International Journal of Celiac Disease

2

Authors: Jarmila Kabátová

Celiac disease (CD) is a chronic autoimmune disorder, elicited by gluten and related prolamines, with gluten dependant clinical manifestation in genetically susceptible individuals, with specific antibodies, HLA haplotyps and enteropathy. In Slovakia epidemiology situation of patients with diagnosed CD was being repeatedly surveyed. Patient with CD in Slovakia has possibility for prescriptions up to 50 specific gluten free products, partially covered by health insurance.

3

Authors: Fariba Fathi, Fatemeh Ektefa, Kaveh Sohrabzadeh, Afsaneh Arefi-Oskouie, Mohsen Tafazzoli, Kamran Rostami, Mohammad-Reza Zali, Mohammad Rostami-Nejad

Celiac disease (CD) is an immune reaction as a consequence of ingestion of gluten. Diagnosis of CD is not easily using the clinical tests. Then, the discovery of appropriate methods for CD diagnosis is necessary. This study was concentrated to seek the metabolic biomarkers causes of CD compare to healthy subjects.In the present study, we classify CD and healthy subjects using classification and regression tree (CART). To find metabolites in serum which are helpful for the diagnosis of CD, the metabolic profiling was employed using the proton nuclear magnetic resonance spectroscopy (1HNMR). Based on CART results, it was concluded that just using one descriptor, CD and control groups could be classified separately. The 89 % of data in the test set was predicted correctly by the obtained classification model. Our study indicates that quantitative metabolite analysis of serum can be employed to distinguish healthy from CD subjects.

3

Authors: Aaron Lerner

The majority of celiac disease affected patients are undiagnosed. Since the epidemiology and phenotype of CD is constantly changing towards latent, hyposymptomatic or asymptomatic behavior and since there is an increased risk of complications, early diagnosis and subsequent adherence to gluten-free diet is highly recommended. Multiple serological tests are on the market and the most frequently used test is IgA-tTG. This is not sensitive enough to be used alone, and combined tests enhance detection. Several combinations have been studied but not accurately compared to each other. The most frequently used combination is anti IgG-DGP with IgA-tTG, however, increasingly the new generation of anti neo-epitope DGP+tTG IgG+IgA is being used. At present, there is insufficient information to demonstrate that screening general populations definitely results in clinical benefit. However, asymptomatic individuals in high-prevalence groups should be screened.

4

Authors: Abangah Ghobad, Asadollahi Ruhangiz, Rahmani Asghar, Asadollahi Khairollah, Teimouri hadi

Background: Celiac is a chronic hereditary intestinal disorder caused by autoimmune stimulation and injury of intestinal mucosa and different studies have reported an increase of inflammatory cytokines production in these patients. This study aimed to investigate the serum level of inflammatory cytokines and their correlations with the severity of histological variations among celiac patients. Material and methods: By a cross sectional study all celiac patients attending to gastrointestinal clinics in Ilam city during Oct. 2011- MAR. 2013 were investigated. Demographic data was collected using a validate questionnaire and patient's interview and each patient was taken a blood sample for laboratory investigation of tTG-IgA antibody via ELISA test and the serum level of hs-CRP, IL-6 and TNF-a was measured. All patients underwent endoscopic evaluation and biopsy samples were evaluated according to Marsh classification and correlation between severity of histological variations and serum levels of inflammatory cytokines was measured. Results: Totally 274 patients including 90 male and 184 female with a mean age of 28.8±14.4 years were evaluated. The mean serum levels of hs-CRP, IL-6 and TNF-a were 7.8±3.1 mg/l, 2.6±0.9 pg/ml and 6.9±4.6 pg/ml respectively (p=0.599, p=0.629 and p= 0.651). Hs-CRP showed a significant relationship with the severity of mucosal damage upon class I of Marsh classification (p=0.01); however, IL-6 showed a significant level among patients with Marsh I, II and IIIC (p=0.000, p=0.02 and p=0.000) but not in those with Marsh class IIIA and IIIB. Conclusion: There was a positive relationship between mean serum levels of IL-6 and TNF-a with increasing the Marsh classification from class I to class IIIC and the highest rate of IL-6 and TNF-a was shown in Marsh IIIC but the serum level of hs-CRP was not increased with Marsh class increasing. It was concluded that as the Marsh classification increased from class I to class IIIC, and/or the severity of pathologic variations was increased, the mean serum levels of inflammatory markers were increased too.

6

Authors: Agnieszka Zebrowska, Hugh J. Cornell, Finlay A. Macrae, Anna Sysa-Jedrzejowska, Elzbieta Waszczykowska, Teodor Stelmasiak

Background: The aetiology of coeliac disease (CD) has many similarities to that of dermatitis herpetiformis (DH), except that DH lesions are mainly manifested in the skin. Mucosal enzyme deficiency plays an important part in CD pathology. Clinical studies indicated that the gluten exposure in CD could be partly corrected by the use of enzyme supplementation. Objective: Enzyme therapy, using enterically coated tablets containing caricain, was investigated as a means of protecting patients with DH against wheat gluten. Methods: A randomized, placebo-controlled clinical trial was carried out on 20 DH patients in clinical remission. The patients were divided into two groups of 10, one group given a placebo daily and the other the enzyme – containing tablets. Both groups were challenged with 6g of gluten daily in a double-blind trial. Symptoms and signs of skin involvement were recorded and graded at the start of the trial, after 7 days and after 14 days. Blood was also taken at the start and after 14 days and assayed for IgA EMA and anti-gliadin antibodies. Results: After 7 days the major features associated with DH were more severe and more common with the placebo compared with enzyme therapy. Before 14 days, seven patients in total, six on placebo, had to withdraw from the trial because of the effects of the gluten challenge whilst 2 patients on therapy developed blisters, erythema and itching. Serological tests indicated that IgA EmA antibodies and anti-gliadin antibodies after 14 days were not affected significantly, but indicated that abnormally high antibodies titers of both types were present in 8 patients at the start of the trial, suggesting the need for enzyme therapy in addition to the normal gluten-free diet for patient well-being. Conclusions: This study supports the use of enzyme supplementation as a safeguard for patients with DH on a nominal gluten-free diet.

1

Authors: Rocío Aguado, Orlando Estevez, Silvia Fernández, Consuelo Ortega, Manuel Santamaría

no abstract

2

Authors: Julia Gorgun, Anna Portyanko

no abstract

3

Authors: Miguel Ribeiro, Patrícia Poeta, Gilberto Igrejas

no abstract

5

Authors: Michael Schumann, Christian Bojarski, Verena Moos, Severin Daum

Since refractory celiac disease (RCD) may cause severe complications and is associated with a poor prognosis in a portion of patients, early diagnosis and treatment is of importance. Current diagnostics include complex PCR-based molecular pathology and FACS techniques in order to differentiate type I and type II RCD, the latter being associated with the development of an enteropathy-associated T cell lymphoma (EATL). Recently established treatment options also include high-dose chemotherapeutic regimens for RCD type II which have significantly improved survival. However, treatment strategies are highly individual targeting also complications of malabsorption and should be started in the RCD phase of the disease. Therefore, adequate diagnostics are pivotal for patient outcome.

6

Authors: Jiri Nevoral

The perception of celiac disease (CD) has changed dramatically during the last two decades, with the introduction of new serological tests with high specificity and sensitivity. CD prevalence in recent years is increasing as it is for other autoimmune diseases. Due to the high prevalence of CD, it is one of the most important diseases of the digestive tract. The clinical manifestations of CD have changed significantly in the last two decades, and these are much more diverse than reported previously. The new European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for CD indicate that biopsy can be avoided in strictly selected groups of pediatric patients. The first experiences with these new criteria are positive. A meta-analysis evaluating the relationship between early nutrition and the risk of CD recommends that both early (< 4 months) and late (> 7 months) introduction of gluten to the diet should be avoided, and that gluten should be introduced while the infant is still breastfeeding. The prevalence rates of CD between two cohorts with different infant feeding practice were significantly different, and the prevalence of CD in 12-year-old children were significantly reduced, suggesting that prevention of CD is possible.

1

Authors: Montasser Nadeem

no abstract

2

Authors: Mohammad Rostami Nejad

no abstract

2

Authors: Nur Arslan

no abstract

3

Authors: Peter Makovicky, Gabriel Samasca

Celiac disease is a disease where both children and adults are affected. It symptoms were previously described in Galen times. Today we recognize its starter, pathological mechanism, and also its atypical behaviour. There is only one causal therapeutic model in terms of compliance with the principles of lifelong strict gluten-free diet. It is an under-diagnosed disease. Further steps should be associated with the improvement of diagnosis and detection of all global forms of disease followed by proper care for patients, including prevention. The second part of the task is to support basic and applicable research with outcomes for further practice and therapeutic outcomes. It is an interdisciplinary issue with lack of its own publishing space. Given these facts, collaboration with the broader but highly professional Editorial Board found a new journal was: International Journal of Celiac Disease, which aims to address the issue at a high professional level, so the results could be applied in practice and science as well.

4

Authors: Hugh James Freeman

Evidence suggests that celiac disease initially emerged as a distinct intestinal disorder sometime after organization of hunter-gatherers into human workforces capable of agriculture, especially wheat cultivation. This Neolithic revolution possibly developed to permit competitive survival over other hunter-gatherer groups. Recent archeological data suggests that wheat cultivation may have occurred in eastern Turkey, near the Gobleki Tepe, a recently discovered archeological site in the Fertile Crescent, about 10,000 to 12,000 years ago. DNA fingerprinting data suggests that diploid Einkorn wheat from this region was domesticated through hybridization into other more modern hexaploid grains with a higher more immunogenic gliadin content. Clinical features suggestive of celiac disease and recommendations for treatment are believed to have been first described by Aretaeus from Cappadocia about 250 AD, and later, by other clinicians from Europe and North America. In recent decades, celiac disease has become further defined as a clinical and pathological disorder developing in genetically predisposed individuals as a result of an immune-mediated reaction to specific peptides in wheat and other grains. Data largely from screening studies also suggests that the disorder is not uncommon, occurring in up to 2% of most populations studied. Detection is also increasing, possibly due to better clinical recognition, wider use of screening methods and, possibly,a true increase in celiac disease occurrence.