I haven’t done a “journal club” type post for a while on here, and there have been some really interesting studies published in the last 4-6 weeks, so here goes…
1. “Altered Duodenal Microbiota Composition in Celiac Disease Patients Suffering from Persistent Symptoms on a Long-Term Gluten-Free Diet.” Authors: Wacklin, P., Laurikka, P., Lindfors, K., et al. Published online in the American Journal of Gastroenterology on Nov. 18, 2014.
Background: Many celiac patients continue to have symptoms while on a strict GF diet.
Objective: To see if there is a relationship between persistent digestive symptoms and abnormal intestinal microbiota (gut bacteria) in patients with treated celiac disease.
Methods: Researchers compared gut bacteria in 18 celiac patients with persistent symptoms and compared them to 18 celiac patients who had no symptoms. Both groups were on the GF diet, and all 36 had experienced a normalization of celiac antibodies and intestinal healing prior to the study.
Results: Celiac patients with persistent symptoms had less diverse bacteria in their small intestines as well as increased numbers of Proteobacteria species.
Conclusion: Some celiac patients may have persistent symptoms due to dysbiosis (an imbalance of gut bacteria).
My opinion: Further evidence that probiotics may someday be part of the medical “standard of care” for celiac disease. As some readers may already know, I am a huge fan of probiotics.
2. “Bone Mineral Density at Diagnosis of Celiac Disease and after 1 Year of Gluten-Free Diet.” Authors: Pantaleoni, S., Luchino, M, Adriani, A. et al. Published online in The Scientific World Journal on October 14, 2014.
Background: Celiac disease is associated with problems with low bone mineral density (osteopenia and osteoporosis).
Objective: To evaluate osteopenia and osteoporosis in patients with newly diagnosed celiac disease, and to see if bone mineral density changes after one year of being on the GF diet.
Methods: 169 subjects with celiac disease had their bone mineral density checked by DXA scan at diagnosis and then at the 1 year GF mark.
Results: The initial study population had 169 subjects. 42% of the subjects with celiac disease had normal bone mineral density at time of diagnosis and were excluded from further analysis. 76 subjects were retested at one year, and there was a significant improvement in bone mineral density average scores across the board.
Conclusion: Over half of newly diagnosed celiacs have low bone mineral density, especially if diagnosis is when > 30 years of age. The authors conclude that DXA scans should be offered to those newly diagnosed with celiac disease.
My opinion: I did not have a DXA scan performed when I was diagnosed in 2010 because my medical insurance refused to cover it. Looking back, I probably should have fought harder for coverage, but at least this journal article made me feel better that, either way, my bone mineral density has probably improved quite a bit since then.
3. “The changing clinical profile of celiac disease: a 15-year experience (1998-2012) in an Italian referral center.” Authors: Volta, U., Caio, G., Stanghellini, V., and DeGiorgio, R. Published in BMC Gastroenterology, 2014, 14:194, online November 18, 2014.
Background: Many patients with celiac disease have “atypical” symptoms, or, in some cases, no symptoms at all.
Objective: To see if celiac patients’ presenting symptoms have changed over time.
Methods: A retrospective review of 770 patients with celiac disease over a 14 year time period.
Patients were classified into 3 groups (Oslo definitions):
- Classical celiac disease: malabsorption syndrome with diarrhea and weight loss
- Non-classical celiac disease: Gastrointestinal symptoms (except for diarrhea) and extraintestinal symptoms
- Subclinical celiac disease: no symptoms or mild symptoms
The 3 groups were compared over 2 time periods, 1998-2007, and 2008-2012.
1998-2007: 47% classical, 43% non-classical, and 10% silent/subclinical
2008-2012: 58% non-classical, 29% silent/subclinical, and 13% classical
Frequent gastrointestinal symptoms in all subjects: diarrhea (27%) , bloating (20%), aphthous stomatitis (canker sores) (18%), constipation (13%), and gastroesophageal reflux disease (12%).
Frequent non-gastrointestinal symptoms: anemia (34%), abnormal liver function tests (29%), and recurrent miscarriage (12%). 52% had abnormal bone mineral density and 26% of the celiac patients in this study population also had autoimmune thyroiditis.
Conclusion: The clinical presentation of celiac disease has markedly changed over time, with the bulk of celiac patients having a non-classical presentation at time of diagnosis.
My opinion: Based on these findings, I feel like everyone should be screened for celiac at some time during young adulthood, as reflux, constipation, etc. are such common symptoms in the general population.
As always, thank you so much for reading, and please feel free to share any research that you have come across and found to be interesting in the comments section.