Celiac Disease Research Articles

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.

Medical and Demographic Characteristics of Patients With Eosinophilic Esophagitis and Celiac Disease

Background: Eosinophilic esophagitis (EoE) and celiac disease are both chronic T helper cell-mediated inflammatory conditions of the digestive tract. Although an association between these two conditions has been suggested, it has not been well characterized in a real-world setting. Goals: Our objective was to better examine the association between celiac disease and EoE using a real-world population database. Study: This was a retrospective cohort study of data using TriNetX, a global population database, to identify patient records using International Classification of Disease 10 (ICD-10) codes. We organized participants into six distinct cohorts predicated on age and diagnoses of celiac disease and EoE between April 28, 2003, and April 28, 2023. Patient demographics, prevalence, incidence, and medical characteristics of each cohort were extracted. Results: Among 46,398 patients with EoE and 84,383 patients with celiac disease, individuals with EoE demonstrated a higher prevalence (2.76%) and incidence (329/100,000 persons/year) of celiac disease compared with those without EoE (0.21% prevalence and 146/100,000 incidence, between 2021 and 2023). A concurrent diagnosis of both conditions increased the risk of asthma (RR: 2.00 pediatric, 1.82 adult), allergic rhinitis (RR: 2.35 pediatric, 1.81 adult), atopic dermatitis (RR: 3.28 pediatric, 2.07 adult), and rheumatoid arthritis (RR: 3.53 pediatric, 1.41 adult). In addition, patients with celiac disease with EoE exhibited a heightened risk for iron deficiency anemia (aHR 1.789; 95% CI: 1.166 to 2.745). Conclusions: Both the incidence and prevalence of EoE are elevated in patients with celiac disease and vice versa. These concurrent diagnoses affect disease characteristics and heighten the risk of complications in celiac disease.

LINE-1 hypomethylation characterizes the inflammatory response in coeliac disease associated-intestinal mucosa and small bowel adenocarcinomas.

Long interspersed nuclear elements 1 (LINE-1) are the most abundant and the only autonomous mobile elements in the human genome. When their epigenetic repression is removed, it can lead to disease, such as autoimmune diseases and cancer. Coeliac disease (CeD) is an immune-mediated disease triggered by an abnormal T-cell response to dietary gluten and a predisposing condition of small bowel adenocarcinoma (SBA), frequently characterized by epigenetic alterations. The aim of this work was to assess LINE-1 methylation by bisulphite pyrosequencing and NanoString® gene transcription analysis in 38 CeD-SBAs compared with 25 SBAs associated with Crohn's disease (CrD-SBAs) and 25 sporadic SBAs (S-SBA). Both analyses were also performed in duodenal mucosae from 12 untreated CeD patients (UCD) and 19 treated CeD patients (TCD), and in 11 samples of normal intestinal mucosa to better investigate the role of LINE-1 deregulation in CeD and in CeD-SBA. A significant loss of LINE-1 methylation was observed in CeD-SBAs and in mucosae from UCD patients (with very similar methylation levels) compared with controls. By contrast, a restoration of normal LINE-1 methylation levels was found in TCD mucosae after a strict gluten-free diet. LINE-1 hypomethylation does not lead to expression of ORF1 and ORF2, with the only exception being for one CeD-SBA. The expression analysis of enzymes modulating DNA methylation and inflammatory genes confirmed that CeD-SBA shared a very similar expression profile of UCD mucosae showing a strong upregulation of genes involved in inflammation, immune response, and T-cell activity compared with TCD mucosae. For the first time, this work demonstrates that loss of DNA methylation is an intrinsic epigenetic feature of CeD, accompanying the immune response as a reversible mechanism in patients following a strict gluten-free diet, and suggests the possible role of LINE-1 hypomethylation in promoting cell adaptability during the gliadin-related inflammatory process. © 2024 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Celiac disease is common in adults with cryptogenic cirrhosis and responds favourably to gluten-free diet

Introduction: Liver involvement is common in celiac disease (CeD), and upto 4.6% of patients with cryptogenic cirrhosis have CeD. We investigated the prevalence of CeD in patients with cryptogenic cirrhosis and assessed liver-related outcomes in them on GFD when compared to a propensity-score matched (PSM) cohort of patients with cryptogenic cirrhosis without CeD. Methods: Consecutive patients with cryptogenic cirrhosis were screened for CeD using IgA anti-tissue-transglutaminase antibody(anti-tTG) followed by anti-endomysial antibody (AEA) and duodenal and liver biopsies, on which IgA/anti-tTG colocalization studies were performed. These patients and a cohort of patients with cryptogenic cirrhosis without CeD [1:4 CeD: no CeD matched using PSM for age, sex, Child-Turcotte-Pugh(CTP) and model for end-stage-liver-disease(MELD)] were initiated on GFD plus standard of care (SOC) and SOC, respectively and followed up for liver-related outcomes for one year. Results: Of 232 patients with cryptogenic cirrhosis, 14 had high anti-tTG Ab (16.9±10.5 fold rise), with 9 AEA positive and 11(4.7%) biopsy-proven CeD. IgA/ anti-tTG-Ab colocalization was demonstrated in 7/8 liver and 10/11 duodenal biopsies. Patients with cryptogenic cirrhosis with definite CeD (n=11) and matched cohort without CeD (n=44) were similar at baseline [age:31.3±7.7 vs 31.8±9.3 years; 5(45.5%) vs 15(34.1%) females; MELDNa 9 (interquartile-range[IQR]: 8-15.5) vs 12(9-15); CTP 7(6-7.5) vs 6(5.75-7)]. Patients with CeD on GFD improved significantly on follow-up compared to those without CeD [follow-up MELDNa:9 (7.5-10.5) vs 18.5 (12-20);p=0.001 and follow-up CTP: 5 (5-5) vs 8(7-9);p&lt;0.001] with less frequent further decompensations and similar mortality (9.1% vs 18.2%;p=0.67). Conclusion: Approximately 4.7% of patients with cryptogenic cirrhosis have biopsy-proven CeD and their liver-related outcomes improve with GFD.

Vaccine Efficacy and Safety in Patients with Celiac Disease

Celiac disease (CD) is an autoimmune disorder caused by gluten intake in genetically predisposed individuals. This article provides an overview of the available data on the risks of infectious diseases and the mechanisms involved in CD, including a detailed analysis of vaccine efficacy, immunogenicity, and safety. The published articles were retrieved from the PubMed database using the terms “celiac disease,” “efficacy,” “hyposplenism,” “immune response,” “infections,” “immunization,” “immunogenicity,” “safety,” “vaccination,” and “vaccine.” CD can be associated with several autoimmune diseases, including selective immunoglobulin A deficiency (SIgAD), altered mucosal permeability, and hyposplenism. These conditions entail an increased risk of infections, which can be prevented by targeted vaccinations, although specific recommendations on immunization practices for subjects with CD have not been released. Regarding vaccinations, the immune response to the Hepatitis B virus (HBV) vaccine can be impaired in patients with CD; therefore, proposed strategies to elicit and maintain protective specific antibody titers are summarized. For patients with conditions that put them at risk of infections, vaccinations against Pneumococcus and other encapsulated bacteria should be recommended. Based on the available evidence, the Rotavirus vaccine offered to children could be useful in preventing CD in at-risk subjects. Overall, except for the HBV vaccine, vaccine efficacy in patients with CD is comparable to that in the general population, and no safety concerns have arisen.

Clinical Characteristics and Prevalence of Celiac Disease in a Large Cohort of Type 1 Diabetes from Saudi Arabia

Background and Objectives: The link between celiac disease (CD) and type 1 diabetes (T1D) has been well-documented in the medical literature and is thought to be due to a shared genetic predisposition in addition to environmental triggers. This study aimed to determine the seroprevalence and biopsy-proven CD (PBCD) prevalence in individuals with T1D from Saudi Arabia and identify their clinical characteristics and the impact on glycemic control. Materials and Methods: A total of 969 children and adolescents with confirmed T1D were investigated. Prospective and retrospective data were collected to include clinical, anthropometric, and biochemical data. Total IgA and anti-TTG-IgA antibodies were screened to detect seropositive cases. Upper intestinal endoscopy and biopsy were performed to find BPCD. Results: The seroprevalence of CD was 14.6% (141/969), while BPCD prevalence was 7.5%. Females had a higher prevalence than males: 17.8% vs. 9.8%, p &lt; 0.001. The CD group had lower HbA1c and more frequent hypoglycemia than the seronegative group. Conclusions: This study highlighted the high prevalence of CD in T1D Saudi patients. CD has multiple effects on glycemic control, growth, and puberty in children and adolescents with T1D. We emphasize the importance of early screening for CD at the time of diabetes diagnosis and periodically after that or if any atypical features present, especially anemia, growth delay, underweight, or frequent hypoglycemia.

Assessing the causal association between celiac disease and autism spectrum disorder: A two-sample Mendelian randomization approach.

The association between celiac disease (CD) and autism spectrum disorder (ASD) remains inconclusive. Reports from different observational studies have become controversial, necessitating exploration of the causal relationship between CD and ASD. To assess true causality, this study used a two-sample Mendelian randomization (MR) analysis to determine the causal association between CD and ASD. Summary-level data from a genome-wide association study (GWAS) of the European population were used to select instrument variables (IVs) at genome-wide significance (p < 5 × 10-8). The strength of IVs was also evaluated with F-statistics. The inverse variance weighted method (IVW) was the primary MR analysis, supported by other MR tests such as the weighted median method and weighted mode. The presence of horizontal pleiotropy was tested with MR-Egger and MR-PRESSO while other sensitivity analyses such as heterogeneity, leave-one-out analysis, and scatterplot were used to assess the validity of our MR results. Our study did not show an association between CD and ASD (OR, 0.994; 95% CI, 0.935-1.057; p = 0.859). There was also no evidence of horizontal pleiotropy (MR-Egger intercept = 0.015; p-value = 0.223) and heterogeneity (Q = 14.029; p-value = 0.051). These results were also complemented by the leave-one-out analyses, forest plot, and scatter plot, which showed that none of the SNPs influenced the result. The result of this study shows that CD is not causally associated with ASD.

Mendelian randomization analysis reveals causal effects of inflammatory bowel disease and autoimmune hyperthyroidism on diffuse large B-cell lymphoma risk

The clinical phenomenon whereby diffuse large B-cell lymphoma (DLBCL) occurs in patients with a history of autoimmune disease (AD) has been noted, but it remains controversial. This study aimed to evaluate the causal associations between nine ADs and DLBCL via a Mendelian randomization (MR) study. Single-nucleotide polymorphism (SNP) obtained from published genome-wide association studies (GWAS) was chosen as instrumental variable (IV). A total of nine ADs of European ancestry including asthma (56,167 cases and 352,255 controls), psoriasis (4,510 cases and 212,242 controls), autoimmune hyperthyroidism (962 cases and 172,976 controls), inflammatory bowel disease (31,665 cases and 33,977 controls), type 1 diabetes (6,683 cases and 12,173 controls), multiple sclerosis (14,498 cases and 24,091 controls), sarcoidosis (2,046 cases and 215,712 controls), ankylosing spondylitis (9,069 cases and 1,550 controls), and celiac disease (12,041 cases and 12,228 controls), were set as the exposure and DLBCL (209 cases and 218,583 controls) of European ancestry as the outcome. Inverse-variance weighted (IVW) was used as the primary analysis method, and the weighted median and MR-Egger method were used as supplementary methods. The sensitivity analyses employed in this study include the MR-Egger intercept, MR-PRESSO global test, Cochran’s Q test, leave-one-out analysis, and funnel plot. IVW showed that inflammatory bowel disease (OR = 1.241, 95% CI 1.009–1.526, P = 0.040) and autoimmune hyperthyroidism (OR = 1.464, 95% CI 1.103–1.942, P = 0.008) increased the risk of DLBCL without significant heterogeneity or horizontal pleiotropy, and the results remained stable according to the leave-one-out analysis. The IVW results revealed no associations between the other seven ADs and DLBCL: asthma (OR = 0.782, 95% CI 0.395–1.546, P = 0.159), psoriasis (OR = 0.842, 95% CI 0.669–1.060, P = 0.143), type 1 diabetes (OR = 1.071, 95% CI 0.860–1.334, P = 0.537), multiple sclerosis (OR = 1.331, 95% CI 0.941–1.883, P = 0.105), sarcoidosis (OR = 1.324, 95% CI 0.861–2.038, P = 0.200), ankylosing spondylitis (OR = 1.884, 95% CI 0.776–4.573, P = 0.161), and celiac disease (OR = 1.003, 95% CI 0.854–1.178, P = 0.969). Although no significant heterogeneity or horizontal pleiotropy was detected in these seven ADs and DLBCL, these results did not pass the leave-one-out analysis; therefore, the results need to be interpreted with caution. Inflammatory bowel disease and autoimmune hyperthyroidism may increase the onset of DLBCL. The risk of DLBCL should be considered in specific types of ADs.

Optimization of Functional Gluten‐Free Cake Formulation Using Rice Flour, Coconut Flour, and Xanthan Gum via D‐Optimal Mixture Design

ABSTRACTProlamins in wheat, barley, and rye cause celiac disease (CD), non‐celiac gluten sensitivity (NCGS), and wheat allergies (WA). Although rice can be a suitable alternative, gluten‐free rice flour products are less technologically advanced. However, coconut flour and xanthan gum could enhance product quality, fiber content, and functional properties. This study employed a response surface D‐optimal mixture design to investigate the impact of substituting Sadri Hashemi rice flour (RF) (15.60%–31.19%) with low‐fat desiccated coconut flour (CF) (0%–15.59%) and xanthan gum (XG) (0%–0.31%) in 17 runs based on batter weight. Eleven responses were analyzed and exhibited significant and valid models (p &lt; 0.0001), with satisfactory coefficient of determination (R2 &gt; 0.85) values and non‐significant lack of fit (p &gt; 0.1). Substitution at all levels significantly increased batter viscosity (R2 = 0.990) and specific weight (R2 = 0.995). Differences in cake crumb color (ΔE) decreased when RF was substituted with CF, while maximum ΔE elevation was observed with 0.31% XG due to synergistic effects with 5.09% CF (R2 = 0.974). Increasing the RF/XG ratio (0% CF) resulted in decreased water activity (aw), while increasing CF increased aw synergistically (R2 = 0.986). Moisture and texture hardness increased significantly with RF substitution up to 7.518% CF and 0.170% XG and 8.944% CF and 0.285% XG, respectively (R2 = 0.976 and 0.993). The volume index decreased with CF and XG (R2 = 0.989). Sensory acceptances were reduced by increasing XG while improved with optimal CF levels, predicted at 6.415% (R2 = 0.997), 6.784% (R2 = 0.999), 9.001% (R2 = 0.999), and 5.924% (R2 = 0.999) for color, taste, texture, and overall acceptance, respectively. Two‐sided prediction interval confirmation runs with 95% confidence (p ≤ 0.05) validated the models' accuracy and prediction of optimized combinations. The optimized gluten‐free cake formula (23.395% RF, 7.795% CF, 0% XG) achieved an 88.0% desirability score. Developing valid regression models facilitates a comprehensive investigation of cake quality and sensory properties, ensuring a viable gluten‐free product for individuals with gluten‐related disorders.

Assessing the Impact of Celiac Disease on the Quality of Life in Jordan

Assessing the Impact of Celiac Disease on the Quality of Life in Jordan

Older Adults with Celiac Disease Are At Increased Risk of Frailty:A Nationwide Cohort Study.

Celiac disease (CeD) is increasingly diagnosed in older adults, though few studies have explored complications in this group. As frailty confers increased risk for adverse events, we aimed to explore frailty in older adults with CeD. In a nationwide Swedish cohort, we identified adults ≥60 years with incident CeD between 2004-2017 which we matched to population-based controls without CeD by age, sex, county, and calendar-period. Baseline frailty within 3 years before CeD diagnosis or index date was assessed using the Hospital Frailty Risk Score. Among those without baseline frailty, we used conditional logistic regression to estimate odds ratios and 95% confidence intervals (CI) of future frailty at 5 years comparing CeD to controls. Logistic regression was used to evaluate the association between persistent villous atrophy vs mucosal healing and frailty in CeD patients. A total of 4,646 older adults with CeD were matched to 21,944 non-CeD individuals. Baseline frailty was increased in CeD patients (54.4%) compared to controls (29.7%, p<0.001), which existed across all frailty categories: low-risk (43.4% vs 23.8%), intermediate-risk (10.3% 5.4%), and high-risk (0.8% vs 0.6%). Among those without baseline frailty, CeD patients had a 66% increased risk of overall frailty at 5 years (95% CI 1.50-1.83). Mucosal healing in CeD individuals on follow-up biopsy did not protect against future frailty. Older adults with CeD were significantly more likely to become frail than matched comparators. This analysis reveals the increased vulnerability that older patients with CeD are likely to experience.

Single-cell integration reveals metaplasia in inflammatory gut diseases

The gastrointestinal tract is a multi-organ system crucial for efficient nutrient uptake and barrier immunity. Advances in genomics and a surge in gastrointestinal diseases1,2 has fuelled efforts to catalogue cells constituting gastrointestinal tissues in health and disease3. Here we present systematic integration of 25 single-cell RNA sequencing datasets spanning the entire healthy gastrointestinal tract in development and in adulthood. We uniformly processed 385 samples from 189 healthy controls using a newly developed automated quality control approach (scAutoQC), leading to a healthy reference atlas with approximately 1.1 million cells and 136 fine-grained cell states. We anchor 12 gastrointestinal disease datasets spanning gastrointestinal cancers, coeliac disease, ulcerative colitis and Crohn’s disease to this reference. Utilizing this 1.6 million cell resource (gutcellatlas.org), we discover epithelial cell metaplasia originating from stem cells in intestinal inflammatory diseases with transcriptional similarity to cells found in pyloric and Brunner’s glands. Although previously linked to mucosal healing4, we now implicate pyloric gland metaplastic cells in inflammation through recruitment of immune cells including T cells and neutrophils. Overall, we describe inflammation-induced changes in stem cells that alter mucosal tissue architecture and promote further inflammation, a concept applicable to other tissues and diseases.

Exploring the views of primary and secondary care physicians on the no-biopsy diagnosis of coeliac disease in adults: a qualitative interview study

ObjectiveDespite mounting evidence supporting a no-biopsy approach for the diagnosis of coeliac disease in adults, established clinical pathways in primary and secondary care could hinder implementation in clinical practice. We...

Characterization of sacha inchi (Plukenetia volubilis) and taro (Colocasia esculenta) flours with potential application in the preparation of both gluten-free and high protein foods.

Background Interest in alternative sources of tubers and legumes has increased in recent years because of the constant search for raw materials that provide bioactive compounds with antioxidant potential benefits for consumers. The functionality of new raw materials is sought through physical and/or chemical modifications to develop and innovate new foods. The objective of this study was to characterize taro (TF) (Colocasia esculenta) and sacha inchi (Plukenetia volubilis) flours, obtained by the wet (SIF-WM) and defatted method (SIF-DM), as an alternative for the formulation of new functional foods. Methods The free polyphenols of the different mixtures were analyzed, and the antioxidant properties of the extracts obtained were measured using ABTS.* (2,2′-Azino-bis(3-ethylbenzthiazoline-6-sulfonic acid). The ABTS radical method, which reacts with the phenolic compounds of the food matrix, using Trolox as a standard. The blends were subjected to pasting analysis, flow profile tests, determination of viscoelastic properties (temperature sweep). Characterization of common microorganisms in these foods was performed. Results The highest protein value was obtained in the sacha inchi flour obtained by the defatted method (72.62%). The majority of components in taro were carbohydrates (85.4%). About antioxidant and determination of free polyphenols, taro flour obtained values of 2.71 μmol ET/g and 7.47 mg EAG/g, higher than sacha inchi flours. In the rheological analysis (pasting properties, flow profile, and viscoelasticity), we observed that adding taro flour in different mixtures increases the viscosity peak and a lower breakdown, while there was an increase in setback. Except for defatted sacha flour, the others presented a flow index &gt;1 before heating, showing a dilatant fluid behavior. The presence of taro flour improves gel formation and stability. Staphylococcus aureus and Salmonella were present in the taro flour. Conclusions The flours analyzed represent a raw material with great potential for the development of products such as protein snacks due to the contribution of sacha inchi, with good expansion due to taro starch, and naturally gluten-free for people with celiac disease.

Severe Acute ulcerative Colitis Disease with Severe Celiac Disease Associated with Clostridium difficile Colitis Infection Complicated with Refeeding Syndrome, Challenging Case Report

Severe Acute ulcerative Colitis Disease with Severe Celiac Disease Associated with Clostridium difficile Colitis Infection Complicated with Refeeding Syndrome, Challenging Case Report

Prevalence and etiologies of non-responsive celiac disease: A systematic review and meta-analysis.

Non-responsive celiac disease (NRCD) is defined as ongoing symptoms despite 6-12months of gluten-free diet (GFD), the only known treatment for celiac disease (CeD). There is inconsistency in studies describing the proportion of patients having NRCD and its various causes among patients with CeD. We therefore conducted a systematic review and meta-analysis to determine the prevalence and causes of NRCD. The PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases were searched for original studies reporting the proportion of patients with persistent symptoms after ≥6months of GFD. Studies reporting the etiologies of NRCD were also identified. The systematic review was conducted as per the Meta-analysis of Observational Studies in Epidemiology guidelines. Statistical analysis was performed in STATA. Of 2965 search results, nine studies met the inclusion and exclusion criteria. Five studies (n=4414) reported data on prevalence, and seven studies (n=790) reported the causes of NRCD. The pooled prevalence of NRCD was 22% (95% confidence interval, 11-35%). Among patients with NRCD, inadvertent exposure to gluten was the most common cause (33%), followed by functional gastrointestinal disorders including irritable bowel syndrome in 16%. Refractory CeD type II along with its premalignant and malignant sequelae was observed in 7% of patients with NRCD. One in five patients with CeD may not respond to GFD and would likely be classified as NRCD. Inadvertent gluten exposure was the cause of ongoing symptoms in one-third of patients with NRCD. Improving adherence to GFD along with developing novel therapeutics to mitigate symptoms due to ongoing gluten exposure is critical.

Celiac Disease and Inflammatory Cardiomyopathies: Exploring the Heart-Gut Axis.

Background: Celiac disease (CD) is associated with an increased risk of cardiovascular (CV) events, especially inflammatory heart diseases. We aimed to gather evidence on the association between CD and inflammatory CV diseases, including pericarditis and myocarditis, and the underlying pathophysiological mechanisms. Methods: The PubMed, Scopus, and Google Scholar databases were searched for studies assessing the prevalence and the long-term outcomes of patients with CD and inflammatory CV diseases. Result: Ten studies (nine case series/reports and one prospective observational study) covering a total of 22 patients, including 9 women (41%) and 13 men (59%), were evaluated. The median age was 23 (IQR, 12-41) years. A total of 6 patients had recurrent pericarditis, while 16 patients had celiac-related myocarditis (11 patients presented with heart failure and 5 with arrhythmia). A strict gluten-free diet (GFD) alone was effective in 87.5% of cases (4/6 for pericarditis and 10/16 for myocarditis). All patients with pericarditis achieved complete resolution of symptoms. Conversely, heart function was restored in 81% of patients with myocarditis. Only one patient died. Conclusions: Myocarditis and/or pericarditis, especially if recurrent, may complicate CD in pediatric and adult subjects due to an autoimmune reaction involving the pericardium/myocardium and the small intestine.

Common Presentation and Clinical Correlates of Celiac Disease in Pediatric Population of Pakistan

Objective: To explore the various clinical presentations in childhood celiac disease patients of Sindh, Pakistan. Study Design: Cross-sectional study Setting and Duration of Study: Pediatric Department, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Khaipur Mirs Pakistan, from Sep 2018 to Mar 2020. Methodology: A total of 140 children aged between 1-15 years, with diagnosed cases of celiac disease were enrolled in the study. Patients with inconclusive diagnosis, with multiple comorbidities, age &gt;15 years, or children whose parents did not give consent to take part in the study were excluded from the current study. All children were further categorized according to the sociodemographic and clinical presentation. Results: The mean age of patients at the onset of symptoms was 3.15±1.25 years. Out of 140 patients, 74(52.8%) were male and 66(47.1%) female. Out of 140 patients, 28(20%) patients had positive anti-endomysial antibody titers. About 8 patients had concomitant autoimmune diseases i.e. Type 1 diabetes mellitus, out of these 5 tested positive for anti-endomysial antibody titers. The most common presentation was chronic diarrhea, seen in 13(32%) of patients. Conclusion: The current study revealed that the majority of the diagnosed pediatric patients presented with a typical clinical picture of celiac disease.

Evaluating osteopontin levels in pediatric celiac disease: a potential indicator for mucosal atrophy and osteoporosis

Evaluating osteopontin levels in pediatric celiac disease: a potential indicator for mucosal atrophy and osteoporosis