International Journal of Celiac Disease

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Authors: M.O Flores Barriguete and M.A Okorie

Celiac disease has been recognized as a multisystem immunological disorder commonly manifested in children and adults. Celiac disease is a common syndrome which is usually efficiently treated with a gluten-free diet as well as an optimal prognosis. Some major symptoms of celiac disease include malabsorption syndrome which could manifest in the form of chronic diarrhea, weight loss, and abdominal distention. COVID-19 have been observed to impact and worsen several disorders and lifestyle habits but have been found to not affect patients with autoimmune diseases such as celiac disease. This article would serve as a foundation for further research on the impact of COVID-19 on celiac disease.

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Authors: Aaron Lerner

SARS-CoV-2, the virus that causes COVID-19, impacts human health all over the world with high morbidity and mortality. Many chronic diseases predispose the patients to be infected, including autoimmune diseases. Despite theoretical and rare exceptions, celiac disease is not a high-risk condition for COVID-19 infection. The present review expends on those potential circumstances that put the CD patients at risk for COVID-19.

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Authors: Mahmoud M. M. Zaky, Saly M. E. Toubar and Ahmed Samy El-Shafey

Chemical pollution of water is the contamination of water by foreign matter that deteriorates the quality of the water. Pollution of water by heavy metals are dangerous because they tend to cause Bioaccumulation that means an increase in the concentration of a chemical in a biological organism over time, compared to the chemical's concentration in the environment. Chemical pollution of Manzala lake was studied in 4 main localities, Kapoty, Bashtier, Mataryia and Gamil areas which receives high load of sewage, agricultural and industrial wastes from different sources. Heavy metals, such as Zn, Pb, Cd and Hg were estimated in water and fish samples, to reveal high pollution of lake Manzala with such toxic elements, where Zn, reached 800µg/L. Pb,195 µg/L. Cd 45 µg/L and. Hg, 5000 µg/L in water samples.

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Authors: Agustina Norambuena, Daiana Quintiliano and Magdalena Aray

Background. Gluten-free diet continues being the most effective treatment of celiac disease but current evidence on its nutritional characteristics and metabolic effects rises concerns. Objectives. To assess the total diet of adult celiac patients and the contribution of gluten-free foods to it, in Chilean celiac patients. Methodology. ociodemographic and clinical characteristics were registered and a food frequency questionnaire including detailed data about gluten-free foods was applied to 71 celiac patients older than 12 years of age receiving medical care at INTA, University of Chile, in Santiago. Total food intake, dietary adequacy and diet nutritional quality was calculated using descriptive statistics. Principal Findings. Of 71 patients, 81.6% were female, 93% were 19-65 years of age and 65% were on GFD for 2 years or more. Nutritional status classified in underweight and overweight/obesity in 2.9% and 35.7%, respectively. 2.8% patients declared to consume willingly gluten containing bread. The whole diet was normocaloric, normoproteic, hyperlipidic and hypoglucidic (FAO/WHO); when calculations were based for individuals’ requirements, 65% of cases consumed excess calories, proteins, and carbohydrates. Gluten-free foods contributed to 17.7%, 11.6%, 11.5% and 23.9% of the total daily intake of calories, protein, lipids, and carbohydrates, respectively. GFF were characterized by having a low protein content. Conclusions. Although the whole diet appeared close to WHO/FAO recommendations when calculated as average for the study group, 65% of participants consumed excess calories, proteins, lipids, and carbohydrates when calculations were made on individual basis. There was neither moderate-severe undernutrition nor overweight/obesity in the group studied. It is interesting that both the total diet quality and the nutritional status of the celiac patients assessed were better than those described in the general local population.

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Authors: Hugh James Freeman

The risk of celiac disease may be increased in patients with inflammatory bowel disease (IBD), however, the precise pathogenetic mechanisms involved remain controversial. In this report, an elderly man with long-standing and extensive ulcerative colitis was treated with daily salazopyrine for over 30 years. His medication was eventually discontinued although endoscopic surveillance studies showed healed colitis with minimal inflammatory change and no dysplasia. He subsequently volunteered as an IBD control in a celiac disease research study. Endomysial and tissue transglutaminase antibodies were unexpectedly positive and a small bowel biopsy showed changes of celiac disease that later responded to a gluten-free diet. Earlier historical duodenal and ileal biopsies had been normal suggesting that changes were new, developing after cessation of the salazopyrine. This unusual presentation “unmasking” celiac disease after cessation of long-standing salazopyrine for colitis raises the potential that the drug may have acted to suppress the inflammatory process in celiac disease and may offer another alternate and inexpensive therapeutic approach.

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Authors: Aaron Lerner and Jozélio Freire de Carvalho

The chain of events, starting from nutrients that change microbiome/dysbiome ratio followed by their secreted mobilome and ending with the leaky gut syndrome, can be applied for cardiovascular diseases. The Gut-heart axis is only one avenue where intestinal luminal eco-events induce remote organ's pathology. The present editorial highlights the mechanisms and potential pathways in the nutrients-microbiota-endocrine-cardiovascular axis that might affect human heart morbidity and mortality in celiac disease.

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Authors: Bhavin Vasavada and Hardik Patel

BACKGROUND: Enhanced recovery after surgery (ERAS) programs aim to improve postoperative outcomes. This meta-analysis aims to evaluate the impact of ERAS programmes on outcomes following liver surgeries. METHODS: EMBASE, MEDLINE, PubMed and the Cochrane Database were searched for studies comparing outcomes in patients undergoing liver surgery utilizing ERAS principles with those patients receiving conventional care. The primary outcome was the occurrence of 30-day morbidity and mortality. Secondary outcomes included length of stay, functional recovery, readmission rates, time to pass flatus, blood loss and hospital costs. RESULTS: Ten articles were included in the meta-analysis. 30 days morbidity and mortality were significantly less in the ERAS group. Hospital stay, time to pass flatus, time to complete recovery and hospital costs were also significantly reduced due to ERAS protocols. Blood loss and readmission rates were also significantly less in the ERAS group. CONCLUSIONS: The adoption of ERAS protocols significantly reduced morbidity, mortality hospital stay, readmission rates, time to recovery, hospital costs, time to pass flatus, blood loss and readmission rates.

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Authors: Ayed Amr, Rima Mashal and Bashayer Al-Enezi

Registered dietitians /nutritionists play a crucial role in the management of celiac disease (CD). The present study aims to evaluate the knowledge of nutritionists working with CD patients in Kuwait, which has lately been witnessing increased incidence of this disease. A convenient cross-sectional sample of 156 nutritionists from both genders, different age groups, educational levels and experience working in different hospitals and health centers in Kuwait was recruited. To assess their knowledge and practice, a self-administered validated questionnaire was used. Descriptive data analyses were performed using SPSS program. Results of 141 respondents (90% response rate) indicated that nutritionists holding university degrees had highly significant (P ≤ 0.01) higher mean knowledge scores about CD than those holding a diploma degree (9.9 ± 1.3 and 9.3 ± 1.3 vs 8.7± 1.4, out of 14 respectively). It also indicated that gender, geographic area and/or experience had no significant effects (P > 0.05) on the overall mean knowledge scores of the respondents albeit males had higher, though non-significant (P>0.05) mean scores than females in some geographic areas. The age of nutritionists had no effect on their knowledge scores despite the longer experience older ones have. The results also indicated that although most nutritionists seem to be well aware of the causes(99.3 %), treatment (98.6%), diagnosis (61%) and complications(78.7%) associated with CD, the majority of them confused it with wheat allergy (78% vs. 22%; P ≤ 0.01). Nutritionists’ knowledge about “Unsafe Ingredients” in the celiac diet information card” was successfully answered by only 6.4% of the participants, whereas 81.6% of them were not sure (p < 0.05). Results of the study emphasize the need for continued-structured education programs for the Kuwaiti nutritionists working with CD patients in all areas related to CD.

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Authors: Hakim Rahmoune, Mounira Amrane and Nada Boutrid

The concept of celiac disease (CD) has greatly evolved during the last decades; ranging from the classical digestive form to the peculiar monosymptomatic and silent forms. Thus, in order to assess the knowledge of interns and residents in pediatrics about CD, a local survey was conducted through a 14-item questionnaire. This work provided a local glimpse of young doctors' awareness about CD. The level of knowledge was globally correct, but vigorous efforts are needed; notably regarding the use of celiac serology and the introduction of the gluten-free diet.

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Authors: Jack A. Syage and Philip T. Lavin

Introduction: It is common for celiac disease (CD) patients on a gluten-free diet to accidentally consume gluten that can cause symptomatic distress and histologic damage. We present an algorithm to relate the quantity of gluten intake to the severity of episodic symptoms for abdominal pain, bloating and tiredness in CD patients. Methods: This analysis employs a model based on data from the CeliAction study for latiglutenase (ALV003-1221; NCT01917630). A previously estimated average daily quantity of gluten consumed by these trial patients along with the data for frequency and severity of the symptoms for abdominal pain, bloating, and tiredness allowed us to estimate the relationship between episodic inadvertent gluten ingestion and symptom severity. Results: The CD trial patients were previously estimated to consume a mean of 354 mg/day. From the study data, these patients experienced at least one symptom (of six possible) almost every day (6.13/week) and on average experienced 2-3 different symptoms per symptom event. The most common severity (on a 1-5 scale) was 2 for abdominal pain and 3 for bloating and tiredness corresponding to 1.1, 0.9, and 0.7 g gluten consumed per event. The frequency that a severe symptom (4 or 5) occurs during a symptomatic event equates to about 10%, 27%, and 33% for abdominal pain, bloating, and tiredness and correlates to 2.1, 1.2, and 1.0 g gluten consumed per event, respectively. Conclusions: This model suggests that the quantity of ingested gluten varies per event type and likely includes periodic gluten exposures of substantial quantity.

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Authors: Felipe Freire Silva, Aaron Lerner, João Carlos Geber Júnior, Jozélio Freire de Carvalho and Yehuda Shoenfeld

Background: Autoimmune diseases tend to run in families and the affected persons are prone to additional autoimmune conditions. This is the case for celiac disease (CD) and Sjögren's syndrome (SS). Objectives: To describe a patient with both diseases and to analyze the clinical, therapeutic and evolutionary characteristics of published patients with SS associated with CD. Methodology: A systematic review of articles published in PubMed, MEDLINE, LILACS and Scielo dating from 1966 to May 2020, was conducted, using the following search words: Sjögren's syndrome, Celiac disease. Only English, German and French publications were considered. Results: Only 16 studies with 31 patients with SS associated CD were depicted. Adding the present case would mount the total to 17 studies, describing 32 patients. There are 6 observational studies and 10 case reports. In relation to demographics, age varied from 10 to 73 years old, with a median of 45 years and the great majority were female (21/32 patients). SS preceded CD manifestations in 7 studies, CD was the first presentation in 6 articles and simultaneous diseases was observed in 4 reports. Time elapsed between the two diseases varied from 2 to 33 years. Autoantibodies related to SS showed that anti-Ro and anti-La were positive in 8/17, while CD-related antibodies were positive in 12/17 studies. Regarding therapy, the majority received a gluten-free diet as CD therapy (13/17 studies). Glucocorticoid was prescribed in 6/17 studies and hydroxychloroquine in 4/17. When described, all studies demonstrated improvement of CD manifestations and 7/17 improved SS symptoms. Conclusion: The present comprehensive review evaluated all published cases of SS and CD of the literature. In the majority, SS precedes CD and all patients had good responses to appropriate therapy. It is hoped that increased awareness of the combination of SS and CD will result in earlier diagnosis and therapy and improved outcome.

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Authors: Frank Vriesekoop, Emily Wright, Stephanie Swinyard and Wim de Koning

Gluten free products are essential for people who suffer from coeliac disease or have a more generic gluten intolerance. In both instances people are forced to resort to consuming gluten free (GF) foods. We carried out two online surveys to gauge the sentiments from people purchasing GF produce, and we carried out two retail observation studies. These studies were carried out in 2015 and repeated again 2019. Bread was the most commonly purchased GF product, but also the most complained about GF product, both from a quality and a price point of view. These sentiments did not change much from 2015 to 2019. One clear set of trends was that people purchased less specialty flour and raising agent when comparing 2019 to 2015, and they did less home-baking over the same period. Furthermore, the decrease in home-baking coincided with a relative increase in satisfaction in the quality of GF products. With regards to observations made across 11 supermarkets, we observed an overall increase in the number of GF line items, with the budget supermarkets offering a very small selection of produce labelled as GF in 2019 only. Our research shows that the relative cost of GF items increased from 2015 to 2019, with the average price ratio of GF food to non-GF foods rising from 3.2 to 4.1 across all UK supermarkets. Ultimately, GF produce cost significantly more compared to similar, gluten-containing foods, while many of the GF products, especially GF breads, still underperform when it comes to the perceived quality and value for money.

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Authors: Shravan Bohra and Apurva Shah

Cardiac manifestations of celiac disease has been poorly described in literature though some studies have emphasized on correlation of ischemic heart disease, atrial fibrillation and dilated cardiomyopathy with celiac disease. We describe a patient with celiac disease associated cardiomyopathy whose cardiac function improved substantially after treatment with a gluten-free diet. A young lady of 35 years age was admitted with complaints of chronic diarrhea, vomiting, significant weight loss, dizziness and chronic iron deficiency anemia since last 3 months. Physical examination revealed tachycardia, tachypnoea and hypotension requiring multiple high dose inotropic support. She had pallor, skin changes and pedal edema suggestive of malabsorption. Investigations revealed iron deficiency anemia, high bilirubin and transaminases, prothrombin time, low albumin and elevated tissue trasglutaminase antibody. Echocardiography showed global hypokinesia with a left ventricular ejection fraction of 20%. Diagnosis of celiac disease made on clinic features, serology and biopsy finding of subtotal villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. She was kept on gluten free diet and on intravenous steroids for acute celiac crises and celiac related cardiomyopathy as patient had severe diarrhea, hypocalcaemia, weight loss, hypoproteinemia and hypotension. Patient improved within 48 hours of steroid with discontinuation of inotropes. She was discharged with gluten free diet and follow up after 6 months showed near normalization of all biochemical abnormalities and ejection fraction of 55%. Cardiomyopathy associated with celiac disease and celiac crisis is a serious and potentially lethal condition. However, with early diagnosis and treatment with a gluten free diet, and steroids cardiomyopathy in patients with celiac disease may be completely reversible

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Authors: Hugh James Freeman

In 2019, a novel virus emerged in Wuhan, China that caused a febrile respiratory illness, sometimes rapidly fatal and thought to be transmitted by droplet contact. It likely originated from another species (possibly the bat), but later, spread occurred from human-to-human. Over a period of months, this disease disseminated to more than 100 nations as a highly infectious pandemic, reminiscent of disease associated with other coronavirus agents in 2002 (SARS) and 2012 (MERS). This COVID-19 virus also caused other forms of clinical illness, albeit in the minority, and most infected patients (over 50%) had few symptoms or remained completely asymptomatic. Prominent in some patients was watery diarrhea, often lasting less than a week, but sometimes without any respiratory features, such as fever, cough or shortness of breath. It is believed that fecal-oral transmission may result. The virus attaches to the surface of human respiratory and intestinal cells, gains entry into these cells, ultimately leading to production of new virions intraluminally. Fecal shedding may occur for extended periods, even after respiratory secretions become negative. Apart from preventive measures, vaccine development remains the most important strategy.

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Authors: A M. Mahmoudi, I. Benelbarhdadi, C. Berhili, N. Lagdali, M. Borahma, FZ. Ajana

BACKGROUND: The association between celiac disease (CD) and the development of various malignant tumors, in particular gastrointestinal cancers, has been reported by several studies. However, the close relative risks (Odds Ratio) of these complications compared to the population are still insufficiently known and estimates of the risk factors for the development of these complications in patients followed for CD remain controversial. Objective: To estimate the close relative risks of malignant complications in a cohort of patients with celiac disease compared to the Moroccan population and to determine the risk factors for the development of these complications. Methods: Our work is a retrospective, descriptive and analytical study, carried out within the Department of Medicine C of the CHU IBN SINA Mohammed V University of Rabat, over a period of 23 years - between 1995 and 2018 -, and on a basis of 284 cases of celiac disease, from which we have extracted a series of 16 cases of celiac disease with at least one malignant gastrointestinal complication. Using a case-control study, we were able to determine the risk of these complications compared to the general Moroccan population. Results: We gathered a population of 16 celiac patients with one or more malignant gastrointestinal complications, out of a total of 284 cases of CD, the prevalence was 5.6%. We found a significant increase in the risk of developing digestive malignancies during CD with an Odds Ratio (OR) of 46 (95% confidence interval [CI] 34–63) and p value <0.0001). This risk was higher during the period of per diagnosis, we also objectified a significant increase in risk of all types of cancers found in our series compared to those of control cases. The two risk factors for malignant complications found in our study are non-compliance with the gluten-free diet and delayed diagnosis. Conclusions: There is a significant increase in the risk of malignancy in patients diagnosed with CD. Particularly during the period of per diagnosis. This risk according to this cohort can be reduced by the good observance of the gluten-free diet and an early diagnosis in the face of the most severe symptoms of this pathology.

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Authors: Madalina Bordea, Gina Klein, Liliana Salanta, Diana Muntean, Florentina Urda, Adriana Dolha, Camelia Samsudean, Viorica Trifan, Anca Ples, Vera Pop, Lelia Hosu, Aletta Danyi, Roxana Piscoran, Rares Rus, Patricia Rus, Cristian Lutai, Ana Copaciu, Corina Tritean, Carmen Nylas, Ciprian Silaghi, Sorin Man, Cornel Aldea and Gabriel Samasca

Nobody believed in a new pandemic this year. COVID19 pandemic is a public health issue. The evolution of the COVID19 pandemic is important to be known by everyone in the medical world. Our goals in this narrative review were to analyze novel coronavirus from all points of view: epidemiology, clinical, and the relationship with Influenza Virus.

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Authors: Adi Eindor-Abarbanel, Dana ZelnikYovel, Timna Naftali, Nahum Ruhimovich, Tzippora Shalem, Shay Matalon, Haim Shirin, Tomer Ziv-Baran and Efrat Broide

Sense of Coherence (SOC) is a theoretical construct that was developed to explain why some people become ill and others do not, regardless of stressful events. Low SOC was reported to correlate with the development of several multifactorial, chronic diseases such as diabetes mellitus and systemic lupus erythematosus. Aims: To compare the SOC scores of patients diagnosed with celiac disease (CD) and matched healthy controls to investigate possible correlations between low SOC scores and CD. Patients and Methods: Patients provided demographic data and completed the 13-item SOC questionnaire. Patients in the study cohort were matched to healthy controls according to age, gender, education, income, employment status and marital status. Results: A total of 239 CD patients and 124 healthy controls answered the SOC questionnaire. Among them,124 patients were matched to the healthy cohort according to propensity score. CD patients had a median SOC score of 57 (IQR 52.25-62), and controls 65.5 (IQR 57-75) p<0.001. Conclusions: SOC reflects a person's resources and orientation which enable individuals to cope with stressors in a way that promotes health. Lower SOC score is correlated with the development of CD.

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Authors: Lerner Aaron

COVID-19, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), is now a worldwide spreading pandemic. Most of the attention is directed to the upper and lower respiratory airways, however, it appears that the gastrointestinal tract is also inoculated and infected. In this regards, celiac disease patients are a potential high-risk group for the corona virus infection and the endoscopist communities should be aware of their professional risks.

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Authors: Vishal Sanklecha

Recently, at the end of 2019 in Wuhan, China found a novel flu like Corona virus (COVID-related to the severe acute respiratory syndrome (SARS) in 2002 and Middle East respiratory syndrome (MERS) in 2012 and so many cases it confirmed that, it transmitted through human-to-human and spread all over world. There is noproper medicine and vaccine on this novel coronavirus COVID -19. The Economy of so many countries going on declined state due to this novel coronavirus COVID-19.It is challenge to scientists to find out actual medicine and vaccine on this novel coronavirus COVID-19. The present review is an attempt made in the respect of highlighting the some important information regarding detection and treatments on Novel coronavirus COVID-19.

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Authors: Vânia Vieira Borba, Aaron Lerner, Torsten Matthias and Yehuda Shoenfeld

Humans started to drinkmammal’s milk 11,000 years ago. Nowadays, cow, goat and sheep milks account for about 87% of the world milk production. The high incidence of allergies to cow’s milk components and autoimmune diseases is rising in the Western industrialized countries, where milk is a major dietary component, especially in processed foods. When allergenic milk proteins face immature and susceptible immune system in children it might represent a threat for future health. Several studies support strong evidences that exposure to dietary allergens during childhood can increase the risk of developing autoimmune diseases, such as type 1 diabetes, celiac disease, inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, neuropsychiatric disorders, among others. The "Mosaic of Autoimmunity" elucidates the diversity and multifactorial origin of autoimmune disease expression in humans. Growing evidence suggests a large overlap between oral tolerance, food antigens and autoimmune diseases. Assorted mechanisms have been hypothesized to explain the connection between these entities, mainly involving molecular mimicry, shared epitopes, cross-reactivity phenomena, enhanced hosts gut permeability, change in microbiome/ dysbiome ratio and even involving Mycobacterium avium subspecies paratuberculosis infection. Nowadays, different kinds of milk and dairy products are being evaluated for a potential benefit in human health. Likewise, milk derived nutraceutical products, such as bovine colostrum, claim many clinical advantages especially for its immune modulatory capabilities. The aim of this review is to explore the impact of cow’s milk protein son human health, emphasizing its relationship with immune mediated and autoimmune diseases.