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Celiac Disease “Journal Club” 2013 Part 1

As some of you may have figured out, I love to keep up to date with the latest research regarding celiac disease and non-celiac gluten sensitivity (NCGS). My interest in research stems from the countless Journal Clubs that I participated in during my decade of medical training. Journal Club gives medical students, residents, fellows, and other trainees the opportunity to learn how to read, interpret, and critically review research articles. Although there are many things which I do not miss about medical training (especially the sleep deprivation), I do miss Journal Club.

I have created my own overview for you of some of the most interesting research articles about gluten-related diseases that have been published during the past few months. This is part 1 of 2.

1. “Clinical features and symptom recovery on a gluten-free diet in Canadian adults with celiac disease.” Authors: Pulido, et al. Published in the Canadian Journal of Gastroenterology in August 2013.

-Almost 6000 adults with Celiac Disease were surveyed regarding their symptoms of Celiac Disease and their recovery on the GF diet. Average age at diagnosis was 45 and average delay in diagnosis was 12 years.

-Conclusions: Although many subjects had a complete resolution of symptoms after 5 years on the GF diet, almost half reported continuing problems with migraines, lactose intolerance, constipation, itchy skin, and depression after being GF for 5 years. Women were less likely than men to report full recovery from symptoms, especially in the areas of abdominal pain, bloating, weakness, diarrhea, anemia, muscle cramps, constipation, migraine headaches, and swelling of the hands and feet.

2.  “Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study.” Authors: Lebwohl, et al. Published in Annals of Internal Medicine in August 2013.

-Researchers found that 43% of adults with Celiac Disease in their study population had persistent villous atrophy on follow-up biopsies after being GF. These patients were found to have a significantly higher (3.5x) risk of lymphoma than the general population.

-Conclusion: Partially treated Celiac Disease is associated with cancer.

-For more information please check out this summary article from Columbia University.

3. “Antibiotic exposure and the development of celiac disease: a nationwide case-control study.” Authors: Marild, K., et al. Published in BMC Gastroenterology in July 2013.

-Main objective of the study was to examine the association between antibiotic use and the subsequent development of celiac disease by comparing subjects with celiac disease with matched controls (subjects without celiac disease).

-Antibiotic exposure was found to be associated with an increased risk of celiac disease, intestinal inflammation, and “potential” celiac disease (elevated Celiac antibodies on blood testing without any small intestinal changes seen on small bowel biopsy).

-Conclusion: The first study to show an association between antibiotic doses and the subsequent development of celiac disease. The authors postulate that an alteration of gut flora (ie. killing off of “good” bacteria) may play a role in the development of celiac disease.

4. “Markers of celiac disease and gluten sensitivity in children with autism.” Authors: Lau, N, et al. Published in PLOS One in June 2013.

-The researchers examined 37 children with autism and found that they had significantly higher levels of anti-gliadin IgG antibodies than children without autism (controls)

-Of the autistic children with anti-gliadin antibodies, most did not have either of the celiac genes (HLA-DQ2 and DQ8) and did not have other celiac antibodies (TTG IgA and IgG and DGP IgA and IgG). However, the majority of autistic children with anti-gliadin antibodies did have gastrointestinal symptoms.

-Conclusion: The anti-gliadin (gluten) immune response in autism involves a mechanism that is different from celiac disease.

5. “Colonic involvement in celiac disease and possible implications of the sigmoid mucosa involvement in its diagnosis.” Authors: Picarelli, A., et al. Published in the Journal of Clinical Immunology in July 2013.

-Researchers took samples of the colon (large intestine) of patients with Celiac Disease and evaluated the samples for celiac antibodies. They found that 75% of patients with Celiac Disease had anti-endomysial antibodies and 81% had anti-TTG antibodies in colonic tissue.

-Conclusion: The immune tissues of the large intestine are affected by Celiac Disease. In the future, large intestinal biopsies may be used in diagnosis.

Part 2 will be coming soon. Please feel free to comment and share articles related to celiac disease and/or non-celiac gluten sensitivity which you have found interesting as well. I would love to discuss.

15 thoughts on “Celiac Disease “Journal Club” 2013 Part 1

  1. Sierra Lin

    Thoughts on this article?

    Hollon JR, Cureton PA, Martin ML, Leonard Puppa EL, and Fasano A: “Trace gluten contamination may play a role in mucosal and clinical recovery in a subgroup of diet-adherent non-responsive celiac disease patients.”
    BMC Gastroenterology 2013, 13:40 (28 February 2013)

    1. Jess Post author

      Hi Sierra,
      This is actually one of my favorite articles about Celiac Disease from the last year and I did write about it last spring after it was published (see link). Although the sample size is pretty small, the results are pretty dramatic, and I was thankful to see that Fasano and his colleagues are actually looking at this.
      I felt that the “take home” message was that the effects of small amounts of gluten cross contamination, especially in the first few months after diagnosis, have been underappreciated and that this needs to be further studied.
      I was able to relate because I did not experience a resolution of Celiac symptoms until I removed all GF procesed foods from my diet and took gluten out of my household entirely. I hope that in the future that Celiac patients will be advised by their doctors and nutritionists to adopt a “whole foods” diet in the months after diagnosis, instead of just being told to eat gluten free foods.
      What are your thoughts?
      Thanks for sharing the reference. I hope that a few others pipe in!
      Jess

      1. Cris

        Interesting about “gluten free foods” not being enough and just eating whole foods after diagnosis. Our daughter was just diagnosed in May. While we see lots of great improvements, this is food for thought. We do purchase some GF packaged foods. If her antibody levels are not all the way down, I will omit all packaged foods. Reading this is making me consider doing so. It’s hard because she is so young and never even told us and never once complained of not feeling well before diagnosis (even though she was very sick). It is good to hear from adults like yourself and what it took to finally feel better.

        1. Jess Post author

          Hi Cris, Thanks so much for reading and taking the time to share your story! I am at the International Celiac Disease Symposium in Chicago right now so hope to be able to get some new info on this, but I do know that it can take 6 to 12 months for antibodies to totally normalize after going GF. I hope that your daughter’s health is improving on the GF diet. Also, I hope that you have also been tested! My mom discovered she had CD after I was diagnosed when I was 33!
          Jess

  2. Molly (Sprue Story)

    Hi Jess,

    This one’s on gluten sensitivity rather than celiac disease, but I’ve been surprised by how little coverage it’s been getting so far (maybe because it’s out of Australia). I think it’s really compelling because it’s by some of the same folks who did one of the earliest studies indicating the presence of non-celiac gluten sensitivity, but this study couldn’t replicate the results of the earlier one (though it was set up differently). Instead, it pointed to the possibility that FODMAPs (including fructans in grains) are what may be to blame for persistent IBS or IBS-like symptoms in people who self-describe as gluten-sensitive. Here’s a link to the abstract.

    Side note/disclaimer: I actually worked with one of the article’s authors on a book, which is how I found out about it in the first place and may predispose me to find it especially interesting. I’ve been thinking about writing about the article on my own blog but haven’t gotten to it yet/haven’t been totally sure how to go about it, given my prior professional relationship with the author. Anyway, if you haven’t seen it yet, hope you find it interesting!

    1. Jess Post author

      Hi Molly,
      I read this article very quickly right after it was published and am waiting until I work next (24 hour shift tomorrow!) to read through it again before I give my two cents. I will be back in touch soon!
      Jess

      1. Jess Post author

        Okay, I just had a chance to really review it as all of my bitty patients are behaving right now!
        This is a very well designed study and I did not realize that this was the same group with published one of the main papers about NCGS in 2011. One of the biggest strengths of the paper is that each research subject served as his/her own control. I also appreciate how diligent the researchers were in the preparation of the food for the subjects. Another strength is that they controlled very well for other IBS triggers, such as sulfites and lactose, in the 3 day re-challenge. One negative of the study, like so many of the studies on food intolerances, is the small sample size of 37. Another challenge is that it was probably difficult to assess how closely the subjects stuck to each diet. Lastly, gluten sensitivity was associated with abdominal symptoms only (none of the other associated symptoms, such as joint pains, headaches, brain fog, etc. were assessed).
        Anyway, I appreciate that you shared this article, and it really does help to explain why so many of us probably feel better on a paleo type and/or low FODMAPs diet. I personally think that there are many, many of us who have both Celiac Disease and IBS going on….

        1. Molly (Sprue Story)

          I hadn’t thought of the issue of assessing how the subjects stuck to the diet. I guess it must be tough working with human subjects who don’t necessarily do what you tell them to do (or tell the truth about what they’re doing). If humans were perfect, science would be so much easier! Though I suppose if humans were perfect, we wouldn’t have malfunctioning digestive systems that cause us all these problems to begin with. :)

    1. Jess Post author

      Hi Rachael,
      You are welcome. Thanks so much for reading. Sometimes I am not sure if anyone is actually reading my posts, so it is great to get feedback/comments from time to time! I hope you and your family are doing well!
      Jess
      P.S. Please feel free to post any questions you may have at any time as well!

  3. Pingback: Celiac Disease “Journal Club” 2013 Part 2 | The Patient Celiac

  4. Ann

    Thanks for the info. I’m seeking any info I can that’s recent. So many blogs ended years ago and the medical sites only repeat the same facts. I am trying to live in a gluten household and can’t get free of contamination. My kitchen is spotless, but wheat is a sticky thing and it keeps finding me.

    1. Jess Post author

      Hi Ann,
      You are welcome. I tried to live GF in a household with gluten and after 2.5 years I finally gave up. I thought that I was being as careful as possible and had an entire GF section of my kitchen with dedicated pots, pans, colanders, cutting boards, wooden spoons, condiments, etc. and I was still exposed to crumbs. I hope that you are able to work things out to minimize/eliminate contamination. It seems to be easier for some than it is for others, I think part of my main problem is that I had several little people continually making crumbs! Please feel free to write with any questions or suggestions.
      All the best.
      Jess

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