Celiac Disease Research Articles

The cost of coeliac condition: economic availability of gluten-free foods for patients with celiac disease in the Czech Republic

PurposeThis study examines the economic availability of gluten-free foods for people with coeliac condition in the Czech Republic, focusing on the price differences between gluten-free and gluten-containing products.Design/methodology/approachA comprehensive price survey was carried out, analysing almost 7,000 products from different categories. Statistical analysis using IBM SPSS Statistics software was used to calculate average prices and test the significance of price differences between the two groups of products.FindingsThe results show that most gluten-free products are more expensive than their gluten-containing counterparts, with significant price differences between product categories, particularly in bakery products. This economic burden is a barrier to adherence to a gluten-free diet, which is essential for the management of celiac disease.Practical implicationsPolicymakers, healthcare providers and other members of the public can use these findings to develop the policies needed to promote the accessibility of gluten-free products.Originality/valueThis research provides unique insights into the economic availability of gluten-free foods for people with coeliac disease in the Czech Republic, a topic that has not been extensively studied in this specific context. While literature exists on the pricing of gluten-free products in other countries, our comprehensive price survey highlights significant price differences between gluten-free and gluten-containing products in the Czech market. The data reflect current market conditions and highlight the economic burden for people with celiac disease, contributing to the discourse on public health and dietary accessibility in the Czech Republic.

Arsenic Exposure in Celiac Disease: The Hidden Cost of a Gluten-Free Diet.

Arsenic Exposure in Celiac Disease: The Hidden Cost of a Gluten-Free Diet.

Primary ovarian insufficiency consequence of autoimmune diseases: a bidirectional two-sample Mendelian randomization study

BackgroundObservational studies suggest the risk of primary ovarian insufficiency (POI) is increased in autoimmune disorders (AIDs), but it is unclear whether there is a causal relationship. Therefore, we aimed to investigate the bidirectional causality between 20 AIDs and POI using Mendelian randomization (MR) analysis.MethodsA bidirectional two-sample MR investigation was designed by using publicly accessible summary-level data from genome-wide association studies (GWAS). The inverse variance weighted (IVW) method was performed as the main analysis, supplemented by several sensitivity analyses. Cochran Q test was used to evaluate SNP estimate heterogeneity. MR-Egger and MR-PRESSO methods were utilized to detect horizontal pleiotropy.ResultsThe MR analyses revealed that genetically determined coeliac disease (CeD) (OR = 1.124, 95% CI 1.033-1.224, P = 0.007), vitiligo (OR = 1.092, 95% CI 1.003-1.188; P = 0.042), systemic lupus erythematosus (SLE) (OR = 1.122, 95% CI 1.030-1.223, P = 0.008), and selective immunoglobulin A deficiency (SIgAD) (OR = 0.866, 95% CI: 0.776-0.967, P = 0.011) exhibited significant causal relationships with POI. We also found suggestive evidence of positive effect of Addison’s disease (AD) towards POI (OR5e-6 = 1.076, 95% CI 1.002-1.154, P = 0.043).ConclusionThis comprehensive MR analysis indicated that SLE, CeD, vitiligo, and AD caused an increased risk of POI, SIgAD was associated with a decreased risk of POI. These insights carry profound clinical implications, particularly emphasizing the early intervention for women with AIDs/POI who wish to preserve their reproductive potential or plan for future pregnancies.

Red sorghum [Sorghum bicolor L. Moench]: A biochemical, nutritional hub and key food supplement - a review

Red sorghum (Sorghum bicolor (L.) Moench) stands out as a crucial dietary staple food, particularly in economically disadvantaged and food-insecure regions worldwide. Its diversity among landraces makes India a key hub for production. Red sorghum, renowned for its nutrient density and stress tolerance, holds immense potential as an alternate crop amidst climate change challenges. This review explores red sorghum's grain structure and nutritional profile, emphasizing its macronutrient and micronutrient composition, dietary fibre content, soluble sugars and bioactive secondary metabolites, including phenols, tannins and flavonoids. Understanding these aspects underscores the importance of red sorghum in addressing nutritional deficiencies and forecasting agricultural sustainability. Red sorghum offers many health benefits, particularly as a gluten-free alternative for individuals with celiac disease. Its rich phenolic compounds exhibit potential in combating carcinoma, while its starch composition, including slowly digestible starch, benefits diabetics with its low glycemic index. Combining sorghum with probiotic milk reduces oxidative stress in chronic renal disorders. Sorghum emerges as a versatile gluten-free ingredient rich in minerals and phenolic compounds, offering health benefits in various food products like cookies, RTE cereals, pasta and pet food. Additionally, exploring sorghum's genetic variations and health impacts paves the way for developing nutritionally superior varieties with robust agronomic traits.

Practical Approach of Trayopstambha in Preventing Autoimmune Disorders

Trayopstambha are – Aahar, Nidra and Brahmcharya. All of them are helpful for living a healthy life. In all autoimmune disease like Rheumatoid Arthritis, Lupus Erythematous, Celiac diseases, Polymyalgia, Multiple Sclerosis, Type 1 DM and Alopecia aerata body immune system is affected due to over activity of free radicals. Free radicals’ activity is increased due to disbalance in Trayopstambha. Aama Rasa is responsible for development of all autoimmune diseases. This Aama Rasa can be compared to free radical which causes destruction of healthy tissues. Aama's etiological factors may be classified as Aharja, Viharaja and Manasika. Not only food in larger amount, but also qualities such as Guru, Sheeta, Shushka, Ruksha, Vidahi, Viruddha Ahara (incompatible diet), Ajeernabhojana (indigestion), Asatmya Bhojana (toxic food) or Abhojana (self-restraint from food), Deevasvapna (keeping wakeful in the night and sleeping in the day), are chief factors accountable for the creation of Aama. The condition of Aama formation is also exaggerated by mental disorder due to disturbance in Nidra and Brahmcharya. Acharya Sushruta stressed that Nidana is the simple and uttermost basis for a treatment. Prevention is always better than a cure. If we follow proper regimen of Trayopstambha it makes metabolism better, decrease free radical activity in body and reduce the risk of autoimmune diseases.

Ultrarare Cause of Childhood Chorea: Celiac Disease.

Chorea, a movement disorder that commonly affects children, may be caused by various diseases with metabolic, structural, pharmacologic, or autoimmune origins. Celiac disease is an autoimmune enteropathy that may rarely cause neurologic symptoms in children, primarily ataxia and peripheral neuropathy, even in the absence of gastrointestinal symptoms. A 9-year-old male patient diagnosed with Sydenham chorea was admitted to our clinic because of valproic acid resistance. He had involuntary, brief, random, and irregular movements in his arms over the past 2 weeks. A low-dose, high-potency dopamine-2 receptor-blocking agent was added to the patient's treatment regimen. After 2 weeks, he had maculopapular rashes on their hands and arms, as well as arthritis in his left hand. Oral prednisone was prescribed, and the patient's arthritis and rashes were completely resolved. Although movement disorder symptoms persisted in the distal left upper extremity, the chorea in the right upper extremity was recovered. Extensive investigations were conducted to rule out possible metabolic, autoimmune, inflammatory, infectious, and paraneoplastic diseases, all of which yielded normal results. Brain magnetic resonance imaging (MRI) results were normal, and genetic analysis results for chorea were negative. The patient's tissue glutaminase IgG levels exceeded 200 U/mL (normal range: 0-10 U/mL) and IgA levels at 24 U/mL (normal range: 0--10 U/mL), leading to a diagnosis of celiac disease. His duodenal biopsies showed changes consistent with gluten-sensitive enteropathy. After the diagnosis of celiac disease, the patient began a gluten-free diet and remained free of chorea at the 6-month follow-up. Chorea is a rare neurologic celiac disease manifestation that can be reversible. The celiac disease should be considered in the diagnostic workup of chorea for all ages, particularly in the treatment-resistant population, even in the absence of gastrointestinal symptoms. This report presents the first known case of chorea caused by celiac disease in a pediatric patient.

Oligomerization of 33-mer Gliadin Peptides: Supramolecular Assemblies in Celiac Disease.

The 33-mer gliadin peptide and its deamidated derivative, known as 33-mer DGP, are proteolytically resistant peptides central to the pathomechanism of celiac disease (CeD), the autoimmune presentation of gluten-related disorders (GRD). Both peptides can form spontaneous oligomers in the nanomolar concentration, leading to the formation of nanostructures. In other protein-related diseases, oligomers and aggregates are central in their pathomechanism; therefore, it was hypothesized that the oligomerization of proteolytical-resistant 33-mer gliadin peptides could be an underrecognized disease trigger. This review focuses on the current understanding of 33-mer peptides and their oligomers in vitro and cellular experiments. We intend to give the necessary details that incentivize the chemistry community to get involved in the effort to understand the self-assembly of gliadin peptides and the role of their supramolecular structures in CeD and the other GRD. More research is needed to design effective and safe chemical and/or nutritional interventions beyond the gluten-free diet.

Clinical features and adherence to a gluten-free diet in patients with celiac sprue in the north-west of Algeria

This study aims to identify the predominant form of celiac sprue and the adherence to a gluten-free diet in northwest Algeria. A retrospective analysis was performed on 128 celiac patients at the Department of Gastroenterology and the association of celiac patients. The results show a female predominance with a sex ratio of 0.4. The most affected age group is the young adults (15-29 years). Lean patients represent 42.2%, normal-weight patients represent 51.6% of the study sample, and 6.3% are overweight. 47.7% of cases have a familial form of the disease. 93% underwent a biopsy for diagnosis. 60.9% of patients were not diagnosed in childhood. The main classic gastrointestinal symptoms such as Diarrhea (89.1%) and bloating (56.3%) were detected. Extraintestinal symptoms included weight loss (64.1%), weakness and fatigue (58.6%). Other biological disorders like anemia (71.1%), thyroiditis (15.6%), and type 1 diabetes (14.8%) were observed. Most celiac patients (84.4%) follow the gluten-free diet but find its application difficult. The adherence of GFD does not depend on any parameter of the study (p>0.05). The classic form predominates through a variety of gastrointestinal symptoms and extra-digestive disorders. The unavailability and high cost of imported gluten-free products are the major barriers to gluten-free diet adherence.

Immune Checkpoint Inhibitor-Associated Celiac Disease: A Retrospective Analysis and Literature Review

Introduction: Immune checkpoint inhibitors (ICI) are used to treat various malignancies. They block the inhibitory signals of tumor cells and enhance the inflammatory cascade, which results in tumor killing. However, this can lead to unchecked inflammation throughout the body, leading to various adverse effects. A rare gastrointestinal adverse effect of ICI therapy is the development of immune-mediated celiac disease. This entity has a similar clinical presentation to the more common ICI-induced enterocolitis. Our study aims to determine the clinical characteristics and optimal treatment strategies for this rare ICI toxicity and differentiate it from ICI-induced enterocolitis. Methods and Material: We conducted a retrospective analysis of eight cases of ICI-induced celiac disease and 24 cases of ICI-induced enterocolitis from the literature. Data on patient demographics, clinical history, therapeutic interventions and outcomes were collected. A comparative analysis was performed to identify the key differences between the two groups. Results: Patients with ICI-induced celiac disease were more likely to have a pre-existing autoimmune condition and HLA-DQ2 positivity. Significant differences in clinical manifestations, histological findings, and treatment outcomes were observed. Notably, weight loss, nutritional deficiencies and electrolyte abnormalities were more commonly associated with ICI-induced celiac disease. Regarding pathology, duodenal villous blunting was noted more commonly with ICI-induced celiac disease. Initiating a gluten-free diet led to a rapid improvement in patients with ICI-induced celiac disease, while immunosuppressive therapy did not have an impact. Conclusion: ICI-induced celiac disease is a rare and underrecognized gastrointestinal adverse effect of ICI therapy, often misdiagnosed as ICI-induced enterocolitis. Early recognition and treatment with a gluten-free diet can lead to rapid symptom resolution, sparing patients from unnecessary systemic immunosuppression and the discontinuation of antineoplastic immunotherapy.

Proteomic analysis of plasma and duodenal tissue in celiac disease patients reveals potential noninvasive diagnostic biomarkers

The pathogenesis of celiac disease (CeD) remains incompletely understood. Traditional diagnostic techniques for CeD include serological testing and endoscopic examination; however, they have limitations. Therefore, there is a need to identify novel noninvasive biomarkers for CeD diagnosis. We analyzed duodenal and plasma samples from CeD patients by four-dimensional data-dependent acquisition (4D-DIA) proteomics. Differentially expressed proteins (DEPs) were identified for functional analysis and to propose blood biomarkers associated with CeD diagnosis. In duodenal and plasma samples, respectively, 897 and 140 DEPs were identified. Combining weighted gene co-expression network analysis(WGCNA) with the DEPs, five key proteins were identified across three machine learning methods. FGL2 and TXNDC5 were significantly elevated in the CeD group, while CHGA expression showed an increasing trend, but without statistical significance. The receiver operating characteristic curve results indicated an area under the curve (AUC) of 0.7711 for FGL2 and 0.6978 for TXNDC5, with a combined AUC of 0.8944. Exploratory analysis using Mfuzz and three machine learning methods identified four plasma proteins potentially associated with CeD pathological grading (Marsh classification): FABP, CPOX, BHMT, and PPP2CB. We conclude that FGL2 and TXNDC5 deserve exploration as potential sensitive, noninvasive diagnostic biomarkers for CeD.

A feasibility study using quantitative and interpretable histological analyses of celiac disease for automated cell type and tissue area classification

Histological assessment is essential for the diagnosis and management of celiac disease. Current scoring systems, including modified Marsh (Marsh–Oberhuber) score, lack inter-pathologist agreement. To address this unmet need, we aimed to develop a fully automated, quantitative approach for histology characterisation of celiac disease. Convolutional neural network models were trained using pathologist annotations of hematoxylin and eosin-stained biopsies of celiac disease mucosa and normal duodenum to identify cells, tissue and artifact regions. Biopsies of duodenal mucosa of varying celiac disease severity, and normal duodenum were collected from a large central laboratory. Celiac disease slides (N = 318) were split into training (n = 230; 72.3%), validation (n = 60; 18.9%) and test (n = 28; 8.8%) datasets. Normal duodenum slides (N = 58) were similarly divided into training (n = 40; 69.0%), validation (n = 12; 20.7%) and test (n = 6; 10.3%) datasets. Human interpretable features were extracted and the strength of their correlation with Marsh scores were calculated using Spearman rank correlations. Our model identified cells, tissue regions and artifacts, including distinguishing intraepithelial lymphocytes and differentiating villous epithelium from crypt epithelium. Proportional area measurements representing villous atrophy negatively correlated with Marsh scores (r = − 0.79), while measurements indicative of crypt hyperplasia positively correlated (r = 0.71). Furthermore, features distinguishing celiac disease from normal duodenum were identified. Our novel model provides an explainable and fully automated approach for histology characterisation of celiac disease that correlates with modified Marsh scores, potentially facilitating diagnosis, prognosis, clinical trials and treatment response monitoring.

Impact of a Gluten-Free Diet in Adults With Celiac Disease: Nutritional Deficiencies and Challenges

Impact of a Gluten-Free Diet in Adults With Celiac Disease: Nutritional Deficiencies and Challenges

A comprehensive analysis of demographics, comorbidities, and laboratory findings in adult celiac disease patients: a single center experience

Aims: This study aims to evaluate the demographics, comorbidities, and laboratory findings of patients with celiac disease in our clinic. Methods: A total of 91 celiac patients who were followed in our centre between January 2020 and September 2023 were included in the study. Demographic, laboratory and comorbidities data were analysed retrospectively. Results: 72 (79.1%) patients were female, and the mean age of the participants was 42.3 (+-) 15.1 years. Deficiency of iron was observed in 46 (50.6%) participants, vitamin B12 in 9 (9.9%) participants, folat in 11 (12.1%) participants, and vitamin D in 37 (40.7%) participants. Hypothyroidism and diabetes mellitus were found to be the two most common comorbidities of celiac disease. In addition, liver enzymes were demonstrated to be elevated in the 9 (9.9%) patients. Conclusion: Celiac disease is associated with mineral and vitamine deficiency. In addition, mildly elevated liver enzymes may be observed in the clinical course. Notably, extraintestinal manifestations, especially hypothyroidism and diabetes, may accompany the disease.

Gastrointestinal dysfunction in Parkinson's Disease: absence of anti-gliadin antibodies.

Parkinson disease (PD), which is a neurodegenerative disorder, includes several gastrointestinal symptoms that are similar to those of Celiac disease (CD). However, the presence of celiac antibodies in PD patients has not yet been studied. Our aim in this study is to compare anti-transglutaminase (ATA) and antigliadin antibodies (AGA) as well as gastrointestinal symptoms and nutrition habits between patients with Parkinson's disease (PD) and healthy controls. Serum AGA IgG and IgA and the ATA antibodies IgA and IgG were studied in 102 PD patients and 91 healthy controls. Gastrointestinal symptoms, specifically constipation, were investigated using the gastrointestinal system rating scale (GSRS) and the constipation rating scale (CRS). Dietary habits were also investigated and compared between the groups. No significant differences were found between the two groups in terms of celiac antibodies. As expected, the hypokinetic GSRS and CRS scores were significantly higher in the PD group (p<0.001). Dietary habits, especially carbohydrate-rich diets, had a negative impact on gastrointestinal symptoms in the PD patients. Studies have suggested a connection between PD and CD, which infers a probable non-celiac gluten intolerance and the need to offer PD patients an elimination diet. However, the results of our study did not support any link between celiac antibodies and PD. Notwithstanding, the negative impact of a carbohydrate-rich diet in PD patients still leaves a question regarding gluten sensitivity in these patients.

Issue Information

On the Cover: “Food insecurity impacts diet quality and adherence to the gluten‐free diet in youth with celiac disease” Wang, et al., 1180‐1191

120 Neuropsychiatric diseases in patients with dermatitis herpetiformis and other phenotypes of celiac disease: a cohort study

120 Neuropsychiatric diseases in patients with dermatitis herpetiformis and other phenotypes of celiac disease: a cohort study

Molecular Estimation of IL-15 Gene Effect and H. Pylori Prevalence in Celiac Disease

Remarkable positive associations across IL-15 values and the histopathological severity of celiac disease (CeD) indicate that interleukin (IL)-15 plays an essential part in the immunopathogenesis of the illness. There has been inconsistent evidence in certain research linking Helicobacter pylori to CeD. The goal of this meta-analysis was to measure the connection between CeD and H. pylori. Furthermore, the investigation examined the influence of H. pylori on the indications and categorization of CeD. This study includes 35 patients with CeD. They were fully informed of the study's goals before providing their signed consent. A group of 35 healthy blood donors made up the control group. Blood was drawn, transferred into gel tubes, and centrifuged. Serum specimens from both participants and controls have been obtained and then kept at -20°C in a deep freezer for subsequent use. It have been investigated the molecular relationship between IL-15 gene and CeD. It have been investigated the prevalence of H. pylori and CeD. The result of age and CeD incidence correlation indicates that there is no significance between age samples parameter and CeD incidence (control= 12.83 ± 0.4211, n=35 patients=12.23 ± 0.3358, n=35, p value=0.2692). Results of correlation between gender and CeD incidence indicates that number of male samples (24) and CeD incidence is more than that of female samples (11). Results of correlation between urban-rural residence and CeD incidence indicate that the average CDAT score for those who live in rural was higher in the urban area (good adherence to a gluten-free diet).

Genetic variants in the HLA-DQ2 and HLA-DQ8 genes and their involvement in the predisposition to celiac disease

Celiac disease is a multisystem disorder that is triggered by the consumption of gluten in genetically predisposed people, particularly those who carry the HLA-DQ2 and HLA-DQ8 alleles. Environmental factors and certain epigenetic mechanisms play a fundamental role in the manifestation of the disease. It has been shown that the gut microbiome can influence disease progression to some extent. Celiac disease presents with gastrointestinal and extraintestinal symptoms that complicate the diagnosis. Classic symptoms include digestive disorders, while non-classic symptoms include anemia, osteoporosis, and unexplained fatigue. Serological antibody tests and duodenal biopsy are key to a diagnosis, especially in atypical cases. At present, the only treatment is a strict gluten-free diet, although this presents certain problems due to the high cost and nutritional deficiencies. New research is looking for alternatives such as gluten-breaking enzymes as well as immunomodulatory treatments in hopes of more comprehensive options in the future.

Patient perceptions of the Finnish guidelines enabling coeliac disease diagnosis without biopsies in adults

Objectives Diagnosis of coeliac disease based on serology only has been allowed since 2018 in Finland for adults meeting specific criteria. We studied the patient experiences and perceptions of this novel diagnostic option. Methods Altogether 194 adult patients were questioned on socio‐demographic and health-related characteristics, quality of life and various coeliac disease-related issues. The results were compared between patients diagnosed with intestinal biopsy or based on serology only. Results Altogether 69 (36%) of the patients were diagnosed without duodenal biopsies. They were younger (median 43 vs. 51 years, p = 0.046), diagnosed more recently (2021 vs. 2020, p < 0.001) and more often in primary health care (78% vs. 43%, p = 0.001), had fewer esophageal symptoms at diagnosis (17% vs. 30%, p = 0.046) and considered the diagnostic process easier (49% vs. 30%, p = 0.032) than those diagnosed by duodenal biopsy (n = 125). The no-biopsy group received less often dietician follow-up (4% vs. 17%, p = 0.012), reported more persistent symptoms (36% vs. 21%, p = 0.026) and experienced more stress due to the diet (68% vs. 47%, p = 0.039). Symptom persistence or stress were not associated with year of diagnosis or dietician follow-up. The groups were comparable in socio-economic characteristics, general health, quality of life, diagnostic delay, dietician guidance at diagnosis, and dietary adherence. Conclusions The non-invasive approach resulted in de-centralized diagnosis and easier patient-experienced diagnostic process of coeliac disease, but was associated with increased risk for persistent symptoms and stress due to gluten-free diet. These results highlight the significance of appropriate patient guidance and support regardless of the diagnostic strategy.

Degradation of gluten using plant proteases

The paper describes the fact of the presence of a proteolytic enzyme in the leaves of the natural hybrid variety of grape - Isabella (Vitis Labrusca L.) and the perspective of its practical application for breaking down wheat gluten. As our research has shown, this enzyme effectively degradates the constituent components of the protein fraction of wheat flour-the gluten fraction. It is known that the wheat gluten is a strong allergen for many people, which can initiate a disease such as celiac disease. Protease from Isabella leaves carries out deep hydrolysis of gluten to low molecular weight soluble peptides and amino acids. This effect can be successfully used in the production of gluten-free bread products.