International Journal of Celiac Disease

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Authors: Uttayan Chakrabarti, Manisha Bais Thakur and Ashish Goel

Celiac disease is an autoimmune disorder induced by dietary gluten, characterized by a chronic inflammatory state of the small intestinal mucosa, resulting in villous atrophy that resolves with gluten free diet. A small number have classical symptoms and the majority present as atypical celiac disease with absent or few GI symptoms. Celiac crisis is a rare life threatening complication of celiac disease which needs prompt recognition and intervention. We report a rare case of Celiac disease which presented as Celiac crisis with hypokalemic quadriparesis

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Authors: Hugh James Freeman

A 48-yr old female was reviewed for ongoing symptoms of diarrhea and weight loss following a total colectomy for colitis. Pathological review of the surgical specimens revealed changes of Crohn’s colitis. Subsequent investigations after the colectomy revealed endoscopic evidence of duodenal mucosal scalloping, negative celiac serological studies and moderate to severe changes in villous architecture including crypt hyperplasia with complete villus atrophy and increased numbers of intra-epithelial lymphocytes. No changes were present in the distal small intestine. Over the course of almost a decade, measures directed towards symptom relief were effective. However, in spite of a strict gluten-free diet, repeated endoscopic biopsies of the proximal small bowel remained severely abnormal with persistent crypt hyperplastic villus atrophy. “Sprue-like” intestinal disease occurs in Crohn’s disease limited to the duodenum, mimicking biopsy changes of celiac disease and may represent a post-colectomy complication in Crohn’s disease.

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Authors: Uttayan Chakrabarti, Manisha Bais Thakur and Geetika Khanna

Celiac Disease is an autoimmune disorder due to hypersensitivity to gluten. Gluten free diet usually reverses the pathological changes but in 7-30 % of cases when there is no reversal one should look for the evidence of Microscopic colitis. Celiac disease is also associated with multiple haematological and renal abnormalities and here we report an atypical case of Celiac presenting in an unusual age with multisystem involvement.

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Authors: Crystal Sparks, Taylor Zingg and Marshall K. Cheney

The objective of this study was to examine individual and social influences on college student compliance with a gluten-free diet. Individual semi-structured interviews were conducted in 2016-2017 with undergraduates (n=24) at a large public university. Eligible participants were 18-25 years old with self-reported physician-diagnosed celiac disease. The interview question path was based on the Health Belief Model and assessed individual and social influences on eating choices. Transcribed interviews were independently coded by three researchers (ICR=.82) then analyzed for themes using the Health Belief Model as a guiding framework. Barriers to complying with a gluten-free diet included the college meal plan, meal planning and cooking skills, negotiating social interactions around food, financial burden of purchasing gluten-free food, and intentionally eating gluten as self-confidence grew. Students often reframed non-compliance as a “cheat day,” discussing it as they would a reduced-calorie diet, which could reduce perceived threat. Providers discussed threats to health in terms of long-term outcomes but students focused on the immediate impact of eating gluten. Nutritionists, parents, and health care providers can better prepare college students for the transition to independent food choices and how to remain compliant with a gluten-free diet within the challenging college food environment.

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Authors: Nada Boutrid, Hakim Rahmoune, Mounira Amrane, Reda Belbouab and Belkacem Bioud

The expanding spectrum of gluten-related autoimmune disorders may encompass distal tubular acidosis. We report a case of an infant presenting a classical digestive celiac disease along with a transient, reversible tubular acidosis that vanished after gluten free diet.

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Authors: Peter Makovicky

Here we are continuing interview articles and now Assistant Professor Hakim Rahmoune from Department of Paediatrics of Setif University Hospital & University of Setif-1 is questioned.

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Authors: Nastaran Asri and Mohammad Rostami-Nejad

Celiac disease (CD) is the most common permanent T-cell mediated gluten intolerance, caused by the dietary gluten in individuals who are genetically susceptible to the disease. CD characterized by small intestine mucosal lesions, subtotal, or total intestinal villi atrophy and nutrient malabsorptions. Sometimes the diagnosis of CD is so challenging and needs a combination of clinical, serological, histopathological and genetic evaluations. The well-known cornerstone treatment of CD is gluten-free diet (GFD) and there is need to regular monitoring of patients after starting the GFD. The main aim of this review was to discussing the definition and pathogenesis of CD, together with the diagnostics, treatment and follow-up strategies in this disease.

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Authors: Moni Kumari, Malika Arora, Navdeep Kaur and Parveen Bansal

Celiac disease (CD) is an autoimmune disorder precipitated generally in genetically susceptible individuals by the ingestion of gluten and is becoming a major communal health problem throughout the globe. Initially the disease was reported in few of the countries specifically in predominant Caucasian populations, but now a day it is being reported from almost all parts of the world. Simplification of the diagnostic criteria and widespread use of serologic tests have made it possible to estimate the prevalence of CD in the general population. But the exact global prevalence of the celiac disease is quite ambiguous due to the fact that when the disease is diagnosed with tTG test it is generally not confirmed with the biopsy examinations whereas, diagnosis should be based on the combination of both as per current guidelines on diagnosis of CD. The seropositive based (anti-tissue transglutaminase and/or anti-endomysial antibodies) data shows a high global prevalence of 1.4% whereas biopsy-confirmation based data shows a global prevalence of only 0.7%. Although prevalence of celiac disease varies with respect to sex, age, and location etc. but its accurate prevalence is not being reported due to various reasons. At the same time, a classified data of prevalence of the celiac disease based on multiple factors does not exist. This manuscript intends to highlight various underlying reasons responsible for generating vague prevalence data worldwide along with an awareness note regarding practical implications of diagnostic modalities.

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Authors: Mara Sur, Andreea Aldea, Loredana Dascal, Emanuela Duca, Ciprian Silaghi, Lucia Sur, Cornel Aldea

Patients affected by non-celiac gluten sensitivity usually report both intestinal and extra-intestinal symptoms arising shortly after the ingestion of gluten-containing food. Atopic dermatitis is a chronic inflammatory skin disease that affects both children and adults. We present the case of a family composed of a mother (32 years old) and her two daughters (6 and 9 years old) who were diagnosed with atopic dermatitis and gluten related disorders.

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Authors: Amina Mounir, Nessrine Akasbi, Nihad Siar, Taoufik Harzy

Rheumatoid arthritis (RA) and celiac disease (CD) belong to the autoimmune disease family. Even though these diseases are separate entities, they share multiple aspects. This association has rarely been reported. We had the opportunity to study the case of a patient with CD and RA.

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Authors: Justyna Chojdak-Łukasiewicz, Edyta Dziadkowiak, Małgorzata Błauciak, Bogusław Paradowski

Coeliac disease (CD) is a chronic autoimmune enteropathy of the small intestine that occurs in genetically predisposed individuals. It is characterized by atrophy of intestinal villi accompanied by an increase in the number of intraepithelial lymphocytes and crypt hypertrophy as well as the presence of specific endomysial antibodies (EMA), IgA tissue transglutaminase antibodies (IgA-tTG), and IgA and IgG deaminated gliadin peptide antibodies (DGP IgA and IgG). CD is associated with a wide spectrum of clinical signs and symptoms secondary to malabsorption (vitamin deficiency, anaemia, osteoporosis) or unrelated to the gastrointestinal tract. Neurological disorders are a common problem in patients with CD and are not always accompanied by gastrointestinal symptoms. The most common neurological manifestations of CD are cerebellar ataxia, epilepsy, and peripheral neuropathy.

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Authors: Elif Yorulmaz, Pınar Neva Fındık, Meltem Aksoy, Rüya Akbayrak, Gizem Genç, Hatice Yorulmaz

The study was conducted to investigate the factors affecting the perception of disease and coping attitudes in patients with celiac disease. The study was conducted with 100 celiac patients in Istanbul. The data were collected by applying “Introductory Information Form”, “Illness Perception Questionnaire”, and “Coping Inventory”. In the statistical analysis, t-test, Tukey and Pearson Correlation Analysis were used. It was observed that 63% of the patients were female, 52% were single, 21% were overweight. It was determined that there was a significant difference in terms of gender, marital status and income level, diet list, difficulty in dietary compliance in coping inventory (p<0.05). It was observed that the patients were emotionally affected by their diseases and exhibited problem-focused coping behaviors from coping attitudes. It was determined that there was a negative correlation between the patients’ age and illness coherence and emotional representations and between diagnosis time and emotional representation, personal attribution, lifestyle and chance factor (p<0.01). It was determined that there was a negative correlation between the dieting duration and emotional representations, personal attribution, lifestyle and chance factor (p<0.01). It was seen that there was a positive correlation between the age and problem-focused coping method and a negative correlation between the age and the dysfunctional subscale (p<0.01). It was seen that there was a positive correlation between the timeline (acute/chronic) and emotional-focused coping subscales, between personal control and problem focused and emotional focused coping subscales and between the treatment control and emotional focused coping subscale (p<0.05). It was also observed that 88% of the patients experienced symptoms like constipation and diarrhea, perceived their diseases as chronic, and the disease affected their physical, social and psychological functions. It may be recommended to comprehensively examine especially the factors obstructing their dietary compliance and influencing perception of disease.

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Authors: Nada Boutrid, Hakim Rahmoune, Mounira Amrane

The expanding knowledge about gluten-related autoimmunity led to a serology-based step-wised approach to diagnose celiac disease that might be misleading due to laboratory techniques. We present a rare case associating initial false-negative anti-transglutaminase IgA antibodies while CD was confirmed by IgG antitransglutaminase and subsequent duodenal biopsy.

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Authors: Hugh James Freeman

In celiac disease, treatment with a gluten-free diet is highly effective for management of clinical features, particularly resolution of diarrhea and weight loss. In children, normalization of growth results. In adult celiacs with iron deficiency anemia, complete normalization of iron levels and resolution of anemia may occur with a gluten-free diet alone. In addition, the small intestinal mucosa responds to restriction of dietary gluten and, eventually, in the vast majority, complete histological recovery occurs. Although effective in celiac disease, the gluten-free diet has been increasingly used in clinical conditions unrelated to celiac disease. Unfortunately, gluten-free diets may have significant negative effects with evidence for development of nutrient deficiencies, an increased risk for obesity particularly in children, and measurable evidence for the accumulation of several heavy metals in blood and urine. Although longer term studies are still needed, caution must be advised in the use of gluten-free diets for non-celiac disorders including those based solely on patient-reported gluten sensitivity

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Authors: Ana Cláudia Cavaco de Sousa, Ana Maria Pires

Celiac disease (CD) is an autoimmune disorder that is expressed by chronic food sensitivity to gluten. Among the autoimmune diseases, CD is the one that has more expression, having the numbers of new cases increased steadily during the last years. In addition to the most common symptoms, such as low weight, diarrhea and abdominal pain, atypical cases, such as overweight, arise which imply the development of new approaches and diagnostic methodologies. The most obvious diagnosis involves endoscopy, an invasive and costly method that causes discomfort to the patient and overload of the health systems. The protocol methodology for CD diagnosis from WGO, NASPGHAN, ESPGHAN and BSPGHAN, the worldwide most recognized specialist ‘organizations, was analyzed in order to assess if social implications were considered on their guidelines. After a detailed review of the literature, a global chart was completed in order to summarize the most referenced protocols for the screening and CD diagnosis.

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Authors: Rubén Peña, Gabriela Román, Natalia Zuloaga and Magdalena Araya

Knowledge on the clinical, autoimmune, genetic and more recently microbiome and epigenetic interactions in celiac disease (CD) is consistently improving; however, the pathogenic mechanisms of neurological manifestations of gluten sensitivity (NMGS) and their potential relationship with CD remain unclear. Difficulties in assessing both conditions include their highly variable clinical manifestations and the insufficient sensitivity and specificities of currently available diagnostics tools. Patients with neurological manifestations that respond to gluten withdrawal may or may not present enteropathy and others having demonstrable mucosal damage may or may not respond to GFD. Current pathogenic hypotheses that may relate both conditions, the spectrum of clinical manifestations, diagnostic problems, including differences in types and subtypes of antibodies described for diagnosis and the effects of gluten-free diet are reviewed. The evidence show that decisions based on clinical data may be successful for patient management, but do not allow drawing conclusions on the relations between CD and NMGS.

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Authors: Hakim Rahmoune, Nada Boutrid, Mounira Amrane, Ahmed Aziz Bousfiha, Belkacem Bioud

The autoimmune-related basis in the pathogenesis of celiac disease is merely supported by the increased frequency of association with other autoimmune disorders. We present a peculiar case report associating three different autoimmune disorders in a teenage boy: Celiac Disease, Type1 Diabetes and Crohn Disease.

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Authors: Eric P. Borrelli

Celiac disease is a chronic gastrointestinal autoimmune disease that occurs in approximately 0.5-1% of the U.S. population. At this point in time there is no cure nor therapeutic option available for patients with CD. The only treatment option is a 100% strict adherence to a gluten free diet. However, even complete adherence may not be enough as some foods might contain cross contaminated gluten. The purpose of this study was to analyze and describe different therapy options currently being investigated for potential use in patients with CD. An analysis of ClinicalTrials.gov was performed with the search term “Celiac Disease”. The search returned 192 results, however only 8 were pharmacologic treatment options. The pharmacologic therapies located were TIMP-GLIA, ALV003, AMG714, pancrelipase, Nexvax2, RO5459072, Hu-Mik Beta-1, and Necator americanus (Na). With the nonexistent treatment options currently available, further research needs to be completed to create new therapeutic options for patients with CD with the goal of ultimately curing patients.

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Authors: Amal Abdulla, Malin Garemo

Celiac Disease (CD) is an autoimmune disease triggered by the ingestion of gluten. The only effective treatment available at present is to follow a strict lifelong gluten free (GF) diet, resulting in the need to buy products that are certified gluten free. The aim of this study was to compare the cost of gluten free products in supermarkets with similar regular non-gluten free products. The price and weight of all GF products available in the GF section in two supermarkets in Abu Dhabi, United Arab Emirates, were collected in fall 2017. The GF items were divided into 13 categories (bread, bread mixes, flour, cakes, cake/biscuits mixes, chips, cereals, pasta, chocolates/sweet, crackers/ biscuits, sweet biscuits, seeds, odd products) and the same information was collected for similar regular products. A total of 266 GF products were found and their price/100 gram compared to 117 non-GF products. Most GF products were significantly more expensive than their non-GF equivalents. On average, the price difference was an additional 259% for the GF products, ranging from an additional 5% for chocolates to 1100% for bread mixes. There were no significant price differences found between the supermarkets. Based on the findings in this study, GF products are expensive in comparison to regular products, which is likely leading to an increase in food spending for people with celiac disease in Abu Dhabi. Whether this is impacting adherence to a GF diet among celiac patients requires further studies to be determined.

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Authors: Rodica Elena Cornean, Dan Gheban, Bianca Simionescu, Mircea Margescu

Growth is a very reliable index of health assessment, both in children and teenagers. Growth is often affected (slowed or arrested) in children who suffer from chronic diseases, including the gastrointestinal disorders. Since the use of the serologic markers and small intestinal biopsy as diagnostic tools, it has become evident that the clinical presentation is highly variable in patients with celiac disease. Some patients present the classic symptoms of the celiac disease (diarrhea, malnutrition and growth failure), while others, unveil their disorder at puberty when growth failure and delayed puberty seem to be the only symptoms of the disease. We present the clinical case of a 16 years old girl, referred to our endocrine unit for short stature, failure to thrive and lack of menarche.