficients of FFQ and 7-day weighed food record ranged from .13 to .73 for nutrients and from .23 to .75 for food groups. A moderate agreement, which was defined as a weighted κ value of .40 to .60, was obtained for 30% of the analyzed nutrients, and 40% of the nutrients showed values between .30 and .40. The weighted κ exceeded .40 for 60% of the 15 analyzed food groups. ConclusionsThe modified EPIC FFQ demonstrated moderate congruence with a weighed food record in ranking individuals by dietary intakes, particularly food groups.

The Enigma of Oats in Nutritional Therapy for Celiac Disease

Celiac disease (CD) is a life-long autoimmune condition affecting the small intestine of genetically susceptible individuals. Gluten is one of the offending inducers of the disease, with structurally related molecules found in barley, rye, and oats, where the offending peptides are called avenins. Avoiding toxic prolamins is the only established therapy but most patients have compliance difficulty on a gluten-free diet. Oats are considered less immunogenic than other cereals, and have high nutritional value, which is very desirable in an often undernourished celiac population; however, the consumption of oats by patients with CD is still controversial and debatable. Most clinical and in vitro studies favor oat consumption, but many of these studies were poorly designed and oat cultivar and purity was not considered. A recent study reported a wide range of susceptibility to avenin peptides in patients with CD. Oat cultivars can be subdivided based on toxicity and immunogenicity into none, partial, or highly immunogenic types. Furthermore, most commercial oat products are likely to be contaminated byprolamins. Those products should be avoided by the celiac population and well labeled for contaminants containing gluten. More basic and clinical research and active national celiac associations efforts are needed to characterize the place of oats in a gluten-free diet and to implement non immunogenic and uncontaminated oat products for the benefit of patients with CD. Great care should be taken when recommending consumption of commercial oat products to patients with CD.The most important messages of the review are: 1. Immunogenic oat cultivars are present in oat products. Patients with CD should be cautioned about using them when on a gluten-free diet. 2. Many oat products are cross contaminated with toxic levels of gluten. 3. Interstudy comparisons are difficult because of variability in design, conditions during testing, and difference in oat cultivars studied. Several studies also had small cohorts or significant patient withdrawals during studies. 4. This review aims to encourage clinical and in vitro studies to investigate the benefits of recommending oats in a gluten-free diet.

Small Intestinal Mucosal Biopsies for Case-Finding in Celiac Disease

A number of studies have explored the role of different serological methods along with endoscopic biopsies for celiac disease population screening as well as case finding in clinical practice. Serological testing with quantitative assays is highly sensitive with a positive predictive value for strongly positive levels of tissue transglutaminase antibodies approaching 80% or more. In a recent comparative study, endoscopic biopsies were reported to have a positive predictive value up to 100% and appear to be especially valuable in selected groups with key symptoms, including diarrhea, weight loss and anemia. Overall, studies have suggested that celiac disease occurs in about 1% of the population in some nations of Europe and the . However, in some symptomatic patients referred for endoscopic evaluation, added duodenal biopsy is a critical investigative tool that, in many instances, has been underutilized as a case-finding tool. Some long-term studies have also suggested that detection of celiac disease has increased, possibly due to better awareness and recognition. Others believe that a recent increase in the disease per se may have occurred, possibly related to environmental factors, including newly developed pharmacologic or biologic agents.

Essential and non-essential elements in Brazilian infant food and other rice-based products frequently consumed by children and celiac population

Rice and its derivatives are important source of essential and non-essential elements. Essential elements as cobalt (Co) and selenium (Se) are vital for human homeostasis. However, non-essential elements such as arsenic (As), cadmium (Cd) and lead (Pb) may be present in rice-based food and consequently, people can be exposed—especially children and the celiac population. This study aimed to determine essentials and non-essentials elements in rice-based products and baby food and also to evaluate nutritional risk by estimating the daily intake of non-essential elements. Regarding essential elements, Co and Se presented the highest concentrations in rice flour (56μgkg−1) and porridge (254μgkg−1), respectively. For non-essential elements, the highest concentrations of As, Cd and Pb were 104μgkg−1 (porridge), 16μgkg−1 (flour), and 188μgkg−1 (bread), respectively. Total As concentration in Brazilian rice-based baby food was <29μgkg−1. However, As-speciation revealed inorganic-As (i-As) as the main specie. The highest estimated daily intake of Cd, Pb and i-As were 1.37 (rice-based baby food); 10.39 (pasta); and 3.34 (pasta) μgd−1, respectively. Therefore, continuous food monitoring for nutritional and toxicological purpose is necessary, especially concerning these particular populations and discussions for maximum levels of non-essential elements.

843 Validity and Reliability of the Celiac Disease Self-Management Inventory: A Self-Reported Tool to Assess Compliance of the Gluten-Free Diet in Adult Celiac Population

843 Validity and Reliability of the Celiac Disease Self-Management Inventory: A Self-Reported Tool to Assess Compliance of the Gluten-Free Diet in Adult Celiac Population

Etiologies and Clinical Features of Nonresponsive Celiac Disease in Children Under the Age of 18 Years: ACG Fellows-In-Training Award

Introduction: Celiac disease (CD) is a chronic immune-mediated enteropathy precipitated by exposure to gluten in genetically predisposed individuals occurring in 1 % of the general population. The only treatment available is the gluten free diet (GFD) and it is estimated that 7-30% of adults do not respond completely to treatment, referred to as nonresponsive celiac disease (NRCD). Common causes of NRCD in adults include gluten exposure, irritable bowel syndrome, and refractory celiac disease. To our knowledge, all studies of NRCD have been in adults. Our aim was to determine the prevalence and spectrum of NRCD in the pediatric celiac population. Methods: Medical records of all children less than 18 years old diagnosed with biopsy proven CD at Boston Children's Hospital (BCH) between years 2008 and 2012 were reviewed and cases of NRCD were identified. Cases of NRCD were defined as 1) Persistent clinical symptoms beyond 6 months on a GFD or 2) Persistently elevated celiac antibody levels, greater than 50% above the upper limit of normal at 12 months or less than a 20 percent decrease in levels by 6 months after diagnosis. Clinical features including demographics, comorbidities, family history and associated conditions were collected and analyzed for correlation with specific etiologies of NRCD. Results: 754 children under age 18 with biopsy proven CD were diagnosed at BCH between 2008 and 2012. Of these, 177 children met criteria for NRCD for an incidence of NRCD 23.4%. The mean age of celiac diagnosis in the NRCD cohort was 9 years compared to 11 years in the overall cohort. In initial review of a subset of children with NRCD, the most common symptoms were abdominal pain, constipation and GERD seen in 70%, 30% and 15% of the patients, respectively. The most frequent causes of NRCD were gluten exposure in 40%, constipation in 20%, other functional disorders in 10% and lactose intolerance in 5%. 15% of NRCD patients experiencing persistent functional abdominal symptoms had underlying neuropsychiatric illnesses including anxiety, panic attacks, and autism. 10% of the children had a slow fall in celiac antibody levels without any underlying etiology. Conclusion: NRCD is common in children as with adults, with a prevalence of approximately 25%. Similar to in adults, gluten exposure and overlapping functional symptoms are the most common etiologies. Providers caring for pediatric patients with celiac disease should be aware of these common issues.

A comparison of the nutritional status between adult celiac patients on a long-term, strictly gluten-free diet and healthy subjects.

There are conflicting data on the effect of a gluten-free diet (GFD) on the nutritional status of celiac patients. In the present study, we evaluated, in adult celiac patients, the influence of a long-term, strictly GFD on their nutritional status and compared it with matched healthy volunteers. Our study included 39 celiac patients and 39 healthy volunteers. The body mass index (BMI) of patients and controls was evaluated at enrollment, while the patients' BMI before the GFD was retrieved from clinical records. In addition, at enrollment, in both groups, we compared BMI, fat mass (FM), bone mineral density (BMD), as well as their dietary intake, recorded on a 7-day diary. At the time of diagnosis, the majority of celiac patients (82.0%) had a normal BMI or were overweight, while 10.3% were malnourished. After the GFD, patients with a normal BMI showed a significant weight increase (P=0.002), but none of them switched in the overweight or obese category. Two (50%) of the four malnourished patients achieved a normal BMI. Controls and patients on a GFD had a similar BMI, FM, BMD and total calorie intake, but the amount of lipids and fiber intake was significantly different in the two groups (P=0.003 and P<0.0001, respectively). Our study demonstrates that a GFD is able to improve the nutritional status of celiac patients without inducing overweight or obesity. Our findings are related to a celiac population adopting a GFD based on a Mediterranean-type diet.

Gluten‐Free Snacks Using Plantain–Chickpea and Maize Blend: Chemical Composition, Starch Digestibility, and Predicted Glycemic Index

An increase in celiac consumers has caused an increasing interest to develop good quality gluten-free food products with high nutritional value. Snack foods are consumed worldwide and have become a normal part of the eating habits of the celiac population making them a target to improve their nutritive value. Extrusion and deep-frying of unripe plantain, chickpea, and maize flours blends produced gluten-free snacks with high dietary fiber contents (13.7-18.2 g/100 g) and low predicted glycemic index (28 to 35). The gluten-free snacks presented lower fat content (12.7 to 13.6 g/100 g) than those reported in similar commercial snacks. The snack with the highest unripe plantain flour showed higher slowly digestible starch (11.6 and 13.4 g/100 g) than its counterpart with the highest chickpea flour level (6 g/100 g). The overall acceptability of the gluten-free snacks was similar to that chili-flavored commercial snack. It was possible to develop gluten-free snacks with high dietary fiber content and low predicted glycemic index with the blend of the 3 flours, and these gluten-free snacks may also be useful as an alternative to reduce excess weight and obesity problems in the general population and celiac community.

Sa1296 Duodenal Eosinophilia in Celiac Disease and Functional Dyspepsia - A Marker for Wheat Sensitivity?

Introduction and Aim: Duodenal eosinophilia has been previously described in subsets of patients with functional dyspepsia1 (FD), non-celiac wheat sensitivity2 and celiac disease (CD)3. CD has varied clinical presentations, including symptoms of functional gastrointestinal disorders (FGIDs), FD and irritable bowel syndrome (IBS). We aimed to determine if duodenal eosinophilia is present in patients with CD presenting with dyspepsia. Methods: The celiac study population comprised 61 patients, 44 female, mean age 42, (range 17-74) years with a new presentation of subsequent biopsy proven coeliac disease to a single centre from 2003-13. A standard symptom questionnaire was documented for all patients. The control population (53 adults) presenting for endoscopy with no CD was drawn from the same centre with similar demographics for age and gender1. Duodenal biopsies from both groups were assessed for eosinophil counts/ mm2. Results: In patients with coeliac disease 37/61 (60%) had symptoms of a FGID, 9 FD, 17 IBS, 11 overlap FD and IBS. 15 (71% of FD) had early satiety (ES) symptoms, 19 with reflux symptoms. In controls 33/53 (64%) had symptoms of FD, 17 (51%) with ES, 21 IBS. Early satiety was an equally common presentation in celiac and control patients. IBS was more common in celiac patients (p= 0.01). See Table. Compared to a similar population from the same hospital, duodenal eosinophils are significantly raised in CD compared to a group without coeliac disease attending for endoscopy, mean 45/mm2 vs 65/mm2 p=0.005. Eosinophil counts were similar in control patients with symptoms of dyspepsia (mean 50/ mm2) and early satiety (ES) (mean 55/ mm2), compared to those with CD and dyspepsia (mean 47/ mm2), p=0.80 and CD and ES (mean 56/ mm2), p=0.87. In controls with no dyspepsia eosinophil counts were significantly lower (mean 40/ mm2) than those with CD and no dyspepsia (mean 70/ mm2), p=0.005. See Figure. Among control patients, 3 reported food allergies, 2 with ES all 3 with D2 eosinophilia. Conclusions: Duodenal eosinophilia in coeliac patients with dyspepsia and ES is of a similar level to patients without CD with FD and ES. As duodenal eosinophilia is described in non-celiac wheat sensitivity it is possible that eosinophils are a sign of wheat intolerance and suggests a wheat free diet may benefit certain FD patients if duodenal eosinophilia is present.

Sa1297 The Degree of Mucosal Damage to the Small Intestine and Serum IgG4 Levels Correlate With Celiac Disease

Introduction and Aim: Duodenal eosinophilia has been previously described in subsets of patients with functional dyspepsia1 (FD), non-celiac wheat sensitivity2 and celiac disease (CD)3. CD has varied clinical presentations, including symptoms of functional gastrointestinal disorders (FGIDs), FD and irritable bowel syndrome (IBS). We aimed to determine if duodenal eosinophilia is present in patients with CD presenting with dyspepsia. Methods: The celiac study population comprised 61 patients, 44 female, mean age 42, (range 17-74) years with a new presentation of subsequent biopsy proven coeliac disease to a single centre from 2003-13. A standard symptom questionnaire was documented for all patients. The control population (53 adults) presenting for endoscopy with no CD was drawn from the same centre with similar demographics for age and gender1. Duodenal biopsies from both groups were assessed for eosinophil counts/ mm2. Results: In patients with coeliac disease 37/61 (60%) had symptoms of a FGID, 9 FD, 17 IBS, 11 overlap FD and IBS. 15 (71% of FD) had early satiety (ES) symptoms, 19 with reflux symptoms. In controls 33/53 (64%) had symptoms of FD, 17 (51%) with ES, 21 IBS. Early satiety was an equally common presentation in celiac and control patients. IBS was more common in celiac patients (p= 0.01). See Table. Compared to a similar population from the same hospital, duodenal eosinophils are significantly raised in CD compared to a group without coeliac disease attending for endoscopy, mean 45/mm2 vs 65/mm2 p=0.005. Eosinophil counts were similar in control patients with symptoms of dyspepsia (mean 50/ mm2) and early satiety (ES) (mean 55/ mm2), compared to those with CD and dyspepsia (mean 47/ mm2), p=0.80 and CD and ES (mean 56/ mm2), p=0.87. In controls with no dyspepsia eosinophil counts were significantly lower (mean 40/ mm2) than those with CD and no dyspepsia (mean 70/ mm2), p=0.005. See Figure. Among control patients, 3 reported food allergies, 2 with ES all 3 with D2 eosinophilia. Conclusions: Duodenal eosinophilia in coeliac patients with dyspepsia and ES is of a similar level to patients without CD with FD and ES. As duodenal eosinophilia is described in non-celiac wheat sensitivity it is possible that eosinophils are a sign of wheat intolerance and suggests a wheat free diet may benefit certain FD patients if duodenal eosinophilia is present.

HLA-DQ2/DQ8 and HLA-DQB1*02 homozygosity typing by real-time polymerase chain reaction for the assessment of celiac disease genetic risk: evaluation of a Spanish celiac population.

Celiac disease (CD) is a complex autoimmune disorder caused by ingestion of gluten in genetically susceptible individuals. Different genetic risk factors have been identified, but virtually all patients are human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8 positive. We describe a new, fast, accurate and simple real-time polymerase chain reaction (PCR)-based assay for the genotyping and homozygosity analysis of the CD-related HLA alleles. The assay overcomes the major limitations of protocols currently in use, allowing HLA-DQ2/DQ8 genotyping by using only three real-time PCR reactions. For the appraisal of DQ2 homozygosity, only one more reaction is needed. These reactions are easily automated and suitable for large screening studies in diagnostic procedures, as it is demonstrated by their successful application in our HLA diagnostic laboratory. Finally, we assessed the clinical relevance of this real-time PCR-based assay by studying a cohort of fully characterized patients. As expected, all CD patients had at least one of the CD-associated alleles, and the highest CD risk was indicated by the presence of the HLA-DQ2.5 heterodimer (HLA-DQA1*05-DQB1*02) with HLA-DQB1*02 in homozygosity.

Higher Prevalence of Celiac Disease in Patients With Microscopic Colitis: Results From a Large Pathology Database

Introduction: Microscopic colitis (MC) refers to 2 medical conditions that cause chronic diarrhea: collagenous colitis (CC) and lymphocytic colitis (LC). Previous studies have reported an increased prevalence of microscopic colitis in the celiac disease population. These studies were limited by small numbers, and further characterization of the patients who harbor both conditions is needed. The aims of this study were: 1) to determine the strength of the association between MC and celiac disease; and 2) to compare the demographic and clinical characteristics of patients with MC and celiac sprue to those of patients with MC alone. Methods: Miraca Life Sciences is a nationwide pathology laboratory that receives specimens submitted by approximately 1,500 gastroenterologists distributed throughout the United States. From the electronic database of Miraca Life Sciences we extracted all patients who had an upper gastrointestinal endoscopy (EGD) and colonoscopy with biopsy sampling from the duodenum and colon between January 2008 and December 2013. We extracted demographic, clinical, and histopathologic information and stratified patients based on the presence of MC. We then performed a search of patients with celiac sprue, defined as duodenal villous atrophy (Marsh type 3a, b, or c histology), in a population of patients with MC, compared to a control population of patients without MC. Results: There were 156,399 patients who had both duodenal and colon biopsies during the study period. Of these, 4,417 had MC (2,266 with CC and 2,151 with LC). The mean age of the MC population was 61.9 years, with a female:male ratio of 3.83:1. Celiac sprue was diagnosed in 1,113 patients, of whom 116 also had microscopic colitis. Compared to controls without MC, there was a greater association of celiac sprue in patients with CC (OR 4.08; 95% CI 3.36, 4.96), LC (OR 4.71; 95% CI 3.66, 6.05), and all MC (OR 4.08; 95% CI 3.36, 4.96). In patients with MC and celiac sprue versus MC alone, average age was 54.0 years vs. 61.9 years (p<0.0001) with a similar female:male predominance (ratio 4.04:1). Of the 116 subjects with MC and celiac sprue, microscopic colitis was diagnosed before celiac sprue in 32 (28%) cases, simultaneously in 58 (50%), and after celiac sprue in 26 (22%). Conclusion: In a large nationwide pathology database, we found a significantly increased association of microscopic colitis and celiac disease. Such association could reflect on a shared set of risk factors or a common pathophysiology of the 2 disease entities. Disclosure - Dr. Genta is an employee of Miraca Life Sciences. Drs. Yen and Sonnenberg declare no relevant conflicts of interest.

Dissemination of an online theory-based intervention to improve gluten-free diet adherence in coeliac disease: the relationship between acceptability, effectiveness, and attrition.

Both acceptability and behaviour change data provide important information about the likelihood of success of an intervention when disseminated outside the research context. Despite this, few studies have combined such data for use in ongoing intervention development. To assess the acceptability and feasibility of an online intervention to improve gluten-free diet (GFD) adherence in coeliac disease, and to examine the relationships with participant characteristics, attrition, and effectiveness to inform ongoing intervention developments to ultimately reduce attrition and improve the reach and effectiveness of the programme. All participants completed measures of GFD adherence, theory of planned behaviour variables, psychological symptoms, and demographic and disease characteristics. Acceptability and feasibility ratings were obtained at the conclusion of each of the six intervention modules. Chi-square analyses were used to examine differences between completers and non-completers, and Spearman's correlations were used to determine the relationships between participant characteristics, effectiveness, and acceptability and feasibility. Participants who rated the early modules less favourably were more likely to drop-out of the intervention. Acceptability and feasibility ratings were also associated with the presence of psychological symptoms, use of adaptive coping strategies, GFD duration, and attitude change. The findings suggest that changes to the structure and implementation of the intervention may be useful in minimising attrition and maximising effectiveness for future dissemination in a wider coeliac disease population.

Potential celiac children: 9-year follow-up on a gluten-containing diet.

Potential celiac disease (CD) is defined by the presence of serum anti-tissue-transglutaminase (anti-TG2) antibodies and normal duodenal mucosa. The major clinical problem is the management of asymptomatic patients and how to predict the development of villous atrophy. This prospective longitudinal cohort study describes the natural history of potential CD up to 9 years and explores risk factors associated with the development of mucosal damage. Two hundred and ten potential CD children were eligible for the study; 175/210 asymptomatic children were left on a gluten-containing diet. Antibodies and clinical symptoms were checked every 6 months, and a small bowel biopsy was taken every 2 years to evaluate histological, immunohistochemical, and anti-TG2 deposits. Patients were genotyped for HLA and a set of non-HLA CD-associated genes. Forty-three percent of patients showed persistently elevated anti-TG2 level, 20% became negative during follow-up, and 37% showed a fluctuant anti-TG2 course with transiently negative values. At 3 years of follow-up, 86% of cases remained potential; 73 and 67% still had normal duodenal architecture at 6 and 9 years, respectively. Male sex, slight mucosal inflammation at time 0, and a peculiar genetic profile delineate a cohort of individuals who were prone to develop mucosal damage during time. A sizeable proportion of asymptomatic potential celiac patients showed fluctuation or negativization of antibody production, and many of these, with persistently positive anti-TG2, did not develop mucosal damage after 9 years of follow-up. Celiac population is a multivariate aggregate of individuals with different genetic and phenotypic profiles. Caution is required before prescribing a gluten-free diet for life to asymptomatic individuals with potential CD.

Reduced-Gliadin Wheat Bread: An Alternative to the Gluten-Free Diet for Consumers Suffering Gluten-Related Pathologies

Wheat flour cannot be tolerated by those who suffer allergies to gluten. Human pathologies associated with grain proteins have increased worldwide in recent years, and the only effective treatment available is a lifelong gluten-free diet, which is complicated to follow and detrimental to gut health. This manuscript describes the development of wheat bread potentially suitable for celiac patients and other gluten-intolerant individuals. We have made bread using wheat flour with very low content of the specific gluten proteins (near gliadin-free) that are the causal agents for pathologies such as celiac disease. Loaves were compared with normal wheat breads and rice bread. Organoleptic, nutritional, and immunotoxic properties were studied. The reduced-gliadin breads showed baking and sensory properties, and overall acceptance, similar to those of normal flour, but with up to 97% lower gliadin content. Moreover, the low-gliadin flour has improved nutritional properties since its lysine content is significantly higher than that of normal flour. Conservative estimates indicate that celiac patients could safely consume 67 grams of bread per day that is made with low-gliadin flour. However, additional studies, such as feeding trials with gluten-intolerant patients, are still needed in order to determine whether or not the product can be consumed by the general celiac population, as well as the actual tolerated amount that can be safely ingested. The results presented here offer a major opportunity to improve the quality of life for millions of sufferers of gluten intolerance throughout the world.

Nutritional Differences Between a Gluten-free Diet and a Diet Containing Equivalent Products with Gluten

The gluten-free (GF) products market represents one of the most prosperous markets in the field of food and beverages in the immediate future. Historically, counselling for celiac disease has focused on the absence of gluten in foods, however the nutritional quality of GF foodstuffs is an important aspect to consider. The aim of the present work was to compare the nutritional composition of the 206 GF rendered products most consumed in Spain, against the composition of 289 equivalent foods with gluten, and to make a comparison between the diet including GF products and the same diet with equivalent products with gluten in a 58 adult celiac population. The results of the present collaborative study pointed out differences in calorie, macronutrient, fiber, sodium, salt and cholesterol content between GF rendered and gluten-containing foodstuffs. Thus, calorie and nutrient intake in a GF diet is different when compared to its equivalent diet with gluten. Following a diet based on GF products could suppose a nutritional imbalance for celiac patients as well as for non-celiacs who follow a diet that includes many GF rendered foodstuffs.

Evaluation of the response to vaccination with hepatitis B vaccine in pediatric patients diagnosed with celiac disease.

Background:A gap exists in the literature on celiac disease populations and the response to hepatitis B vaccination.Objective:To identify pediatric patients with celiac disease who received the primary hepatitis B vaccination and investigate their response to vaccine.Design/Methods:Patients underwent blood draw for hepatitis B surface antibody titers. Patients with undetectable or non-protective HBsAb titers were contacted. Study outcome measures and patient characteristics variables were summarized by means, standard deviations, medians, and ranges. A two-sample t-test was used to compare normally distributed continuous variables between responders and non-responders.Results:In all, 58% of patients did not meet the threshold for “protective” antibody titers. The mean time between completion of hepatitis B vaccination and diagnosis of celiac disease was 8.1 years for responders versus 10.5 years for non-responders. In a multivariate analysis, time between completion of vaccine and diagnosis of celiac disease was statistically significant predictor of response with an adjusted odds ratio of 0.69 (95% confidence interval: 0.50–0.95; p = 0.021).Conclusion:Our celiac disease population shows a high hepatitis B vaccine failure. The time between completion of vaccine series and diagnosis of celiac disease is an independent predictor for response.

Diagnosing small bowel malabsorption

The review article published in the present issue of Intern Emerg Med, from Corazza’s group [1], is an in-depth description of the up-to-date clinical features of small bowel malabsorption, but at the same time offers a practical clinical approach to this difficult diagnosis. Small bowel malabsorption often overlaps complex clinical scenarios, and is one of the most challenging diagnoses in gastroenterology. A key factor is the differential diagnosis, and this is presented starting with the pathological mimics of coeliac disease (CD), where the interplay between genes and environment (i.e. gluten) is described, and finishing with irritable bowel syndrome (IBS). The relationships between IBS and non-motility-related gastrointestinal disorders continue to be the subject of much debate. Population-based studies have shown that many of the symptoms reported by IBS patients (particularly in the tertiary care setting) overlap with symptoms suggestive of coeliac disease or intestinal malabsorption, including lactose malabsorption [2]. One study shows that IBS-like symptoms are present in 20 % of the celiac disease population studied (n = 150) [3]. In a recent metaanalysis, no specific complaint could predict lactose malabsorption, with sensitivities ranging from 0 to 90 % and specificities ranging from 18 to 96 % for symptoms such as bloating, diarrhoea, flatulence, and abdominal pain in individual studies [4]. Upper gastrointestinal symptoms reported by patients with functional dyspepsia are described in CD. Prevalence of biopsy-proven CD in subjects with dyspepsia is around 1 % and is higher than in controls, but this difference is not statistically significant in a recent meta-analysis [5]. In this complex scenario, no serological clinical markers validated in clinical practice are available. However, in the review by Papadia et al., a new research tool that could change the fate of intestinal malabsorption diagnosis is described. Plasma citrulline concentration is a new single marker whose role in the field is widely debated. Papadia et al. [6] show that plasma citrulline is not affected by intestinal inflammation; moreover, the citrulline assay provides a reliable clinical index of global function, and so the nutritional prognosis, of a compromised intestine and is independent from the nutritional status. Other recent markers, such as IgA F-actin and intestinal fatty acid-binding protein (I-FABP), in the light of some recent interesting results, may also contribute to assessing the extent of villous atrophy. As awareness, detection, and treatment for small bowel atrophy and malabsorption all improve, the laboratory’s role in facilitating follow-up and monitoring is sure to increase in the near future.

IL-17 Producing T Cells in Celiac Disease: Angels or Devils?

Celiac disease (CD) is a very common chronic condition in human beings, affecting approximately one in 100 individuals. It is an autoimmune disease with a defined environmental trigger, the gluten contained in dietary cereals, occurring in genetically susceptible individuals. The disease has a very strong HLA association. More than 90% of CD patients have HLA-DQ2, and almost all of the remaining celiac population possesses HLA-DQ8 molecules. Th17 cells seem to participate in the disease pathogenesis producing and secreting either proinflammatory or anti-inflammatory cytokines.

Celiac disease and HLA-DQ genotype: diagnosis of different genetic risk profiles related to the age in Badajoz, southwestern Spain

celiac disease is associated with the HLA class II alleles: DQA1*05-DQB1*02 and DQB1*0302. The genetic risk for celiac disease may depend on the presence or absence of such alleles, their combination or number of copies. This study aimed to establish the differences in HLA genotypes between celiac patients diagnosed during childhood and adulthood, and between patients and healthy controls, and to determine the risk of disease in each genotypic category. we classified 350 celiac patients at time of diagnosis and 218 controls into 14 categories according to their HLA genotype, based on the presence or absence of risk alleles. we found statistically significant differences between the genotype frequencies of celiac patients diagnosed as being children and adults. DQA1*05 (x 1 copy), DQB1*02 (x 1 copy), DQB1*0302 (x 0 copies) was the most frequent genotype in individuals diagnosed in childhood, whereas DQA1*05 (x 1 copy), DQB1*02 (x 2 copies), DQB1*0302 (x 0 copies) was the most frequent in adults. The risk for disease in each genotypic category in celiac children and adults turned out to be different. The presence of DQB1*0302 did not increase risk in children, but did in adults. in our celiac population, we found a different genetic pattern according to age of diagnosis. That could suggest that the pathogenic mechanism of the disease is not exactly the same in both age groups, which could somehow determine clinical presentation of the disease, its epidemiology, coexisting diseases, and complications.