Ingestion Of Gluten Research Articles

Individual variability in patterns and dynamics of fecal gluten immunogenic peptides excretion after low gluten intake

PurposeDetermination of Gluten Immunogenic Peptides (GIP) in feces is a direct tool for gluten exposure detection. The sensitivity of GIP detection methods for cases of unintentional low gluten intakes is unknown. We studied the interindividual variability in the kinetic of excretion under homogeneously controlled dietary conditions, and the sensitivity of fecal GIP tests after low amounts of punctual gluten ingestions.MethodsParticipants (n = 20) followed the same gluten-free menu for 12 days in which two separated doses of gluten (50 mg and 2 g) were ingested and all the depositions were collected. GIP from stool samples were analyzed by ELISA and lateral flow immunoassay (LFIA) tests.ResultsMost participants had detectable GIP after 50 mg and 2 g gluten ingestions using ELISA test (72.2% and 95%, respectively), whereas the LFIA test showed less sensitivity (22.2% and 80%, respectively). GIP were detected at higher either frequency or concentration in the range of 12–36 h after 50 mg intake, and 12–84 h after 2 g consumption. Considering this period, diagnostic sensitivity of GIP detection after a single 50 mg ingestion may be significatively increased analyzing three stool samples per individual. High variability among participants was found in the time and amount of GIP excretion; however, some individuals showed common patterns for both gluten intakes.ConclusionSporadic gluten exposure detection may require several fecal samples to achieve level of sensitivity above 90%. Interindividual variability in the dynamic of GIP excretion may suggest patterns of gluten metabolism.

The global burden of coeliac disease: opportunities and challenges.

Coeliac disease is a systemic disorder characterized by immune-mediated enteropathy, which is caused by gluten ingestion in genetically susceptible individuals. The clinical presentation of coeliac disease is highly variable and ranges from malabsorption through solely extra-intestinal manifestations to asymptomatic. As a result, the majority of patients with coeliac disease remain undiagnosed, misdiagnosed or experience a substantial delay in diagnosis. Coeliac disease is diagnosed by a combination of serological findings of disease-related antibodies and histological evidence of villous abnormalities in duodenal biopsy samples. However, variability in histological grading and in the diagnostic performance of some commercially available serological tests remains unacceptably high and confirmatory assays are not readily available in many parts of the world. Currently, the only effective treatment for coeliac disease is a lifelong, strict, gluten-free diet. However, many barriers impede patients' adherence to this diet, including lack of widespread availability, high cost, cross-contamination and its overall restrictive nature. Routine follow-up is necessary to ensure adherence to a gluten-free diet but considerable variation is evident in follow-up protocols and the optimal disease management strategy is not clear. However, these challenges in the diagnosis and management of coeliac disease suggest opportunities for future research.

POSA362 Symptom Assessment in Adolescents and Adults with Celiac Disease

Celiac disease (CeD) is a systemic, immune-mediated disorder characterized by inflammation in the small intestine. It is triggered by the ingestion of gluten and is associated with substantial patient burden. This study aimed to revise the Celiac Disease Symptom Diary (CDSD), a novel patient-reported outcome measure developed for use with patients with CeD, to reflect regulatory guidance and evaluate the content validity of the measure in both adults and adolescents.

Association in Clinical Practice Between Gluten Intake and Gluten Immunogenic Peptides in Celiac Children.

The dietary compliance and its assessment in celiac disease (CD) patients on a strict gluten-free diet (GFD) remain a challenge. Two relatively new, validated methods have been proposed to detect occasional gluten ingestion: standardized dietary questionnaire and determination of urinary gluten immunogenic peptides (GIPs). Our aim was to prospectively assess dietary compliance via these methods and compare their results with those of tissue transglutaminase antibodies (tTGA). This was a prospective single-center study. Consecutive CD patients (aged 1-18 years) on a GFD scheduled for regular consultation between March and August 2019 were invited. In addition to standard care, a completed dietary questionnaire and urine sample for GIP were collected. Pearson's chi-square test, Fisher's exact test, and Mann-Whitney U test were performed. Of the 156 eligible children, 110 provided informed consent. Completed dietary questionnaire, GIP, and tTGA results were available from 86 children (median age 12.8 years, median GFD duration 30 months, 65% female). Adherence to the GFD evaluated by GIP, dietary questionnaire, and anti-tTGA was 94.2%, 75.6% and 94.2%, respectively. No association was found between the tTGA results and the detection of GIP, as well as between the tTGA results and the dietary questionnaires scores (P= .5 and .312, respectively). The participants perceived both the questionnaire and the measurement of GIP as reassuring with regard to correct implementation of the GFD. All the 3 methods have limitations to monitor dietary compliance. The comparison of their performance shows that the best single method is the use of the validated dietary questionnaire, which should therefore be implemented in the regular care for children with CD. The most effective combination of dietary questionnaire and urinary GIP determination should be used in specific clinical situations.

Gluten, Inflammation, and Neurodegeneration.

Growing evidence supports a potential link between dietary gluten intake and neurodegenerative disease in susceptible populations. Observational data supporting this link are described along with interventional study data evaluating the effects of restricting gluten from the diet in patients with neurologic disorders. Suggested underlying mechanisms between gluten intake and neurodegeneration are discussed.

Detection of Gluten in Dishes Offered as Gluten-Free in a Gastronomic Area Located in San José, Costa Rica

Celiac disease, gluten sensitivity and gluten intolerance are health conditions that require consumers to avoid their gluten intake. In Costa Rica, Law 8975 regulates the amount of gluten permitted in prepackaged products labeled as “gluten-free”, but the parameters to be followed are not mandated for food service operations. This study investigated whether restaurants with gluten-free (GF) options in a gastronomic area of the city of San José, Costa Rica, achieved the requirements of the legislation that the dishes offered should contain less than 20 ppm gluten. Using data collected from five restaurants offering GF dishes, two provided dishes with quantities of gluten greater than 20 ppm (restaurant A, four samples and restaurant B, three samples); particularly dishes from the category “meat with sauce”. Although those dishes are naturally gluten-free, when they are handled in areas of shared production, they are exposed to the risk of cross contact, furthermore the adding of misscellaneous such as: marinades, sauces and condiments, which could contain traces of gluten or hidden gluten, a risk associated with the use of ingredients without certification GF (supplier’s practices and label declaration). Therefore improvements in food service procedures should be enforced. The findings of the present study emphasize the need to include restaurant foods in the relevant legislation to ensure that the gluten-intolerant sector of the population remains safe when eating out.

Effect of The Gluten-Free Diet on Quality of Life, Gastrointestinal Symptoms and Immune System in Patients with Fibromyalgia and Non-Celiac Wheat Sensitivity. Fibromyalgia and Non-Celiac Wheat Sensitivity

Fibromyalgia (FM) is a clinical syndrome characterized by chronic pain. FM patients complain hyperalgesia and allodynia and they are frequently affected by Non Celiac Wheat Sensitivity (NCWS), a condition where gastrointestinal and extraintestinal symptoms are triggered by gluten and/or wheat ingestion. The gluten-free diet (GFD) impact was evaluated on fibromyalgia-related and gastrointestinal symptoms, health-related quality of life and immune response of patients with both FM and NCWS in order to detect a possible pathogenetic role of wheat/gluten in the triggering of the inflammatory process. Peripheral blood from 8 FM patients, 10 FM and NCWS patients (FM+NCWS patients), 13 NCWS patients and 14 healthy subjects (HS) was taken before and after 8 weeks of GFD and used for cytofluorimetric analysis. In all FM+NCWS patients after GFD almost all the clinical parameters used to evaluate musculoskeletal and systemic symptoms related to FM were reduced as well as intestinal symptoms present before GFD. Moreover, pro-inflammatory cytokines production (IFN-γ, TNF- α, IL-17 and IL-22) by T helper (Th) cells of FM+NCWS patients was reduced after GFD. Our findings suggest that gluten/wheat could represent one of the triggering factors of the inflammatory condition playing an important role in the etiopathogenesis of both FM and NCWS.

Effect of Gluten-Free Diets on Nutritional Status in celiac patients: a systematic review

Introduction: Celiac disease (CD) is an autoimmune disease of the small intestine in which ingestion of gluten leads to destruction of intestinal areas in affected patients. Lifelong adherence to a gluten-free diet (GFD) is the only possible treatment for CD. It is less evident in adults considering the nutrient status in patients on GFD. Therefore, the aim of the study is to systematically evaluate the effect of GFD on the nutritional status of celiac patients. Methodology: A comprehensive electronic search with time and language restrictions was done. Several known databases were included: “Google Scholar, PubMed, The Cochrane Library, Web of Science” from 2000 to 2022. Keywords used included “celiac disease”, “nutrient status”, “gluten-free diet”, “nutritional deficiencies”, “dietary deficiencies”, “nutrient intake”, “micronutrient”, “macronutrient”, “vitamin”, “mineral”, “fiber intake”, “Protein intake”, and “Fat intake” Results: The electronic search strategy conducted in this review ended in 875 hits which after removing duplications reduced to 360 studies. These 360 studies were considered eligible for further evaluation, from which 346 studies were excluded for different reasons as 216 studies were based on title and abstract, 86 studies were not relevant to the subject of this study or of this review, 17 were considered replies of authors, 2 were books, and 27 were reviews. Finally , 12 articles were included in the qualitative synthesis of the present review. Conclusion: The current review showed that gluten free diet is associated with unbalanced intake of macro and micronutrients in both, celiac women and men mainly because of the unhealthy dietary habits and difficulty eliminating gluten from the diet which leads to low cereal intake and high consumption of processed gluten free products. Keywords: Gluten free diet, nutritional status, celiac disease, Saudi Arabia

Coexistence of Celiac Disease and Systemic Lupus Erythematosus: A Case Report

Celiac disease (CD) is a chronic inflammatory disorder of the small intestine triggered by the ingestion of gluten. It has been associated with auto-immune disorders. Although many similarities exist between the pathogenesis of CD and systemic lupus erythematosus (SLE), their association has been rarely reported. We describe a case of a 23-year-old woman diagnosed with CD, and one year later developed SLE.

The importance of gluten exclusion in the management of Hashimoto's thyroiditis.

There is a growing interest in a gluten-free diet (GFD) in the management of various autoimmune diseases, including Hashimoto's thyroiditis (HT). Even medical professionals claim that gluten elimination may improve a patient's treatment. Some studies suggest a relationship between gluten intake and HT development or progression. The aim of the study was to analyze and describe available knowledge regarding the effect of gluten or a gluten-free diet on thyroid autoimmunity in HT with or without celiac disease. Potentially applicable records were obtained through review and analysis of the PUBMED (MEDLINE) and Google Scholar database by using the following phrases: 'hypothyroidism gluten', 'Hashimoto gluten' and 'thyroiditis gluten'. If a record focused on the subject by title and abstrakt, the full paper was screened. Authors' scientific achievements and references of eligible records were screened for possibly omitted studies. The review was focused only on human studies. Gluten exclusion might increase the risk of HT development because of the potential nutritional deficiencies related to the low quality of gluten-free products. Gluten intake from crops grown on selenium-depleted soil increases the risk of HT development. Only a few studies suggest that GFD would be beneficial for HT patients, even without the coexistence of CD. The strongest connection between gluten intake and thyroid destruction seems to be based on a mechanism of molecular mimicry between gut and thyroid tissue transglutaminase. Studies conducted so far do not support the claim that HT patients should eliminate gluten from their diet. In view of the limited number of studies, with major limitations and ambiguous results, a gluten-free diet is not recommended.

Preserved central cholinergic functioning to transcranial magnetic stimulation in de novo patients with celiac disease.

BackgroundCeliac disease (CD) is now viewed as a systemic disease with multifaceted clinical manifestations. Among the extra-intestinal features, neurological and neuropsychiatric symptoms are still a diagnostic challenge, since they can precede or follow the diagnosis of CD. In particular, it is well known that some adults with CD may complain of cognitive symptoms, that improve when the gluten-free diet (GFD) is started, although they may re-appear after incidental gluten intake. Among the neurophysiological techniques, motor evoked potentials (MEPs) to transcranial magnetic stimulation (TMS) can non-invasively probe in vivo the excitation state of cortical areas and cortico-spinal conductivity, being also able to unveil preclinical impairment in several neurological and psychiatric disorders, as well as in some systemic diseases affecting the central nervous system (CNS), such as CD. We previously demonstrated an intracortical disinhibition and hyperfacilitation of MEP responses to TMS in newly diagnosed patients. However, no data are available on the central cholinergic functioning indexed by specific TMS measures, such as the short-latency afferent inhibition (SAI), which might represent the neurophysiological correlate of cognitive changes in CD patients, also at the preclinical level.MethodsCognitive and depressive symptoms were screened by means of the Montreal Cognitive Assessment (MoCA) and the 17-item Hamilton Depression Rating Scale (HDRS), respectively, in 15 consecutive de novo CD patients and 15 healthy controls. All patients were on normal diet at the time of the enrolment. Brain computed tomography (CT) was performed in all patients. SAI, recorded at two interstimulus intervals (2 and 8 ms), was assessed as the percentage amplitude ratio between the conditioned and the unconditioned MEP response. Resting motor threshold, MEP amplitude and latency, and central motor conduction time were also measured.ResultsThe two groups were comparable for age, sex, anthropometric features, and educational level. Brain CT ruled out intracranial calcifications and clear radiological abnormalities in all patients. Scores at MoCA and HDRS were significantly worse in patients than in controls. The comparison of TMS data between the two groups revealed no statistically significant difference for all measures, including SAI at both interstimulus intervals.ConclusionsCentral cholinergic functioning explored by the SAI of the motor cortex resulted to be not affected in these de novo CD patients compared to age-matched healthy controls. Although the statistically significant difference in MoCA, an overt cognitive impairment was not clinically evident in CD patients. Coherently, to date, no study based on TMS or other diagnostic techniques has shown any involvement of the central acetylcholine or the cholinergic fibers within the CNS in CD. This finding might add support to the vascular inflammation hypothesis underlying the so-called “gluten encephalopathy”, which seems to be due to an aetiology different from that of the cholinergic dysfunction. Longitudinal studies correlating clinical, TMS, and neuroimaging data, both before and after GFD, are needed.

Multi‐ Fabaceae flour for gluten‐free pizza base: Rheology, processing, microstructural, and physico‐sensory characteristics

This study was focused on the formulation and processing of gluten-free variants of pizza base (PB) using the grains of the Fabaceae family. The Bengal gram, soya bean, black gram, and fenugreek seeds were milled to 200 µm size, and multi-Fabaceae gluten-free variant was prepared by blending these grains at 33:33:33:1 ratio. The rheologic characteristics of MFGF indicated that farinograph WAC, DDT, stability; amylograph viscosity values decreased compared with WF. The hardness and gumminess of the WF pizza dough were 17.43 and 5.85, respectively, and increased to 53.41 N and 44.70 kgf for MFGF. The weight (133.40–161.80 g) and breaking strength (37.43–83.41 N) of PB increased and the spread ratio (11.92–8.04) decreased in MFGFPB than WFPB. The use of CA improved the rheologic, textural, and physico-sensory properties of MFGFPB. The MFGFPB +CA had low in vitro starch digestibility (19.21) than WFPB (40.50). ELISA studies indicated that the gluten content of MFGFPB +CA was (15.77 ppm) within the permissible limit for GF products with a substantial increase in protein and dietary fiber. Novelty impact statement Celiac disease (CD) is one of the autoimmune genetic disorders triggered by the ingestion of gluten that affects mucosal damage of the small intestine. The only treatment for CD is lifelong strict adherence to a gluten-free (GF) diet. Recent studies revealed that the GF products available in the market are loaded with starch and sugars with poor nutrition and priced very high. While in CD, there is a requirement for high nutrition diet, due to poor digestion and absorption in the small intestine. Studies suggest to improve the nutritional quality and reduce the cost of GF products in the market and also to introduce a new range of commonly consumed foods as GF products without compromising the originality. The formulation and processing methodologies developed in this research is very helpful to address these issues and exploiting MFGFPB, as a carrier of functional ingredients with health benefit is having huge potential for industrial commercialization.

Intestinal Cellular Biomarkers of Mucosal Lesion Progression in Pediatric Celiac Disease.

Celiac disease (CD) is a chronic intestinal inflammation caused by gluten ingestion in genetically predisposed individuals. Overt-CD and potential-CD are the two main forms of gluten intolerance in pediatric patients with different grades of intestinal mucosa lesion and clinical management. For overt-CD patients the gluten-free diet is mandatory, while for potential-CD the dietary therapy is recommended only for those subjects becoming clinically symptomatic overtime. To date, specific early biomarkers of evolution to villous atrophy in potential-CD are lacking. We recently observed an expansion of TCRγδ+ T cells and a concomitant disappearance of IL4-producing T cells in the intestinal mucosa of overt-CD patients compared to potential-CD children, suggesting the involvement of these two cells subsets in the transition from potential-CD to overt-CD. In this study, we demonstrated that the intestinal densities of IL4+ T cells inversely correlated with TCRγδ+ T cell expansion (p < 0.005) and with the serum levels of anti-tissue transglutaminase antibodies (p < 0.01). The changes of these two cell subsets strongly correlated with mucosal lesions, according to the histological Marsh classification, as the transition from M0 to M3 lesions was associated with a significant reduction of IL4+ T cells (M0 vs. M1 p < 0.04, M0 vs. M3 p < 0.007) and an increase of TCRγδ+ T cells (M0 vs. M1 p < 0.05, M0 vs. M3 p < 0.0006). These findings strongly suggest that the detection of TCRγδ+ and IL4+ T cells could serve as cellular biomarkers of mucosal lesion and targets of novel immunomodulatory therapies for CD.

Gluten Intake and Risk of Digestive System Cancers in 3 Large Prospective Cohort Studies

Background & AimsIn patients with celiac disease, gluten triggers an immune reaction that damages small intestinal villi and may increase long-term risk of gastrointestinal cancer. However, the health impacts of gluten in the general population are understudied. We aimed to examine the association between gluten intake and risk of digestive system cancers among individuals without celiac disease. MethodsWe leveraged longitudinal data from 3 prospective cohorts, the Nurses’ Health Study (1984–2018, 73,166 women aged 65.1 ± 10.8 years), Nurses’ Health Study II (1991–2017, 90,423 women aged 49.1 ± 8.2 years), and Health Professionals Follow-Up Study (1986–2016, 42,617 men aged 64.8 ± 10.8 years). Using Cox proportional hazards regression, we estimated hazard ratios and 95% confidence intervals of digestive system cancers according to quintiles of gluten intake assessed from food frequency questionnaires. ResultsDuring 4,801,513 person-years of follow-up, we documented 6231 incident digestive system cancer cases among 3 cohorts. After adjusting for a wide-range of risk factors, including body mass index, physical activity, diet quality, gluten intake was not associated with an increased risk of digestive system cancer, with a hazard ratio of 0.94 (95% confidence interval, 0.87–1.02) comparing the highest with the lowest quintile of gluten intake (P trend = .05). Similar null associations were found for individual digestive system cancers: oral cavity and oropharyngeal cancer, esophageal cancer, stomach cancer, small intestine cancer, colorectal cancer, pancreatic cancer, gallbladder cancer, and liver cancer. ConclusionsGluten intake was not associated with risk of digestive system cancers in adults without celiac disease. Restricting dietary gluten is unlikely to be beneficial to the prevention of digestive system cancers in the general population.

Gluten-free Diet Reduces the Risk of Irritable Bowel Syndrome: A Mendelian Randomization Analysis.

Background: Whether a gluten-free diet (GFD) is a cause of irritable bowel syndrome (IBS) remains controversial. We aim at exploring the causal relationship between gluten intake and IBS within Mendelian randomization (MR) design. Methods: We conducted a two-sample MR and selected single-nucleotide polymorphisms (SNPs) associated with GFD as instrumental variables (IVs). SNPs and genetic associations with GFD and IBS were obtained from the latest genome-wide association studies (GWAS) in Europeans (GFD: cases: 1,376; controls: 63,573; IBS: cases:1,121; controls: 360,073). We performed inverse variance weighting (IVW) as the primary method with several sensitivity analyses like MR-Egger and MR-PRESSO for quality control. The above analyses were re-run using another large dataset of IBS, as well as changing the p-value threshold when screening IVs, to verify the stability of the results. Results: The final estimate indicated significant causal association [per one copy of effect allele predicted log odds ratio (OR) change in GFD intake: OR = 0.97, 95% confidence interval (CI) 0.96 to 0.99, p < 0.01] without heterogeneity statistically (Q = 2.48, p = 0.78) nor horizontal pleiotropy biasing the causality (p = 0.92). Consistent results were found in validation analyses. Results of MR Steiger directionality test indicated the accuracy of our estimate of the causal direction (Steiger p < 0.001). Conclusion: GFD might be a protective factor of IBS. Therefore, we suggest taking a diet of lower gluten intake into account in IBS prevention and clinical practice.

Prevalence of medically unsupervised activated charcoal use a cause for concern in celiac disease?

BackgroundCeliac disease is an autoimmune disorder that causes an intolerance to gluten. Owing to hidden sources, lack of clear labeling, and cross-contamination, it is not uncommon for individuals with celiac disease to inadvertently ingest gluten. A strict gluten-free diet is the only treatment. ObjectivesThe purpose of this study was to identify the frequency of activated charcoal use in celiac disease as a purported remedy despite the lack of literature on the safety and efficacy of the practice and to elucidate the manner in which using activated charcoal as a treatment for acute gluten ingestion is being communicated. MethodsUsing a descriptive study design, a Web-based survey was sent to members of the celiac disease community via social media pages for voluntary participants 18 years and older diagnosed with celiac disease. Participants were stratified into 3 major groups: (1) those who had heard of using activated charcoal as a remedy to counteract gluten ingestion and used it, (2) those who had heard of using activated charcoal but had not used it, and (3) those who had not heard of using activated charcoal. ResultsIn subjects with celiac disease, 424 of 1613 respondents (26%) had heard of using activated charcoal as a potential remedy for gluten ingestion, and 12% had used it. The top source of information regarding any general information including remedies for maladies related to celiac disease was social media networks 72.3% (879/1613). Of those who had used activated charcoal, 122 participants (61.3%) reported subjectively feeling a reduced severity of symptoms. ConclusionPharmacists should be aware of the off-label use of activated charcoal for accidental gluten ingestion in celiac disease. Pharmacists should educate patients with celiac disease that there is not sufficient evidence to support the use of activated charcoal.

Insights from tissue "omics" analysis on intestinal remodeling in celiac disease.

Celiac disease (CeD) is a prevalent intestinal disorder that only develops in genetically susceptible individuals when they mount a harmful CD4+ T-cell response towards gluten peptides. Intake of gluten leads to inflammation and remodeling of the small intestine with symptoms such as nausea and diarrhea. The only current treatment is a lifelong gluten free diet. The immunological basis for CeD is well characterized but the mechanisms that drive intestinal remodeling are still poorly understood. Transcriptome or proteome analysis of intestinal biopsies gives a global snapshot of all processes that occur in the tissue, including alterations in the epithelial cell layer. This paper will introduce concepts of intestinal remodeling, recapitulate the current understanding of CeD pathogenesis and discuss findings from relevant tissue "omics" studies. On the basis of this review, I give perspectives on what tissue "omics" studies can tell us about disease pathogenesis with a particular focus on the gluten induced intestinal remodeling.

The Risk of Malignancies in Celiac Disease-A Literature Review.

Simple SummaryCeliac disease (CeD) is an multiorgan autoimmune disease precipitated by the ingestion of gluten in genetically predisposed individuals. After the initiation of a gluten-free diet, CeD generally has a benign course, with the complete remission of symptoms and a normal life expectancy; however, robust evidence suggests that subjects with CeD are at increased risk of developing malignancies compared to the general population. Peculiar associations with lymphomas, including enteropathy-associated T-cell lymphoma (EATL), and small bowel carcinoma (SBC), as well as correlations with other cancers, have been thoroughly investigated. In this review, we will examine the risk of developing malignancies in patients with CeD, as well as clinical aspects of and therapeutic options for EATL and SBC.Celiac disease (CeD) is an immune-mediated enteropathy precipitated by ingestion of gluten in genetically predisposed individuals. Considering that CeD affects approximately 1% of the Western population, it may be considered a global health problem. In the large majority of cases, CeD has a benign course, characterized by the complete resolution of symptoms and a normal life expectancy after the beginning of a gluten-free-diet (GFD); however, an increased risk of developing malignancies, such as lymphomas and small bowel carcinoma (SBC), has been reported. In particular, enteropathy-associated T-cell lymphoma (EATL), a peculiar type of T-cell lymphoma, is characteristically associated with CeD. Moreover, the possible association between CeD and several other malignancies has been also investigated in a considerable number of studies. In this paper, we aim to provide a comprehensive review of the current knowledge about the associations between CeD and cancer, focusing in particular on EATL and SBC, two rare but aggressive malignancies.

Skin Manifestations and Coeliac Disease in Paediatric Population.

Celiac disease (CD) is an immune-mediated enteropathy caused by gluten ingestion, affecting approximately 1% of the worldwide population. Extraintestinal symptoms may be present as the first signs of CD, years before the CD diagnosis is made. A great variety of extraintestinal manifestations may be associated with CD. Cutaneous manifestations represent the main extraintestinal manifestations, with dermatitis herpetiformis being the most common in patients with CD. In adults, it has been demonstrated that the role of a gluten-free diet is crucial not only for the recovery of signs and symptoms associated with CD but also for cutaneous manifestations, which often improve after gluten avoidance. In children with CD, the association with skin disorders is well documented regarding dermatitis herpetiformis, but studies considering other dermatological conditions, such as psoriasis and atopic dermatitis, are few. The prevalence and manifestations of dermatological disorders in celiac children are often different from those in adults, explaining the gap between these populations. In addition, the therapeutic role of a gluten-free diet in the improvement in skin alterations is not fully understood in children and in adult population except for dermatitis herpetiformis. Therefore, cutaneous CD symptoms need to be known and recognized by physicians despite their specialties to improve early CD diagnosis, which is critical for a better prognosis. This review describes the current scientific evidence on skin manifestations associated with CD in the pediatric population.

Celiac Disease.

Celiac Disease.