1,721,096 research outputs found
Coeliac disease and dermatitis herpetiformis
No full textPotential coeliac disease is characterised by the presence of serological and genetic markers of coeliac di-sease with little or no damage to the mucosa of the small intestine. Potential coeliac disease is a growing clinical entity, accounting for 10–20% of the total number of coeliac disease cases.In their excellent Seminar, Benjamin Lebwohl and colleagues do not give adequate attention to this increasingly observed disorder. Patients with potential coeliac disease can manifest with gastrointestinal or extraintestinal symptoms, or both, or be completely asymptomatic. Because villous atrophy is lacking in potential coeliac disease, whether a gluten-free diet should be recommended to patients is still a matter of debate. The scientific community suggests a gluten-free diet for patients with symptomatic potential coeliac disease, whereas asymptomatic patients are left on a gluten-containing diet and periodically followed up.
With the aim of improving knowledge about potential coeliac disease, our research group has designed a (still ongoing) prospective cohort study and found that about 80% of adult patients with potential coeliac disease are symptomatic and benefit from gluten-free diet. Only 5% of the patients with asymptomatic potential coeliac disease left on a gluten-containing diet progress to active coeliac disease (ie, new onset of villous atrophy) in a median follow-up period of 7 years (mean 6·52 years, SD 3·54). On the basis of these results, we suggest a gluten-free diet for patients with symptomatic potential coeliac disease, whereas asymptomatic patients should be left on a gluten-containing diet. We would be delighted to learn what Lebwohl and colleagues think about the management of patients with potential coeliac disease
Diagnosis of Seronegative and Ultrashort Celiac Disease
No full text: In its conventional form, celiac disease (CeD) is characterized by both positive serology and flat villi in the duodenum, and is well known by gastroenterologists and general practitioners. The aim of this review was to shed light on 2 neglected and not yet well-defined celiac phenotypes, that is, seronegative and ultrashort CeD. Seronegative CeD can be suspected in the presence of flat villi, positive HLA-DQ2 and/or HLA-DQ8, and the absence of CeD antibodies. After ruling out other seronegative enteropathies, the diagnosis can be confirmed by both clinical and histologic improvements after 1 year of a gluten-free diet. Ultrashort CeD is characterized by the finding of flat villi in the duodenal bulb in the absence of mucosal damage in the distal duodenum and with serologic positivity. Data on the prevalence, clinical manifestations, histologic lesions, genetic features, and outcome of seronegative and ultrashort CeD are inconclusive due to the few studies available and the small number of patients diagnosed. Some additional diagnostic tools have been developed recently, such as assessing intestinal transglutaminase 2 deposits, flow cytometry technique, microRNA detection, or proteomic analysis, and they seem to be useful in the identification of complex cases. Further cooperative studies are highly desirable to improve the knowledge of these 2 still-obscure variants of CeD
Sensitivity to wheat, gluten and FODMAPs in IBS: Facts or fiction?
No full textIBS is one of the most common types of functional bowel disorder. Increasing attention has been paid to the causative role of food in IBS. Food ingestion precipitates or exacerbates symptoms, such as abdominal pain and bloating in patients with IBS through different hypothesised mechanisms including immune and mast cell activation, mechanoreceptor stimulation and chemosensory activation. Wheat is regarded as one of the most relevant IBS triggers, although which component(s) of this cereal is/are involved remain(s) unknown. Gluten, other wheat proteins, for example, amylase-trypsin inhibitors, and fructans (the latter belonging to fermentable oligo-di-mono-saccharides and polyols (FODMAPs)), have been identified as possible factors for symptom generation/exacerbation. This uncertainty on the true culprit(s) opened a scenario of semantic definitions favoured by the discordant results of double-blind placebo-controlled trials, which have generated various terms ranging from non-coeliac gluten sensitivity to the broader one of non-coeliac wheat or wheat protein sensitivity or, even, FODMAP sensitivity. The role of FODMAPs in eliciting the clinical picture of IBS goes further since these short-chain carbohydrates are found in many other dietary components, including vegetables and fruits. In this review, we assessed current literature in order to unravel whether gluten/wheat/FODMAP sensitivity represent 'facts' and not 'fiction' in IBS symptoms. This knowledge is expected to promote standardisation in dietary strategies (gluten/wheat-free and low FODMAP) as effective measures for the management of IBS symptoms
La malattia celiaca nel terzo millennio: Nuove prospettive su patogenesi, clinica, diagnosi e terapia
No full textCeliac disease is a disorder triggered by an immune reaction to gluten contained in wheat and
related grains, resulting in the atrophy of small intestinal villi and therefore malabsorption. The
identification of tissue transglutaminase as the autoantigen of celiac disease has definitely
confirmed the autoimmune nature of this condition. This disease, which can occur only in HLA-
DQ2/DQ8 positive patients, is very common in the general population (>1%). Female gender is
more commonly affected (F/M = 2:1) and the disease can occur at any age with a myriad of
symptoms/manifestations. The great variability of the clinical presentation along with a different
expression of diagnostic markers led to the identification of a number of phenotypes, i.e. classical,
non classical, subclinical, potential, non-responsive and refractory. The identification of celiac
disease is challenging since it can occur not only with diarrhoea and weight loss, but also with other
gastrointestinal symptoms (such as constipation, bloating, recurrent abdominal pain), extra-
intestinal signs (anaemia, raised transaminases, osteoporosis, recurrent miscarriages, aphthous
stomatitis and associated autoimmune disorders) or being completely symptomless. Although small
intestinal biopsy remains the diagnostic “gold standard”, highly sensitive and specific serological
tests such as tissue transglutaminase and anti-endomysial antibodies of IgA class became more and
more important in the diagnostic work-up of celiac disease. Currently, the only treatment for celiac
disease is still a long-life strict gluten-free diet, which improves the quality of life with
disappearance of symptoms and prevents the complications such as ulcerative jejunoileitis as well
as small intestinal adenocarcinoma and lymphoma
More Than One Culprit for Nonceliac Gluten/Wheat Sensitivity
No full textThe letter comments the article by Skodje et al(doi 10.1053/j.gastro.2017.10.040) reporting a double-blind placebo-controlled food challenge aimed at establishing whether gluten or fructan, a component of fermentable oligo-, di-, monosaccharides and polyols, evokes gastrointestinal (GI) symptoms in subjects with self-reported nonceliac gluten/wheat sensitivity
Subclass Profile of IgG Antibody Response to Gluten Differentiates Nonceliac Gluten Sensitivity From Celiac Disease
No full textObjective: Non-celiac wheat sensitivity (NCWS) is associated with significantly elevated levels of antibody to gluten, but how these antibodies contrast with those in celiac disease is not well-understood. We aimed to characterize the subclass distribution of the IgG antibody response to gluten and explore potential relationships with markers of disease pathology.
Design: Study participants included individuals who reported symptoms in response to wheat intake and in whom celiac disease and wheat allergy were ruled out, celiac disease patients, and healthy controls. Sera were analyzed for subclass profile of IgG anti-gliadin antibody response, and potential correlations between IgG subclass and previously identified markers of innate immune activation and intestinal cell damage were examined. Multivariate principal component analysis was used to assess group clustering based on subclass data.
Results. In comparison with celiac disease patients, the IgG anti-gliadin antibody response in NCWS was characterized by significantly lower levels of IgG1 and IgG3, and greater levels IgG4. Within the NCWS cohort, levels of IgG4 and IgG1 anti-gliadin antibodies correlated with circulating concentrations of intestinal fatty acid-binding protein (FABP2), a marker of intestinal epithelial cell damage. In contrast, FABP2 concentration correlated with levels of IgG3 in the celiac disease cohort.
Conclusions: The data reveal significant differences in the subclass distribution of IgG anti-gliadin antibody between celiac disease and NCWS, indicating divergent mechanisms in the adaptive immune response to ingested gluten. Furthermore, the subclass-specific correlation of the anti-gliadin IgG response with FABP2 expression is suggestive of a relationship between the antibodies and intestinal pathology
Nonceliac Wheat Sensitivity: An Immune-Mediated Condition with Systemic Manifestations
No full textNon-celiac wheat sensitivity (NCWS) is characterized by gastrointestinal and extra-intestinal symptoms following the ingestion of gluten-containing cereals in subjects without celiac disease or wheat allergy. The identity of the molecular triggers in these cereals responsible for the symptoms of NCWS remains to be delineated. Recent research has identified a biological basis for the condition, with the observation of systemic immune activation in response to microbial translocation that appears to be linked to intestinal barrier defects. Ongoing research efforts are aimed at further characterizing the etiology, mechanism, and biomarkers of the condition
Non-celiac gluten sensitivity: A work-in-progress entity in the spectrum of wheat-related disorders
No full textNon-celiac gluten sensitivity is an undefined syndrome with gastrointestinal and extra-intestinal manifestations triggered by gluten in patients without celiac disease and wheat allergy. The pathogenesis involves immune-mediated mechanisms requiring further research. Symptoms disappear in a few hours or days after gluten withdrawal and recur rapidly after gluten ingestion. Besides gluten, other wheat proteins as well as fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) may contribute to this syndrome. This syndrome occurs mainly in young women, being rare in children. Its prevalence ranges from 0.6% to 6%, based on primary or tertiary care center estimates. No biomarker is available, but half of patients tests positive for IgG anti-gliadin antibodies, which disappear quickly after gluten-free diet together with symptoms. Also, genetic markers are still undefined. Although currently limited to a research setting, double-blind, placebo-controlled, cross-over trial strategy is recommended to confirm the diagnosis. Treatment is based on dietary restriction with special care to nutrient intake
Non-celiac gluten sensitivity: A work-in-progress entity in the spectrum of wheat-related disorders
No full textNon-celiac gluten sensitivity is an undefined syndrome with gastrointestinal and extra-intestinal manifestations triggered by gluten in patients without celiac disease and wheat allergy. The pathogenesis involves immune-mediated mechanisms requiring further research. Symptoms disappear in a few hours or days after gluten withdrawal and recur rapidly after gluten ingestion. Besides gluten, other wheat proteins as well as fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) may contribute to this syndrome. This syndrome occurs mainly in young women, being rare in children. Its prevalence ranges from 0.6% to 6%, based on primary or tertiary care center estimates. No biomarker is available, but half of patients tests positive for IgG anti-gliadin antibodies, which disappear quickly after gluten-free diet together with symptoms. Also, genetic markers are still undefined. Although currently limited to a research setting, double-blind, placebo-controlled, cross-over trial strategy is recommended to confirm the diagnosis. Treatment is based on dietary restriction with special care to nutrient intake
Non-coeliac gluten/wheat sensitivity: advances in knowledge and relevant questions
No full textIntroduction: Non-coeliac gluten/wheat sensitivity (NCG/WS) is a syndrome characterized by intestinal and extra-intestinal symptoms occurring a few hours or days after the ingestion of gluten and wheat proteins in patients testing negative for coeliac disease and wheat allergy. Areas covered: The present review deals with recent scientific acquisitions of this gluten-related syndrome, including pathogenetic mechanisms, clinical picture, symptom score, biomarkers and double-blind placebo-controlled trial for diagnosis, and treatment. The methodology used was a literature search on NCG/WS using Medline and Premedline from 1970 to August 2016. Expert commentary: We discussed the pathogenesis of symptom generation and altered gut physiology in NCG/WS. Possible mechanisms include innate and adaptive immune activation, impaired intestinal epithelial barrier and changes in gut microbiome. These interlinked factors may be exploited for their clinical relevance as possible biomarkers. A systemic immune response to microbial and wheat antigens, together with intestinal cell damage, occurs in patients with NCG/WS. Due to the lack of established biomarkers, it is mandatory to validate the diagnosis of the syndrome by means of a well-defined work-up involving dietary challenge. Finally, dietary and other therapeutic indications have been thoroughly reviewed
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