Recent PubMed Articles on Coeliac Disease (External)

High SMAD7 and p-SMAD2,3 expression is associated with environmental enteropathy in children.

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High SMAD7 and p-SMAD2,3 expression is associated with environmental enteropathy in children.

PLoS Negl Trop Dis. 2018 02;12(2):e0006224

Authors: Syed S, Dinallo V, Iqbal NT, Di Iorio L, Di Fusco D, Guleria S, Amadi BC, Sadiq K, Moskaluk C, Ali SA, Kelly P, Monteleone G

Abstract
Enteropathies such as Crohn's disease are associated with enteric inflammation characterized by impaired TGF-β signaling, decreased expression of phosphorylated (p)-SMAD2,3 and increased expression of SMAD7 (an inhibitor of SMAD3 phosphorylation). Environmental enteropathy (EE) is an acquired inflammatory disease of the small intestine (SI), which is associated with linear growth disruption, cognitive deficits, and reduced oral vaccine responsiveness in children <5 y in resource-poor countries. We aimed to characterize EE inflammatory pathways by determining SMAD7 and p-SMAD2,3 levels (using Western blotting) in EE duodenal biopsies (N = 19 children, 7 from Pakistan, 12 from Zambia) and comparing these with healthy controls (Ctl) and celiac disease (CD) patients from Italy. Densitometric analysis of immunoblots showed that EE SI biopsies expressed higher levels of both SMAD7 (mean±SD in arbitrary units [a.u.], Ctl = 0.47±0.20 a.u., EE = 1.13±0.25 a.u., p-value = 0.03) and p-SMAD2,3 (mean±SD, Ctl = 0.38±0.14 a.u., EE = 0.60±0.10 a.u., p-value = 0.03). Immunohistochemistry showed that, in EE, SMAD7 is expressed in both the epithelium and in mononuclear cells of the lamina propria (LP). In contrast, p-SMAD3 in EE is expressed much more prominently in epithelial cells than in the LP. The high SMAD7 immunoreactivity and lack of p-SMAD3 expression in the LP suggests defective TGF-β signaling in the LP in EE similar to a previously reported SMAD7-mediated inflammatory pathway in refractory CD and Crohn's disease. However, Western blot densitometry showed elevated p-SMAD2,3 levels in EE, possibly suggesting a different inflammatory pathway than Crohn's disease but more likely reflecting cumulative protein expression from across all compartments of the mucosa as opposed to the LP alone. Further studies are needed to substantiate these preliminary results and to illustrate the relationship between SMAD proteins, TGF-β signaling, and inflammatory cytokine production, all of which may be potential therapeutic targets.

PMID: 29415065 [PubMed - indexed for MEDLINE]

Indications and Use of the Gluten Contamination Elimination Diet for Patients with Non-Responsive Celiac Disease.

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Indications and Use of the Gluten Contamination Elimination Diet for Patients with Non-Responsive Celiac Disease.

Nutrients. 2017 Oct 18;9(10):

Authors: Leonard MM, Cureton P, Fasano A

Abstract
For the majority of patients diagnosed with celiac disease, once a gluten-free diet is initiated, symptoms improve within weeks and may completely resolve in months. However, up to 30% of patients may show signs, symptoms or persistent small intestinal damage after one year on a gluten-free diet. These patients require evaluation for other common GI etiologies and assessment of their celiac disease status in order to make a diagnosis and suggest treatment. Here, we propose an approach to evaluating patients with celiac disease with persistent symptoms, persistently elevated serology, and or persistent villous atrophy despite a gluten-free diet. We detail how to diagnose and distinguish between non-responsive and refractory celiac disease. Finally, we introduce the indications for use of the gluten contamination elimination diet and provide information for practitioners to implement the diet when necessary in their practice.

PMID: 29057833 [PubMed - indexed for MEDLINE]

Evaluation of T cells in blood after a short gluten challenge for coeliac disease diagnosis.

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Evaluation of T cells in blood after a short gluten challenge for coeliac disease diagnosis.

Dig Liver Dis. 2018 Apr 27;:

Authors: López-Palacios N, Pascual V, Castaño M, Bodas A, Fernández-Prieto M, Espino-Paisán L, Martínez-Ojinaga E, Salazar I, Martínez-Curiel R, Rey E, Estrada L, Molero-Abraham M, Reche PA, Dieli-Crimi R, Núñez C

Abstract
BACKGROUND AND AIM: To diagnose coeliac disease (CD) in individuals on a gluten free diet (GFD), we aimed to assess the utility of detecting activated γδ and CD8 T cells expressing gut-homing receptors after a short gluten challenge.
METHODS: We studied 15 CD patients and 35 non-CD controls, all exposed to three days of gluten when following a GFD. Peripheral blood was collected before and six days after starting gluten consumption, and the expression of CD103, β7 and CD38 in γδ and CD8 T cells was assessed by flow cytometry. Determination of IFN-γ and IP-10 was performed by means of ELISPOT and/or Luminex technology.
RESULTS: We observed both γδ and CD8 T cells coexpressing CD103, β7hi and CD38 in every patient with CD on day six, but only in one control. The studied CD8 T subpopulation was easier to detect than the γδ subpopulation. Increased IFN-γ and IP-10 levels after challenge were observed in patients with CD, but not in controls.
CONCLUSION: A short three-day gluten challenge elicits the activation of CD103+ β7hi CD8+ T cells in CD. These cells can be detected by flow cytometry in peripheral blood, opening new possibilities for CD diagnosis in individuals on a GFD.

PMID: 29903545 [PubMed - as supplied by publisher]

Management of bone health in patients with celiac disease: Practical guide for clinicians.

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Management of bone health in patients with celiac disease: Practical guide for clinicians.

Can Fam Physician. 2018 Jun;64(6):433-438

Authors: Duerksen D, Pinto-Sanchez MI, Anca A, Schnetzler J, Case S, Zelin J, Smallwood A, Turner J, Verdú E, Butzner JD, Rashid M

Abstract
OBJECTIVE: To describe clinical issues related to bone health in patients with celiac disease (CD) and to provide guidance on monitoring bone health in these patients.
SOURCES OF INFORMATION: A PubMed search was conducted to review literature relevant to CD and bone health, including guidelines published by professional gastroenterological organizations.
MAIN MESSAGE: Bone health can be negatively affected in both adults and children with CD owing to the inflammatory process and malabsorption of calcium and vitamin D. Most adults with symptomatic CD at diagnosis have low bone mass. Bone mineral density should be tested at diagnosis and at follow-up, especially in adult patients. Vitamin D levels should be measured at diagnosis and annually until they are normal. In addition to a strict gluten-free diet, supplementation with calcium and vitamin D should be provided and weight-bearing exercises encouraged.
CONCLUSION: Bone health can be adversely affected in patients with CD. These patients require adequate calcium and vitamin D supplementation, as well as monitoring of vitamin D levels and bone mineral density with regular follow-up to help prevent osteoporosis and fractures.

PMID: 29898932 [PubMed - in process]

Inflammatory Bowel Diseases in Children and Young Adults with Celiac Disease. A Multigroup Matched Comparison.

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Inflammatory Bowel Diseases in Children and Young Adults with Celiac Disease. A Multigroup Matched Comparison.

Inflamm Bowel Dis. 2017 Nov;23(11):1996-2000

Authors: Canova C, Pitter G, Zanier L, Zanotti R, Simonato L, Ludvigsson JF

Abstract
BACKGROUND: Celiac disease (CD) has been linked to inflammatory bowel disease (IBD) but previous reports have been inconsistent and may have been affected by surveillance bias.
METHODS: Matched birth cohort study in Friuli-Venezia Giulia Region, Italy. We identified 1294 individuals with CD aged 0 to 23 years at diagnosis using pathology reports, hospital discharge records, or copayment exemptions. Each CD individual was matched with up to 5 general population reference individuals from the regional Medical Birth Register in Friuli-Venezia Giulia (n = 5681). As secondary comparison groups, we used individuals undergoing small intestinal biopsy but not having villous atrophy (either Marsh 0-1-2 or exclusively Marsh 0). Individuals with IBD were identified through hospital discharge records or copayment exemptions. Conditional logistic regression was used to estimate odds ratios (ORs) for having IBD among CD individuals (before or after CD diagnosis) compared with their matched references.
RESULTS: Overall 35 individuals with IBD were identified (29 with CD and 6 general population controls). This corresponded to an increased risk of IBD in CD (OR = 24.17; 95% CI, 10.03-58.21). However, compared with individuals with Marsh 0-1-2 the OR decreased to 1.41 (95% CI, 0.91-2.18) and restricting our comparison group to individuals with Marsh 0, the OR was 1.28 (95% CI, 0.61-2.70).
CONCLUSIONS: In conclusion, this article found a highly increased risk of IBD in individuals with CD when comparing with the general population. Bias is the likely explanation for the very high risk increase for IBD in CD because the excess risk was substantially lower when we used individuals with a small intestinal biopsy without villous atrophy as our reference.

PMID: 28837516 [PubMed - indexed for MEDLINE]

Extra-Intestinal Manifestation of Celiac Disease in Children.

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Extra-Intestinal Manifestation of Celiac Disease in Children.

Nutrients. 2018 Jun 12;10(6):

Authors: Jericho H, Guandalini S

Abstract
The aim of this literature review is to discuss the extra-intestinal manifestations of celiac disease within the pediatric celiac population.

PMID: 29895731 [PubMed - in process]

Dietary Intake and Micronutrient Supplementation in Youth with Celiac Disease with and without Type 1 Diabetes.

Dietary Intake and Micronutrient Supplementation in Youth with Celiac Disease with and without Type 1 Diabetes.

Can J Diet Pract Res. 2018 Jun 12;:1-7

Authors: Liu A, Marcon M, Assor E, Mahmud FH, Turner J, Mager D

Abstract
The study purpose was to describe dietary intake and the factors influencing micronutrient supplements (MS) use in Celiac Disease (CD) ± Type 1 Diabetes (T1D). Three-day food records collected from parents of youth (3-18 years) with CD (n = 14) ± T1D (n = 10) were assessed for macro and micronutrient intake, diet quality (DQ), glycemic index (GI), glycemic load (GL), and food group intake. Focus group methodology and thematic concept analysis were conducted to determine factors influencing adolescent MS use. Mean ± SD age was 11 ± 4.4 (CD) and 13 ± 3.7 (CD + T1D) (P = 0.32). Body mass index was within healthy reference ranges (17.9 ± 2.5 [CD]; 19.3 ± 3.8 [CD + T1D] kg/m2; P = 0.61). The majority of youth with CD ± T1D (>90%) had high intakes of sugar and saturated fat, had high GI and GL, and met food serving recommendations and DQs that were indicative of "needs improvement." With the exception of vitamin D, vitamin E, folate, calcium, and potassium, youth in both groups met the estimated average requirements (EAR) for most micronutrients. MS use corrected suboptimal vitamin D intake; however, vitamin E, folate, calcium, and potassium intake remained below the EAR. Variables influencing adolescent MS use included daily routine, health professional influence, disease management (CD + T1D), and lack of knowledge about the need for MS. Strategies to elicit adolescent MS use varied between parent and adolescents.

PMID: 29893137 [PubMed - as supplied by publisher]

Neonatal Presentation of Unremitting Inflammatory Bowel Disease.

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Neonatal Presentation of Unremitting Inflammatory Bowel Disease.

Iran J Med Sci. 2018 May;43(3):328-331

Authors: Ebrahimi S, Khademi G, Jafari SA, Zaboli Nejad N, Norouzy A, Imani B

Abstract
Very-early-onset inflammatory bowel disease (VEO-IBD) has a distinct phenotype and should be considered a specific entity. VEO-IBD presents with very severe clinical pictures and is frequently known by an indeterminate colitis whose clinical remission is unmanageable. This study examines the case of a neonate with VEO-IBD, not responding to medical and surgical treatment. A 7-day-old Iranian female neonate presented with severe bloody diarrhea, poor feeding, abdominal distention, and dehydration suggesting severe proctocolitis due to an allergy to the protein in cow's milk. The condition did not respond to the elimination of diet for 1 month. Infections, celiac disease, and cystic fibrosis were excluded. Immunological investigations were negative, but antineutrophil cytoplasmic antibodies were positive. Due to the neonate's persistent symptoms and failure to thrive, upper and lower endoscopies were performed, showing ulcerative colitis. At the age of 4 months, she presented with signs and symptoms of toxic colitis and acute intestinal perforation, which prompted an emergency laparotomy. Due to the necrosis of the colon, hemicolectomy and colostomy were done. The patient was resuscitated and rehabilitated and was given glucocorticoid and mesalamine. We believe that the incidence of this problem is increasing, as is shown by the rise in the number of children under 10 years old being diagnosed. These patients require more aggressive therapeutic interventions than older IBD patients to achieve complete remission because they are more likely to have extensive colonic disease.

PMID: 29892152 [PubMed]

Intraepithelial lymphocyte immunophenotype: a useful tool in the diagnosis of celiac disease.

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Intraepithelial lymphocyte immunophenotype: a useful tool in the diagnosis of celiac disease.

J Physiol Biochem. 2018 Feb;74(1):153-158

Authors: Saborido R, Martinón N, Regueiro A, Crujeiras V, Eiras P, Leis R

Abstract
According to new ESPGHAN guidelines, gluten challenge is considered necessary when there is doubt about the initial diagnosis of celiac disease (CD). The main aim of this study was to quantify intraepithelial lymphocyte (IEL) immunophenotype on celiac patients on gluten-containing diet (GCD) compared to those on gluten-free diet (GFD). Another aim was to evaluate the clinical utility of IELs in the CD diagnosis, especially in selected patients on GFD where diagnostic uncertainty remains. IEL immunophenotype (TCRγδ and NK-like IELs) were studied by flow cytometry in 111 children with CD (81 children with CD on GCD and 30 celiac patients on GFD) and a control group (10 children). Duration of GFD was 5.4 ± 1.6 years. TCRγδ IELs in celiac patients receiving a GCD or GFD were significantly higher (p < 0.001) than in the control group. NK-like IELs in patients receiving a GCD or GFD were significantly lower than in the control group (p < 0.001). We observed a permanent decrease of NK-like IELs and an increment of TCRγδ IELs after following an adequate establishment and compliance of a long-term GFD in celiac patients. Recognition of IELs changes in the intestinal mucosa on celiac patients after long-term establishment of a GFD could constitute a useful tool for CD diagnosis in various situations: in which there is doubt about the initial diagnosis and repeat biopsy is necessary (avoiding the need of gluten challenges), and in those patients with symptoms/signs suggestive of CD who maintain a low gluten diet.

PMID: 28815514 [PubMed - indexed for MEDLINE]

Is the evidence of breast feeding protection against coeliac disease real?

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Is the evidence of breast feeding protection against coeliac disease real?

Allergol Immunopathol (Madr). 2017 Nov - Dec;45(6):616-618

Authors: Girbovan A, Sur G, Samasca G, Lupan I

Abstract
Many recent studies discredit breastfeeding protection against coeliac disease. We will try to answer the question: "Is the evidence of breast feeding protection against coeliac disease real?"

PMID: 28410871 [PubMed - indexed for MEDLINE]

HLA class II alleles in Norwegian patients with coexisting type 1 diabetes and celiac disease.

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HLA class II alleles in Norwegian patients with coexisting type 1 diabetes and celiac disease.

HLA. 2017 May;89(5):278-284

Authors: Viken MK, Flåm ST, Skrivarhaug T, Amundsen SS, Sollid LM, Drivvoll AK, Joner G, Dahl-Jørgensen K, Lie BA

Abstract
BACKGROUND: Type 1 diabetes (T1D) and celiac disease (CeD) are 2 distinct diseases, but there is an increased risk of developing CeD for T1D patients. Both diseases are associated with HLA-class II alleles, such as DQB1 *02:01 and DQB1 *03:02; however, their risk contribution vary between the diseases.
MATERIALS AND METHODS: We genotyped HLA-DRB1 and - DQB1 in 215 patients with coexisting T1D and CeD identified from a T1D cohort, and compared them to patients with T1D (N = 487) and CeD (N = 327), as well as healthy controls (N = 368).
RESULTS: The patients with coexisting T1D and CeD had an intermediate carrier frequency (72.8%) of the DRB1 *03:01- DQB1 *02:01- DQA1 *05:01 haplotype compared to T1D (64.1%) and CeD (88.7%) patients. The DRB1 *03:01- DQB1 *02:01- DQA1 *05:01/ DRB1 *04- DQB1 *03:02- DQA1 *03 haplotype combination, encoding DQ2.5 and DQ8 molecules, was equally frequent among patients with both T1D and CeD (52.6%) and T1D patients (46.8%) but significantly lower in CeD patients (9.5%).
CONCLUSION: Overall, the patients with coexisting T1D and CeD had an HLA profile more similar to T1D patients than CeD patients.

PMID: 28247576 [PubMed - indexed for MEDLINE]

Seasonality of birth affects paediatric coeliac disease.

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Seasonality of birth affects paediatric coeliac disease.

Acta Paediatr. 2018 Jun 09;:

Authors: Sharon D, Kalansky A, Tsur A, Pinsk V, Ling G, Rannan R, Yerushalmi B

Abstract
AIM: This study investigated the seasonality of birth in children diagnosed with coeliac disease (CD) at a tertiary University hospital in Southern Israel.
METHODS: This was a population-based retrospective time series analysis study from January 1988 to December 2014. There were 308,903 live births at Soroka University Medical Centre during the study period and 699 were diagnosed with CD. We combined three databases covering births, CD diagnoses and weather indices. The daily proportion of births that resulted in CD for the different four seasons and high seasons were compared to the weather indices on the day of birth by using negative-binomial regression.
RESULTS: Statistically significant associations were found between the season of birth and the rate of CD, with autumn births being associated with a higher risk for the development of CD than births during the summer, with an incidence ratio of 1.22. The association was further increased when the defined summer and autumn high seasons were used, with an incidence ratio of 1.40. No association was found between coeliac disease and the mean temperature and global radiation.
CONCLUSION: Coeliac disease was associated with birth during the autumn and the autumn high season, posed an even more significant risk factor. This article is protected by copyright. All rights reserved.

PMID: 29885263 [PubMed - as supplied by publisher]

Whole lipid profile and not only HDL cholesterol is impaired in children with coexisting type 1 diabetes and untreated celiac disease.

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Whole lipid profile and not only HDL cholesterol is impaired in children with coexisting type 1 diabetes and untreated celiac disease.

Acta Diabetol. 2017 Oct;54(10):889-894

Authors: Salardi S, Maltoni G, Zucchini S, Iafusco D, Zanfardino A, Confetto S, Toni S, Zioutas M, Marigliano M, Cauvin V, Franceschi R, Rabbone I, Predieri B, Schiaffini R, Salvatoni A, Diabetes Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED)

Abstract
AIMS: Low HDL cholesterol (HDL-C) levels have been described in patients with coexisting type 1 diabetes mellitus (T1DM) and celiac disease (CD). Data on other possible lipid abnormalities that could further increase cardiovascular risk in these patients are scarce and incomplete. Aim of this retrospective multicenter study was to evaluate whole lipid profiles, besides HDL-C, in children with T1DM associated with biopsy-proven CD, and to investigate the influence of age and degree of adherence to gluten-free diet (GFD) on lipid changes.
METHODS: A total of 261 children with both T1DM and CD were enrolled. Serum lipid profiles at CD diagnosis were compared with those after 1 year of GFD and with those of 224 matched children with T1DM alone. The adherence to GFD was judged by means of CD-related antibodies.
RESULTS: At CD diagnosis, children with T1DM + CD showed higher LDL cholesterol (LDL-C) compared to children with T1DM alone. Gluten withdrawal failed to normalize LDL-C levels, not even in completely adherent individuals. HbA1c values were not influenced by GFD. The youngest children were characterized at diagnosis by lower levels of total cholesterol and on treatment by a greater decrease in triglycerides levels.
CONCLUSIONS: An unfavorable lipid profile, characterized not only by low HDL-C levels but also by high LDL-C values, may increase the risk of cardiovascular disease in children with T1DM and untreated CD. Therefore, a strict gluten-free diet is mandatory in these children, especially the youngest.

PMID: 28639064 [PubMed - indexed for MEDLINE]

Serum zinc, copper and iron status of children with coeliac disease on three months of gluten-free diet with or without four weeks of zinc supplements: a randomised controlled trial.

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Serum zinc, copper and iron status of children with coeliac disease on three months of gluten-free diet with or without four weeks of zinc supplements: a randomised controlled trial.

Trop Doct. 2018 Apr;48(2):112-116

Authors: Negi K, Kumar R, Sharma L, Datta SP, Choudhury M, Kumar P

Abstract
Data about the effect of zinc supplementation with gluten-free diet on normalisation of plasma zinc, copper and iron in patients with coeliac disease are scanty. We evaluated the effect of zinc supplementation on serum zinc, copper and iron levels in patients with coeliac disease, by randomising 71 children newly diagnosed with coeliac disease into two groups: Group A = gluten-free diet (GFD); and Group B = gluten-free diet with zinc supplements (GFD +Zn). The rise in iron and zinc was significantly higher in the latter, but the mean rise of copper levels was slightly higher in the former, but the difference was not significant.

PMID: 29141505 [PubMed - indexed for MEDLINE]

The impact of human breast milk components on the infant metabolism.

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The impact of human breast milk components on the infant metabolism.

PLoS One. 2018;13(6):e0197713

Authors: Hellmuth C, Uhl O, Demmelmair H, Grunewald M, Auricchio R, Castillejo G, Korponay-Szabo IR, Polanco I, Roca M, Vriezinga SL, Werkstetter KJ, Koletzko B, Mearin ML, Kirchberg FF

Abstract
BACKGROUND & AIMS: Breastfeeding is beneficial for mothers and infants. Underlying mechanisms and biochemical mediators thus need to be investigated to develop and support improved infant nutrition practices promoting the child health. We analysed the relation between maternal breast milk composition and infant metabolism.
METHODS: 196 pairs of mothers and infants from a European research project (PreventCD) were studied. Maternal milk samples collected at month 1 and month 4 after birth were analysed for macronutrient classes, hormone, and fatty acid (FA) content. Phospholipids, acylcarnitines, and amino acids were measured in serum samples of 4-month old infants. Associations between milk components and infant metabolites were analysed with spearman correlation and linear mixed effect models (LME). P-values were corrected for multiple testing (PLME).
RESULTS: Month 1 milk protein content was strongly associated with infant serum lyso-phosphatidylcholine (LPC) 14:0 (PLME = 0.009). Month 1 milk insulin was associated to infant acetylcarnitine (PLME = 0.01). There were no associations between milk protein content and serum amino acids and milk total fat content and serum polar lipids. Middle- and odd-chain FA% in breast milk at both ages were significantly related to serum LPC and sphingomyelins (SM) species in infant serum (all PLME<0.05), while FA% 20:5n-3 and 22:6n-3 percentages were significantly associated to serum LPC 22:6 (PLME = 1.91×10-4/7.93×10-5) in milk only at month 4. Other polyunsaturated fatty acids and hormones in milk showed only weak associations with infant serum metabolites.
CONCLUSIONS: Infant serum LPC are influenced by breast milk FA composition and, intriguingly, milk protein content in early but not late lactation. LPC 14:0, previously found positively associated with obesity risk, was the serum metabolite which was the most strongly associated to milk protein content. Thus, LPC 14:0 might be a key metabolite not only reflecting milk protein intake in infants, but also relating high protein content in milk or infant formula to childhood obesity risk.

PMID: 29856767 [PubMed - in process]

Coeliac screening in a high-risk population: paediatric type 1 diabetes-a review of current guidelines and practice.

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Coeliac screening in a high-risk population: paediatric type 1 diabetes-a review of current guidelines and practice.

Ir J Med Sci. 2018 May 31;:

Authors: Forde L, McGrath N, Devaney D, Awadalla S, McDonnell CM, Murphy NP

Abstract
BACKGROUND AND AIMS: Coeliac disease (CD) is more common in those with type 1 diabetes mellitus (T1DM) and may be asymptomatic despite the presence of intestinal histological changes. Optimal screening practice guidelines differ internationally. We undertook a retrospective audit to determine the efficacy of current screening practice for CD in T1DM in our centre.
METHODS: All children and adolescents < 16 years, diagnosed with T1DM in our service and continuing to attend the service in January 2017 were included. Data on CD screening was collected and compared to current NICE, NASPGHAN and ESPGHAN guidelines.
RESULTS: Of the 355 patients attending our service, 253 attended from T1DM diagnosis and all had CD screening performed in our centre. In 37 of 253 patients, IgA-TTG was positive, providing a cumulative prevalence of 14.6%. Of these, 31(83.78%) with an elevated TTG on screening had no recorded gastrointestinal symptoms or CD-related clinical signs. Of the 35 TTG plus EMA-positive patients, 22/35 (59.46%) had diagnostic endoscopic biopsy. Nineteen (83.4%) had CD confirmed, 1 (4.54%) had negative biopsy and 2 (9%) had equivocal, non-diagnostic changes.
CONCLUSIONS: Timely diagnosis of CD can prevent chronic ill health in affected individuals, and in patients with T1DM, CD is an independent risk factor for increased morbidity and mortality. Given the high prevalence of atypical symptoms and silent CD in those with T1DM, in this and other studies, and the benefits of detection and treatment of CD, screening is essential. Large-scale data collection allowing for the development of evidence-based guidelines is required.

PMID: 29855860 [PubMed - as supplied by publisher]

Oxidative and Antioxidative Status of Children with Celiac Disease Treated with a Gluten Free-Diet.

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Oxidative and Antioxidative Status of Children with Celiac Disease Treated with a Gluten Free-Diet.

Oxid Med Cell Longev. 2018;2018:1324820

Authors: Rowicka G, Czaja-Bulsa G, Chełchowska M, Riahi A, Strucińska M, Weker H, Ambroszkiewicz J

Abstract
Aims: Oxidative stress is a factor involved in the pathogenesis of celiac disease (CD), possibly affecting the course of the disease and celiac-related complications. We assessed the intensity of oxidative processes and the efficiency of antioxidant defense in children with celiac disease. Methods. Group I (n = 32) consisted of children with CD treated with a gluten-free diet, and group II (n = 24) consisted of healthy children on a traditional diet. Antioxidative and oxidative status was assessed by measurement of serum total antioxidant capacity (TAC), total oxidant capacity (TOC), and oxidized low-density lipoprotein (ox-LDL) and on the basis of oxidative stress index (OSI).
Results: There were no significant differences in serum TAC, TOC, ox-LDL, and OSI between children with CD and healthy children. Cluster analysis showed that the group of children with CD is not homogeneous in terms of serum TAC and TOC levels. About 50% of these children had TAC levels < 1.3 mmol/L and TOC levels > 0.35 mmol/L.
Conclusions: Strict adherence to a gluten-free diet by children with CD seems to be important for maintaining oxidative-antioxidant balance. However, further research is needed to identify factors potentially responsible for increased oxidative stress in some children with celiac disease despite adherence to a gluten-free diet.

PMID: 29854070 [PubMed - in process]

Coeliac disease in infants: antibodies to deamidated gliadin peptide come first!

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Coeliac disease in infants: antibodies to deamidated gliadin peptide come first!

Ital J Pediatr. 2017 Aug 10;43(1):70

Authors: Arigliani M, Rech Morassutti F, Fabris M, Melli P, Tonutti E, Cogo P

Abstract
BACKGROUND: The onset of coeliac disease (CD) in the first year of life is uncommon and the diagnosis can be challenging due to the suboptimal sensitivity of tissue transglutaminase antibodies (tTG) at this age and the many other possible causes of malabsorption in infants. Antibodies to deamidated gliadin peptides (anti-DGPs), especially IgG, may appear earlier than IgA anti-tTG in very young children with CD.
CASE PRESENTATION: We report here on an 8-month-old child who was evaluated for failure to thrive, constipation and developmental delay. The symptoms started following gluten introduction in the diet. Laboratory tests showed high fecal elastase concentration, normal serum IgA levels with positive IgG and IgA anti-DGPs, whereas anti-tTG were not detected. The duodenal biopsy revealed a complete villous atrophy (Marsh-Oberhuber 3C). The culture of biopsy fragments in the presence of gliadin peptides did not stimulate the production of IgA anti-endomysial antibodies. Genetic testing proved the child was positive for HLA-DQ2 (DQA1*05; DQB1*02) and HLA-DQ8 (DQA1*03, DQB1*0302). Having initiated the gluten-free diet, the symptoms disappeared and the infant experienced rapid catch-up growth with normalization of psychomotor development.
CONCLUSIONS: This case report highlights the utility of anti-DGPs for screening infants with suspected CD. The pattern with positivity for IgG and IgA anti-DGPs only is rare in IgA-competent children with biopsy-proven CD. It could be explained in infancy as immaturity of the adaptive immune system.

PMID: 28797308 [PubMed - indexed for MEDLINE]

Diagnostic challenges of celiac disease in a young child: A case report and a review of the literature.

Diagnostic challenges of celiac disease in a young child: A case report and a review of the literature.

Medicine (Baltimore). 2018 Jun;97(22):e10893

Authors: Mărginean CO, Meliţ LE, Stefănuţ Săsăran V, Mărginean CD, Mărginean MO

Abstract
RATIONALE: Celiac disease is a chronic, immune-mediated, multiorgan disorder that affects susceptible individuals, and it is triggered by gluten and other prolamins.
PATIENT CONCERNS: We present the case of a 1-year-old male child, with a history of idiopathic pericardial effusion, admitted in our clinic for severe abdominal bloating, irritability, loss of appetite and intermittent diarrheic stools. The clinical findings were: influenced general status, irritability, distended abdomen, and diffuse abdominal tenderness.
DIAGNOSES: The initial laboratory tests revealed anemia, leukocytosis, increased inflammatory biomarkers, high levels of transaminases, and hypoalbuminemia. The stool culture identified an enterocolitis with enteropathogenic Escherichia coli (E. coli).
INTERVENTIONS: We initiated antibiotic treatment, substitution therapy with human albumin and probiotics with initial favorable evolution, but after 1 month, the patient was re-admitted for the persistence of intermittent diarrheic stools and abdominal bloating, when we established the diagnosis of cow's milk protein allergy. We initiated diary-free diet.
OUTCOMES: Unfortunately, the patient was re-admitted after another 8 months, presenting the same clinical and laboratory findings as during the initial admission. We repeated the serology for celiac disease and we performed an upper gastrointestinal endoscopy with duodenal biopsies, which established the diagnosis of celiac disease. After 1 month of gluten-free diet, the patient's evolution improved considerably.
LESSONS: Enterocolitis with E. coli could be considered as trigger for CD in our case. The diagnosis of CD in small children can be hindered by an insufficient gluten-exposure, and can lead to a delay in the diagnosis as in the case presented above.

PMID: 29851812 [PubMed - in process]

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