Gluten-free Diet In Patients Research Articles

Characteristics of Hospitalized Patients With and Without Celiac Disease on a Gluten-Free Diet.

Most people maintaining a gluten-free diet (GFD) do not have celiac disease (CD). Comorbidities and associated conditions in this population are largely unknown. This study identified demographics, dietary patterns, and diagnoses for patients prescribed a GFD during hospitalization and compared patients with CD to those without CD. We performed a retrospective cross-sectional study for hospital admissions with a GFD between Jan 1, 2010 and June 30, 2022, while excluding patients missing demographic data (n = 113). We compared patients with and without a CD diagnosis, including multivariable logistic regression to identify characteristics independently associated with a CD diagnosis. We analyzed 1527 hospitalized patients of all ages. A minority (n = 467, 30.6%) carried a CD diagnosis. Age, sex, body mass index, and Medicare/Medicaid enrollment and additional diagnoses associated with a GFD (e.g., IBS) were not significantly different. The CD cohort was more predominantly white (66.6% vs 58.4%, p = 0.007) and non-Hispanic (62.5% vs. 52.7%, p = 0.001). While hospitalized, patients with CD had fewer additional dietary restrictions (mean 0.33 vs 0.56, p < 0.001) and more frequent micronutrient supplementation (26.6% vs 21.4%, p = 0.03). CD was independently associated with malnutrition (OR 1.86, 95% CI 1.31-2.65) and inversely associated with a vegetarian diet (OR 0.35, 95% CI 0.15-0.81), reduced lactose diet (OR 0.25, 95% CI 0.13-0.50), and Hispanic ethnicity (OR 0.56, 95% CI 0.35-0.90) while controlling for other covariates. Two-thirds of hospitalized patients receiving a GFD do not have a diagnosis of CD. Among GFD inpatients, CD is associated with fewer dietary restrictions and independently associated with malnutrition.

The effect of a gluten-free diet in patients with autoimmune thyroiditis, type 1 diabetes mellitus, psoriasis, metabolic syndrome and without gluten-related disorder - a literature review

Introduction and aim of the study: The growing awareness of gluten-related disorders has led to widespread misinformation about the gluten-free diet(GFD). The potential benefits of removing gluten are not well evaluated, yet it is often recommended or self-implemented by patients without robust supporting evidence. This paper aims to determine whether eliminating gluten from the diet provides proven benefits for individuals with specific diseases, including autoimmune thyroiditis (AIT), type 1 diabetes (T1D), psoriasis, and metabolic syndrome, who do not have a diagnosed gluten-related disorder. Description of the state of knowledge: Adhering to a gluten-free diet may benefit patients with AIT and T1D even without celiac disease, although there is no clear evidence that it alleviates AIT or T1D symptoms and the improvements are not significant enough to recommend it universally. Further research on humans is needed to explore the potential preventive effect of GFD on T1D risk and prolonging partial remission. For psoriasis, a GFD can be beneficial for patients with gluten-related antibodies, potentially reducing or clearing skin lesions, but it shows no benefit for those without these antibodies. The data on the GFD's impact on cardiovascular disease remains contradictory and unreliable. Conclusion: For psoriasis patients who test positive for gluten-related antibodies, a gluten-free diet can be recommended. Current studies do not substantiate the necessity for patients with AIT, T1D or metabolic syndrome to completely eliminate gluten from their diet.

Development and Validation of a Tool for Assessing Adherence to Gluten-Free Diet in Patients With Celiac Disease.

Life-long adherence to gluten-free diet (GFD) and its assessment is essential for patients with celiac disease (CeD). We have developed and validated a tool for assessing adherence to GFD which can be used by both physicians and dietitians. Phase 1: Development, content validation, and assessment of reliability of tool. Phase 2: Validation of tool against standard dietary evaluation (SDE) (gold standard), immunoglobulin A - anti-tissue transglutaminase antibodies (IgA anti-tTG Ab), and gluten immunogenic peptides in urine. Overall, 380 biopsy-confirmed patients with CeD (derivation cohort: n = 100 [phase 1], n = 210 [phase 2] and independent validation cohort, n = 70) were recruited. Of an initial 90-point questionnaire, 84 items (Celiac Disease: Compliance Assessment Test [CD-CAT.v1]) were retained after content validation and pilot testing. In phase 1, upon administering CD-CAT.v1 on 100 patients, a comprehensive 35-item tool (CD-CAT.v2; α = 0.86) was obtained after removing items with low test-retest reliability and item-rest correlation values. In phase 2, upon administering CD-CAT.v2 on 210 patients, 22 items were removed having low correlation values (R < 0.4) with SDE. Finally, a 13-item tool (CD-CAT.v3; α = 0.84) was obtained with high criterion validity with SDE ( r = 0.806, P < 0.001), moderate convergent validity with celiac disease adherence test ( r = 0.602, P = 0.007), and moderate to weak correlation with urine gluten immunogenic peptides ( r = 0.46, P = 0.001) and IgA anti-tTG Ab ( r = 0.39, P = 0.008), respectively. The final 13-item tool also strongly correlated with SDE ( r = 0.78, P < 0.001) in an independent validation cohort of 70 patients with CeD. Principal component analysis identified 3 relevant subscales with a cumulative variance of 62%. The sensitivity and specificity of CD-CAT.v3 were 80% and 91%, respectively, with an area under curve of 0.905 with SDE. The obtained cutoff score of <19 from the receiver operating characteristic curve was further categorized as 13 = excellent, 14-18 = very good, 19-28 = average, and >28 = poor adherence to GFD. CD-CAT is a new and rapid tool for monitoring dietary adherence to GFD with high sensitivity and specificity, which can be administered by both physicians and dietitians.

Relationship between vitamin D levels and pediatric celiac disease: a systematic review and meta-analysis

BackgroundThe relationship between Vitamin D levels and pediatric celiac disease (CD) remains controversial. In this study, we conducted a systematic review and meta-analysis to examine the relationship between Vitamin D and pediatric CD. Methods: We screened relevant studies from PubMed, EMBASE, and Web of Science published in English from January 1, 2000, to August 1, 2023. The included studies were assessed according to the STROBE checklist. Heterogeneity was quantified by Cochran’s Q test and the I2 statistic. Publication bias was estimated by Begg’s test and Egger’s test. Meta‐regression was used to detect potential sources of heterogeneity. Results: A total of 26 studies were included in the meta-analysis. Nineteen articles compared 25(OH)D3 levels between CD patients and control groups, average 25-hydroxyvitamin D3 [25(OH)D3 or calcidiol], and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3 or calcitriol] levels, as the main forms of Vitamin D, there was a significant difference in CD patients and healthy controls (weighted mean difference (WMD) = − 5.77, 95% confidence interval (CI) = [− 10.86, − 0.69] nmol/L). Meanwhile, eleven articles reported the numbers of patients and controls with Vitamin D deficiency, there was a significant difference in the incidence of 25(OH)D3 deficiency between CD patients and healthy controls (odds ratio 2.20, 95% CI= [1.19, 4.08]). Nine articles reported changes in 25(OH)D3 levels before and after administering a GFD in patients with CD, the result of this study revealed the increase of 25(OH)D3 levels in CD patients after a gluten-free diet (GFD) (WMD = − 6.74, 95% CI = [− 9.78, − 3.70] nmol/L). Conclusions: Vitamin D levels in pediatric CD patients were lower than in healthy controls, and 25(OH)D3 deficiency was more prevalent in CD patients. We found that 25(OH)D3 levels were elevated in CD patients after GFD, which is consistent with previous research. Further well-designed, longitudinal, prospective cohort studies focusing on the role of Vitamin D in the pathogenesis of CD are therefore needed.

Body Mass Index during Gluten-Free Diet in Patients with Celiac Disease.

The association of clinical variables with body mass index (BMI) and changes experienced during a gluten-free diet (GFD) in celiac disease (CD) is not well established. In this retrospective cohort study, we aimed to investigate factors aligned with baseline and a follow-up regarding BMI in CD cases diagnosed at the University of Pécs (Hungary). Data were collected regarding gender, age, clinical presentation, histology, serology, extraintestinal manifestations, and BMI upon diagnosis and during follow-up. To compare variables with baseline BMI and BMI changes in short-, intermediate-, and long-term periods, we applied univariate analyses. A total of 192 CD patients were included. Males had significantly higher mean BMI when compared with females at diagnosis (22.9 ± 4.1 vs. 21.4 ± 4.3 kg/m2, p = 0.041) and during follow-up (p = 0.031, p = 0.029, and p = 0.033 for short-, intermediate-, and long-term follow-ups, respectively). Non-classical CD patients experienced higher mean BMI at diagnosis (22.9 ± 4.0 vs. 20.7 ± 4.4 kg/m2, p < 0.001) and following long-term follow-up (24.5 ± 3.2 vs. 22.6 ± 3.4 kg/m2, p = 0.039) than classical patients. In conclusion, although the mean BMI remained in the normal range, it increased significantly during follow-up, even at the short-term follow-up. This change was characteristic for non-classical cases and males on the long-term follow-ups.

Does a Gluten-Free Diet Improve Quality of Life and Sleep in Patients with Non-Coeliac Gluten/Wheat Sensitivity?

The role of a gluten-free diet (GFD) in Non-Coeliac Gluten/Wheat Sensitivity (NCGWS) is unclear. We present the largest study comparing adherence to a GFD in patients with Coeliac Disease (CD) and NCGWS and assess its impact on quality of life (QoL) and sleep in patients with NCGWS. Patients with NCGWS at a tertiary centre completed the Coeliac Disease Adherence Test (CDAT), Coeliac Symptom Index (CSI) and Sleep Condition Indicator (SCI). Higher CDAT scores indicate worse adherence, higher CSI scores indicate poorer QoL, and higher SCI scores indicate better sleep. CDAT scores were correlated with CSI and SCI scores. A second group of patients with CD completed the CDAT questionnaire only. Results were compared with the CDAT responses from the NCGWS group. For the NCGWS cohort (n = 125), the median CDAT score was 17/35, indicating poor adherence. The median CSI score was 44/80, with 40% of scores associated with a poor QoL. The median SCI score was 14/32, and DSM-V criteria for insomnia was met by 42% of patients. There was a positive correlation between CSI and CDAT scores (r = 0.59, p < 0.0001) and a negative correlation between SCI and CDAT scores (r = -0.37, p = 0.0002). In the CD cohort (n = 170), the median CDAT score was 13/35. Patients with NCGWS had poorer adherence compared to CD (CDAT: 17.0 vs. 13.0, respectively, p = 0.0001). Patients with NCGWS adhere to a GFD less than those with CD. Poorer adherence to a GFD in patients with NCGWS correlates with a worse QoL and sleep performance.

Metabolic Syndrome in Celiac Disease: What Does Following a One-Year Gluten-Free Diet Bring?

Background: Metabolic syndrome (MetS) is a set of conditions that occur together and increase the risk of cardiovascular disease. Previous studies have linked a gluten-free diet (GFD) to obesity and MetS in some populations. However, others have suggested that weight gain is usually regulated only in underweight individuals with celiac disease (CD). Owing to the lack of sufficient data and the importance of GFD in controlling cardiovascular disease, we surveyed the prevalence of MetS and its components before and after a year of GFD in patients referred to the main celiac clinic in southern Iran. Methods: This was a repeated cross-sectional study conducted on 69 patients with a definite diagnosis of cardiovascular disease who were on follow-up and registered at the Shiraz Celiac Clinic. Demographic, anthropometric, and laboratory measurements at the time of diagnosis and one year after the GFD were extracted from their medical records. Results: The participants' mean age was 35.53, and 68.1% were women. The prevalence of MetS increased from 5.8% to 11.6% after a year of the GFD; however, this increase was not statistically significant. Waist circumference (WC) and serum triglyceride levels were significantly elevated during the study period. Conclusion: A GFD may contribute to the development of MetS in patients with cardiovascular disease; however, the rate of MetS is still lower than that in the general population. It is critical to educate patients about these potential risks and encourage them to have a healthy lifestyle that includes a balanced diet and physical activity.

#3121 THE EFFECTIVENESS OF A GLUTEN-FREE DIET IN PATIENTS WITH IGA NEPHROPATHY

Abstract Background and Aims Modern data from the world literature confirm the association of IgA nephropathy (IgAN) and celiac disease. The inclusion of a gluten-free diet (GFD) in the diet has a beneficial effect not only on gastrointestinal symptoms, but also reduces the clinical and laboratory activity of IgAN. The aim of this study was to evaluate the effect of a gluten-free diet on the course of IgAN using general clinical and immunological tests 6 months after the start of its use. Method 65 patients with morphologically confirmed IgAN were included in the study. To detect a violation of gluten metabolism, screening determination of the level of IgA antibodies to tissue transglutaminase (Anti-TTG IgA) and IgA antibodies to deamidated gliadin peptides (Anti-DPG IgA) was performed. According to the results of the screening examination, a group of patients with the level of antibodies exceeding the reference values were formed (group 1, n = 13) and a group of patients in whose blood did not exceed the reference values, or were absent at all (group 2, n = 52). Patients of both groups were recommended GFD for a period of at least 6 months. The effectiveness of GFD was evaluated by the following indicators: protein in urine (g/l); red blood cells in urine (RBCs) (hpf); daily proteinuria (g/day); blood creatinine (mmol/l), GFR calculated by the formula CKD-EPI (ml/min /1.73 m2) at the beginning of the study and 6 months after the inclusion of dietary recommendations. Statistical analysis of the data obtained was carried out using the statistical program SPSS Statistics 26.0 (IBM, USA). When comparing quantitative indicators, the distribution of which differed from normal in two related groups, the Wilcoxon criterion was used. The null statistical hypothesis about the absence of differences and connections was rejected at p&amp;lt;0.05. Results among the examined patients there were 61 men (93.8%), 4 women (6.2%). The average age of men was 39.0±8.2 years, women - 34.7±9.7 years. The duration of the underlying disease at the time of inclusion in the study was 55.98 [40.67-71.28] months. 57 people (85.1%) received ACE inhibitors/sartans in therapeutic doses as the main therapy, 8 people (11.9%) did not receive drug therapy. It was possible to evaluate the effectiveness of GFD in patients from group 1 in 9 people. During the follow-up period, 2 patients from group 1 showed progression of the disease to the End-Stage Renal Disease (GFR according to CKD-EPI &amp;lt;15 ml/min/1.73 m2), which required their exclusion from the study, in 2 more patients it was not possible to evaluate the effectiveness of GFD due to insufficient follow-up periods (less than 6 months.) GFD was also recommended to patients from group 2. Dietary restrictions were applied to patients with daily protein loss &amp;gt; 0.5 g/day and/or anti-TTG IgA and anti-DPG IgA levels in the range of pre-reference values, thus it was possible to evaluate the effectiveness of GFD in patients of group 2 in 21 people. According to the results of the analysis, a statistically significant decrease in daily proteinuria (p = 0.028) and microscopic hematuria (p = 0.018) was revealed. After 6 months from the start of compliance with GFD, daily proteinuria decreased in 66.7%; microscopic hematuria – in 77.8% in group 1 patients. Among group 2 patients, a statistically significant decrease in microscopic hematuria (p = 0.05) was observed in 76.2% of those included in the study. Conclusion the inclusion of GFD in the diet of patients with IgAN is justified in patients with the presence of gluten antibodies in the blood serum, as it allows to significantly reduce the severity of proteinuria, microscopic hematuria in these patients. Screening examination of patients with IgAN for gluten metabolism disorders will expand therapeutic possibilities, and GFD can become part of a nephroprotective strategy.

Uveitis as a Manifestation of Celiac Disease: A Population-Based Study

Introduction: The prevalence of celiac disease (CD) in the United States population has been estimated to be 0.71%, or 1 in 141, with the prevalence in first- and second-degree relatives of those affected being 4.55% and 2.59% respectively. Due to the multitude of ways in which this disease may initially present, it is important to screen for CD to avoid the potential consequences of inadequately managed disease. Many ophthalmic conditions have also been implicated as extraintestinal manifestations of CD, including uveitis. Despite several studies and case reports suggesting a positive correlation between CD and uveitis, there has yet to be a nationwide study in the United States quantifying this relationship. Therefore, the aim of this study is to conduct a large-scale multi-center population-based study to assess whether there is a statistically significant increased risk of uveitis in individuals with celiac disease. Methods: A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States consisting of data accumulated from 1999 to September 2022 was utilized to construct this study. We excluded patients with a history of autoimmune diseases, cataract surgery, or any type of eye infection. We included a subgroup of patients with a diagnosis of “uveitis” for further analysis. The risk of developing uveitis was calculated using a univariate logistic regression. A multivariate analysis was also done to account for confounding variables including African American ethnicity, male gender, sexually transmitted diseases, and celiac disease. Results: 70,632,440 patients were screened and a cohort of 46,895,750 individuals was selected for the final analysis after accounting for inclusion and exclusion criteria were met. The incidence of uveitis in patients with celiac disease in the past 3 years was 280 per 100,000 people. The prevalence of uveitis in the US population from 1999 to September 2022 was 150 per 100,000 people (0.15%). In order to adjust for confounding variables, a multivariate regression analysis was performed and showed an increased risk of being African-American (OR: 3.20%; 95% CI: 3.14-3.26) and male (OR: 1.13%; 95% CI: 1.12-1.16); and having a diagnosis of celiac disease (OR: 3.80%; 95% CI: 3.35-4.28) and sexually transmitted diseases (OR: 4.12%; 95% CI: 3.96-4.29) in patients with uveitis. Discussion: Recent population-based studies demonstrated that the prevalence of CD in the United States is much greater than previously thought, such that a trend of underdiagnoses is suspected to have occurred for several years. Many newly diagnosed uveitis cases, 48%, have been classified as idiopathic uveitis even after a complete workup was done. Several studies have been published in which a correlation between uveitis and CD is reported. The findings of this study further emphasize the importance of a thorough workup to evaluate for an underlying inflammatory process prior to diagnosing uveitis as idiopathic. Conclusion: In conclusion, we established that patients with celiac disease are at increased risk of developing uveitis after excluding and controlling for any confounding variables. In further studies, it could be interesting to investigate the impact of gluten-free diet in patients with celiac disease on the risk of developing uveitis.

Establishment of New Immunostatistical Equations for Diagnosis and Follow-Up of Gluten-Free Diet in Patients with Celiac Disease.

&lt;b&gt;Background and Objective:&lt;/b&gt; Celiac disease (CD) is an autoimmune condition characterized by immune responses to gluten. The reported prevalence of CD has increased globally due to improved screening and diagnostic techniques, however, there is significant global variation in methods of diagnosis and follow-up. A new immunostatistical equation that determines the values of two types of antibodies using the total IgA test. &lt;b&gt;Materials and Methods:&lt;/b&gt; Only 70 blood samples were taken from people who had celiac disease or were suspected of having it, with ages ranging from 5 to 40 years and they were separated into two groups. The first group contained 40 people of both sexes who had previously been diagnosed with celiac disease, while the second group included 30 individuals of both sexes, with ages ranging from 5 to 35 years, who were suspected of having celiac disease due to the appearance of some clinical symptoms. The control group also included 30 blood samples from healthy individuals of both sexes, with ages ranging from 5 to 40 years. Total IgA antibody tTG/IgA and DGP/IgA levels were estimated for all study samples. &lt;b&gt;Results:&lt;/b&gt; By using a regression coefficient test the results showed the percentage of the effect of total IgA on tTG/IgA, DGP/IgA amounted to 11 and 25%, respectively, as shown by the value of the coefficient of clarifications (R&lt;sup&gt;2&lt;/sup&gt;) in patients with CD. On the other hand, The percentage of the effect of total IgA on tTG/IgA and DGP/IgA amounted to 11, 14%, respectively, as shown by the value of the coefficient of clarifications (R&lt;sup&gt;2&lt;/sup&gt;) in patients with suspected CD in p&lt;u&gt;<&lt;/u&gt;0.05. The results of the study were revealed and through the regression coefficient, four new immunostatistical equations were mathematically derived that give the value of tTG/IgA and DGP/IgA based solely on the total IgA test in the laboratory. &lt;b&gt;Conclusion:&lt;/b&gt; By adopting one laboratory test which determines total IgA, the study concluded four new immunostatistical equations that will help academic researchers and attending physicians to diagnose celiac disease in addition to following up on patient's adherence to a gluten-free diet.

Gluten-Free Diet in Co-Existent Celiac Disease and Type 1 Diabetes Mellitus: Is It Detrimental or Beneficial to Glycemic Control, Vascular Complications, and Quality of Life?

Celiac disease (CeD) is associated with type 1 diabetes mellitus (T1DM), and both have the same genetic background. Most patients with T1DM who develop CeD are either asymptomatic or have mild CeD-related gastrointestinal symptoms. Therefore, children affected by T1DM should undergo screening for asymptomatic CeD. The aim of this review is to highlight the influence of a gluten-free diet (GFD) on glycemic control, growth rate, microvascular complications, and quality of life in patients with T1DM and CeD. PubMed, Google Scholar, Web of Science, and Cochrane Central databases were searched. Reports reviewed were those published from 1969 to 2022 that focused on the interplay of T1DM and CeD and examined the effect of diet on glycemic control, growth rate, and quality of life. The most challenging aspect for a child with T1DM and CeD is that most GFD foods have a high glycemic index, while low glycemic index foods are recommended for T1DM. Interestingly, dietary therapy for CeD could improve the elevated HbA1c levels. Avoiding gluten added to a diabetic dietary regimen in T1DM patients might impose practical limitations and lead to important restrictions in the lifestyle of a young patient. Consequently, non-adherence to GFD in patients with T1DM and CeD is common. GFD in patients with T1DM and CeD seems to lower the incidence of micro- and macrovascular complications, but this requires further investigation. It seems that adherence to GFD in young patients with T1DM and CeD leads to regular growth and a stable body mass index without any negative effect on HbA1c or insulin requirements. Furthermore, the lipid profile and quality of life seem to have improved with the introduction of GFD.

Does a gluten-free diet affect the course of Hashimoto's disease? - the review of the literature

Introduction and purpose&#x0D; The fashion for following a gluten-free diet is causing more and more people to opt for it. It is indicated in the treatment of celiac disease. Due to the high prevalence of Hashimoto's disease in the population and the lack of causal treatment for the disease, many researchers have tested the validity of gluten elimination for those burdened with it. This work aimed to review the results achieved so far and assess whether this diet has a real impact on the course of Hashimoto's disease.&#x0D; A brief description of the state of knowledge&#x0D; A PubMed database was searched for studies describing the relationship between gluten consumption and the course of Hashimoto's disease. Some studies indicated a potential beneficial effect of the introduced diet on thyroid function. However, these were mostly survey-based studies of questionable research quality. More reliable studies that took into account antibody and TSH levels showed no significant improvement in thyroid function in response to the diet.&#x0D; Conclusions&#x0D; Based on the studies reviewed, there is no need for a gluten-free diet in patients with chronic autoimmune thyroid disease. It has not been proven that gluten can provoke the body to produce autoantibodies that cause the destruction of thyroid tissue. It is more important to maintain a balanced diet rich in zinc, selenium, iodine, vitamin D3, and iron, as they are essential in the process of hormone production by the thyroid gland.

Anemia-Resistant to Gluten-Free Diet in Patients With Celiac Disease: Is It Just a Malabsorption Problem?

Seidita, Aurelio MD1; Mansueto, Pasquale MD1; Giuliano, Alessandra MD2; Carroccio, Antonio MD2,a Author Information

P235 Cerebellar ataxia in primary Sjogren’s syndrome: is gluten sensitivity the answer?

Abstract Background/Aims Cerebellar ataxia is an uncommon neurological complication of Primary Sjogren’s Syndrome (PSS), with case reports being the highest level of evidence available. The underlying disease pathogenesis is unknown, although an immunologically mediated mechanism seems plausible. Gluten sensitivity is common amongst patients with PSS and is a known cause of immune-mediated ataxia (gluten ataxia). We aimed to investigate the presence of ataxia in patients with PSS seen in the joint rheumatology-neurology clinics at our institution, and determine if gluten sensitivity is responsible for cerebellar ataxia in some of these patients. Methods A retrospective review of all patients who attend the rheumatology and joint rheumatology-neurology clinics was conducted. Patient data including patient demographics, the presence of gluten sensitivity-related antibodies (anti-tissue transglutaminase 2, anti-gliadin IgG and IgA, endomysial antibodies, anti-transglutaminase 6 IgG and IgA), were collected. Patients attending the rheumatology clinics with PSS were asked about the presence of any symptoms of unsteadiness. Such patients underwent MR spectroscopy of the cerebellum looking for any evidence of abnormal cerebellar metabolites (N-acetylaspartate-to-creatine (NAA/Cr) ratio &amp;lt;1). Electrophysiology results in the form of nerve conduction studies (NCS) or electromyography (EMG) were also collected. Results We identified 45 patients with symptoms of impaired balance. Not all of the 236 patients with PSS who regularly attend the rheumatology clinics were assessed for any evidence of loss of balance. Nonetheless, at least 45 out of 236 patients (19.1%) complained of balance problems. The majority of these patients were female (41/45, 91.1%) with a mean age of 64.3 years. Thirty-three out of 45 patients with ataxia (73.3%) tested positive for one or more of gluten sensitivity-related antibodies, with IgA TG6 being the most common (17/33 patients, 51.5%). Out of the 33 gluten sensitive patients, 25 had MR spectroscopy of the cerebellum and 17/25 (68%) had an abnormal NAA/Cr ratio. Twenty-two patients had NCS/EMG studies performed, of which 13 (59.1%) had either a sensory-motor neuropathy or sensory ganglionopathy. Conclusion The high prevalence of gluten sensitivity-related autoantibodies, combined with objective evidence of ataxia, suggest that gluten sensitivity may be responsible for the majority of cases of ataxia in PSS. The presence of a neuropathy in some of these patients suggests that sensory ataxia may also be contributing to the impaired balance in some of these patients. There is, however, a cohort of patients with ataxia and PSS who are not gluten sensitive. These patients may well have primary autoimmune cerebellar ataxia (PACA). Whilst a therapeutic response to a gluten free diet in patients with gluten ataxia has already been established, it remains to be seen if those patients with PSS and ataxia who have no evidence of gluten sensitivity may benefit from immunosuppression. Disclosure F. Kon: None. M. Akil: None. R. Kilding: None. K. Kuet: None. P. Shanmugarajah: None. N. Hoggard: None. M. Hadjivassiliou: None.

Positive Gluten Sensitivity Serologies and the Impact of Gluten-free Diet in Patients With IBD.

Positive Gluten Sensitivity Serologies and the Impact of Gluten-free Diet in Patients With IBD.

Oral Consumption of Bread from an RNAi Wheat Line with Strongly Silenced Gliadins Elicits No Immunogenic Response in a Pilot Study with Celiac Disease Patients.

Celiac disease (CD) is a genetically predisposed, T cell-mediated and autoimmune-like disorder caused by dietary exposure to the storage proteins of wheat and related cereals. A gluten-free diet (GFD) is the only treatment available for CD. The celiac immune response mediated by CD4+ T-cells can be assessed with a short-term oral gluten challenge. This study aimed to determine whether the consumption of bread made using flour from a low-gluten RNAi wheat line (named E82) can activate the immune response in DQ2.5-positive patients with CD after a blind crossover challenge. The experimental protocol included assessing IFN-γ production by peripheral blood mononuclear cells (PBMCs), evaluating gastrointestinal symptoms, and measuring gluten immunogenic peptides (GIP) in stool samples. The response of PBMCs was not significant to gliadin and the 33-mer peptide after E82 bread consumption. In contrast, PBMCs reacted significantly to Standard bread. This lack of immune response is correlated with the fact that, after E82 bread consumption, stool samples from patients with CD showed very low levels of GIP, and the symptoms were comparable to those of the GFD. This pilot study provides evidence that bread from RNAi E82 flour does not elicit an immune response after a short-term oral challenge and could help manage GFD in patients with CD.

Expanded Role of a Dietitian in Monitoring a Gluten-Free Diet in Patients with Celiac Disease: Implications for Clinical Practice.

Access to a registered dietitian experienced in celiac disease (CD) is still limited, and consultation when available focuses primarily on the elimination of gluten from the diet. Thus, the aim of this study was to evaluate the nutritional value of a gluten-free diet (GFD) in adult CD patients before, and one year after, the standard dietary education. The study included 72 CD patients on a GFD and 30 healthy controls. The dietary intake of both groups was assessed through a 3-day food diary, while adherence to a GFD in celiac subjects was assessed using Standardized Dietician Evaluation (SDE). Subsequently, all CD patients received detailed education on gluten sources, and 48 of them participated in a one-year follow-up. Results: Comparison with the control group showed that consumption of plant protein in CD patients was significantly lower, whereas fat and calories were higher. At baseline, only 62% of CD patients adhered to a GFD, but the standard dietary education successfully improved it. However, the nutritional value of a GFD after one year did not change, except for a reduced sodium intake. The CD subjects still did not consume enough calcium, iron, vitamin D, folic acid or fiber. In conclusion, while the standard dietary education improved GFD adherence, it did not significantly alter its nutritional value. Therefore, it is necessary to increase the role of a dietitian in the treatment of CD.

Does cystic fibrosis make susceptible to celiac disease?

Patients with cystic fibrosis (CF) have a higher incidence of celiac disease (CD) than the healthy population; however, the actual incidence of coexisting CF and CD is unclear. In this report, we aimed to evaluate the frequency of CD and CF coexistence and to assess the clinical findings of affected patients during follow-up. We conducted a retrospective review of patients with CF to reveal the frequency of CD and also investigated the clinical characteristics and clinical response to gluten-free diet in patients with CD. The incidence of CD in 515 patients with CF was 1.4%. The median age at the time of CF diagnosis was 2 months (1-6 months). CD was diagnosed in six patients with poor weight gain, fatty stools, and low z score for BMI and one patient with poor weight gain despite a high protein and calorie diet and pancreatic enzyme replacement. The median age of CD diagnosis was 8 years (2-12 years). Except for one patient who was recently diagnosed, the other six patients gained weight and their accompanying symptoms resolved after starting a gluten-free diet.Conclusion: CD should be investigated in patients with CF in the presence of inadequate weight and/or height gain or poor control of malabsorption symptoms despite appropriate and adequate nutritional and enzyme replacement treatment. What is Known: • CFTR dysfunction may be a risk factor for CD, due to increased intestinal permeability and intestinal inflammation, pancreatic exocrine insufficiency that results in higher antigen load and increased antibodies against to nutritional antigens such as anti-gliadin IgA antibodies. • Although coexistence of CF and CD are rare in the same patient; there is still no consensus on when children with CF should be screened for CD. What is New: • Physicians should consider the investigation of CD in patients with CF, in the presence of inadequate weight and/or height gain or poor control of malabsorption symptoms despite appropriate and adequate nutritional and enzyme replacement treatment. • CFTR dysfunction has been emphasized to develop susceptibility to CD, and patients with CF who have persistent gastrointestinal symptoms despite appropriate and adequate nutritional and enzyme replacement treatment should be screened for CD.

Colonic paracellular permeability and circulating zonulin-related proteins

Objective Irritable bowel syndrome (IBS) is a gut-brain disorder associated with increased gut permeability. Zonulin has been suggested to regulate the gut barrier and claimed to be pre-haptoglobin 2 (pre-HP2) and circulating zonulin is often used as a proxy for gastrointestinal permeability. This study investigated the correlation between colonic paracellular permeability and levels of circulating zonulin and pre-HP2. Materials and Methods Colonic biopsies from 32 patients with IBS and 15 healthy controls (HC) were used to measure permeability in Ussing chambers and levels of zonulin (Cusabio ELISA). Zonulin was also measured in blood samples from 40 HC, 78 patients with IBS and 20 patients with celiac disease (CeD), before and after a gluten-free diet. In addition, we verified HP genotype and circulating pre-HP2 using a monoclonal pre-HP2 antibody (Bio-Rad) by ELISA. Results Increased colonic paracellular permeability correlated positively with zonulin levels in IBS biopsies, but negatively with plasma zonulin. We found no agreement between circulating zonulin and pre-HP2. Genotyping revealed non-specificity of the zonulin kit, as all pre-HP2 non-producers presented detectable levels. Patients with CeD displayed higher pre-HP2 and zonulin levels compared to HC. A gluten-free diet in patients with CeD led to lower serum zonulin and pre-HP2 concentrations. Conclusions Our study suggests that neither circulating zonulin nor pre-HP2 mirror colonic permeability. Our data corroborate previous reports showing the inability of the Cusabio zonulin kit to target zonulin and highlights that the results of studies using this kit must be re-examined with caution.

The Effect of Group-Based Education on Knowledge and Adherence to a Gluten-Free Diet in Patients with Celiac Disease: Randomized Controlled Clinical Trial.

Considering the importance of educational programs on compliance of patients with celiac disease with a gluten-free diet (GFD), we investigated the effect of a group-based education program on knowledge and adherence to a GFD in patients with celiac disease. In the present controlled clinical trial, patients in the intervention group (n=66) underwent a three-session group-based educational program, and patients in the control group (n=64) received routine education in visits to the clinic. The primary outcomes were knowledge and adherence to a GFD. Participant knowledge was assessed by a validated author-designed questionnaire. Adherence rate was evaluated by the Persian version of celiac disease adherence test (CDAT) questionnaire. Results were analyzed based on intention-to-treat (ITT) analysis. Results of the ANCOVA test showed that the mean score of knowledge about celiac disease and gluten in the intervention group was significantly higher compared with the control group immediately after intervention (p=0.002) and 3 months post-intervention (p=0.03). In terms of gluten-free food item selection, the intervention group achieved a significantly better score than the control group immediately after intervention (p<0.001) as well as 3 months post-intervention (p<0.001). Additionally, there was a significant difference in the CDAT score between the two groups 3 months post-intervention (p=0.02). Evidence suggests that group-based education was an effective intervention among patients with celiac disease to improve knowledge and adherence to a GFD. Trial registration IRCT code: IRCT20080904001197N21; registration date: 5/23/2019.