1,721,163 research outputs found
Periscopio sulla celiachia. Quali esami principali per diagnosticare la malattia: l’importanza dei test genetici e basati sugli anticorpi
No full textN/
Gluten sensitivity: an emerging issue behind neurological impairment?
No full text[No abstract available
Coeliac disease: changing diagnostic criteria?
No full textCoeliac disease (CD) is a chronic,
multisystemic, autoimmune disorder, induced by
gluten exposure, in genetically sensitive
individuals (1-3). Its clinical presentation is
extremely various, and changes considerably from
full-blown malabsorption syndrome, seen in the
classic childhood-onset disease, to subtle and
atypical symptomatology, especially in the lateonset
forms. The prevalence of CD varies widely
in different parts of the world; however recent
studies, employing new highly sensitive and
specific serologic assays, have shown it to be a
fairly common disease worldwide, about 1% in
general population. This variability is most
probably due to the differences in the diagnostic
protocols used, the level of public health
awareness, the nutrition habits (large use of gluten
free cereals – i.e. rice, corn) and also, partially, to
the true differences in the incidence of the disease
(4)
Is Autoimmunity More Predominant in Nonceliac Wheat Sensitivity Than Celiac Disease?
No full textThe recent paper published by Carroccio et al reported on the prevalence of autoimmunity (as identified by positivity of antinuclear antibodies [ANA] and associated autoimmune disorders) in nonceliac wheat sensitivity (NCWS) versus celiac disease (CD) and irritable bowel syndrome (IBS). More in detail, the results of the study, based on a retrospective and prospective arm, showed that the prevalence of ANA in NCWS was significantly higher than in CD and IBS (46% in NCWS vs 24% in CD and 2% in IBS, retrospectively; and 28% in NCWS vs 7.5% in CD and 6% in IBS, prospectively). Moreover, in both retrospective and prospective analysis, autoimmune disorders (mainly autoimmune thyroiditis) were found in a slightly higher proportion in NCWS (29% vs 24%) than CD (21% vs 20%). Both NCWS and CD showed a significantly higher prevalence of autoimmune disorders than IBS. ANA were significantly related to HLA-DQ2 and -DQ8 in NCWS (both retrospectively and prospectively), whereas these autoantibodies were associated significantly with autoimmune disorders only in the prospective arm
Clinical and immunological features of celiac disease in patients with Type 1 diabetes mellitus
No full textCeliac disease (CD) is one of the most frequent autoimmune disorders occurring in Type 1 diabetes mellitus (T1DM). The prevalence of CD in T1DM varies from 3 to 16%, with a mean prevalence of 8%. The clinical presentation of CD in T1DM is classified as symptomless in approximately half of cases, but a more accurate analysis often discloses a wide array of symptoms suggestive of CD. Both T1DM and CD show the same genetic background and an abnormal small intestinal immune response with inflammation and a variable grade of enteropathy. Serological screening for CD should be performed in all T1DM patients by means of antibodies to tissue transglutaminase at T1DM onset. T1DM patients found to be celiacs must be treated by a gluten-free diet. Potential CD cases (especially when asymptomatic) should be kept on a gluten-containing diet with a careful clinical and antibody follow-up, since many of them will not develop villous atrophy
New understanding of gluten sensitivity.
No full textAmong gluten-related disorders, gluten sensitivity is an emerging entity that is characterized by a wide array of manifestations. In particular, patients complain of IBS-like symptoms and extraintestinal manifestations that occur shortly after the ingestion of gluten. Symptoms improve or disappear when gluten is withdrawn from the diet, and recur if gluten is reintroduced. Laboratory tests are usually unhelpful for diagnosis, although ∼50% of patients are positive for IgG antigliadin antibodies. The natural history of gluten sensitivity is unknown; in particular, it is still to be clarified whether this disorder is permanent or transient and whether it is linked to autoimmunity. The pathogenesis of gluten sensitivity is unclear; data so far demonstrate a predominant activation of innate immune responses. Further research is necessary to establish the main clinicopathological features of gluten sensitivity, thus enabling physicians to improve their management of the increasing number of patients who are sensitive to dietary gluten. © 2012 Macmillan Publishers Limited. All rights reserved
Effect of a Gluten-free Diet on the Risk of Enteropathy-associated T-cell Lymphoma in Celiac Disease
No full textPatients with celiac disease have an increased
rate of enteropathy-associated T-cell lymphoma, but conflicting
data are available about the protective role of a
gluten-free diet with regard to the development of this
malignancy. We followed 1,757 celiac patients for a total
period of 31,801 person-years, collecting data about the
frequency of gluten intake and the incidence of the enteropathy-associated T-cell lymphoma. Out of the nine
celiac patients who developed an intestinal lymphoma
[standard morbidity ratio of 6.42 (95% CI = 2.9–12.2;
P\0.001)], only two kept a strict gluten-free diet after the
diagnosis of celiac diasese and developed the malignancy
after the peridiagnosis period of 3 years, dropping therefore
the standard morbidity ratio to 0.22 (95%CI = 0.02–0.88;P\0.001). The risk of developing an intestinal lymphoma
for the celiac patients that used to have dietary gluten was
significant (X2 = 4.8 P = 0.01). These results show that a
strict gluten-free diet is protective towards the development
of enteropathy-associated T-cell lymphoma
Non-celiac gluten sensitivity: an emerging syndrome with many unsettled issues
No full textNon-celiac gluten sensitivity is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence. Gluten is likely responsible for the clinical picture in a subset of patients, whereas in other cases it concurs to this syndrome together with fermentable mono-oligo-disaccharides and polyols and wheat proteins (e.g., amylase trypsin inhibitors). Innate immunity plays a pivotal role in the development of this syndrome, which is characterized by gut inflammation without villous atrophy and likely changes of intestinal barrier function. Data on its epidemiology are still undefined and largely variable. In the USA its prevalence varies from 0.6% to 6% in primary or tertiary care, respectively. Clinically, patients complain of gastrointestinal and extra-intestinal symptoms triggered by the ingestion of gluten without evidence of celiac disease and wheat allergy. Intestinal symptoms resemble those of irritable bowel syndrome, whereas neurological signs are quite common among extra-intestinal manifestations. So far, there are no biomarkers for non-celiac gluten sensitivity, but about half of patients shows anti-gliadin antibodies of immunoglobulin G class. Although not specific for non-celiac gluten sensitivity, the detection of such antibodies can support the diagnosis in patients with gluten-related symptoms. In the absence of diagnostic biomarkers a double-blind, placebo-controlled food challenge is currently the best way for confirming non-celiac gluten sensitivity. Studies aimed at clarifying the pathophysiological, clinical and laboratory features of non-celiac gluten sensitivity will help a better management of patients with this novel and intriguing clinical entity
Gut-liver axis: an immune link between celiac disease and primary biliary cirrhosis
No full textThe association between celiac disease and primary biliary cirrhosis is well established. The breakdown of gut-liver axis equilibrium plays a central role in the development of immune disorders involving the small bowel and liver. In celiac disease, immunologically active molecules generated from the cross-linking between tissue transglutaminase and food/bacterial antigens reach the liver through the portal circulation owing to the increased intestinal permeability. A molecular mimicry between bacterial antigens and the pyruvate dehydrogenase E2 component, recognized by antimitochondrial autoantibodies, may have a role in primary biliary cirrhosis pathogenesis. An aberrant intestinal T lymphocyte homing to the liver may contribute to trigger immune hepatic damage. Both celiac disease and primary biliary cirrhosis share several features, including a higher prevalence in females, autoimmune comorbidities and specific autoantibodies. Reciprocal screening for both diseases is recommended, as an early diagnosis with the appropriate treatment can improve the outcome of these patient
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