Gluten-sensitive Enteropathy Research Articles

A review of gluten and sorghum as a gluten free substitute

The review explores the role of gluten in food products, its associated health issues, and the growing market for gluten-free alternatives. Gluten, a protein in wheat, barley, and rye, is widely used in the food industry for its binding and stabilizing properties. Increasing gluten intolerance, especially in those with celiac disease, has boosted demand for gluten-free options like sorghum. Sorghum, a gluten-free grain, offers high protein and fiber content but also contains antinutritional factors like tannins, phytates, and protease inhibitors. Various processing techniques, such as dehulling, soaking, fermentation, and heating, have been developed to address these factors. Future trends in sorghum are expected to focus on innovative processing methods to enhance its nutritional value. This review also provides a detailed examination of gluten, its functions in foods, health concerns, gluten-free products, sorghum-based foods, antinutritional properties, processing technologies, and future opportunities.

Otorhinolaryngological Manifestations and Esophageal Disorders in Celiac Disease: A Narrative Review.

Celiac disease (CeD) is a chronic gluten-sensitive immune-mediated enteropathy characterized by numerous intestinal and extra-intestinal signs and symptoms. Among extra-intestinal manifestations, otorhinolaryngological (ORL) complaints in CeD are relatively rare and their relation to CeD is frequently overlooked by physicians. Recent studies underlined that the prevalence of recurrent aphthous stomatitis, aphthous ulcers, geographic tongue, and xerostomia was significantly increased in CeD patients compared with healthy individuals. However, data about the other oral manifestations of CeD, such as atrophic glossitis, glossodynia, angular cheilitis, and salivary abnormalities, are scanty. Further ORL conditions associated with CeD include sensorineural hearing loss, nasal abnormalities, and obstructive sleep apnea. Moreover, several esophageal disorders such as gastroesophageal reflux disease and eosinophilic esophagitis have been associated with CeD. The pathophysiological link between both ORL and esophageal manifestations and CeD might be further investigated. In addition, also the role of gluten-free diet in improving these conditions is largely unclear. Certainly, otorhinolaryngologists can play an important role in identifying people with unrecognized CeD and may help prevent its long-term complications. The aim of this narrative review is to analyze the latest evidence on the association between CeD and ORL and esophageal manifestations.

Nutritional and Health Benefits of Millets

Millets are group of small seeded grasses that have been cultivated for thousands of years in various parts of the world. They are highly nutritious and versatile, making them an essential part of many traditional diets. Millets are also drought-resistant and require less water than other cereal crops, making them an ideal crop of regions with limited water resources. There are several types of millets like Sorghum, Pearl millet, Proso millet, Kodo millet, Finger millet, Foxtail millet and Barnyard millet, Little millet, Browntop millet. Each type has its unique nutritional profile and uses. Apart from being a nutritious food source, millets also have several health benefits. They are gluten-free, making them an excellent alternative for people with celiac disease or gluten intolerance. Millets are also low in glycemic index, making them an ideal food for people with diabetes. They also have a environmental benefits as they require less water than other crops like rice, wheat, making them ideal for regions with limited water resources. So, this article is an effort to put emphasis on Nutritional and Health Benefits of millets.

SOFTWARE FOR NUTRITIONAL ASSESSMENT OF PEOPLE WITH GLUTEN-RELATED DISORDERS

In the context of complex nutrition issues, nutritional assessment software for people with gluten-related disorders can be a precious tool for professionals in the field. It could serve as a support for novice nutritionists. The purpose of this research is to develop software for the nutritional assessment of people with Gluten-related disorders (GRDs) in the Republic of Moldova, intended for nutrition students. The development of the Software followed the systemic approach of the Nutrition Care Process, which is a graphical visualization illustrating the internal and external steps and factors that influence the use of the process. The nutritional Software was developed based on the information system Embarcadero RAD Studio Alexandria Edition, having Microsoft SQL Server as a database. The developed Software offers a personalized and precise approach, taking into account the consumer's anamnesis, the results of clinical evaluations, and anthropometric parameters, but also specific biomarkers for GRDs and offering the possibility of data recording, scanning and archiving of the results obtained from the laboratories analysis sampling. The system includes functionality to monitor and evaluate client progress toward health goals, and nutrition users can effectively track progress and make appropriate adjustments.

Comprehensive review on millets: Nutritional values, effect of food processing and dietary aspects

Millets are a group of small-seeded grains cultivated for centuries as staple food crops in many parts of the world. In the recent years, there has been a growing interest in millet due to its exceptional nutritional and health benefits. Millets are rich in essential nutrients such as proteins, dietary fiber, vitamins, minerals, and antioxidants. They are also gluten-free and have a low glycemic index, making them suitable for individuals with gluten intolerance or diabetes. Studies have shown that regular millet consumption can contribute to several health benefits. The high fiber content in millet aids digestion, prevents constipation, and promotes a healthy gut microbiome. Millets reduce the risk of chronic diseases, including cardiovascular diseases, type 2 diabetes, and certain cancers. The antioxidants in millet help to protect against oxidative stress and inflammation, which are underlying factors in various conditions. Furthermore, millet has a positive impact on weight management. The combination of high fiber and low glycemic index in millets promotes satiety, regulates blood sugar levels, and helps to maintain a healthy body weight. Additionally, millet has anti-inflammatory, antimicrobial, and anticancer properties. In conclusion, millet offers a wide range of nutritional and health benefits. Their nutrient density, gluten-free nature, and low glycemic index make them valuable in a balanced diet. Incorporating millet into regular meals can contribute to improved overall health and well-being. Further research is needed to explore the full potential of millets and their specific health effects on different populations. This review discussed the various involved government bodies and their dietary guidelines. Policy development and dietary guidelines play a crucial role in promoting millet consumption.

A review on the use and scope of finger millet (Ragi) in prevention and management of non-communicable diseases

Ragi (Eleusine coracana L.), or finger millet, is one of the ancient millets used as a staple food in India. Modernization has created an impact on the food habits of humans. Refined flours, polished grains, newly harvested grains, processed and preservative-added foods are causative factors for lifestyle diseases namely diabetes, hypertension, cardiovascular diseases, obesity, lung disorders, gluten enteropathy, and hormonal imbalances. Good quality nutritional food is essential for maintaining health. The Indian government is endeavoring to introduce traditional food practices to the globe. International Year of Millets 2023 has widely gained the global attention toward millets and their health benefits. Millets are nutri-cereals and are vital part of grains in Indian foods. Ragi is a prime millet crop with nutritional, therapeutic, and commercial importance. Ragi contains high amounts of calcium, and protein with well-balanced essential amino acids. Thus, ragi is an ideal food for diseases such as diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, and cancer. Its high fiber content prevents constipation, high blood pressure, and gluten intolerance. It has demonstrated the ability to control blood glucose levels due to low glycemic index (54–68) and insoluble fibers, which helps to control blood glucose levels in hyperglycemia, making it an essential food for diabetes. It is pesticide-free, easy to grow, and cost-effective crop, hence a choice for commercial gains. The current review presents ragi's significance in preventing and managing non-communicable diseases.

Clinicopathological Profile of Dermatitis Herpetiformis Patients in Saudi Arabia.

Objectives The aim of this study was to describe the clinical, serological, and histopathological features of patients with dermatitis herpetiformis (DH) in Saudi Arabia. Methods We retrospectively reviewed the medical charts of all patients diagnosed with DH in the dermatology departments of National Guard Health Affairs (NGHA) hospitals in five different cities, from 2016 to 2022. We included patients who had been diagnosed by a dermatologist and had a combination of typical DH skin lesions, positive immunoglobulin A (IgA) on direct immunofluorescence (DIF), and/or positive tissue transglutaminase (tTG) IgA. Results A total of 11 patients were included. Their average age was 43.6 ± 12.5 years, and the ratio of females: males was 2.7: 1. Among the eight skin biopsies performed, IgA was detected on DIF in five patients. Seven out of nine patients (77.8%) had positive tTG IgA. Nine patients were managed with dapsone and a gluten-free diet (GFD); they had excellent responses within months. Conclusion The profiles of Saudi patients with DH were similar to those of Caucasian patients, but DH appears to be less common in Saudi Arabia. The high positive rates of tTG IgA make it an important tool for diagnosis in unclear cases. Dermatitis herpetiformis is likely associated with underlying gluten-sensitive enteropathy in Saudi patients.

Trends in biological and genetic markers of gluten-related disorders research

This study aimed to evaluate the distribution and progress of the scientific production on biological and genetic markers of gluten-related disorders (BGM-GRD), supporting by a scientometric analysis. Emerging trends were mapped using CiteSpace. 1,050 studies were retrieved from Web of Science (1945-2022), of which 452 were eligible. Early 90s, research started to rise significantly until now. Celiac disease (CD) was the most studied. Studies were performed in patients with 53 different diseases or conditions, mainly type 1 diabetes mellitus (24.1%). Scientific production increased by 2.4 times from 2001-2021, while the citations numbers quintupled, which reflects the high quality of research (H-index of 56). Italy, USA and Spain stood out in productivity; USA was the core of the network of the largest and oldest cluster of countries. Australia, Germany, Israel and Poland stood out in quality. Eighteen from 817 institutions produced 46.7% of studies. Recently, the main interests are in the effect of environmental on metabolic pathways, determination of the prevalence and diagnosis of CD, mainly in children, as well as risk assessment and validation of biomarkers for CD diagnosis, with a focus on non-invasive methods.

The Potential of Edible Films, Sheets, and Coatings Based on Fruits and Vegetables in the Context of Sustainable Food Packaging Development.

Several consumable substances, including fruit and vegetable purees, extracts, juices, and plant residue, were analyzed for their matrix-forming potential. These matrices serve as the basis for the production of edible films, sheets, and coatings that can be eaten as nutritional treats or applied to food products, thereby contributing to their overall good quality. Furthermore, this innovative approach also contributes to optimizing the performance of synthetic packaging, ultimately reducing reliance on synthetic polymers in various applications. This article explores the viability of incorporating fruits and vegetables as basic ingredients within edible films, sheets, and coatings. The utilization of fruits and vegetables in this manner becomes achievable due to the existence of polysaccharides and proteins that facilitate the formation of matrices in their makeup. Moreover, including bioactive substances like vitamins and polyphenols can impart attributes akin to active materials, such as antioxidants or antimicrobial agents. Advancing the creation of edible films, sheets, and coatings derived from fruits and vegetables holds great potential for merging the barrier and mechanical attributes of biopolymers with the nutritional and sensory qualities inherent in these natural components. These edible films made from fruits and vegetables could potentially serve as alternatives to seaweed in sushi production or even replace conventional bread, pancakes, tortillas, and lavash in the diet of people suffering from celiac disease or gluten allergy, while fruit and vegetable coatings may be used in fresh and processed food products, especially fruits and vegetables but also sweets.

Pathological Manifestations of Gluten-Related Neuro-Psychiatric Disorders and the Impact of Gluten-Free Diet in a Pediatric Age Group: A Systematic Review.

Gluten, as a term, causes unease amonga vast majority of the population. The reason is the body's inability to process gluten, causing various pathological manifestations. While celiac disease is predominantly a gastrointestinal disease, it also has various extra-intestinal manifestations. Many children receive diagnoses of idiopathic neuropsychiatric symptoms such as epilepsy, attention-deficit hyperactivity disorder (ADHD), restless leg syndrome (RLS), and peripheral neuropathy without ever finding the root cause. A majority of these cases may be associated with celiac disease if only their antibody titers and other appropriate investigations were conducted. The treatment of these manifestations may be eliminated or at least controllable with dietary modification to a gluten-free diet (GFD). In this paper, we will discuss the pathology of celiac disease and the impact of GFD on the neuropsychiatric aspects of this disease, which is of higher prevalence in the pediatric population. A comprehensive literature search was conducted in prominent databases, namely PubMed and Google Scholar, to include studies that provided individual-level data on the neuropathological manifestations and the impact of a GFD on extra-intestinal manifestations of celiac disease. The research protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) with the registration ID: CRD42023415100. Based on the inclusion and exclusion criteria, we included prospective studies, observational studies, and case reports on pediatric patients with biopsy-proven celiac disease, serologically positive celiac disease, celiac disease with neuropsychiatric manifestations, and studies reporting the impact of GFD. After a rigorous quality assessment to remove the risk of bias, we finally included 20 studies to be discussed. In 6 (30%) studies, patients with neuropsychiatric manifestations had positive serology findings and a relatively higher grade of biopsy results. Seven studies discussed the positive impact of GFD. Five of these seven studies reported statistically significant results (p ≤ 0.001).Our study suggests that gluten plays a role in the severity of neuropsychiatric manifestations of celiac disease. Considering the results of our study, we can see that GFD does impact the prognosis of the disease. Neuropsychiatric findings without gastrointestinal manifestations are more common in the pediatric age group. We have clear evidence that several neurological conditions (neuropathy, ADHD, epilepsy, and RLS) have not only a significant association with gluten but can also potentially benefit from GFD. Thus, screening, with a combination of serological, biopsy, and imaging techniques, must be adapted into the guidelines for early detection and induction of GFD. Furthermore, studies should aim at introducing GFD in the pediatric population as a mode of primary prevention. In conclusion, our review underscores the importance of gluten while dealing with idiopathic neurological conditions in children and hopes to shed light on this commonly misdiagnosed and easily manageable disease.

FRI258 A Diagnostic Journey To Autoimmune Polyendocrine Syndrome Type 2

Abstract Disclosure: S. Amankwah: None. H.K. Driscoll: None. C. Muojieje: None. M. Sanati: None. Background: Approximately 50-65% of patients with autoimmune adrenal insufficiency have one or more autoimmune endocrine disorders. This case demonstrates the importance of considering autoimmune polyendocrine syndrome (APS) when a patient presents with more than one autoimmune endocrine disorder. Case: A 29-year-old woman with history of idiopathic intracranial hypertension, hypothyroidism on levothyroxine 50 mcg daily, endometriosis, and chronic migraines complained of fatigue, word finding difficulty, misspeaking of words, and staring spells. An MRI of the brain w+wo IV contrast revealed hypo-enhancing appearance of the pituitary gland. The patient was referred to endocrinology by neurology. Hormonal work up was performed checking for prolactin, ACTH, morning cortisol, TSH, Free T4, FSH, LH, IGF-1 and a serum chemistry panel. Thyroid antibodies were also ordered to help understand the etiology of her hypothyroidism. Pituitary hormones were normal except elevated TSH and borderline low serum cortisol. Subsequently a co-syntropin stimulation test resulted in inadequate cortisol rise. ACTH level measured inappropriately low normal. The patient then started steroid replacement therapy. Thereafter, 21-hydroxylase antibodies, serum renin and aldosterone were checked to screen for Addison Disease. Her 21-hydroxylase antibody was positive, aldosterone level low, and renin elevated pointing to autoimmune adrenalitis etiology. Her thyroid antibodies were also positive indicating autoimmune thyroid disease. Considering these results, the condition of APS came into question. Hence, the patient was screened for type 1 diabetes mellitus which was positive for glutamic acid decarboxylase 65 antibody but negative for insulin and pancreatic islet cell antibodies. Her hemoglobin A1c was 5.0%. Due to her history of gluten intolerance, she was screened for celiac disease which was negative for t-Transglutaminase antibody. The patient’s fatigue improved on steroid replacement therapy. She became euthyroid after increasing her levothyroxine dose to 75 mcg daily, and repeated MRI a year later did not show pituitary abnormalities. Discussion: APS type 2 is a polygenic inherited disorder associated with HLA-DR3 and DR4 that affects adult females more than males. The syndrome is characterized by type 1 diabetes mellitus, autoimmune thyroid disease and Addison disease. Associated nonendocrine autoimmune syndromes include celiac disease, pernicious anemia, and atrophic gastritis. These characteristics overlap with APS type 1 except for autoimmune thyroid disease that presents with type 2. It should be noted that thyroxine therapy can precipitate a life-threatening Addison crisis in a patient with untreated adrenal insufficiency and hypothyroidism. Therefore, it is necessary to evaluate adrenal function in all hypothyroid patients in whom APS is suspected. Presentation: Friday, June 16, 2023

Gluten related disorders: a review of the literature

Gluten-related disorders have become an epidemiologically significant phenomenon, with an estimated prevalence of about 5% worldwide. The current classification of gluten-related disorders is based mainly on their pathophysiology, and the following categories can be distinguished: Immune-mediated disorders, which include celiac disease, allergic reactions, such as wheat allerg, and non-celiac gluten sensitivity, a condition characterized by both gastrointestinal and extraintestinal symptoms, which has recently gained popularity. Diagnostic errors in gluten-associated diseases are still a pressing clinical problem. Based on the literature, we propose a practical methodological approach to guide clinicians on how to recognize them and avoid errors. The first part of the review presents literature data on the history, causal factors in the development of gluten-related diseases, and autoimmune gluten intolerance celiac disease.

Can open label placebos improve pain and gluten tolerance via open label placebos in fibromyalgia patients? A study protocol for a randomised clinical trial in an outpatient centre

IntroductionFibromyalgia syndrome (FMS) is defined as a medical condition with chronic widespread musculoskeletal pain accompanied by mood disorders, fatigue and sleep disturbances. Treatment of this condition can often be challenging....

Chronic application of alcohol-soluble gluten extract over undamaged skin causes clinical sensitization for life-threatening anaphylaxis via activation of systemic Th2 immune responses in mice.

Gluten allergy is a major public health problem that is growing at an alarming rate. Specific mechanisms underlying sensitization to gluten remain incompletely understood. Currently, it is unclear whether chronic exposure to alcohol-soluble gluten extract via undamaged skin has the capacity to clinically sensitize mice for life-threatening anaphylaxis. Using an adjuvant-free mouse model, here we tested the hypothesis that chronic application of alcohol-soluble durum gluten (ASDG) extract will clinically sensitize mice for life-threatening anaphylaxis. This study was conducted in a gluten-free Balb/c mouse colony that was established and maintained on a plant protein-free diet. Groups of adult female mice were exposed dermally to ASDG extract or vehicle once a week for 9-weeks. Specific (s) and total (t) IgE levels were quantified. Mice were challenged systemically with ASDG to measure symptoms of systemic anaphylaxis. Hypothermic shock response (HSR) and mucosal mast cell degranulation response (MMCR) were determined upon challenge. Spleen Th1, Th2, and other immune markers were quantified. We found that chronic exposure to ASDG elicited robust elevation of sIgE and tIgE. Systemic challenge with ASDG, but not vehicle, elicited life-threatening anaphylaxis associated with dramatic HSR and MMCR. Correlation analysis demonstrated direct positive inter-relationships among IgE, HSR, and MMCR. Anaphylaxis was associated with significant elevation of prototypic Th2 but not Th1 immune markers in the spleen. Our study collectively demonstrates that ASDG is intrinsically allergenic; and chronic exposure to ASDG via undamaged skin can clinically sensitize mice for life-threatening anaphylaxis via activating the systemic Th2 immune responses.

Gut Microbiota Alteration and Its Modulation with Probiotics in Celiac Disease.

Celiac disease (CD) is a chronic inflammation of the small intestine triggered by gluten ingestion in genetically predisposed people. Recent literature studies highlight the possible role of the gut microbiota in the pathogenesis of this disease. The gut microbiota is a complex community of microorganisms that can interact with the innate and adaptative immune systems. A condition of dysbiosis, which refers to an alteration in the composition and function of the human gut microbiota, can lead to a dysregulated immune response. This condition may contribute to triggering gluten intolerance, favoring the development and/or progression of CD in genetically susceptible patients. Interestingly, studies on children and adults with CD showed a different microbiome profile in fecal samples, with a different degree of "activity" for the disease. From this point of view, our review aimed to collect and discuss modern evidence about the alteration of the gut microbiota and its modulation with probiotics, with possible future indications in the management of patients affected by CD.

Effectiveness of Anthocyanin-Rich Sour Cherry Extract on Gliadin-Induced Caco-2 Barrier Damage.

Several types of gluten-related disorders are known, in which the common starting point is gluten-induced zonulin release. Zonulin results in varying degrees of increased permeability in certain gluten-related disorders but is largely responsible for the development of further pathogenic processes and symptoms. Therefore, it is important to know the barrier-modulating role of individual nutritional components and to what extent the antioxidant substance supports the protection of gliadin-induced membrane damage with its radical scavenging capacity. We investigated the pH dependence of the gliadin-anthocyanin interaction using UV photometry, during which a concentration-dependent interaction was observed at pH 6.8. The barrier modulatory effect of the anthocyanin-rich sour cherry extract (AC) was analyzed on Caco-2 cell culture with pepsin-trypsin-resistant gliadin (PT-gliadin) exposure by TEER measurement, zonula occludens-1 (ZO-1), and Occludin immunohistochemistry. In addition to the TEER-reducing and TJ-rearranging effects of PT-gliadin, NF-κB activation, an increase in cytokine (TNF-α, IFN-γ, and IL-8) release, and mitochondrial ROS levels were observed. We confirmed the anti-inflammatory, stabilizing, and restoring roles of AC extract during gliadin treatment on the Caco-2 monolayer. The extract was able to significantly reduce cytokine and ROS levels despite the known interaction of the main components of the extract with PT-gliadin.

Low fat and high protein meat analogue of cowpea (Vigna unguiculata) with stabilizer cocoa pod husk extract (Theobroma cacao L.)

Meat analogue is a plant-based protein product with nutritional and sensory qualities similar to conventional meat. Meat analogue is usually made from wheat flour. People with gluten intolerance can not consume wheat flour. Gluten-free meat analogue is appropriate for such people. In this research, gluten-free meat analogue was made from cowpea flour and cocoa pod husk extract, in three different formulations. Cocoa pod husk extract serves as stabilizer and sticking agent. The formulation was based on the ratio of the main ingredients. The ratios were 98.5:1.5 (A), 99.0:1.0 (B), and 99.5:0.5 (C). The control meat analogue was made from cowpeas flour and commercial pectin with the ratio of 98.5: 1.5. The parameter of quality was the physicochemical aspect including moisture content, ash content, fat content, protein content, carbohydrate content, fibre content, amino acid quality, and in vitro protein digestibility. In addition, the microbiological, texture, and sensory analysis were also conducted. Meat analogue B had 41.56% water content, 4.71% ash content, 3.88% fat content, 19.16% protein content, 8.75% soluble fibre content, 10.21% insoluble fibre content, protein digestibility 65.94%, total plate count of 4.40×102 CFU/g and yeast and mould count of 2.27×102 CFU/g. It is considered the best formulation among the meat analogues.

Atypical manifestation of celiac disease in carriers of HLA mutant gene

Annotation. Celiac disease is an autoimmune disease, which is manifested by enteropathy of the small intestine and is caused by the consumption of gluten-containing foods. According to statistics, the number of patients suffering from this disease has increased by 7.5% recently, which may be due to epigenetic factors and improvements in diagnostic methods of gluten intolerance. Human Leukocyte Antigen (HLA) gene plays a major role in the pathophysiological development of celiac disease. The function of HLA is an autoimmune response to endogenous and exogenous proteins. The pathogenesis of organ damage is based on an autoimmune reaction that occurs as a result of the entry of gliadin – the main component of gluten – into the organism. The influence of circulating immune complexes (CIC) leads to the appearance of typical and numerous atypical manifestations of the disease. This, in turn, significantly complicates the diagnosis and prescription of the correct treatment, which can ensure the restoration of the structure of the affected organs and improve the quality of life for patients. Atypical manifestations of gluten enteropathy are diverse, including chronic fatigue syndrome, damage to joints, bones, liver, male and female infertility, thyroid gland dysfunction, dermatitis, and tooth enamel structure disorders. Taking into account the importance of this issue, we conducted a systematic review and analysis of sources related to this question. The search was conducted in the scientometric databases PubMed, Google Scholar, Web of Science, Scopus, mostly over the last three years. In particular, it was found that screening for the specific HLA gene in first-degree relatives of patients with gluten enteropathy allows for an explanation of the exact etiology of possible atypical symptoms - manifestations of celiac disease, and subsequently prescribing a gluten-free diet that leads to the involution of the negative impact of the immune system on target organs. Moreover, this screening will be useful for identifying risk groups because manifestations of celiac disease could be in different ages and have different symptoms.

Epidemiology of Celiac Disease in Northern Morocco in 2018–2021: A Descriptive Cross-Sectional Study

Celiac disease is an autoimmune disease caused by gluten. This retrospective cross-sectional study with descriptive and analytical aims was conducted over three years, from 2018 to 2021. The participants were 280 patients diagnosed with celiac disease registered in the Gluten Intolerant and Allergic Association of the North in the Tangier-Tetouan-Al Hoceima region. The prevalence and incidence of celiac disease in this region were 1/135 and 1/253, respectively. The average age was 21.18 ± 1.13, and the first symptoms appeared between 10 and 25 years. The data showed a female predominance of 68% versus 32% for males, with a male/female sex ratio of 0.45. The clinical signs of celiac disease manifested more in gastrointestinal symptoms. This study obtained data on 22.6% of microcytic hypochromic anemia patients and 40.7% of Helicobacter pylori infections. In addition to celiac disease, the patients showed other pathologies with different rates: repeated spontaneous abortions (2.14%), type 1 diabetes mellitus (1.42%), autism (1.42%), dermatitis herpetiformis (0.72%), cancer(0.72%), and epilepsy (0.35%). Serologically, anti-transglutaminase antibodies were positive in 47.2% of patients. Analyses of histological data from intestinal biopsies from 141 patients were positive in 50.8% of patients. There was a minor correlation between the serological profile and the degree of atrophy.

Gluten Intolerance and Its Association With Skin Disorders: A Narrative Review.

Gluten sensitivity is defined as a chronic intolerance to gluten ingestion in genetically predisposed individuals. The etiology is thought to be immune-mediated and has a variable dermatologic presentation. Celiac disease (CD) is one of the most common forms of gluten intolerance and encompasses a wide range of extra-intestinal pathology, including cutaneous, endocrine, nervous, and hematologic systems. Psoriasis, another long-term inflammatory skin condition, has been linked to significant symptomatic improvement with a gluten-free diet (GFD). Palmoplantar pustulosis (PP), a variant of psoriasis, and aphthous stomatitis, which causes recurrent oral ulcers, have also exhibited beneficial results after the dietary elimination of gluten. In addition to this, dermatitis herpetiformis (DH), another immune-mediated skin disorder, is genetically similar to CD and has, therefore, shown tremendous improvement with a GFD. Another highly prevalent long-term skin condition called atopic dermatitis (AD), however, has revealed inconsistent results with gluten elimination and would require further research in the future to yield concrete results. Hereditary angioedema (HA) has shown an association with gluten intolerance in some patients who had symptomatic benefits with a GFD. Similarly, vitiligo and linear IgA bullous dermatosis have also shown some clinical evidence of reversal with a GFD. On the contrary, rosacea enhances the risk of developing CD.This narrative review emphasizes the potential impact of gluten intolerance on different cutaneous conditions and the potential therapeutic effect of a GFD on various symptomatic manifestations. There is a need for additional clinical and observational trials to further expand on the underlying pathophysiology and provide conclusive and comprehensive recommendations for possible dietary interventions.