1,721,059 research outputs found
Non-celiac gluten sensitivity : time for sifting the grain
Full text linkIn the last few years, a new nomenclature has been proposed for the disease induced by the ingestion of gluten, a protein present in wheat, rice, barley and oats. Besides celiac disease and wheat allergy, the most studied forms of gluten-related disorders characterized by an evident immune mechanism (autoimmune in celiac disease and IgE-mediated in wheat allergy), a new entity has been included, apparently not driven by an aberrant immune response: the non-celiac gluten sensitivity (NCGS). NCGS is characterized by a heterogeneous clinical picture with intestinal and extraintestinal symptoms arising after gluten ingestion and rapidly improving after its withdrawal from the diet. The pathogenesis of NCGS is largely unknown, but a mixture of factors such as the stimulation of the innate immune system, the direct cytotoxic effects of gluten, and probably the synergy with other wheat molecules, are clues for the complicated puzzle. In addition, the diagnostic procedures still remain problematic due to the absence of efficient diagnostic markers; thus, diagnosis is based upon the symptomatic response to a gluten-free diet and the recurrence of symptoms after gluten reintroduction with the possibility of an important involvement of a placebo effect. The temporary withdrawal of gluten seems a reasonable therapy, but the timing of gluten reintroduction and the correct patient management approach are have not yet been determined
Gliadin cytotoxicity and in vitro cell cultures
No full textInterest in celiac disease, a common enteropathy in Europe and the USA (1/200) caused by the dietary ingestion of gluten in susceptible subjects, has increased over the last few years. Its pathogenesis is still not completely clear, but it certainly involves immune-mediated mechanisms. Although a number of studies have been published concerning the role of T cells in inducing intestinal damage, little is known about the early stages in which gliadin (the toxic component of gluten) starts the whole process. In vitro two- and three-dimensional (multicellular spheroid) cell cultures are a simple and useful means of studying the direct cellular effects of gliadin and other "toxic" cereal peptides. Furthermore, in addition to improving our understanding of pathogenetic mechanisms, cell cultures can also be used to test modified peptides that could replace the toxic components present in the foods that celiac patients must avoid
Risk of intestinal lymphoma in undiagnosed coeliac disease : results from a registered population with different coeliac disease prevalence
No full textBACKGROUND:
Coeliac disease is often undiagnosed, early diagnosis and treatment could be relevant to avoid fearful complications as intestinal lymphoma. Our aim is to estimate the risk of intestinal lymphoma in undiagnosed coeliac patients, evaluating the real incidences and applying different theoretical settings of coeliac prevalence.
METHODS:
We collected cases of intestinal lymphomas from the Lombardy Cancer Registry and coeliac patients through computerized search of all Pathology Departments; duodenal pathological reports compatible with a Marsh 3 grade were included. The lymphoproliferative risk was calculated for theoretical different settings of coeliac prevalence (from 1:50 to 1:200), relative risks for intestinal lymphomas and compared to the real incidence of the lymphomas in this population.
RESULTS:
Population consisted in 815,362 inhabitants; during the investigated period of time, 237 intestinal lymphomas and 326 coeliac patients were diagnosed. None of the coeliac patients had lymphoma. In the different scenarios calculated and compared with the real lymphoma incidence the relative risks of undiagnosed celiac disease for gastrointestinal B- and T-cell lymphomas ranges from 1.0 to 2.0 for 1:100 coeliac disease prevalence.
CONCLUSIONS:
Undiagnosed coeliac patients have no increased risk of developing intestinal lymphoma; population screening programmes, aimed at early diagnosis of lymphoma may not be useful in this setting
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