Tag Archives: celiac disease research

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Spring 2016 Celiac Research Round-Up

I figured that there’s no better way to celebrate the sixth anniversary of my celiac disease diagnosis (March 2010, I have no clue what my actual date of diagnosis was) than by scouting out the medical literature for interesting new articles. I love doing this, but lately it’s been on the back burner.

  1. “Risk of Headache-Related Healthcare Visits in Patients with Celiac Disease: A Population-Based Observational Study.” By Lebwohl, B, Alaedini, A, Green, P, and Ludvigsson, J. Published in the March 12, 2016 issue of Headache.

This was a retrospective study in which almost 30,000 Swedish patients with biopsy-confirmed celiac disease were compared with controls (people without celiac). The research team found that those with celiac disease had 50% more doctors’ visits for headaches than the control population did. Interestingly enough, patients with elevated celiac antibody levels, but normal biopsies (aka “potential” celiacs) also had a significantly higher risk of headaches.

Take Home Point(s): Patients with celiac disease have a high risk of headaches. Headaches can be a presenting symptom of celiac disease.

  1. “HLA typing using buccal swabs as accurate and non-invasive substitute for venipuncture in children at risk for celiac disease.” By Adriaanse, M, et al. Published in March 2016 issue the Journal of Gastroenterology and Hepatology.

The two main genes associated with the development of celiac disease are HLA-DQ2 and HLA-DQ8. Testing for the celiac genes is typically done via obtaining a blood sample (requiring a blood draw, which can be challenging in toddlers and young children). In this study researchers compared gene analysis from buccal swabs (tissue samples obtained from swabbing the inside of the mouth) vs blood samples. They found that the buccal samples were of good enough quality to do gene analysis in all 77 subjects who were tested.

Take Home Point: Celiac genetic testing can now be performed in children without having to have blood drawn. This testing can also be done at home.

  1. “Decrease by 50% of plasma IgA tissue transglutaminase antibody concentrations within 2 months after start of gluten-free diet in children with celiac disease used as a confirming diagnostic test.” By Lund, F. et al. Published in the April 2016 issue of the Scandinavian Journal of Clinical Lab Investigations.

This article’s title is a mouthful, so bear with me! In children with biopsy-confirmed celiac disease, TTG-IgA antibodies on average decrease by 50% after 2 months on the GF diet.  In this study researchers examined a group of children who had suspected celiac disease (high TTG-IGA antibodies and symptoms) but who went GF without ever having a small bowel biopsy.  They found that this group of children (suspected or presumed celiacs) also experienced a 50% decrease in celiac antibody levels after starting the GF diet.   The researchers conclude that the significant response to the GF diet can be used as a way to to diagnose celiac disease.

Take Home Point(s): TTG-IgA antibodies decrease by half after two months in children with celiac disease after the GF diet is initiated.  In the future, the response to the GF diet may be used as a way to diagnose celiac disease in children who have not had biopsies.

  1. Infant feeding and risk of developing celiac disease: a systematic review.By Silani, S., Agostini, C., Sanz, Y., and Guandalini, S. Published in BMJ Open on January 25, 2016.

The authors reviewed 16 studies for evidence for the association of breast feeding, breastfeeding duration or the timing of gluten introduction and the later development of celiac disease. They concluded there is no evidence on the optimal breastfeeding duration or the effects of avoiding early (<4 months of age) or late (≥6 or even at 12 months) gluten introduction in children at risk of celiac disease.

Take Home Point: At the present time, there is no scientific evidence that the timing of gluten introduction and/or breastfeeding can prevent the development of celiac disease.

  1. Celiac Disease and Drug-Based Therapies: Inquiry into Patients Demands.” By Branchi, F., et al. Published in the journal Digestion in Jan. 2016.

This was a survey of 372 Italian celiac patients. Although 88% of those sampled accepted the gluten-free diet as treatment, 65% believe there is a need for alternative therapies for treatment of celiac disease.

Take Home Point: Per the authors, The GF diet is favorably accepted by most celiac patients. Nevertheless, a proportion of patients pronounce themselves in favor of the development of alternative drugs.”

Have any of you came across any recent celiac research of interest? If so, please share in the comments section.

 

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CDGEMM Study: An effort to understand why celiac disease develops (and what can be done to prevent it)

The Celiac Disease Genomic, Environmental, Microbiome, and Metabolomic (CDGEMM) Study, recently launched by the Center for Celiac Research at Mass General Hospital for Children, is a long-term, prospective study aimed at understanding the genetic, microbial (gut bacteria), and environmental processes that trigger the onset of celiac disease—the information gathered by this study will help to explain why celiac disease develops with an ultimate goal to be able to prevent the development of celiac disease and other autoimmune conditions.

The principal investigators, Drs. Maureen Leonard and Alessio Fasano, aim to recruit 500 infants from age 0 to 6 months of age who have a first-degree relative (mother, father, and/or sibling) with celiac disease. According to study materials, the risk of developing celiac disease in those with a first-degree relative with celiac is 8-15% compared with 1% in the general population. Subjects enrolled in the CDGEMM Study will be tested for the presence of celiac disease genes and then followed until age five via blood and stool samples. Parental involvement includes keeping a diary of dietary patterns and antibiotic use during the first year of life, and then completing online questionnaires every six months. Subjects can be enrolled from anywhere in the U.S. There is no travel requirement as blood samples can be collected from local pediatrician’s offices/labs and sent in and stool samples are collected at home and mailed in.

To learn more about the CDGEMM study, including FAQs about the study, you can visit the website  www.CDGEMM.org or email the study coordinators at CDGEMM@mgh.harvard.edu.

For more detailed scientific information about the study, please refer to the following paper:

Leonard, M., Camhi, S., Huedo-Medina, T., Fasano, A. Celiac Disease Genomic, Environmental, Microbiome, and Metabolomic (CDGEMM) Study Design: Approach to the Future of Personalized Prevention of Celiac Disease. Nutrients. 2015. 7: 9325-9336.

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Celiac Disease Research Awareness

I’ve come across many recent headlines stating that scientists are working toward finding a “cure” for celiac disease, including this recent article.  In actuality, the bulk of the current celiac disease drug studies are focusing on treatments to be used in addition to the gluten-free diet to protect those of us with celiac from damage from gluten cross-contamination. I wrote about some potential future celiac disese treatments in my post from last October.

I was curious to learn about other current celiac disease studies, so I searched the website clinicaltrials.gov using the search terms “celiac disease” and “gluten” earlier today.  I found that there are over 150 studies of celiac disease and gluten sensitivity worldwide and that many of them are currently recruiting subjects. One of the current studies that I found to be the most interesting is the Celiac Disease Genomic Microbiome and Metabolomic (CDGEMM) Study at Massachusetts General Hospital, led by Dr. Alessio Fasano. The CDGEMM study is investigating the role of the microbiome, and other factors, in the development of celiac disease in genetically-predisposed babies.

Topics of other gluten-related studies that are currently recruiting subjects include the following:

-Non-invasive markers of gluten ingestion in celiac disease patients

-Neurocognitive effects of gluten exposure in patients with celiac disease and non-celiac gluten  sensitivity

-Use of the gluten free diet in schizophrenic patients with elevated anti-gliadin antibodies

-Probiotics to treat IBS symptoms in patients with celiac disease

-Non-celiac wheat sensitivity (mulitple studies including biomarkers to be used for testing)

-Gluten free diet for patients with autistic spectrum disorders

In addition, I recently learned that Stanford University is recruiting families with at least one parent and child with celiac disease for a research study on the genetics of celiac. Subjects can live anywhere in the U.S., the testing consists of a simple blood draw, and the “child” in the study can be an adult. Please see this link for more details.

For more information on celiac disease research and studies, please check out the National Foundation for Celiac Awareness and the University of Chicago Center for Celiac Disease websites. The National Institutes of Health (NIH) Celiac Disease Awareness Campaign website also has great information about celiac disease research and clinical trials as well.

Have any of you had the opportunity to participate in any celiac disease studies? If so, I would love to hear about your experiences. I was interested in participating in the recent Celiaction Study but was unable to because I lived too far from any of the research centers.

Thank you and Happy Celiac Awareness Month to all of you!

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Fall 2014 Celiac Disease Research Round-Up

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):

  1. Classical celiac disease: malabsorption syndrome with diarrhea and weight loss
  2. Non-classical celiac disease: Gastrointestinal symptoms (except for diarrhea) and extraintestinal symptoms
  3. Subclinical celiac disease: no symptoms or mild symptoms

The 3 groups were compared over 2 time periods, 1998-2007, and 2008-2012.

Results:

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.

 

 

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Celiac Disease: 10 Things for Doctors and Patients to Know

I came across this list on PubMed the other day, and although I posted it on Facebook, I thought it might be worth sharing on here for everyone else. It comes from an abstract titled “Celiac Disease: Ten Things that Every Gastroenterologist Should Know.” It was written by Drs. A. Oxentenko and J. Murray (from the Mayo Clinic) and published online in the journal “Clinical Gastroenterology and Hepatology” on July 19, 2014. I usually don’t like “Top 10” lists, but it has some good information for both gastroenterologists and their patients. Just for clarification, the quoted statements come directly from the publication and the words in italics are mine.

  1. “The IgA TTG is the single best serologic test to use for the detection of celiac disease (CD).” Most celiac antibody panels (blood tests) include the TTG IgA. However, it is possible for a person to have a negative TTG IgA and still have celiac disease. False negatives can occur in small children, people with a condition called selective IgA deficiency, and in people who are tested after already starting on the gluten free diet.
  2. “Celiac disease can be recognized endoscopically, and water immersion enhances villi detection, although a normal endoscopic appearance does not preclude the diagnosis.” If an endoscopy is done to look for celiac disease, biopsies also need to be done.  The damage from celiac disease is often microscopic. I have met people whose GI doctors did endoscopies and told them they did not have celiac without doing any biopsies!
  3. “It is recommended that four biopsies be taken from the second part of the duodenum, and two bulb biopsies taken at the 9 and 12-o’clock positions to maximize the sensitivity for histologic confirmation of CD.” The intestinal damage from celiac disease can be patchy, so if not enough biopsies are done, it can be missed.
  4. “Consider serologic testing of first-degree relatives, patients with type 1 diabetes, Down’s, Turner’s and William’s syndromes, as well as those with premature osteoporosis, iron deficiency, abnormal liver biochemistries and other manifestations of CD.” First degree relatives are parents, siblings, and children of those with celiac disease.  Screening in high-risk people also needs to be repeated periodically, as celiac disease can develop at any time during one’s life.
  5. “Patients already on a prolonged gluten-free diet (GFD) should be tested for the presence of HLA DQ2 or DQ8, thereby avoiding the need for further evaluation of CD in non-allelic carriers.”This can be very helpful in people who go GF prior to being tested for celiac disease. If one does not carry the 2 main genes, the chances of having celiac disease are very low (between 1-2% of celiacs are DQ2 and DQ8 negative) and non-celiac gluten sensitivity is much more likely than celiac. 
  6. “The basic treatment of CD is a strict, life-long GFD, enabled by an expert dietitian.” Don’t think I need to explain this one!
  7. “Newly-diagnosed adults with CD should be assessed for micronutrient deficiencies (iron, B12, folate, zinc, copper), fat soluble vitamins deficiencies (vitamin D) and bone densitometry.” Osteopenia (low bone mineral density) is rather common. Vitamin and mineral levels should be assessed at follow-up appointments, as well, to make sure there has been improvement.
  8. “All patients diagnosed with CD should have clinical follow-up to ensure response and adherence to a GFD.” From what I have read, this should happen between 6 and 12 months after going on the gluten-free diet.
  9. “In those with persistent or relapsing symptoms, the robustness of the original diagnosis should be reviewed, gluten exposure sought, and a systematic evaluation for alternative and associated diseases.” I was given the opportunity to write about this problem, which is called nonresponsive celiac disease, in Gluten-Free Living magazine. You can find my article here. Although the most common cause of continued symptoms is accidental gluten exposure, In some cases people do not get better because they were misdiagnosed with celiac disease in the first place!
  10. “Evaluate those with refractory disease for malignant transformation.”  People with refractory celiac disease are at risk for lymphoma. This is why it is important to get medical follow-up if you do not get better on the gluten-free diet.

Thanks for reading! I hope you are all having a nice summer and I really appreciate your comments, emails, questions, etc. Please keep them coming!

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2013 International Celiac Disease Symposium Poster Highlights

Although I did not allot enough time to check out all of the posters of abstracts that were on display at the International Celiac Disease Symposium (ICDS) in person, all of us received a spiral bound book that contained the hundreds of scientific posters that were presented. Abstracts are summaries of new research studies, and in many cases, they have not yet been published in a journal. I have started to review the book of abstracts that I received from the ICDS and there are some abstracts that are truly fascinating. We’ll hopefully hear more about these studies in the future as they get published in journals.

Here is a brief synopsis of five of the most interesting studies that I’ve been reading about:

1. “Nine years of follow-up of potential celiac disease in children.” A group of researchers from Naples, Italy (Aurrichio, et al) followed 156 with potential celiac disease who were not on a GF diet. Potential celiac disease, as I discussed here, is when a patient has abnormally high celiac antibodies on blood screening, and often symptoms, but a normal intestinal biopsy. The management is currently controversial. In this study, over a 5-year period, 46.8% of the children with potential celiac disease developed full-blown celiac disease.

2. “Celiac disease detection in asymptomatic children of 2 and 11 years old in a primary care health center using a transglutaminase antibodies quick test.” A Spanish team (Vallejo, et al) screened groups of 2 and 11 year olds for celiac disease in an outpatient clinic using rapid tests. 2% of the 2 year olds had confirmed celiac disease, and 1.5% of the 11 years had celiac disease. The overall rate of celiac disease in their population was 1.7%, which is higher than previously described.

3. “Absence of HLA-DQ2 and HLA-DQ8 does not exclude celiac disease in Brazilian patients.” HLA DQ2 and DQ8 are the 2 main celiac disease genes and are the ones that are currently tested for by most U.S. laboratories. In this study, a Brazilian team (Kotze, et al) performed gene tests on 101 patients with biopsy confirmed celiac disease. They found that 9 (8.9%) of their patients with celiac disease were DQ2 and DQ8 negative. They suspect that this is related to having such an ethnically diverse population in Brazil.

4. “Neurological dysfunction in patients with newly diagnosed celiac disease: a large prospective study.” Dr. Hadjivassiliou and team from the UK performed neurological evaluations on 73 patients with newly diagnosed celiac disease. 63% complained of neurologic symptoms; the most common were frequent headaches, problems with balance, and sensory symptoms. 32% had abnormal white matter lesions on MRI scanning and 43% had abnormal spectroscopy of the vermis of the cerebellum. The cerebellum is the part of the brain involved in balance and posture.

5. “Potential or definite celiac disease: push enteroscopy changes the diagnosis.” A celiac research team from the UK, lead by Dr. Eross, evaluated 16 patients with “potential” celiac disease. Potential celiac disease, as discussed above, is the term for when a patient has abnormally elevated celiac antibodies but no evidence of celiac disease on small bowel biopsy. They found that when their original duodenal biopsies were re-reviewed and biopsies of the jejunum (2nd part of the small intestine that is not typically biopsied when a patient is evaluated for celiac disease) were performed that 15 of the 16 patients actually did have celiac disease. They recommend that a diagnosis of potential celiac disease can only be made if the jejunum has been evaluated by biopsy.

Please let me know if you are interested in reading more about the abstracts that were presented at the ICDS poster session, as there are literally hundreds more that I can summarize for you. Also, I would love to hear about any interesting research that you have stumbled upon!

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Updates on Celiac Disease Screening and Testing from the 2013 International Celiac Disease Symposium

It’s been a busy three weeks since I attended the 2013 International Celiac Disease Symposium (ICDS) in Chicago and I have dedicated only two posts to the symposium thus far (as I was reminded by my friend last night). So, here is some more information for you. This will be post #3 of about 9 or 10 total.

On the first day of the conference, Dr. Benjamin Lebwohl from Columbia gave a lecture entitled “The Correct Diagnostic Approach.” Some of his bullet points on the diagnosis of Celiac Disease included the following:

  • At the current time, most algorithms for diagnosis use both blood tests (serology) and a small bowel biopsy.
  • The TTG IgA antibody is the blood test that is the most sensitive and specific for Celiac Disease. If a patient has a selective IgA deficiency (occurs in about 3% of the population), the deamidated gliadin peptide IgG (DGP IgG) can be useful for screening. The DGP IgA antibody is also more sensitive than the TTG IgA antibody in children under the age of 2.
  • The Celiac antibody tests are imperfect. In approximately 10% of Celiac patients, at time of diagnosis the antibody tests will be negative (normal) but there is still damage seen on biopsy. If these patients had only blood tests performed, their cases of Celiac Disease would be missed.
  • All patients with Irritable Bowel Syndrome (IBS) should be tested for Celiac Disease.
  • It is not feasible to screen all people for Celiac Disease because the positive predictive value (PPV) of the Celiac tests is too low. PPV refers to the percentage of patients with a positive test result who actually have a disease. He stated that if all people were screened, 2/3 of people with abnormal Celiac antibodies would actually not have Celiac Disease (too many false positives) .
  • Lastly, he reminded us that it is crucial that 4 to 6 biopsies be taken during endoscopy, as the damage from Celiac Disease can be missed if too few biopsies are taken. There are many people walking around who have Celiac Disease but were told that their small bowel biopsies were normal because not enough biopsies were taken. If you are interested in reading more about this, I discussed this in a recent post.

Later in the day, Dr. Enzo Bravi from Europe discussed rapid “point of care” tests for Celiac Disease.  There are several tests on the market that require only a few drops of blood and can give results in 5 to 10 minutes.  Simtomax and Biocard are two examples that are used in Europe and other parts of the world.  All of the rapid tests look for some combination of antibodies (TTG IgA, total IgA, DGP IgA and IgG, etc).  There are hopes that these tests will be especially useful in pediatric populations and in developing countries.  Dr. Bravi is currently researching if these tests can be used to assess compliance with the GF diet in Celiac patients who are already GF.   He emphasized that these tests are not intended to be used for the final diagnosis of Celiac Disease.  For more on the Simtomax tests, please see link.  I had an opportunity to briefly speak with Dr. Bravi during one of the breaks and learned that none of these tests are FDA approved for use in the U.S.  If/when they are approved,  I would love to be able to use them in a clinical research study!

Session 4 of the ICDS focused on the pathology of Celiac Disease.  The speakers were Drs. Marsh, Hart, and Bhagat.  We were reminded that small intestinal (duodenal) tissue biopsies are graded from Marsh Type 0 (normal) to Type 3 (villous atrophy and destruction).  Types 1 and 2, the intermediate lesions, have infiltration of tissues with white blood cells, which is called intraepithelial lymphocytosis (IEL). Type 2 also includes tissue hyperplasia, or thickening.

Type 1 lesions, with IEL only, can be seen in IBS and other causes of malabsorption.  If a patient has a Marsh Type 1 lesion in the duodenum and positive TTG antibodies, the diagnosis is either Celiac Disease or Crohn’s Disease.  If anti-endomysial antibodies are present, it is Celiac Disease, and if they are absent, it is Crohn’s Disease.

There are several other diseases that can cause villous blunting that is similar to that seen in Celiac Disease.  They include the following:

  1. Olmesartan associated enteropathy
  2. Common variable immunodeficiency (CVID)
  3. Crohn’s Disease
  4. Giardia infection
  5. Tropical sprue
  6. Autoimmune enterocolitis

CVID, an immunodeficiency, has a mean age of diagnosis of 35.  Two thirds of patients with CVID have increased IEL +/- villous atrophy on their biopsies.  Celiac antibody tests are often negative.  Patients with CVID have no improvement on the gluten free diet. This is one of the biggest red flags that CVID is a possibility for a patient.  CVID needs to be ruled out in cases of refractory (non-responsive) Celiac Disease.

Olmesartan is a medication used for high blood pressure (hypertension) that is in a category of drugs called ACE inhibitors. It can cause duodenal damage that is almost identical to that seen in Celiac Disease. Colchicine is another drug that can cause similar bowel changes.

The speakers emphasized that in patients with refractory Celiac Disease (that do not respond to the gluten free diet), #1-6 need to be excluded.

More information from ICDS to come, including what to do for those with “potential” Celiac Disease and nutrional aspects of Celiac Disease.  Thank you for both reading and being patient with me!

For additional information from the conference, please check out recent posts from both The Savvy Celiac  and Pretty Little Celiac who were official ICDS bloggers.

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Celiac Disease “Journal Club” 2013 Part 2

This is going to be a quick post, as I am getting ready to head to Cincinnati for a wedding, and then to Chicago for the International Celiac Disease Symposium 9/22-9/25. I look forward to being able to meet some of you in person at this conference, and to hear the experts, including Dr. Fasano, speak about the most recent research, recommendations, and guidelines regarding the diagnosis and management of both celiac disease and non-celiac gluten sensitivity.

Below are summaries of three recent journal articles that may be of interest. Part 1 of my Celiac “Journal Club” series can be seen here. Under each article summary statement I am including a link to some of my previous posts about relevant topics.

1. “2013 update on celiac disease and eosinophilic esophagitis.” Authors: Pellicano, R, et al. Published in Nutrients in Aug. 2013.

-authors reviewed 30 publications regarding celiac disease and eosinophilic esophagitis (EoE), a chronic inflammatory disorder of the esophagus which is on the rise. They found that the prevalence of EoE in subjects with celiac disease is 10x higher than the general population in the majority of the studies. They recommend that all children who get small intestinal biopsies for celiac disease diagnosis also get evaluated for EoE.

-for more information on the relationship between EoE and Celiac Disease, as well as an overview of the symptoms of EoE, please see my post from Jan. 2013.

2. “The rising incidence of celiac disease in Scotland.”  Authors: White, L, et al. Published in Pediatrics in Sept. 2013.

-researchers looked at the incidence of celiac disease in children in Scotland from 1990 to 2009. Overall incidence increased by 640% over this 20 year period, with the incidence of “atypical” celiac disease increasing by 1140%!

-of note, 51% of the children who were actively screened for celiac disease and found to have celiac disease had no symptoms at all. Active screening takes place if a child is in a “high risk” category for celiac disease, i.e. has a sibling or other first degree relative with celiac disease.

-for more information on the screening of children for celiac disease, and who should be screened, please check out my post from June 2013.

3. “Potential new mechanisms of placental damage in celiac disease: anti-tranglutaminase antibodies impair human endometrial angiogenesis.” Authors: Simone, N., et al. Published in Biol Reprod in Aug. 2013.

-the authors demonstrate that tissue transglutaminase antibodies seen in celiac disease damage the placenta by interfering with the development of crucial placental blood vessels.  This finding helps to explain why women with untreated celiac disease often have problems of infertility, miscarriages, and fetal growth restriction.

-I wrote about the topics of Celiac Disease and Pregnancy in Jan. 2013 (see link) and Celiac Disease and Infertility in Mar. 2013 (see link).

I anticipate returning from Chicago with a lot to write about on this page. I will also be making my conference tweeting debut (@PatientCeliac), so feel free to follow me for real-time updates. Lastly, if you will be attending, please reach out and let me know so that we can meet!