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Colonoscopic findings in coeliac disease on a gluten-free diet
Casella,G.; Villanacci,V.; Di Bella,C.; Marco,E. de; Pagni,F.; Drera,E.; Ortenzi,R.; Baldini,V.; Bassotti,G.;
Revista Espa?ola de Enfermedades Digestivas , 2010, DOI: 10.4321/S1130-01082010000900005
Abstract: background: to date, there are few data on colonoscopic findings in patients with celiac disease, and most of these obtained in patients with iron deficiency anaemia. aims: we assessed colonoscopic findings in unselected patients with coeliac disease, since there are no studies available also considering morphological aspects, and there is literature suggestion of increased prevalence of colorectal tumours. material and methods: colonoscopies with multiple biopsies were retrospectively analyzed in 42 coeliac disease patients on gluten-free diet above age 40; 16 had clinical or laboratory features of iron deficiency anaemia. mucosal biopsies were evaluated for the presence of intraepithelial lymphocytes and of mucosal eosinophils, in addition to conventional histologic assessment, and compared with those obtained in 15 controls. results: macroscopic abnormalities (polyps, diverticula, inflammatory changes) were found in 26% of patients. microscopic abnormalities (lymphocytic colitis, melanosis coli, rectal histiocytosis) were found in 36% of patients. none of these findings was found in controls. coeliac disease patients had significantly higher eosinophil score than controls in the right colon, whereas this was not significantly different between groups in the left colon. conclusions: colonoscopic findings in coeliac disease on gluten-free diet may reveal significant findings, even in patients without iron deficiency anaemia. there is the need of further studies in larger cohorts of patients to establish whether colonoscopy in these patients may be clinically useful.
Colonoscopic findings in coeliac disease on a gluten-free diet  [cached]
G. Casella,V. Villanacci,C. Di Bella,E. de Marco
Revista Espa?ola de Enfermedades Digestivas , 2010,
Abstract: Background: to date, there are few data on colonoscopic findings in patients with celiac disease, and most of these obtained in patients with iron deficiency anaemia. Aims: we assessed colonoscopic findings in unselected patients with coeliac disease, since there are no studies available also considering morphological aspects, and there is literature suggestion of increased prevalence of colorectal tumours. Material and methods: colonoscopies with multiple biopsies were retrospectively analyzed in 42 coeliac disease patients on gluten-free diet above age 40; 16 had clinical or laboratory features of iron deficiency anaemia. Mucosal biopsies were evaluated for the presence of intraepithelial lymphocytes and of mucosal eosinophils, in addition to conventional histologic assessment, and compared with those obtained in 15 controls. Results: macroscopic abnormalities (polyps, diverticula, inflammatory changes) were found in 26% of patients. Microscopic abnormalities (lymphocytic colitis, melanosis coli, rectal histiocytosis) were found in 36% of patients. None of these findings was found in controls. Coeliac disease patients had significantly higher eosinophil score than controls in the right colon, whereas this was not significantly different between groups in the left colon. Conclusions: colonoscopic findings in coeliac disease on gluten-free diet may reveal significant findings, even in patients without iron deficiency anaemia. There is the need of further studies in larger cohorts of patients to establish whether colonoscopy in these patients may be clinically useful.
Subclinical Cardiac Dysfunction in Children with Coeliac Disease: Is the Gluten-Free Diet Effective?  [PDF]
Berna Saylan,Ayhan Cevik,Ceyda Tuna Kirsaclioglu,Filiz Ekici,Ozgur Tosun,Gonca Ustundag
ISRN Gastroenterology , 2012, DOI: 10.5402/2012/706937
Abstract: Objectives. The aim of this study is to investigate the effects of coeliac disease on cardiac function in children using conventional transthoracic echocardiography (TTE) and tissue Doppler echocardiography (TDE). Methods. Coeliac disease patients were evaluated in two different groups based on serum endomysial antibody (EmA) titers (EmA (+) and EmA (?)), and the data obtained by conventional and TDE studies were compared between the patient groups and healthy controls. Results. There was no significant difference between EmA (+) and EmA (?) groups in terms of the conventional TTE parameters, including ejection fraction (EF), fractional shortening (FS), and left ventricle end diastolic diameter (LVEDD), that show the left ventricular systolic function ( , , ). TDE showed a significant difference in left ventricle (LV) isovolumic relaxation time (LV IVRT) and LV myocardial performance index (LV MPI) parameters between EmA (+) and EmA (?) patient groups ( ). Conclusion. The measurement of LV MPI and LV IVRT parameters by TDE would be beneficial in early determination of the cardiac involvement and establishing appropriate treatment and followup of patients with coeliac disease as well as in making distinction between EmA (+) and EmA (?) patients. 1. Introduction Coeliac disease (CD) is childhood disorder characterized by malabsorption and steatorrhoea but can also affect adults of any age [1, 2]. Studies have shown that Coeliac disease affects about 1% of European and American children and adults [3, 4]. This disease may present in various forms depending on the age at onset and disease duration and may be silent or remain asymptomatic [5, 6]. Autoimmune myocarditis and idiopathic dilated cardiomyopathy are a well-known cause of significant morbidity and mortality among comorbidities of Coeliac disease [7]. In Coeliac disease, many theories have been proposed to explain the development of cardiomyopathy [8, 9]. One theory suggests that intestinal malabsorption leads to nutritional deficiency, and another theory suggests that abnormalities of intestinal absorption leads to increased intestinal absorption of antigens and infectious agents and thus to activation of immune mechanisms, which eventuates in myocardial damage. Finally, the direct immune response may cause damage to small intestine and myocardium [10]. In one study, gluten-free diet was found to be protective in the development of autoimmune diseases [11]. However, it is controversial whether gluten-free diet prevents the progression once the Coeliac disease has been diagnosed [12]. Tissue Doppler
Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study
P?ivi A Pynn?nen, Erkki T Isomets?, Matti A Verkasalo, Seppo A K?hk?nen, Ilkka Sipil?, Erkki Savilahti, Veikko A Aalberg
BMC Psychiatry , 2005, DOI: 10.1186/1471-244x-5-14
Abstract: Nine adolescents with celiac disease, aged 12 to 16 years, were assessed using the semi-structured K-SADS-Present and Lifetime Diagnostic interview and several symptom scales. Seven of them were followed at 1 to 2, 3, and 6 months on a gluten-free diet.Adolescent coeliac disease patients with depression had significantly lower pre-diet tryptophan/ competing amino-acid (CAA) ratios and free tryptophan concentrations, and significantly higher biopsy morning prolactin levels compared to those without depression. A significant decrease in psychiatric symptoms was found at 3 months on a gluten-free diet compared to patients' baseline condition, coinciding with significantly decreased coeliac disease activity and prolactin levels and with a significant increase in serum concentrations of CAAs.Although our results of the amino acid analysis and prolactin levels in adolescents are only preliminary, they give support to previous findings on patients with coeliac disease, suggesting that serotonergic dysfunction due to impaired availability of tryptophan may play a role in vulnerability to depressive and behavioural disorders also among adolescents with untreated coeliac disease.Coeliac disease is an under-diagnosed autoimmune type of gastrointestinal disorder resulting from gluten ingestion in genetically susceptible individuals. Non-specific symptoms such as fatigue and dyspepsia are common, but the disease may also be clinically silent. Diagnosis is based on small-bowel biopsy, and a permanent gluten-free diet is the essential treatment. Undetected or neglected, coeliac disease is associated with serious complications. [1-3] Depressive symptoms [4,5] and disorders [6] are common among adult patients with coeliac disease, and depressive and disruptive behavioural disorders are highly common also among adolescents, particularly in the phase before diet treatment [7]. Recently 73% of patients with untreated coeliac disease – but only 7% of patients adhering to a gluten-free d
Effect of gluten-free diet on the growth and nutritional status of children with coeliac disease  [PDF]
Radlovi? Nedeljko,Mladenovi? Marija,Lekovi? Zoran,?ivanovi? Dragana
Srpski Arhiv za Celokupno Lekarstvo , 2009, DOI: 10.2298/sarh0912632r
Abstract: Introduction. Gluten-free diet (GFD) presents the basis of coeliac disease (CD) treatment. If strictly applied, the disorders of the small bowel mucosa and other disease signs rapidly resolve. Objective. The goal of the study was to evaluate the effect of GFD on the growth and nutritional status of children with the classical form of CD. In addition, we analyzed the differences between these parameters with the duration and the patients' compliance with GFD. Methods. The study goals were achieved on a sample of 90 children, 56 female and 34 male, aged 0.5-7.5 (1.53±1.05) years, with the classic CD diagnosed on the basis of typical pathohistological findings of the small bowel mucosa and clinical recovery of patients on GFD. The duration of the patients' follow-up was 1.08-8.75 (3.03±1.14) years, i.e. until the age of 2.5-15 (4.59±1.78) years. The initial and control values of body height (BH) in relation to matched values for age and gender were expressed in percentiles, while the deviation in body weight (BW) for the matched values of height and gender was expressed in percentages. The referent haemoglobin (Hb) rate in blood, as a laboratory indicator of nutritional status in children aged up to 5 years was ≥110 g/L, and for those aged above 5 years it was ≥115 g/L. Compliance with GFD was based on the pathohistological findings of the small bowel mucosa or determination of tissue transglutaminase. Results. Over the studied period, the effect of GFD was highly significant, both on the increase of BH percentiles (37.62±26.26 vs. 57.22±25.29; p<0.001), and on the decrease of BW deficit 11.58±10.80 vs. 0.89±8.194; p<0.001). After the treatment period, none of the children showed slowed growth rate or BW deficit above 20%, while BW deviation ranging between 10-20% in relation to the referent values was registered in 17 (18.19%) and the excess of over 20% in 2 patients. In 86 (95.56%) patients, control Hb values in blood were normal, while mild anaemia was registered in 4 patients, all compliant with GFD. The difference between the compliant and non-compliant patients with GFD was not detected either in BH percentiles (p=0.586) or in BW percentage deviation as compared to standard values (p=0.516) or in blood Hb values (p=0.445). In addition, differences between the children on GFD lasting over and below 3 years were not detected either in BH percentiles (p=0.915) or in BW deviation percentages in relation to the ideal rate (p=0.476). Conclusion. GFD applied for 1-3 years has a highly significant effect on the growth rate and nutritional status of children
Coeliac disease as an example of malabsorbtion syndrome – an unappreciated problem in human's reproduction Zespó z ego wch aniania na przyk adzie celiakii – problem niedoceniany w rozrodzie cz owieka
Rados?aw Blok,Joanna Gawe?,Dominika Klimkiewicz-Blok
Polish Gastroenterology , 2011,
Abstract: In this article coeliac disease is described as an example of gastrointestinal disturbance which can have a relevant impact on comfort of live and fertility in procreative women and also on pregnancy. Coeliac disease is often cause of oligomenorrhoea, amenorrhoea, IUGR (intrauterine growth retardation) and has influence on lactation. Gluten-free diet is the method to eliminate these problems.
How Could a Gluten- and Casein-Free Diet Ameliorate Symptoms Associated with Autism Spectrum Conditions?
Paul Whiteley, Paul Shattock, Kevin Carr, Malcolm Hooper and Lynda Todd
Autism Insights , 2012, DOI: 10.4137/AUI.S6275
Abstract: There is a considerable body of experimental evidence suggesting potential efficacy of a diet devoid of gluten and casein in ameliorating some of the core and peripheral symptoms of autism spectrum conditions. Although phenotypic details of best- and non-responders to dietary change remain under investigation, the range of biological mechanisms implicated during intervention is growing. The question of how diet works remains unanswered. We discuss three prospective modes of action used alone and in combination to explain the effects of a gluten- and casein-free diet on autism spectrum conditions focussed on direct or co-morbid consequences of: i) gluten sensitive enteropathy or coeliac disease, ii) food allergy and/or atopic disease, and iii) underlying hyperpermeability of the gastrointestinal tract (leaky gut) and subsequent passage of biologically-active peptide and related species into the central nervous system. No single theory offers a universal explanation for the biological basis of dietary effectiveness despite individual associations with various cases of autism. Impaired intestinal barrier function is a common denominator and represents a promising area for investigation. Furthermore, a number of key points derived from each model offer testable markers for experimental evaluation onwards to ascertaining potential responsiveness to such dietary intervention in autism.
Anaplastic Large-Cell Lymphoma in a Child with Type I Diabetes and Unrecognised Coeliac Disease
Jemima Sharp,Barry Pizer,George Kokai,Marcus K. H. Auth
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/269689
Abstract: Screening for coeliac disease is recommended for children from certain risk groups, with implications for diagnostic procedures and dietetic management. The risk of a malignant complication in untreated coeliac disease is not considered high in children. We present the case of a girl with type I diabetes who developed weight loss, fatigue, and inguinal lymphadenopathy. Four years before, when she was asymptomatic, a screening coeliac tTG test was positive, but gluten was not eliminated from her diet. Based on clinical examination, a duodenal biopsy, and an inguinal lymph node biopsy were performed, which confirmed both coeliac disease and an anaplastic large-cell lymphoma. HLA-typing demonstrated that she was homozygous for HLA-DQ8, which is associated with higher risk for celiac disease, more severe gluten sensitivity, and diabetes susceptibility. She responded well to chemotherapy and has been in remission for over 4 years. She remains on a gluten-free diet. This is the first case reporting the association of coeliac disease, type I diabetes, and anaplastic large-cell lymphoma in childhood. The case highlights the malignancy risk in a genetically predisposed individual, and the possible role of a perpetuated immunologic response by prolonged gluten exposure.
Coeliac disease in a child with anorectal malformation: The importance of considering other causes of diarrhea  [cached]
Gopal Milan,Nour Shawqui,Hoskyns Wren
Journal of Indian Association of Pediatric Surgeons , 2010,
Abstract: We present the case of an Indian child with a high anorectal malformation (ARM) who postoperatively had troublesome fecal incontinence. Based on a dietary history, weight loss, and diarrhea, a duodenal biopsy was performed that revealed coeliac disease. Since being on a gluten-free diet, her symptoms have improved dramatically. To the best of our knowledge this is the first report in the English literature of such an association between ARMs and coeliac disease. Dietary modification alone can dramatically improve symptoms in these children.
The Gluten-Free Diet: Safety and Nutritional Quality  [PDF]
Letizia Saturni,Gianna Ferretti,Tiziana Bacchetti
Nutrients , 2010, DOI: 10.3390/nu2010016
Abstract: The prevalence of Celiac Disease (CD), an autoimmune enteropathy, characterized by chronic inflammation of the intestinal mucosa, atrophy of intestinal villi and several clinical manifestations has increased in recent years. Subjects affected by CD cannot tolerate gluten protein, a mixture of storage proteins contained in several cereals (wheat, rye, barley and derivatives). Gluten free-diet remains the cornerstone treatment for celiac patients. Therefore the absence of gluten in natural and processed foods represents a key aspect of food safety of the gluten-free diet. A promising area is the use of minor or pseudo-cereals such as amaranth, buckwheat, quinoa, sorghum and teff. The paper is focused on the new definition of gluten-free products in food label, the nutritional properties of the gluten-free cereals and their use to prevent nutritional deficiencies of celiac subjects.
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