566 research outputs found
Nutrition: Searching for the immunological basis of wheat sensitivity
No full textA new study has advanced our knowledge on the pathogenesis of noncoeliac wheat sensitivity (NCWS), implicating the activation of innate immunity markers and immunological mechanisms at the basis of NCWS. However, limitations in the design of studies performed in this field will need addressing to help identify the root cause of NCWS
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No full textRegarding the first question, however, we believe that there is a clear answer in the article itself. We stated, in the Methods section, that “the biopsy specimens were assessed in Palermo by 2 pathologists (G.G. and/or A.M.F.)”; the eosinophil count, which seems to be one of the most important findings of the study, “was further assessed by an experienced gastrointestinal pathologist (V.V.) in Brescia.” We also added that “all reviewers were blinded to the diet allocation and final diagnosis of each patient.” Consequently, the k value provided in the Results section referred to the agreement between the evaluation performed in Palermo and the evaluation performed in Brescia. No further details were given in Supplementary Appendix 2 regarding this point. As far as the reference method for the eosinophil count is concerned, we thank Professor Weiner for his question and the opportunity given to us to be more precise. We quoted the Walker and Talley report because in this extensive review it clearly was stated that “normal duodenal counts (of eosinophils) are defined as fewer than 10 HPF [high-power fields] in children and 19/5 HPF in adults, in studies based on control values”; to be precise, the review was referring to another study here. The point of interest is that this upper limit (19 per 5 high-power fields) is almost identical to the one indicated in our laboratory: 40 lamina propria eosinophils per 10 high-power fields. In the rectal biopsy specimens, the upper limit of the reference interval was fewer than 9 lamina propria eosinophils per 5 high-power fields. This was an internal reference for our laboratory and the method was similar to that described by one of the review authors (V.V.) in children, and validated by another author (A.C.) in adults. In any case, a recent review underlined the problem of the cut-off value of eosinophils in the different gastrointestinal tract segments. On the topic of the possible role of mast cells in causing the irritable bowel syndrome (IBS)-like symptoms, we found a trend toward higher values in the nonceliac wheat sensitivity (NCWS) patients than in the non-NCWS controls, although the difference was not statistically significant. On the other hand, despite some relevant evidence for a mast cell role in IBS, it has been shown that increased mast cells are not present homogeneously throughout the whole colon mucosa because the increase was detected in the cecum but not in the left colon. Other studies have shown that a significant mast cell infiltration could be detected only in IBS patients with constipation, but not with diarrhea. Furthermore, the relevance of a concomitant presence of eosinophils that, in turn, activate mast cells, has been underlined. Thus, we did not exclude a possible role for mast cells in the pathogenesis of IBS-like symptoms in NCWS patients, but future studies need to be designed to better focus on this point. Finally, we suggested a possible clinical role for the eosinophil count in NCWS. In fact, as underlined in the Editorial that accompanied our article, our findings showed that “the sensitivity and specificity of the presence of rectal eosinophilia (>9 eosinophils in the rectal lamina propria) was 94% and 70%, respectively, and a positive and negative predictive value for true NCGS of 81% and 89%, respectively.” Obviously, this does not mean that an increased number of eosinophils in the rectal mucosa is equivalent to a NCWS diagnosis, but that in the absence of endoscopic findings and/or other obvious causes (ie, parasitic infection), an eosinophil infiltration could be a marker of NCWS and must address the clinician to consider prescribing an elimination diet in subjects with suspected NCWS, as also was confirmed in a recent publication on the matter. In conclusion, we by no means presume to have found “the diagnostic marker of NCWS,” but we think rather that we have suggested a candidate pathogenetic player (the eosinophil) and a target intestinal site (the rectum) for NCWS disease. These are relevant clinical data to be investigated further in future studies
REVIEW ARTICLE: CHRONIC CONSTIPATION AND FOOD HYPERSENSITIVITY – AN INTRIGUING RELATIONSHIP.
No full textPediatric noncoeliac gluten sensitivity
No full textFunctional gastrointestinal disorders remain a rather obscure and vague chapter of medicine, clouded with discordant, or even completely contradictory findings and opinions, depending on the different researchers and studies. The two main etiological hypotheses are an alteration of the brain-gut axis with visceral hypersensitivity, or a microscopic inflammation of the gastro-intestinal mucosa. However, what appears to link these and other hypotheses is the evidence that the symptoms reported by patients, both in adults and in the pediatric age, are very often presented in association with the intake of specific foods. To further complicate this heterogeneous situation, several authors have reported cases of patients without the celiac disease (CeD) or wheat allergy (WA) criteria, who referred a marked improvement in gastro-intestinal functional symptoms on a gluten-free diet (GFD). This condition was initially defined as ‘gluten sensitivity’ (GS), only to be changed to ‘non-celiac gluten sensitivity’ (NCGS), to better differentiate it from CeD, and finally redefined as ‘non-celiac wheat sensitivity’ (NCWS), as it is still not certain even today which of the components of wheat is the real culprit of this pathology. To date, this is one of the most studied and controversial areas of research in the gastroenterological field, with data that, at least in part, seem to indicate that NCGS/NCWS in adults could represent a form of non-IgE-mediated allergic reaction that has its roots in some clinical reactions already in the pediatric ag
Non-celiac wheat sensitivity: rationality and irrationality of a gluten-free diet in individuals affected with non-celiac disease: a review
No full textNon-celiac gluten or wheat sensitivity (NCWS) is a “clinical entity induced by the ingestion of wheat leading to intestinal and/or extraintestinal symptoms that improve once the wheat-containing foodstuff is removed from the diet, and celiac disease and wheat allergy have been excluded”. This mostly accepted definition raises several points that remain controversial on this condition. In the present review, the authors summarize the most recent advances in the clinic and research on NCWS through an accurate analysis of different studies. We screened PubMed, Medline, Embase, and Scopus using the keywords “non-celiac gluten sensitivity”, “non-celiac wheat sensitivity”, and “diagnosis”. We would like to emphasize two main points, including (A) the controversial clinical and etiological aspects in different trials and experiences with particular attention to the Salerno criteria for the diagnosis of NCWS and (B) the histological aspects. The etiology of NCWS remains controversial, and the relationship with irritable bowel syndrome is obscure. Histologically, the duodenal mucosa may show a variable pattern from unremarkable to a slight increase in the number of T lymphocytes in the superficial epithelium of villi. The endorsement of this disease is based on a positive response to a gluten-free diet for a limited period, followed by the reappearance of symptoms after gluten challenge. The Salerno expert criteria may help to diagnose NCWS accurately. Social media and inaccurate interpretation of websites may jeopardize the diagnostic process if individuals self-label as gluten intolerant
Benedetto CARROCCIO, Dal basileus Agatocle a Roma. Le monetazioni siciliane d'età ellenistica (cronologia - iconografia - metrologia).
No full textMoscati Castelnuovo Luisa. Benedetto CARROCCIO, Dal basileus Agatocle a Roma. Le monetazioni siciliane d'età ellenistica (cronologia - iconografia - metrologia). . In: L'antiquité classique, Tome 75, 2006. pp. 503-505
Suspected Nonceliac Gluten Sensitivity Confirmed in Few Patients After Gluten Challenge in Double-Blind, Placebo-Controlled Trials
No full textA double-blind, placebo-controlled, gluten challenge has been proposed to confirm a diagnosis of non-celiac gluten sensitivity (NCGS) in patients without celiac disease who respond to a gluten-free diet. To determine the accuracy of this approach, we analyzed data from 10 double-blind, placebo-controlled, gluten challenge trials, comprising 1312 adults. The studies varied in the duration of the challenge (ranging from 1 day to 6 weeks), daily doses for the gluten challenge (ranging from 2 g to 52 g; 3 studies administered less than 8 g/day), and composition of the placebo (gluten-free products, xylose, whey protein, rice, or corn starch containing fermentable carbohydrates). Most of the studies found gluten challenge to significantly increase symptom scores compared with placebo. However, only 38/231 of NCGS patients (16%) showed gluten-specific symptoms. Furthermore, 40% of these subjects had a nocebo response (similar or increased symptoms in response to placebo). These findings reveal heterogeneity among and potential methodology flaws in studies of gluten challenge, cast doubt on gluten as the culprit food component in most patients with presumptive NCGS, and highlight the importance of nocebo effect in these types of studies
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