Gluten-free Research Articles

Development and characterisation of gluten‐free fresh pasta using teff, rice, and buckwheat flours enhanced with thermal waters: a mixture design approach

SummaryTo meet the demand for gluten‐free (GF) products, this study developed artisanal fresh pasta using teff, rice, and buckwheat flours, enhanced with mineral‐rich thermal waters (TW). A mixture design approach optimised flour proportions to balance texture, cooking time, water absorption, and cooking loss, along with functional properties such as total phenolic compounds (TPC) and antioxidant activity. Two promising formulations were identified: 36.3 g buckwheat, 9.35 g rice, and 9.35 g teff; and 27.5 g teff and 27.5 g buckwheat. These formulations, with and without TW, were evaluated for chemical, technological, microbiological, and functional attributes. The pasta had satisfactory technological properties, macronutrient levels comparable to standard pasta, and was rich in phenolic compounds with antioxidant activity. Ca, Zn, Fe, K, and Mn were predominant, although TW incorporation did not significantly affect their levels in the samples. All formulations showed microbiological stability for at least 3 days at 4 °C.

Comparison of Self-Care Practices and BMI between Celiac and Non-Celiac Adolescent Populations.

Celiac disease (CD) is a chronic gastrointestinal disorder that is most frequently found in Western countries, and the only treatment available today is a lifelong gluten-free diet (GFD). The main aim of the present study is to compare the self-care practices and body mass index (BMI) of adolescents with CD and without CD in different dimensions (physical, psychological, social, and management). The non-probabilistic sample included 236 participants (118 with CD) aged between 12 and 16 years old, who were part of the project "Role of the family in the perception of youth self-care". The data were obtained through the self-administration of the Practice and Management of Youth Self-care questionnaire, while the celiac population also completed the Adherence to a Gluten-Free Diet (GFD) questionnaire. The celiac population analyzed showed significant correlations between the Physical Practices and Management with adherence to a GFD, and between a GFD and Psychological Practices. Differences were observed between the celiac and the non-celiac populations in the dimensions of Physical Practices, Social Practices, and Management. With respect to BMI, age and CD showed a significant influence of a GFD on BMI (p < 0.001). In conclusion, the application of multi-dimensional questionnaires and their relationship with the adherence to a GFD provide valuable information to propose interventions directed to this population.

Sembra un deficit di GH, e invece non lo è!

A 2.5-year-old girl was evaluated for poor growth. Despite low IGF-1 levels, GH deficiency was excluded. Further investigation revealed celiac disease, diagnosed via EGDS. After starting a gluten-free diet, catch-up growth was observed. The patient remained under follow-up to monitor her growth progress.

Effects of fructan and gluten on gut microbiota in individuals with self-reported non-celiac gluten/wheat sensitivity—a randomised controlled crossover trial

BackgroundIndividuals with non-celiac gluten/wheat sensitivity (NCGWS) experience improvement in gastrointestinal symptoms following a gluten-free diet. Although previous results have indicated that fructo-oligosaccharides (FOS), a type of short-chain fructans, were more likely to induce symptoms than gluten in self-reported NCGWS patients, the underlying mechanisms are unresolved.MethodsOur main objective was therefore to investigate whether FOS-fructans and gluten affect the composition and diversity of the faecal microbiota (16S rRNA gene sequencing), faecal metabolites of microbial fermentation (short-chain fatty acids [SCFA]; gas chromatography with flame ionization detector), and a faecal biomarker of gut inflammation (neutrophil gelatinase-associated lipocalin, also known as lipocalin 2, NGAL/LCN2; ELISA). In the randomised double-blind placebo-controlled crossover study, 59 participants with self-reported NCGWS underwent three different 7-day diet challenges with gluten (5.7 g/day), FOS-fructans (2.1 g/day), and placebo separately (three periods, six challenge sequences).ResultsThe relative abundances of certain bacterial taxa were affected differently by the diet challenges. After the FOS-fructan challenge, Fusicatenibacter increased, while Eubacterium (E.) coprostanoligenes group, Anaerotruncus, and unknown Ruminococcaceae genera decreased. The gluten challenge was primarily characterized by increased abundance of Eubacterium xylanophilum group. However, no differences were found for bacterial diversity (α-diversity), overall bacterial community structure (β-diversity), faecal metabolites (SCFA), or NGAL/LCN2. Furthermore, gastrointestinal symptoms in response to FOS-fructans were generally not linked to substantial shifts in the gut bacterial community. However, the reduction in E. coprostanoligenes group following the FOS-fructan challenge was associated with increased gastrointestinal pain. Finally, correlation analysis revealed that changes in gastrointestinal symptoms following the FOS-fructan and gluten challenges were linked to varying bacterial abundances at baseline.ConclusionsIn conclusion, while FOS-fructans induced more gastrointestinal symptoms than gluten in the NCGWS patients, we did not find that substantial shifts in the composition nor function of the faecal microbiota could explain these differences in the current study. However, our results indicate that individual variations in baseline bacterial composition/function may influence the gastrointestinal symptom response to both FOS-fructans and gluten. Additionally, the change in E. coprostanoligenes group, which was associated with increased symptoms, implies that attention should be given to these bacteria in future trials investigating the impact of dietary treatments on gastrointestinal symptoms.Trial registrationClinicaltrials.gov as NCT02464150.

Knowledge and Attitude of Celiac Disease Among the Population of Riyadh, Saudi Arabia.

Background and aims Celiac disease (CD) is a chronic autoimmune disease that is characterized by inflammation of the intestinal mucosa, primarily triggered by gluten. So far, the effective management of CD only includes a gluten-free diet. For early diagnosis and management, adequate knowledge and a positive attitude towards CD are crucial. This study aims to investigate the CD-related knowledge and attitudes of the public in Riyadh, Saudi Arabia. Methods A cross-sectional online survey was conducted among individuals aged 16 and older. The data regarding demographic factors, knowledge, and attitudes about CD was collected via an online questionnaire. Statistical analysis was conducted using version 26 of SPSS(IBM Corp., Armonk, NY). Results In the current study, 669 individuals responded to the online survey. The majority of participants (82.1%) were familiar with CD. A total of 59.9% of respondents had adequate knowledge, 32.3% had outstanding knowledge, and 7.8% reported no knowledge of CD. The majority (69.5%) of respondents held negative attitudes concerning CD. The correlation between age and CD knowledge (P<0.05) and attitude (P<0.05) was statistically significant. Similarly, the correlation between occupation and CD knowledge (P<0.05) and attitude (P<0.05) was statistically significant. However, no significant association between gender and CD knowledge (p=0.720) or attitude (p=0.244) was found in males and females. Conclusion This study revealed that the majority of the residents of Riyadh, Saudi Arabia, had an adequate or excellent understanding of CD. However, the majority of respondents had a negative attitude towards CD management.

Monitoring the Quality of Life and the Relationship between Quality of Life, Dietary Intervention, and Dietary Adherence in Patients with Coeliac Disease.

Inadequate adherence to a gluten-free diet in coeliac disease triggers autoimmune reactions and can reduce the quality of life. The strict diet requires constant vigilance, which can cause psychological distress. Our research aimed to assess the quality of life in adult patients with coeliac disease and to find a correlation between quality of life, dietary intervention, and adherence. The study included 51 adult patients with coeliac disease who completed a quality-of-life questionnaire. Adherence was assessed using serological tests and a dietary adherence test. The patients were divided into two groups: those on a gluten-free diet for at least three months (Group I) and newly diagnosed patients (Group II). Group I showed a significant decrease in the dysphoria subscale of the quality-of-life test between the first and last surveys. Poor quality of life was associated with worse adherence in Group II. A higher "Health concerns" quality of life subscale score was also associated with worse adherence in Group II. Our results suggest that dietetic care may be beneficial for patients with coeliac disease by reducing dysphoria. We recommend regular and long-term dietary monitoring from diagnosis to ensure adherence to a gluten-free diet and to maintain quality of life.

Psychiatric Difficulties in Children with Celiac Disease and the Relationship between Adherence to Treatment and Parental Attitudes.

Our knowledge of the factors related to parenting styles affecting adherence to diet in children with celiac diseases (CDs) and the association between psychiatric difficulties and diet compliance is largely based on limited data. Therefore, our work aims to examine primarily coexisting psychiatric difficulties in children with CD and raising attitudes of their parents and secondarily the relationship among adherence to treatment, psychiatric difficulties, and parental attitudes. Children aged 4-12 years (n = 42) who have been followed up with the diagnosis of CD in a Paediatric Gastroenterology Outpatient Clinic were compared with those of healthy controls (n = 31). One of the parents was asked to fill out the socio-demographic information form, Diet Compliance Form (only the patient group), "Parental Attitude Research Instrument" (PARI) and Strengths and Difficulties Questionnaire-parent form (SDQ). The scores from "emotional problems," "peer relationship problems," and "total difficulties" areas were statistically significantly higher in the disease group than healthy controls. The average score of SDQ subscales and none of the PARI subscales differed between dietary compliance +/- groups. Significant positive correlations were detected between disease duration and PARI-overprotection/extreme motherhood (r = .421, P = .017) and PARI-strict/hard discipline (r = .368, P = .038) subscales. Clarifying the factors related to parenting that may affect patients' adherence to a gluten-free diet will contribute positively to the course of the disease and the quality of life of patients and their families.

Severe Coagulopathy and Intra-Alveolar Haemorrhage Due to Fat Malabsorption in Celiac Disease.

Celiac disease can cause severe coagulopathy due to fat malabsorption and vitamin K deficiency.High suspicion is required for atypical presentations of celiac disease.A gluten-free diet is essential for managing celiac disease and normalising coagulation profiles.

Considering a more sustainable gluten-free diet? Gluten-free cereals in European dietary practice

BackgroundThe inclusion of minor and pseudo-cereals enhances the nutritional quality of a gluten-free diet. Yet, affordability determines practical implementation. Environmental concerns should also be considered as moving towards a more sustainable diet. How do these aspects of sustainability manifest themselves in a special diet, such as gluten-free?MethodsAn international pilot survey among practicing dietitians was conducted during the Congress of The European Federation of the Associations of Dietitians (EFAD, Budapest, 2023). Respondents marked their recommendation for eight gluten-free cereals based on five criteria, including nutritional quality, accessibility/price, and climate change. Differences were analysed using Cohran’s Q and pairwise post-hoc tests (N = 38).ResultsThere were significant differences in the recommendation for cereals (p < 0.05 for each grain), with quinoa (89.5%), gluten-free oats (89.5%), rice (86.8%), and corn (65.8%) being the most recommended. Buckwheat (55.3%), millet (50.0%), amaranth (44.7%) and sorghum (26.3%) were less recommended. Although gluten-free oats were recommended overall, quinoa was recommended for its nutritional content, and rice and corn were recommended for accessibility/price. No cereal received a high recommendation for climate change.ConclusionsAccording to this pilot survey, nutritional content and accessibility/price were the most important criteria for evaluating gluten-free grains. Dietitians were willing to integrate climate change considerations into practice, but more information is needed. The recommendation for minor and pseudo-cereals contradicted the importance emphasised by the literature. Further research is needed to integrate these aspects, helping dietitians formulate recommendations.

Symptom Outcomes of Celiac Disease in Those on a Gluten-free Diet.

We aimed to evaluate symptom outcomes in those on a gluten-free diet during the 5 years after diagnosis. Celiac disease is common; however, little is known about long-term symptom outcomes. We performed a retrospective chart review on individuals with celiac disease followed at a tertiary referral center between 2012 and 2018. To minimize bias, strict inclusion/exclusion criteria were utilized. Only those with definitive biopsy-proven celiac disease, on a gluten-free diet, and with systematic follow-up were included. The standardized care at this center reduced the risk that decisions on testing and follow-up visits were determined by symptom status. Summary statistics were computed and generalized linear models with a logit link were used to associate the proportion of symptomatic visits with various covariates using R statistical programming. Of the 1023 records reviewed, 212 met inclusion/exclusion criteria; 146 (69%) were female and the mean age at diagnosis was 43 (range: 11 to 84y old). During follow-up, over 50% remained symptomatic, with many having the same symptoms that prompted the diagnosis. The only predictors for remaining symptomatic were female sex and younger age at diagnosis. Abnormal serology during follow-up and small bowel normalization were not predictive. In individuals with definitive celiac disease with systematic long-term follow-up in a Celiac Clinic, roughly half remained symptomatic despite a gluten-free diet. Many suffer from the same symptoms that prompted the diagnosis of celiac disease. Small bowel healing and abnormal serology in follow-up were not predictive of remaining symptomatic. These findings stress the importance of long-term care in celiac disease.

Dietary Interventions and Supplements for Managing Attention-Deficit/Hyperactivity Disorder (ADHD): A Systematic Review of Efficacy and Recommendations.

Attention-deficit/hyperactivity disorder (ADHD) significantly impacts children's neurological development, behaviour, and overall well-being, affecting academic performance and social interactions. This systematic review investigates the effectiveness of dietary interventions (DASH(Dietary Approaches to Stop Hypertension) diet, Vitamin D3 supplementation, magnesium, and impact of artificial food colors and marine oils) and supplements alongside standard pharmacotherapy in managing ADHD symptoms. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we extensively searched various databases for studies published from 2016 to 2022. Out of an initial pool of 7873 records, 14 randomized controlled trials met our inclusion criteria following rigorous screening. Our findings suggest that gluten-free diets may alleviate ADHD symptoms despite negative celiac serology, highlighting the role of non-celiac gluten sensitivity. Moreover, vitamin and mineral supplements like vitamin D and magnesium showed varying degrees of effectiveness in improving behavioural and emotional symptoms. Innovative treatments, such as combining saffron with methylphenidate and using marine oil extracts, also demonstrated potential in enhancing behaviours associated with ADHD. The review underscores the importance of dietary approaches, such as the DASH diet and specific exclusions (e.g., a few foods diet and an oligoantigenic diet), in managing symptoms by addressing nutritional factors. Studies on probiotics and interventions targeting gut microbiota composition yielded mixed results, necessitating further exploration. Limitations include study diversity and short-term outcome assessments, cautioning against broad generalizations. Integrating personalized dietary assessments and interventions into ADHD treatment strategies could optimize therapeutic outcomes and potentially reduce reliance on pharmacotherapy alone. In summary, this systematic review highlights the potential benefits of dietary modifications and supplements in managing ADHD symptoms. Future research should prioritize long-term efficacy, interactions with conventional medications, and personalized dietary approaches to refine ADHD treatment strategies.

Diet and Lifestyle Modifications for Fibromyalgia.

Fibromyalgia (FM) is a complex, widespread pain disorder characterized by symptoms such as fatigue, sleep deprivation, mental fog, mood swings, and headaches. Currently, there are only three FDA-approved medications for FM patients: duloxetine, milnacipran, and pregabalin, with outcomes frequently being inadequate. This research team aims to investigate the effects of diet and lifestyle modifications on FM, with emphasis on anti-inflammatory diet, antioxidants, and gluten-free diets, as well as supplementation with Magnesium, CQ10, and Vitamin D, microbiome, sleep, exercise, and cognitive behavioral therapy. We reviewed the pathophysiology of certain foods that can be proinflammatory with the release of cytokines leading to activation of pain, fatigue and aggravation of the majority of Fibromyalgia symptoms. A literature review was performed by identifying FM articles published between 1994 and 2022 via PubMed and EMBASE databases, with particular emphasis on randomized controlled trials, meta-analysis, and evidence-based treatment guidelines. This review article was completed by a comprehensive narrative review process, in which our team systematically examined relevant scientific literature to provide a comprehensive overview of the significant role that diet and other lifestyle modifications play in mediating symptoms of Fibromyalgia. We propose that diet modifications and lifestyle changes, such as sleep, exercise, and weight loss, can be important steps in managing FM.

Factors associated with dietary practices and beliefs on food of patients with rheumatic and musculoskeletal diseases: A multicentre cross-sectional study

ObjectivesTo investigate dietary practices and beliefs of patients with rheumatic and musculoskeletal diseases (RMDs) and associated factors. MethodsIn 2019–2020, a cross-sectional multicentre study enrolled patients with inflammatory arthritis (IA) (rheumatoid arthritis [RA], axial spondyloarthritis [axSpA]) or hand osteoarthritis (HOA) from secondary- and tertiary-care centres. A self-administered questionnaire explored dietary practices and patients’ perceived effects of diet, foods and beverages on symptoms. Univariable and multivariable analyses investigated factors associated with diets and patients’ views. ResultsOf 448 included patients, data for 392 were analysed (123 with RA, 161 with axSpA, 108 with HOA), 26% were on or had been on at least one exclusion diet (mostly cow's milk- and gluten-free diets in IA, mostly cow's milk-free diet and detox/fasting in HOA). Only 5% of patients followed the Mediterranean diet. Among patients who had tried a diet, 51% reported a decrease in pain. Overall, 42% of patients identified at least one food or beverage that increased or decreased pain. On multivariable analyses, dieting or the perceived effect of food on pain was associated with health beliefs (positive or negative), the use of complementary and alternative medicines, and lack of support or information from healthcare professionals. Patients had received little dietary information from their physicians. ConclusionsThis study provides insights into patients’ dietary practices and factors associated with these practices, including patients’ health beliefs and insufficient support by health professionals, in RMDs.

CELIAC DISEASE AND ITS IMPACT ON AUTOIMMUNE THYROID

The small intestinal condition known as Celiac Disease (CD) or gluten-sensitive enteropathy is brought on by the bodys immune system reacting to gluten consumption. In populations in the West, it is quite prevalent, with an incidence of 1%. Patients with autoimmune thyroid illness, type 1 diabetes mellitus, autoimmune liver diseases, and inflammatory bowel disease have been observed to have a higher prevalence of CD among autoimmune disorders. Autoimmune thyroid diseases are more common in persons with CD, with hypothyroidism being more common than hyperthyroidism. Examining the frequency of CD in patients with ATD was the goal of this investigation. Adopting a Gluten-Free Diet (GFD) promotes the development of related disorders and enhances the entire therapeutic course. Certain conditions, including iron deficiency anaemia, are made worse by the GFD and eventually go away. This makes it possible to better regulate diseases like type 1 diabetes mellitus. Adequate GFD compliance may also slow down the progression of various other problems and/or related disorders, particularly if started early.

A Review On: Role of Pearl Millet Derived Gluten Free Product and Its Benefit in Treating Iron Deficiency Anaemia in Celiac Patients

Hidden hunger is a global issue and is coming up as a alarming problem for mankind. At the same time world’s most popular countries data showed the occurrence of Celiac Disease, mostly popular in India, Brazil, Russia also in US. 5-8 million people of India is expected to have celiac disease which is not a number can be ignored. The Strict Gluten Free Diet (GFD) is the only therapy intended for celiac patients, as a result most of the patient suffers from Iron Deficiency Anemia which is one of the most reported additional intestinal manifestations of celiac disease. Today’s market lacks the proper gluten free diet products. Most of them are either too costly or not nutrient dense. Millets being a Nutri cereal and old-style staple food of the dry land areas of the world can work as wonder in treating this problem. Among millets, Pearl millet is famous and important grain in the dry and semitropical areas of many developing countries. Proper fortification, enrichment and introducing millets in the plate of celiac patients are showing beneficial result in improving their health status. Our present study will review the part of pearl millet derived product and their efficacy, in treating iron deficiency anemia in celiac patients.

THE PROCESSING TECHNIQUE AFFECTS THE PHYSICOCHEMICAL AND TEXTURAL CHARACTERISTICS OF PURPLE YAM BASED GLUTEN-FREE DOUGH

Purple yam tuber in the form of flour has been applied for functional food products. Processing purple yam tubers into flour eliminates many beneficial compounds of the tubers. Another alternative for processing purple yam tubers is to process them directly into a paste to be mixed into the dough. This study was carried out to determine the effect of the processing technique of yam tuber on the texture profile of gluten-free dough made up of yam tuber and modified cassava flour (mocaf). Four (4) types of processing techniques were applied to produce purple yam+mocaf dough. First (ST), steaming yam tuber, mashing + mocaf + water. Second (SST), steaming slice of yam tuber, mashing + mocaf + water. Third (SCT0.5), soaking slices of yam tuber in citric acid 0.5%, mashing + mocaf + yam tuber mucus. The last (SCT1) is soaking slices of yam tuber in citric acid 1%, mashing + mocaf + yam tuber mucus. The result showed that the amount of water, the ratio between purple yam paste and mocaf, the lead time, and the processing technique play important roles in shaping the texture of the dough. The third technique (SCT0.5) produced higher hardness, adhesiveness, springiness, and cohesiveness dough than the other techniques. However, none of the texture profiles strongly correlate with the dietary fiber content. These results can be used better to understand the free gluten food application of yam tuber.

Revealing the influence of sorghum flour on the rheological and baking properties of dough, the quality and nutritional value of bread

The object of this study is the quality of bread using wheat flour mixed with sorghum flour. The implementation of the task of stable provision of the population with good quality bread and high nutritional value is based on improving the technology of bread using sorghum flour in accordance with the global trend of safe and healthy nutrition. The results on the chemical composition and nutritional value (amino acid content, mineral composition, and vitamins) of sorghum flour were obtained, a comparative analysis with wheat flour was carried out. An analysis of the amylographic characteristics of flour and dough with the addition of various amounts of sorghum flour, improvers, and enzyme preparations was carried out. As a source of nutrients, the effect of sorghum flour on the rheological and baking properties of wheat dough was studied. The effect of the studied flour on the quality of finished bread was established. The complex effect of the Emceft improver and the KAZenzym enzyme preparation on the quality of dough and bread, including from sorghum flour, was studied. For the first time, the use of sorghum flour of the Kazakhstan 20 variety for the production of bread in combination with an improver and an enzyme preparation has improved the chemical composition, rheological and baking properties of the dough. Research shows that bread with the use of sorghum flour diversifies the diet and promotes human health due to its nutritional composition and potential as a gluten-free food. The scope and conditions of practical use of the results are the possibility of using sorghum for bread making. Achieving these capabilities is based on the developed technology of bread in combination with an improver and an enzyme preparation

Expression of MicroRNAs in Adults with Celiac Disease: A Narrative Review.

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of proline- and glutamine-rich proteins, widely termed "gluten", in genetically susceptible individuals. CD induces an altered immune response that leads to chronic inflammation and duodenal mucosal damage. Currently, there are no specific tests for the accurate diagnosis of CD, and no drugs are available to treat this condition. The only available treatment strategy is lifelong adherence to a gluten-free diet. However, some studies have investigated the involvement of microRNAs (miRNAs) in CD pathogenesis. miRNAs are small noncoding ribonucleic acid molecules that regulate gene expression. Despite the growing number of studies on the role of miRNAs in autoimmune disorders, data on miRNAs and CD are scarce. Therefore, this study aimed to perform a literature review to summarize CD, miRNAs, and the potential interactions between miRNAs and CD in adults. This review shows that miRNA expression can suppress or stimulate pathways related to CD pathogenesis by regulating cell proliferation and differentiation, regulatory T-cell development, innate immune response, activation of the inflammatory cascade, focal adhesion, T-cell commitment, tissue transglutaminase synthesis, and cell cycle. Thus, identifying miRNAs and their related effects on CD could open new possibilities for diagnosis, prognosis, and follow-up of biomarkers.

Collagenous and lymphocytic gastritis in pediatric patients. A single-center experience observing an increase in diagnosis in recent years

Background Collagenous gastritis (CG) and Lymphocytic gastritis (LG) are rare types of gastritis. Thick sub-epithelial collagen bands characterize CG. Numerous lymphocytes in the surface and foveolar epithelium characterize LG. We aimed to characterize these disorders in our pediatric unit. Methods A retrospective review of children diagnosed with CG and LG between 2000 and 2023. Baseline data; demographics, anthropometric, symptoms, laboratory data, macroscopic and histopathologic findings. Follow-up data; treatment, improvement of symptoms and laboratory parameters. Results We identified 31 children, 11 (35.5%) had CG and 20 (64.5%) LG, mean age 9.07 ± 5.04 years. Seven (22.6%) children were diagnosed between 2000 and 2016 and 24 (77.4%) between 2017 and 2023. Baseline characteristics included gastrointestinal symptoms in 16 (51.6%), iron deficiency anemia in 22 (71%), with a mean hemoglobin level of 8.8 ± 2.5 gr/dl. Gastric endoscopic findings were normal in 12 (38.7%), demonstrated nodularity in 14 (45.2%) and an inflamed mucosa without nodularity in 5 (16.1%). Helicobacter pylori was positive in 3 (9.7%) children, celiac disease was diagnosed in 7 (22.6%). Treatment included iron supplementation in 24 (77.4%), proton pump inhibitors in 16 (51.6%) and a gluten free diet in seven. Mean follow-up was 2.9 ± 2.2 years. Hemoglobin levels normalized in 21/22; however, 9 (29%) patients required repeat iron supplementation. Eight patients had a repeat endoscopy (6 CG and 2 LG) without changes in their gastric histopathology. Conclusions CG and LG are not rare in pediatric patients. Physicians and pathologist should be aware of these types of gastritis.

Effect of Sourdough-Yeast Co-Fermentation on Physicochemical Properties of Corn Fagao Batter.

Fagao is one of China's traditional gluten-free staple foods made with rice or corn flour. Corn Fagao prepared by co-fermentation with sourdough and yeast exhibits better quality and less staling compared to traditional yeast-fermented Fagao. The physicochemical properties of corn Fagao batter during sourdough-yeast co-fermentation were investigated. The results showed that compared with yeast fermentation, the gas production and viscosity of the batter increased with co-fermentation. The co-fermented batter showed a higher hydrolysis of starch and less amylose content. The integrity of starch granules in the co-fermented batter was damaged more seriously, and the crystallinity and short-range ordered structure were less than in the yeast-fermented batter, even though the crystal structure type of starch did not obviously change. The peak viscosity, minimum viscosity, final viscosity, decay value, and recovery value of the corn batter were reduced by co-fermentation, which improved the thermal stability of the batter and slowed down the aging. Co-fermentation also resulted in a more pronounced reduction in protein subunit content than yeast fermentation. The changes in the physicochemical properties of the corn Fagao batter help explain the improvement in quality of corn Fagao made from the co-fermentation method and may provide theoretical references for co-fermentation with sourdough and yeast to other gluten-free foods.