[jccgf]

Celiac disease and antibodies associated with celiac disease in patients with inflammatory myopathy.
PMID: 16967485 Sept 2006


Peripheral Neurological Disturbances, Autonomic Dysfunction, and Antineuronal Antibodies in Adult Celiac Disease Before and After a Gluten-Free Diet.
PMID: 16967315 Sept 2006


Adult celiac disease: MRI findings.
PMID: 16967239 Sept 2006


Capsule endoscopy: An alternative to duodenal biopsy for the recognition of villous atrophy in coeliac disease?
PMID: 16965945 Sept 2006

[jccgf]

Hematological manifestations of celiac disease. PMID: 16973955 Sept 2006

Celiac disease is a common systemic disorder which can have multiple hematological manifestations. Patients with celiac disease may present to hematologists for evaluation of various hematological problems prior to receiving a diagnosis of celiac disease. Anemia secondary to malabsorption of iron, folic acid and or vitamin B12 is a common complication of celiac disease and many patients present with anemia or have anemia at the time of diagnosis. Celiac disease may also be associated with thrombocytosis, thrombocytopenia, leukopenia, venous thromboembolism, hyposplenism and IgA deficiency. Patients with celiac disease are at increased risk of being diagnosed with lymphoma, especially of the T-cell type. The risk is highest for enteropathy-type T-cell lymphoma (ETL) and B-cell lymphoma of the gut but extraintestinal lymphomas can also be seen. ETL is an aggressive disease with poor prognosis but strict adherence to a gluten free diet may prevent its occurrence.
PMID: 16973955

Patterns and presentations of adult coeliac disease in a rural setting. PMID: 16972991 Sept 2006

ABSTRACT: Background In recent years there has been a noticeable change in the patterns and presenting symptoms of coeliac disease. This may lead to delayed diagnosis and treatment and hence increased development of complications. Aim The aim of this audit was investigate the presenting complaints of patients diagnosed with Coeliac Disease. In addition, the prevalence of associated conditions in coeliac patients. Methods Observational retrospective cross-sectional study using the medical notes from the time of diagnosis of 32 adult patients attending the specialist coeliac clinic. Results The main presenting complaint was anaemia at (21 patients, 66%). Less than half of the patients had any of the classical symptoms of coeliac disease and 8 patients (25%) had no classical symptoms at all. Biopsy was 97% sensitive, with Anti-gliadin antibodies, Anti-endomysial antibody and anti-tissue transglutaminase showing 75%, 68% and 90% sensitivity respectively. In combination, serology results were 100% sensitive. Fifty nine percent had developed osteoporosis or osteopenia. There were no malignant complications among the group. Conclusion The majority of patients did not present with diarrhoea and weight loss, the commonest presentation being with.
PMID: 16972991

[Role of allergy in irritable bowel syndrome] PMID: 16898627 Aug 2006

Preliminary studies have noted a possible association between IBS and allergic disorders. An increased prevalence of bronchial hyper-responsiveness in IBS has been reported. Moreover, foods are thought to often play a role in the diarrhea type IBS particularly in patients with atopic dermatitis. More than 50% of diarrhea type IBS patients have a history of allergies to some food and positive skin prick tests. Surveys indicate that as many as 20-30 % of adults have some problems to foods, however, careful studies have suggested a range from <1% to 7.5%. A systematic review of the literature concluded that it is still unclear whether diet is a key factor in exacerbating IBS symptoms and whether dietary manipulation is a valid treatment. The further studies are needed to evaluate the association between IBS and allergic disorders.
PMID: 16898627

[jccgf]

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease. PMID: 16982222 Sept 2006

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.
PMID: 16982222

[Llonghair]

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

In Celiac Disease, a Subset of Autoantibodies against Transglutaminase Binds Toll-Like Receptor 4 and Induces Activation of Monocytes.
• Zanoni G,
• Navone R,
• Lunardi C,
• Tridente G,
• Bason C,
• Sivori S,
• Beri R,
• Dolcino M,
• Valletta E,
• Corrocher R,
• Puccetti A.

BACKGROUND: Celiac disease is a small intestine inflammatory disorder with multiple organ involvement, sustained by an inappropriate immune response to dietary gluten. Anti-transglutaminase antibodies are a typical serological marker in patients with active disease, and may disappear during a gluten-free diet treatment. Involvement of infectious agents and innate immunity has been suggested but never proven. Molecular mimicry is one of the mechanisms that links infection and autoimmunity.

METHODS AND FINDINGS: In our attempt to clarify the pathogenesis of celiac disease, we screened a random peptide library with pooled sera of patients affected by active disease after a pre-screening with the sera of the same patients on a gluten-free diet. We identified a peptide recognized by serum immunoglobulins of patients with active disease, but not by those of patients on a gluten-free diet. This peptide shares homology with the rotavirus major neutralizing protein VP-7 and with the self-antigens tissue transglutaminase, human heat shock protein 60, desmoglein 1, and Toll-like receptor 4. We show that antibodies against the peptide affinity-purified from the sera of patients with active disease recognize the viral product and self-antigens in ELISA and Western blot. These antibodies were able to induce increased epithelial cell permeability evaluated by transepithelial flux of [(3)H] mannitol in the T84 human intestinal epithelial cell line. Finally, the purified antibodies induced monocyte activation upon binding Toll-like receptor 4, evaluated both by surface expression of activation markers and by production of pro-inflammatory cytokines.

CONCLUSIONS: Our findings show that in active celiac disease, a subset of anti-transglutaminase IgA antibodies recognize the viral protein VP-7, suggesting a possible involvement of rotavirus infection in the pathogenesis of the disease, through a mechanism of molecular mimicry. Moreover, such antibodies recognize self-antigens and are functionally active, able to increase intestinal permeability and induce monocyte activation. We therefore provide evidence for the involvement of innate immunity in the pathogenesis of celiac disease through a previously unknown mechanism of engagement of Toll-like receptor 4.

PMID: 16984219 [PubMed - as supplied by publisher]

[jccgf]

Thanks for posting this Linda! I think I browsed past this one too quickly because the title didn't really grab me, and I totally missed the part about ROTAVIRUS. The doctors suspected my daughter had rotavirus... at the very beginning of all her troubles. They never bothered to confirm it because it just has to run its course, they said.

Thanks for posting this!

Cara

[jccgf]

Subclinical exocrine pancreatic dysfunction resulting from decreased cholecystokinin secretion in the presence of intestinal villous atrophy. PMID: 16954951 Sept 2006

The aim of this study was to evaluate the concept that pancreatic dysfunction in patients having gluten sensitivity (celiac disease [CD]) or cow's milk protein enteropathy (CMPE) may result from the lack of pancreatic enzyme stimulation in the absence or decrease of cholecystokinin (CCK) secretion caused by villous atrophy. PATIENTS AND METHODS: The following parameters were measured: plasma CCK in response to a fatty meal and human pancreatic fecal elastase in 24 patients with CD while on gluten-free diet and after gluten provocation and in 12 patients with CMPE at diagnosis and after a 6-month period of cow's milk-free diet. Intestinal mucosa morphology was examined by small bowel biopsy. Sixty-three controls having no organic gastrointestinal problems were investigated once at the time of diagnostic evaluation. RESULTS: Fasting CCK, obtained at a time when patients with CD or CMPE had normal intestinal mucosa, was significantly different from postprandial and comparable to that of the control group. Fasting CCK obtained from patients with villous atrophy was also statistically different, but not significantly, from the postprandial. Fasting and postprandial plasma CCK and fecal pancreatic elastase values from patients having normal intestinal mucosa were significantly higher than those obtained from patients with villous atrophy. Significant correlation of intestinal mucosa morphology and CCK with fecal elastase concentration was documented. CONCLUSION: Exocrine pancreatic dysfunction in individuals having villous atrophy may be the consequence of decreased CCK secretion. Cholecystokinin and pancreatic secretion is restored to normal, with intestinal mucosa regeneration.
PMID: 16954951

[jccgf]

Liver involvement in celiac disease. PMID: 17006040 Sept 2006

Celiac disease may present as a cryptogenic liver disorder being found in 5-10 % of patients with a persistent and cryptogenetic elevation of serum aminotransferase activity. In fact, a wide spectrum of liver injuries in children and adults may be related to CD and in particular: (1) a mild parenchymal damage characterised by absence of any clinical sign or symptom suggesting a chronic liver disease and by non-specific histological changes reversible on a gluten-free diet; (2) a chronic inflammatory liver injury of autoimmune mechanism, including autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cirrhosis, that may lead to fibrosis and cirrhosis, generally unaffected by gluten withdrawal and necessitating an immunosuppressive treatment; (3) a severe liver failure potentially treatable by a gluten-free diet. Such different types of liver injuries may represent a spectrum of a same disorder where individual factors, such as genetic predisposition, precocity and duration of exposure to gluten may influence the reversibility of liver damage. A rigorous cross-checking for a asymptomatic liver damage in CD individuals and conversely, for CD in any cryptogenic liver disorder including end-stage liver failure is recommended.
PMID: 17006040

[jccgf]

[Utility and safety endoscopic digestive procedure in pediatric age] PMID:16910459 May-AUG 2005

The aim of this study is to verify the utility and safety of endoscopic procedures in the evaluation of children with clinically-significant gastrointestinal symptomatology. We report our experience of 87 pediatric endoscopy procedures including esophagogastroduodenoscopy, colonoscopy and tissue biopsies performed in 85 infants, children and adolescent, 3 months-15 years old, over a two-year period, june 2002-november 2004 after complete history, physical examination and basic investigations. General anesthesia was used in all patients after informed consent obtained from parents. Non significant complications were observed in this series of patients. In 81 cases (92.5%) with clinical symptoms and laboratory indications for gastrointestinal disease, the endoscopy and bioptical samples confirmed the utility and safety of procedure. Coeliac disease (39 cases), gastritis (11 cases), esophagitis (6 cases) were the most common organic cause of upper gastrointestinal disease. Allergic and indeterminate colitis (7 cases) were the most common cause of lower gastrointestinal disease. In 4.7% the procedures appear to be particularly helpful in the diagnosis of inflammatory lesions of the esophagus and stomach. In summary, the data demonstrate that endoscopy techniques show low morbidity, provide important diagnostic informations in pediatric gastrointestinal diseases and can be done safely in patients over 3 months of age.
PMID: 16910459