Search

In recent years, celiac disease has become known to the public with the development of medical diagnosis possibilities and increased awareness of the celiac disease. The only cure for celiac disease is a gluten-free diet that must be strictly followed for perpetuity. Food products with gluten content lower than 20 ppm are considered gluten free products. With the increase in the number of people with celiac disease and people on a gluten-free diet, the amount and variety of gluten-free products have increased significantly. Rice and corn are the raw materials of gluten-free products. However, this situation causes people who follow a gluten-free diet to be exposed to a uniform diet and deficient in the intake of essential elements such as copper, iron, and manganese. In this study, 41 gluten free products in Turkey were examined with ICP-OES as copper, iron, manganese, zinc, and strontium content, and the results were reported. The samples with the highest Cu concentration were corn and puffed rice at 51.45 mg/kg and vermicelli at 32.40 mg/kg. Chocolate sauce and cornflakes were the samples at 137.43 mg/kg and 117.20 mg/kg, respectively, with the highest Fe concentration. The highest Mn concentration was precooked chickpea flour at 20.80 mg/kg. The highest strontium concentration value was 12.85 mg/kg in carob flour. The samples with the highest Zn concentration were determined in yeast at 91.98 mg/kg and pistachio croquant at 85.50 mg/kg.

AMAÇ: Gluten sensitif enteropati, genetik duyarlılığı olan kişilerde glutenli tahıllar olan buğday, çavdar ve arpanın neden olduğu intestinal ve ekstraintestinal sistem belirtileri olan otoimmün özellikler taşıyan sistemik bir hastalıktır.GEREÇ VE YÖNTEM: Bu çalışmada 2000-2012 yılları arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalında tanı konulan ve takipte olan 69 hasta retrospektif olarak incelendi. Hastaların başvuru şikayetleri, fizik muayene bulguları, laboratuar bulguları, kemik mineral dansitometre incelemeleri, diyet uyumları, diyet uyumunu etkileyen faktörler değerlendirildi.BULGULAR: Hastalarımızın 48 tanesi kadın, 21 tanesi erkek idi. Hastaların yaş ortalaması 35,6±11,4 (yaş aralığı 19-81) ve hastaların ortalama tanı yaşı 29,6±13,1 olarak saptandı. Major semptom diyare olup (%49,3), karın ağrısı (%18,8), kaşıntı (%4,3) diğer başvuru semptomları olarak göze çarpmaktaydı. Hastalık farklı laboratuar bulgularına yol açmakta olup en sık görülenler demir eksikliği anemisi (%63,8), folik asit eksikliği (%39,1), ALT yüksekliği (%11,6), hipokalsemi (%11,6) ve vitamin B12 eksikliği (%10,1) idi. Bu çalışmada gluten sensitif enteropatiye otoimmün hastalık eşlik etme sıklığı %24,6 olarak bulundu. En sık otoimmün hastalıklar Tip 1 Diyabetes Mellitus (%5,7) ve otoimmün tiroid hastalığı (%7,2) idi. Demir eksikliği anemisi (%60,9) ve osteoporoz (%37,5) en yaygın komorbid durumlardı. Hastaların 24 tanesinin (%34,8) diyet uyumu iyi iken, 38 tanesinin (%55) kısmi diyet uyumu olduğu saptandı.SONUÇ: Gluten sensitif enteropati semptom ve bulgu spektrumunun geniş olması, atipik bulgularla seyredebilmesi, herhangi bir yaşta tanı konabilmesi nedeniyle tüm hekimleri ilgilendiren bir hastalıktır. Tanı gecikmesi hastalığın prognozunu olumsuz etkilemekte olup, uygun semptomlarda doktorlar gluten sensitif enteropatiyi akla getirmelidir., OBJECTIVE: Gluten-sensitive enteropathy is a systemic disease whit has autoimmune features which are intestinal and extraintestinal system symptoms caused by gluten grains such as wheat, rye, and barley in people with genetic sensitivity.MATERIAL AND METHODS: In this study, 69 patients who have been diagnosed and followed up in Eskişehir Osmangazi University, Faculty of Medicine, Department of Gastroenterology, between 2000 and 2012, have been analyzed retrospectively. Admission symptoms, physical examination symptoms, laboratory findings, bone mineral densitometry examinations, diet compliance of the patients, and factors which affect the diet compliance have been evaluated.RESULTS: 48 of our patients were female, and 21 were male. The average age of the patient was 35.6±11.4 (age range 19-81), and the average diagnosis age of the patients was 29.6±13.1. The major symptom was diarrhea (49.3%). Other presenting symptoms were abdominal pain (18.8%) and pruritus (4.3%). The disease can lead to different laboratory findings, but the most frequent findings are iron deficiency anemia (63.8%), folic acid deficiency (39.1%), elevated ALT (11.6%), hypocalcemia (11.6%), and vitamin B12 deficiency (10.1%). In this study, the frequency of autoimmune disease accompanying gluten-sensitive enteropathy was found to be 24.6%. The most frequent autoimmune diseases are Type 1 Diabetes Mellitus (5.7%) and autoimmune thyroid disease (7.2%). The most frequent comorbid diseases were iron deficiency anemia (60.9%) and osteoporosis (37.5%). It has been determined that the diet compliance of 24 patients (34.8%) was good, and 38 patients (55%) have partial diet adaptation.CONCLUSIONS: As the symptoms and finding spectrum of gluten-sensitive enteropathy are broad and can progress with atypical findings and can be diagnosed in at any age, it is a disease that concerns all physicians. Delay in diagnosis affects the prognosis of the disease negatively, and physicians should think about gluten-sensitive enteropathy in matching symptoms.

Amaç: Çölyak hastalığının günümüzde bilinen tek tedavi şekli ömür boyu glutensiz diyet tedavisidir ve hastalığın yönetimindeki en önemli sorun diyete uyumsuzluktur. Bu çalışmada, çocukluk çağında tanı almış çölyak hastalarında diyet tedavisini etkileyen faktörlerin değerlendirilmesi amaçlanmıştır. Bireyler ve Yöntem: Bu çalışmada, çölyak hastalığı tanısı almış ve en az bir yıldır takipli olan 8-18 yaş arasındaki rastgele seçilmiş 92 hasta kesitsel olarak değerlendirilmiştir. Hastaların demografik ve klinik özellikleri, ailelerinin sosyal yapısı ve glutensiz diyet hakkındaki bilgileri incelenmiştir. Hastaların diyete uyumu güncel serum anti-tTG IgA düzeylerine bakılarak değerlendirilmiştir. Seroloji sonucuna göre hastalar, diyete uyumlu ve uyumsuz olarak 2 gruba ayrılmış ve veriler karşılaştırılmıştır. Bulgular: Çalışmaya dahil edilen 92 hastanın güncel yaş ortalaması 13.1±3.5 yıl’dır. Anti-tTG IgA düzeyi normal olan hasta oranı %55.4 olarak saptanmıştır. Diyete uymayan hastalarda yaş ortalamasının daha yüksek (13.8±3.4 yıl; p

Data on factors governing long-term adherence to a gluten-free diet (GFD) in celiac disease (CD) are scarce. We aimed to determine trends and clinical predictors of long-term GFD adherence in adult CD.Initial and long-term (3 years) GFD adherence, clinical characteristics at baseline and follow-up were collected retrospectively from celiac patients followed-up over 20 years (2000-2020). Predictors of long-term GFD adherence at diagnosis, and follow-up were evaluated by multivariate logistic regression.248 patients (37 ± 12 years, 186F, median time on a GFD 90 months) were included. Twenty-five (10.1%) had only short-term follow-up (3 years) while 223 (89.9%) had initial and long-term dietary assessment. 187/223 (83.9%) patients were initially adherent and 36/223 (16.1%) were not. 17/36 (47.2%) patients initially not adherent become adherent, while only 4/187 (2.1%) initially adherent patients became not adherent. In the long-term, 200/223 (89.7%) were adherent and 21/223 (9.4%) patients were not. Adherence improved more frequently than worsened (OR, 39.5; 95% CI, 11.4-178.5; P.01). Classical symptoms (diarrhea, weight loss) at diagnosis of CD predicted stricter long-term GFD adherence (OR, 3.27; 95% CI, 1.21-8.81; P = .02), while anemia (OR, 0.31; 95% CI, 0.12-0.82; P = .02) and dermatitis herpetiformis (OR, 0.23; 95% CI, 0.06-0.91; P = .04) predicted poorer long-term adherence. At follow-up, initial GFD adherence (OR, 42.70; 95% CI, 10.70-171.00; P = .04) was the major determinant of long-term GFD adherence.GFD adherence changes over time in10% of patients, generally improving when it does. Major determinants of long-term GFD adherence are classical symptoms at diagnosis and initial adherence to a GFD. Patients with anemia or dermatitis herpetiformis at diagnosis require stricter dietetic input.

BACKGROUND Wheat and other gluten-containing grains are widely consumed, providing approximately 50% of the caloric intake in both industrialised and developing countries. The widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease prevalence. This condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global media. However, in recent years, the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease (CD) from obscurity to global prominence. These modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of CD. Different scientific societies, mainly from Europe and America, have proposed guidelines based on CD's most recent evidence. AIM To identify the most recent scientific guidelines on CD, aiming to find and critically analyse the main differences. METHODS We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English language. PubMed was lastly accessed on 1 March 2021. RESULTS We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical regions. Differences were noted in the possibility of a no-biopsy diagnosis, HLA testing, follow-up protocols, and procedures. CONCLUSION We found a relatively high concordance between the guidelines for CD. Important modifications have occurred in the last years, especially about the possibility of a no-biopsy diagnosis in children. Other modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.

Celiac disease (CD), a gluten-induced autoimmune disease, is associated with low bone mineral density (BMD) among children. Unfortunately, it is often diagnosed in adulthood, which may lead to an increased risk of fragile bones. The aim of this systematic review was to report on BMD status among young adults newly diagnosed with CD, and to examine the effect of a gluten-free diet (GFD), nutritional supplements, such as vitamin D, or antiresorptive medications on BMD recovery. Databases searched were Medline, Embase, and Cochrane Library up to July 2nd, 2020. Both observational studies and clinical trials were considered, if patients were newly diagnosed and between 20 and 35 years of age and reported on BMD. We critically appraised the identified studies using ROBINS-I and summarized the findings narratively. Out of 3991 references, we identified 3 eligible studies: one cross-sectional study and two longitudinal studies. In total, 188 patients were included, and the study population consisted primarily of women with an age range between 29 and 37 years old. Compared to healthy controls, our target population had lower BMD. Moreover, a strict GFD may increase BMD during a follow-up period of up to 5 years. Newly diagnosed CD patients aged 20–35 years are at risk of lower BMD. Therefore, it may be crucial to assess BMD at time of diagnosis in young women. Whether the results can be extrapolated to young men is unknown. While strict GFD may improve BMD over time, there is a lack of robust evidence to demonstrate that nutritional supplements or antiresorptive agents are beneficial in the prevention of fragile bones in this age group. Supplementary Information The online version contains supplementary material available at 10.1007/s00223-021-00938-w.

Celiac disease (CD) is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes. Vitiligo is a commonly acquired depigmentation of the skin; its clinical manifestation are skin patches caused by localized or generalized melanin deficiency. Both diseases have similar global incidence rates (approximately 1%) and are associated to similar diseases, including autoimmune bullous disease, inflammatory bowel disease, autoimmune thyroiditis, autoimmune gastritis, and type 1 diabetes. The relationship between CD and vitiligo has been reported in several studies, but their conclusions are inconsistent. Further, it has also been reported that a gluten-free diet (GFD) can improve the symptoms of immune-related skin diseases such as vitiligo. In this mini-review, we summarize and review the literature on the relationship between CD and vitiligo, assess the therapeutic significance of GFD for patients with vitiligo, and explore their possible physiopathology. We are hopeful that the information summarized here will assist physicians who treat patients with CD or vitiligo, thereby improving the prognosis.

Aims Lockdown and restricted mobility due to the pandemic of corona virus disease 2019 (COVID-19) has severely affected the continuity of healthcare of patients with acute and chronic diseases. We evaluated the impact of COVID-19 on the adherence to gluten-free diet (GFD), symptom control, and quality of life (QOL) in patients with celiac disease (CeD). Methods A questionnaire, consisting of both ad-hoc and validated questions, was created after review of literature, group discussions, and expert meetings. Standardized questionnaires namely CeD adherence test (CDAT), celiac symptom index score, and CeD-related QOL were used. The web-based questionnaire was sent to 3130 patients via social media and 452 responses (14.4%) were received. Also, additional 68 patients (not available on any social media application) were interviewed telephonically by a trained dietitian. Results Overall, 505 patients (females: 318; mean age: 24.1±14.2 years) were included. While only 6.7% (n = 34) had poor compliance to GFD (CDAT > 17) before COVID-19 pandemic, it almost doubled to 12.6% (n = 64) during the COVID-19 pandemic times (p = 0.02). Furthermore, 4.9% (n = 25) of patients were diagnosed contacting COVID-19. Interestingly, 73.2% (n = 370) patients preferred online appointment than physical appointment. Most common difficulties faced during lockdown period were high delivery charges for getting gluten-free (GF) food at home (54.4%), increased prices of regular GF food (43.1%), and travelling long distance to arrange GF food (44.9%). Conclusions The COVID-19 pandemic has substantially affected the adherence, symptom control, and QOL in patients with CeD, attributable to unavailability, shortage of money, and heightened cost of GF food. The pandemic has offered an opportunity to practice teleconsultation approach for patients with CeD. Supplementary Information The online version contains supplementary material available at 10.1007/s12664-021-01213-4.

Background Both undiagnosed celiac disease and some chronic childhood diseases are associated with lower academic achievement. However, there is little knowledge of achievements in those diagnosed with celiac disease. Our aim was to investigate school achievements in upper secondary school among Swedish adolescents with celiac disease. Methods We performed a retrospective cohort study using register data. We analyzed choice of upper secondary school program, completion of upper secondary school including achievements of basic eligibility for college/university, and final grade in individuals with celiac disease diagnosed before 15 years of age, born 1991–97. We compared with the Swedish population of the same birth years. Analyses were adjusted for sex, year of birth, living region at 17 years of age, and parental education as well as income. Results The cohort included 734 074 individuals, whereof 3 257 (62% females) with celiac disease. There was no significant difference in choice of upper secondary school program. No significant difference was found in completion or achieving basic eligibility for college/university in adjusted analyses. The mean final grade in the celiac disease group was 13.34 (standard deviation 4.85) compared to 12.78 (standard deviation 5.01) in the reference population (p p = 0.012). Conclusions We found that diagnosed celiac disease does not negatively affect school achievements in upper secondary school. This finding suggests the diagnosis, treatment and follow-up programs of celiac disease could reverse potential deleterious academic processes.

This paper proposes a first monetary measure of the private costs of celiac disease, including intangible costs (physical symptoms, logistical constraints, etc.) in Switzerland. This auto-immune disease damages the intestine when patients ingest gluten. The only treatment currently available is a gluten-free diet, which implies great nutritional constraints. To get a monetary equivalent of the costs borne by celiac patients, we used a contingent valuation. The scenario suggested to celiac patients a treatment in form of a daily pill, which would allow them to eat normally and avoid any physical pain from celiac disease. Mean Willingness To Pay (WTP) for the treatment is found to be around CHF 87 (approx. USD 87) per month. WTP is positively influenced by direct and indirect costs of the disease. Oppositely, individuals, who find the gluten-free diet healthier are willing to pay less. Finally, unlike symptoms before diagnostic, the current presence or intensity of physical symptoms are found to be insignificant. The latter result can be explained by the fact that, individuals facing stronger symptoms are more likely to adhere strictly to the GFD and hence to reduce their frequency.

This research aimed to investigated the short- and long-term effects of gluten free diet (GFD) on nutritional intake, glycaemic and insulin response. In a cross-sectional study, participants who consumed a gluten-containing diet (GCD; n=11) and a GFD (n=11) completed a food diary, blood glucose and insulin measurements. In a pre-postn intervention study (n=, 11), glycaemic and insulin responsed were tested individuals completed a food diary, blood glucose and insulin measurements before and after four weeks of a GFD. Food intake was recorded before and after two weeks. No significant differences in nutrient intake, glycaemic or insulin responses were found in the cross-sectional study (p>0.05). In the intervention study, there was a significant reduction in body weight (p=0.007) and, body mass index (BMI) (p=0.004) after four weeks and and lower thiamine intake (p=0.021) after two weeks of GFD. Glycaemic response was significantly higher (p

Celiac disease (CD) is a chronic immune-mediated intestinal disease with genetic susceptibility. It is characterized by inflammatory damage to the small intestine after ingestion of cereals and products containing gluten protein. In recent years, the global prevalence rate of CD has been approximately 1%, and is gradually increasing. CD patients adhere to a gluten-free diet (GFD) throughout their entire life. However, it is difficult to adhere strictly to a GFD. Untreated CD may be accompanied by gastrointestinal symptoms, such as diarrhea, abdominal pain, and extraintestinal symptoms caused by secondary malnutrition. Many studies have suggested that CD is associated with intestinal tumors such as enteropathy-associated T-cell lymphoma (EATL), small bowel cancer (SBC), and colorectal cancer. In this study, we reviewed related studies published in the literature to provide a reference for the prevention and treatment of intestinal tumors in patients with CD. Compared with the general population, CD patients had a high total risk of SBC and EATL, but not colorectal cancer. The protective effect of GFD on CD-related malignancies is controversial. Further studies are needed to confirm whether GFD treatment can reduce the risk of intestinal neoplasms in CD.

Background. Celiac disease (CD) is a chronic immune-mediated disorder characterized by growth retardation and malabsorbtion related to mucosal damage and inflammation of small intestine in genetically predisposed people as a result of gluten exposure. In CD treatment, clinical, histological and serological improvement is possible with gluten-free diet. Thus, we aimed to assess the vitamin and trace element levels of CD patients in regard to their compliance with gluten-free diet. Materials and methods. In our study, 77 patients diagnosed with CD were evaluated retrospectively. All individuals were assessed with Marsh classification histopathologically and surveyed when they follow a gluten-free diet. Demographic features, age of disease onset, physical examination findings, anthropometric measurements and laboratory findings along with clinical and laboratory outcomes of patients after a gluten-free diet were compared between compliant to diet and non-compliant to diet groups. Results. A total of 77 individuals, 48 females and 29 males with a diagnosis of CD and mean age of 9.81 ± 4.73 years on admission, were reqruited in our study. Patients were mostly found to have Marsh type 3a (n = 22) and Marsh type 3b (n = 20) histopathologically. The results of serological screening revealed that 40.3 % of people (n = 31) were compliant with diet whereas 59.7 % (n = 46) — non-compliant. Non-compliant group had significantly lower mean vitamin B12, vitamin D, folate, zinc and selenium levels compared to compliant group (p = 0.000; 0.000; 0.000; 0.000 and 0.031, respectively). In addition, a significantly higher mean serum total IgA level was detected in non-compliant group in comparison to compliant group (p = 0.027). Conclusions. High efficacy of gluten-free diet in correcting nutritional insufficiencies and deficiencies was shown. Thus, there is no doubt that informing patients and their families about lifelong gluten-free diet in detail is beneficial although this treatment contains many social and practical difficulties., Актуальность. Целиакия — хроническое заболевание иммунного генеза, характеризующееся задержкой роста и мальабсорбцией, связанной с повреждением слизистой оболочки и воспалением тонкой кишки у генетически предрасположенных людей в результате воздействия глютена. При лечении целиакии достигается клиническое, гистологическое и серологическое улучшение состояния путем соблюдения безглютеновой диеты. Цель исследования: оценить уровень витаминов и микроэлементов у больных целиакией при соблюдении безглютеновой диеты. Материалы и методы. Под наблюдением находились 77 пациентов с диагнозом «целиакия», выявленным ретроспективно. Все случаи были подтверждены гистологически по классификации Marsh, все пациенты обследованы на фоне соблюдения безглютеновой диеты. Демографические особенности, возраст начала заболевания, результаты клинического обследования, антропометрические показатели и лабораторные результаты сравнивали в группах больных, которые придерживались диеты, и при ее отсутствии. Результаты. В исследование были включены 77 больных (48 женщин и 29 мужчин) с целиакией, средний возраст которых составил 9,81 ± 4,73 года. В основном у пациентов обнаружены гистологически по классификации Marsh типы 3a (n = 22) и 3b (n = 20). Результаты серологического скрининга показали, что в 40,3 % случаев (n = 31) больные соблюдали безглютеновую диету, тогда как в 59,7 % (n = 46) — не соблюдали. У больных этой группы отмечались достоверно более низкие показатели содержания витамина В12, витамина D, фолатов, цинка и селена по сравнению с группой больных, которые соблюдали соответствующую диету (p = 0,000; 0,000; 0,000; 0,000 и 0,031 соответственно). Кроме того, был обнаружен достоверно более высокий средний уровень общего IgA в сыворотке крови в группе больных без соблюдения диеты по сравнению с группой больных, которые соблюдали безглютеновую диету (p = 0,027). Выводы. Установлена высокая эффективность безглютеновой диеты для коррекции недостаточности и дефицита витаминов и микроэлементов. Необходимо детально информировать пациентов с целиакией и их семьи о неуклонном пожизненном соблюдении безглютеновой диеты, хотя соблюдение такого питания создает немало социальных и практических трудностей., Актуальність. Целіакія — хронічне захворювання імунного генезу, що характеризується затримкою росту та маль­абсорбцією, пов’язаною з пошкодженням слизової оболонки і запаленням тонкої кишки у генетично схильних людей внаслідок впливу глютену. При лікуванні целіакії досягається клінічне, гістологічне та серологічне поліпшення стану шляхом дотримання безглютенової дієти. Мета дослідження: оцінити рівень вітамінів та мікроелементів у хворих на целіакію за умов дотримання безглютенової дієти. Матеріали та методи. Під спостереженням перебували 77 пацієнтів з діагнозом «целіакія», виявленим ретроспективно. Усі випадки були підтверджені гістологічно за класифікацією Marsh, усі па­цієнти обстежені на тлі дотримання безглютенової дієти. Демографічні особливості, вік початку захворювання, результати клінічного обстеження, антропометричні показники та лабораторні результати порівнювали у групах хворих, які дотримувалися дієти, та за її відсутності. Результати. До дослідження були включені 77 хворих (48 жінок і 29 чоловіків) із целіакією, середній вік яких становив 9,81 ± 4,73 року. Переважно у пацієнтів виявлені гістологічно за класифікацією Marsh типи 3a (n = 22) і 3b (n = 20). Результати серологічного скринінгу показали, що у 40,3 % випадків (n = 31) хворі дотримувалися безглютенової дієти, тоді як у 59,7 % (n = 46) — не дотримувалися. У хворих цієї групи відзначалися вірогідно нижчі показники вмісту вітаміну В12, вітаміну D, фолатів, цинку та селену порівняно з групою хворих, які дотримувалися відповідної дієти (p = 0,000; 0,000; 0,000; 0,000 та 0,031 відповідно). Крім того, був виявлений вірогідно вищий середній рівень загального IgA в сироватці крові у групі хворих без дотримання дієти порівняно з групою хворих, які дотримувалися безглютенової дієти (p = 0,027). Висновки. Встановлена висока ефективність безглютенової дієти для корекції недостатності та дефіциту вітамінів і мікроелементів. Необхідно детально інформувати пацієнтів з целіакією та їх родини про неухильне пожиттєве дотримання безглютенової дієти, хоча дотримання такого харчування створює чимало соціальних і практичних труднощів.

BackgroundCeliac disease (CeD) is often accompanied by other autoimmune diseases (AID). However, the association of co-existing autoimmunity with the presentation and treatment success in CeD is unclear. We investigated these issues with a large and well-defined cohort of Finnish patients.MethodsAdult CeD patients (n = 806) were collected from multiple heath care sites via nationwide recruitment. They were interviewed, underwent measurement of CeD autoantibodies, and filled out questionnaires to ascertain quality of life (PGWB) and gastrointestinal symptoms (GSRS) after a median of 9.7 years on a gluten-free diet. Data were supplemented retrospectively from patient records. The results were compared between CeD patients with and without a coexisting AID.ResultsAltogether 185 patients had CeD+AID and 621 had CeD only. At CeD diagnosis, patients with CeD+AID were older (median 42 vs. 36 years, p = 0.010) and had more joint symptoms (9.1 vs. 4.2%, p = 0.011), whereas the groups were comparable in sex, family history of CeD, other presenting symptoms, proportion of screen-detected subjects, and severity of duodenal lesion. During follow-up on gluten-free diet, CeD+AID patients experienced poorer general health (median score 12 vs. 14, p < 0.001) in PGWB, more overall gastrointestinal symptoms (2.1 vs. 1.9, p = 0.001), and constipation (2.0 vs. 1.7, p < 0.001) in GSRS, whereas there was no difference in histological and serological recovery, dietary adherence, use of gluten-free oats, smoking, and presence of regular follow-up.ConclusionsCo-existing AID was not significantly associated with the baseline features or with most long-term outcomes in CeD. However, the increased prevalence of gastrointestinal symptoms and reduced poorer self-perceived health during treatment indicates these patients' need for special support.

Currently, the only treatment for coeliac disease (CD) is a strict, lifelong gluten-free diet (GFD); however, their completeness with regard to energy and macro- and micronutrients remains poorly understood. Paediatric studies are often limited by a low quality and a lack of controls, and their findings should be interpreted with caution. The aim of the present study was to evaluate nutritional imbalances in children with CD on a strict GFD. Methods: A single-centre prospective cohort study was conducted. A total of 48 children with CD (33 girls, mean age 11.8 ± 3.68 years) on a strict GFD (mean duration 5.02 ± 3.87 years) were compared with 50 non-coeliac subjects (26 girls, mean age 10.2 ± 3.97 years). In both groups, anthropometric measurements (body height, weight and BMI) and laboratory tests (haemoglobin level, calcium and magnesium serum concentration, folic acid, vitamin B1, B2, B6 and B12 level) were checked. Additionally, in coeliac subjects, a 3-day food record for energy and macro- and micronutrient intake assessment were determined, and the values were compared to those in non-CD participants and the dietary reference intake (DRI) standards. Results: The CD children were more likely to demonstrate significantly lower serum vitamin B1 and folic acid levels compared to controls (p = 0.01 and p = 0.002, respectively). Although mean serum calcium values were within normal ranges, they were significantly lower in CD subjects than controls (p = 0.01). Mean calcium, folic acid and vitamin D intake was below the dietary recommendations in the CD group (69.9%, 71.2% and 68.9% DRI, respectively) but did not differ significantly between CD and non-coeliac subjects. In turn, the mean supply of proteins and carbohydrates in the CD group substantially exceeded the recommended levels (190.3% and 189.4% DRI, respectively) but was similar to controls. A significantly higher number of CD children were classified as underweight, and a significantly lower number as overweight or obese, compared with controls (p < 0.001). Conclusion: Although children with CD receive nutritional education at diagnosis, a GFD often does not provide a balanced set of macro- and micronutrients. This is mainly due to unhealthy dietary habits, as commonly observed in the general population. Children with CD should be informed that while their diet should be free of gluten, it should nevertheless cover all their nutrition requirements in the long term.

A lifelong strict gluten-free diet is the only available treatment for patients with coeliac disease (CD). As with any restrictive diet, it may potentially lead to nutritional deficits. Seventy-six patients with CD (mean age 9.0 ± 4.3 years, 57% female) and 590 healthy controls (HC) (mean age 9.9 ± 0.1 years, 54% female) were recruited and requested to keep a 3-day food record (3DFR). In HC patients, anthropometric data were determined at the time when 3DFRs were collected. In CD patients, anthropometric data were determined at two time points: at diagnosis and at the time of 3DFRs collection. Intake of energy, macronutrients, and micronutrients was determined using PRODI expert 6.9 software and expressed as a percentage of recommended daily intake. In CD patients, all measured anthropometric measures (body weight (BW), body height (BH), and body mass index (BMI) z-scores) increased significantly after the mean duration of 34.1 months of a GFD. Overall, CD patients had significantly lower BW and BH z-scores compared to healthy controls. Patients with CD were generally more compliant with the recommended dietary intakes of macronutrients and some micronutrients, as compared to HC. Three participants were not compliant with the GFD; 42.1% of participants took oral nutritional supplements at the start of their GFD. Our study showed that patients with CD have better compliance with dietary recommendations compared to healthy controls, showing that a well-balanced GFD diet can provide necessary macro- and micronutrients.

Background: Children diagnosed with type 1 diabetes mellitus (T1DM) are more prone to having celiac disease (CD) than the normal population. Moreover, patients with this dual diagnosis who are also on a diabetic and gluten-free diet (GFD) risk faltering growth and uncontrolled blood glucose levels. This review aims to assess the efficacy and effectiveness of managing patients with T1DM screened for CD with GFD to prevent complications associated with these chronic pathologies in childhood and adulthood. Materials and Methods: We abided by the PRISMA guidelines in this meta-analysis and used multiple databases and search engines. We included case–control studies. The primary outcomes were changes in the standard deviation score, body mass index (SDS BMI), and glycosylated hemoglobin (HA1C) after being on a GFD for at least twelve months. Results: The pooled data from the six studies included showed that there was neither a statistically significant difference in the mean SDS BMI (−0.28 (95% CI −0.75, 0.42)) (p = 0.24) nor in the mean of HA1C (mean −0.07 (95% CI −0.44, 0.30)) (p = 0.36) for the same group. HDL cholesterol improved significantly in patients on a strict GFD (p < 0.01). Conclusions: In children with T1DM and asymptomatic CD, being on a GFD had no significant effect on BMI or HA1C. However, it can have a protective effect on the other complications found in both chronic pathologies.

This cross-sectional study aims to assess eating competence (EC—an intra-individual approach to food, behaviors, and attitudes related to food) and aspects related to a gluten-free diet (GFD) in Brazilian adults with gluten-related disorders (GRDs). The research was conducted using an online survey with a self-reported instrument consisting of 40 items, organized into three parts: (I) Socioeconomic and demographic data; (II) the Brazilian version of the Eating Competence Satter Inventory (ec-SI2.0™BR); and (III) questions about adherence and difficulties in following the gluten-free diet. EC was measured by the ecSI2.0™BR instrument, with scores ≥32 were considered competent eaters. The instrument was applied nationwide through the GoogleForms® platform from 14 February 2022 to 30 March 2022. The publicity for the recruitment was supported by Brazilian celiac local and national associations (Acelbras and Fenacelbra), pages of food services or personal pages of tips and posts about gluten-related disorders, and specialized stores that offer gluten-free foods. The recruitment occurred through social networks (emails, Facebook groups, WhatsApp, and Instagram). A total of 1030 Brazilians with GRDs answered the questionnaire. Most participants were female, aged 40 years or older, with an income >R$3000, and a high education level. The main difficulty regarding adherence to GFD was the high cost of gluten-free foods. Individuals younger than 40 years old had lower EC scores, with no differences between men and women. Increasing socioeconomic status, schooling, and culinary practices increased the total score. Participants who “never/almost never” felt socially judged because their diet had higher scores for total EC. Competent eaters GRD individuals (EC ≥ 32) were mostly individuals aged ≥40 y/o; with income > R$3000; following a GFD; satisfied with purchased gluten-free products; consuming gluten-free products prepared at home, mainly by themselves; who do not feel judged because of the GRD and who feel that they can live a normal life with GRD. Our study showed that individuals who strictly adhere to the GFD have higher scores on eating competence than those who sometimes follow the treatment.

One of the most challenging aspects of celiac disease management is lack of awareness in public. Aim of the study was to evaluate public awareness and sensitivity on celiac disease and gluten-free diet. 501 individuals in Manisa, Turkey were subjected to a survey to obtain information on demographics, awareness of celiac disease, celiac and gluten-free diet relationship, effect on social life quality and social awareness and sensitivity. Results were analyzed by chi-square test. 43.9% of the public had never heard of celiac disease before. Females were more aware of the disease and gluten-free diet dependency. Majority of the postgraduates (79.6%) recognized the disease. 44.9% of the respondents remarked that celiac patients had hesitations on dining out, while 32.3% found those people restricted for travel and holiday activities. Above one-third of subjects indicated that gluten-free product variety in the market was inadequate. However, more than half had no idea on these. Over 50% felt that, social awareness and sensitivity towards disease was unsatisfactory. This study was conducted to mirror the society’s approach towards celiac patients. It was demonstrated that public’s awareness and sensitivity about celiac disease was scarce. Knowledge of ‘celiac’ needs to be raised.

Lifelong adherence to a gluten-free diet (GFD) is the cornerstone of management of celiac disease (CD), but adhering to a GFD can be hard. Although several factors are positively associated with adherence of pediatric CD patients to a GFD, it is unknown whether these are influenced by variability caused by the specific tool used to assess adherence to a GFD. Here, we aimed to evaluate how individual patient characteristics and dietary counselling by a trained dietitian influence adherence to a GFD in children with CD, as assessed by two validated questionnaires: the Biagi questionnaire and the Leffler short questionnaire adapted for pediatric patients. Some 139 children and adolescents were recruited in a cross-sectional, multicenter study. Concordance between the two questionnaires in defining adherence was fair (weighted Cohen’s kappa coefficient 0.39, 95%CI 0.19–0.60). Upon regression analysis, having a cohabiting family member with CD, being of Italian origin, and receiving specialized dietary counselling during follow-up were found to positively influence stricter adherence to a GFD for children with CD. Neither questionnaire detected a significant relationship between adherence to a GFD and the presence of symptoms after gluten ingestion. This study provides important new data on the factors influencing GFD adherence in the pediatric population, and highlights the importance of dietician input and overcoming language and cultural barriers when educating patients.

In adults, celiac disease (CD) diagnosis is based on specific serology (anti-transglutaminase IgA-anti-tTG) and duodenal histology. Evidence is raising the possibility of perform CD diagnosis based only on high anti-tTG titer in children. We aimed to evaluate clinical, histological and biochemical differences between adult patients with high tTG IgA titer (HT) and those with low titer (LT) at CD diagnosis and follow-up. This retrospective study included consecutive adult CD patients divided into two groups: HT (anti-tTG > 10 × ULN) and LT (anti-tTG < 10 × ULN). Clinical, biochemical and histological features were compared between groups at CD diagnosis and at follow-up. A total of 291 patients were included (HT: 47.1%; LT: 52.9%). At CD diagnosis, HT patients showed a non ‘classical’ presentation (p = 0.04), Marsh 3C (p = 0.005), hypoferritinaemia (p = 0.006) and osteopenia/osteoporosis (p = 0.04) more frequently than LT patients. A total of 216 patients (HT: 48.6%; LT: 51.4%) performed a follow-up after a median Gluten-free diet of 14 months; HT patients had persistent antibodies positivity (p = 0.001) more frequently and GI symptoms (p = 0.04) less frequently than LT patients. In conclusion, HT patients presented severe histological damage more frequently at diagnosis, recovering similarly to LT patients after the start of the Gluten-free diet. At follow-up, anti-tTG persisted positive in HT more frequently compared to LT patients, without differences regarding histological recovery and clinical improvement.

The auto-immune correlation between sensorineural hearing loss and celiac disease has previously been hypothesized. This review describes available evidence and offers insights for future perspectives. We searched the PubMed database. Studies in the review included children and adults with celiac disease evaluated for hearing loss. Individual case reports and review articles were excluded. The various searches turned in 32 results, of which 10 met the inclusion criteria. Auto-immune hearing loss has been proposed as extra- intestinal symptoms of celiac disease, despite the pathogenetic mechanisms being not entirely clear. Several studies postulated that subclinical hearing loss may be present in children with celiac disease. Despite existing literature not clarifying the link between celiac disease and sensorineural hearing loss, some authors proposed hearing screening in younger patients with celiac disease, to prevent the behavioral, cognitive, and sensorimotor impairment of hearing loss. Further rigorous studies are strongly recommended to better explore the relationship between hearing loss and celiac disease.

Despite following a gluten-free diet, which is currently the only effective therapy for celiac disease, about 5% of patients can develop serious complications, which in the case of refractory type 2 could evolve towards intestinal lymphoma. In this study, we have identified a set of 15 microRNAs in serum discriminating between the two types of refractory disease. Upregulated miR-770-5p, miR-181b-2-3p, miR-1193, and miR-1226-3p could be useful for the better stratification of patients and the monitoring of disease development, while miR-490-3p was found to be dysregulated in patients with refractory type 1. Finally, by using bioinformatic tools applied to the analysis of the targets of dysregulated microRNAs, we have completed a more precise assessment of their functions. These mainly include the pathway of response to Transforming Growth Factor β cell–cell signaling by Wnt; epigenetic regulation, especially novel networks associated with transcriptional and post-transcriptional alterations; and the well-known inflammatory profiles.

A gluten-free diet (GFD) is the main therapy for non-coeliac gluten sensitivity (NCGS). However, the availability of novel enzymes with the ability to digest gluten could represent a therapeutic opportunity for NCGS patients to avoid a GFD.To evaluate the controlled reintroduction of gluten with or without the endopeptidase P1016 in NCGS patients.This is a randomized, double-blind, placebo-controlled monocentric study, Registered under ClinicalTrials.gov Identifier no. NCT01864993. Gluten was reintroduced incrementally over a 3-week period under nutritional control. NCGS patients were randomized into two groups and administered P1016 or placebo during gluten reintroduction. We evaluated symptoms (visual analogue scale, VAS), quality of life (SF-36) and mental health symptoms (SCL-90) on a weekly basis.We enrolled a total 23 patients who were allocated to a placebo group (n = 11, age 38.4 ± 2.9) or an intervention group (n = 12, age 39.5 ± 3.1). No effect of P1016 on symptoms was found. During gluten reintroduction, patients reported a significant increase in abdominal pain and a worsening of stool consistency. Furthermore, no differences were found between the groups regarding SCL-90 and SF-36 scores.Our results demonstrate a lack of effect of P1016 in the management of NCGS patients and the possible reintroduction of gluten.

The prevalence of celiac disease (CD) in patients with chronic autoimmune thyroiditis (CAIT) is estimated to be between 2 and 7.8%. A gluten-free diet (GFD) in patients with CD is suggested to have a beneficial effect on CAIT. Thus, the present systematic review was undertaken to achieve more robust evidence about the change in thyroid stimulating hormone (TSH) and thyroid-specific antibodies (T-Ab) levels obtained in CD patients following a GFD. A specific search strategy was planned. The last search was performed on March 2022. The following data were mainly searched for in order to be extracted: sample size, mean and/or median with standard deviation (SD), and error (SE), individually, of thyroid hormones and T-Ab at baseline and after GFD, and the duration of the study. The initial search retrieved 297 records and 6 articles met the inclusion criteria. In total, 50 patients with both CD and CAIT and 45 controls were reported. The effects of a GFD on the thyroid hormonal and immunological profile could be extracted only in a part of the studies. Two studies were case reports. A low risk of bias was observed. These findings advise further studies, ideally randomized, in order to better investigate the potential relationship between GFD and thyroid homeostasis. The level of evidence is not still sufficient to recommend GFD to patients with CAIT.

The review provides present information on the pathogenesis of irritable bowel syndrome (IBS), the relationship of endogenous and exogenous factors with the development of IBS-symptoms, questions of diet therapy are discussed, diets traditionally prescribed in IBS treatment and diets, such as FODMAP and gluten-free diet, which are the most promising and have a positive effect on the symptoms of IBS.В обзоре представлены современные сведения о патогенезе синдрома раздраженного кишечника (СРК), взаимосвязи эндогенных и экзогенных факторов с развитием симптомов СРК, освещены вопросы диетотерапии, подробно рассматриваются диеты, традиционно назначаемые в схемах лечения СРК, и диеты, такие как FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) и безглютеновая диета, представляющиеся наиболее перспективными и оказывающими положительный эффект на симптоматику СРК.

BACKGROUND Celiac disease (CD) is an immune-mediated enteropathy that is primarily treated with a gluten-free diet (GFD). Mucosal healing is the main target of the therapy. Currently, duodenal biopsy is the only way to evaluate mucosal healing, and non-invasive markers are challenging. Persistent elevation of anti-tissue transglutaminase antibodies (aTTG) is not an ideal predictor of persistent villous atrophy (VA). Data regarding prediction of atrophy using anti-deamidated gliadin peptide antibodies (aDGP) and abdominal ultrasonography are lacking. AIM To evaluate the ability of aTTG, aDGP, small bowel ultrasonography, and clinical and laboratory parameters in predicting persistent VA determined using histology. METHODS Patients with CD at least 1 year on a GFD and available follow-up duodenal biopsy, levels of aTTG and aDGP, and underwent small bowel ultrasonography were included in this retrospective cohort study. We evaluated the sensitivity, specificity, and positive and negative predictive values of aTTG, aDGP, small bowel ultrasonography, laboratory and clinical parameters to predict persistent VA. A receiver operating characteristic (ROC) curve analysis of antibody levels was used to calculate cut off values with the highest accuracy for atrophy prediction. RESULTS Complete data were available for 82 patients who were followed up over a period of four years (2014-2018). Among patients included in the analysis, women (67, 81.7%) were predominant and the mean age at diagnosis was 33.8 years. Follow-up biopsy revealed persistent VA in 19 patients (23.2%). The sensitivity and specificity of aTTG using the manufacturer’s diagnostic cutoff value to predict atrophy was 50% and 85.7%, respectively, while the sensitivity and specificity of aDGP (using the diagnostic cutoff value) was 77.8% and 75%, respectively. Calculation of an optimal cutoff value using ROC analysis (13.4 U/mL for aTTG IgA and 22.6 U/mL for aDGP IgA) increased the accuracy and reached 72.2% [95% confidence interval (CI): 46.5-90.3] sensitivity and 90% (95%CI: 79.5-96.2) specificity for aDGP IgA and 66.7% (95%CI: 41.0-86.7) sensitivity and 93.7% (95%CI: 84.5-98.2) specificity for aTTG IgA. The sensitivity and specificity of small bowel ultrasonography was 64.7% and 73.5%, respectively. A combination of serology with ultrasound imaging to predict persistent atrophy increased the positive predictive value and specificity to 88.9% and 98% for aTTG IgA and to 90.0% and 97.8% for aDGP IgA. Laboratory and clinical parameters had poor predictive values. CONCLUSION The sensitivity, specificity, and negative predictive value of aTTG and aDGP for predicting persistent VA improved by calculating the best cutoff values. The combination of serology and experienced bowel ultrasound examination may achieve better accuracy for the detection of atrophy.

A strict gluten-free diet is the only treatment for celiac disease, and it is especially challenging among adolescents. Participation in food-related activities and self-managing the chronic health condition involve use of cognitive skills. This cross-sectional study examined how executive functions might be associated with participation in food-related activities. Adolescents aged 12–18 years ( N = 65; Mage = 14.67) with celiac were interviewed about participation, and their parents completed an executive function questionnaire. Poorer participation significantly correlated with poorer executive abilities. Identifying executive function profiles may contribute to understanding and advancing resourceful daily functioning and participation in daily food-related activities.

Context An improvement of some autoimmune diseases associated with celiac disease (CD) has been observed after a gluten-free diet (GFD). Objective The aim of this longitudinal study was to evaluate the effect of a GFD on autoimmune pituitary impairment in patients with CD and potential/subclinical lymphocytic hypophysitis (LYH). Design Five-year longitudinal observational study. Setting Tertiary referral center for immunoendocrinology at the University of Campania “Luigi Vanvitelli”. Patients Ninety-three newly diagnosed LYH patients (high titer of antipituitary antibodies [APA] and normal or subclinically impaired pituitary function) were enrolled from 2000 to 2013 and grouped as follows: group 1, consisting of 43 patients with LYH + CD, and group 2, consisting of 50 patients with isolated LYH only. Intervention A GFD was started in patients in group 1 after the diagnosis of CD. Main outcome measures APA titers and pituitary function were evaluated at the beginning of the study and then yearly for 5 years in both groups. Patients progressing to a clinically overt LYH were excluded from the follow-up. Results Complete remission of LYH (disappearance of APA and recovery of pituitary function in patients with previous subclinical hypopituitarism) occurred in 15 patients in group 1 after a GFD (34%) and spontaneously in only 1 patient in group 2 (2%) (P Conclusion In patients with LYH and CD, a GFD may be able to induce remission of subclinical LYH, or prevent the progression to clinical stage of this disease.

The ultimate indicator of adherence to a gluten-free diet is the demonstration of mucosal healing. However, the need for histological reassessment is subject to controversy among "experts". The aim of this study was to evaluate celiac patients who underwent histological reevaluation after starting a gluten-free diet in order to identify those with histological remission and associated factors.This retrospective study included patients who agreed to a histological reassessment after apparent clinical and serological remission and reported at least 12 months of diet adherence. In all cases, informed consent was signed for upper endoscopy.A total of 69 patients were included. In 67.9% of cases, the diagnosis was made in the context of "classic" symptomatology, 17% had "nonclassical" presentation, and 15.1% were in latent phase. 69.2% of the diagnoses were initially suspected by serology. Endoscopically, 11.8% of the patients did not present suggestive features macroscopically, and a histological grade of Marsh IIIa-c was observed in 75.5% of all cases. The histological findings were normalized in 37.7%, which was associated with the presence of lower Marsh score values at diagnosis (Even under a gluten-free diet, celiac histology normalization is difficult to obtain and appears to be independent of most clinical and serological findings at diagnosis. Patients with less severe histological levels at diagnosis reach remission more easily, but only represent the -minority of the population.O indicador final da adesão a uma dieta isenta de glúten é a demonstração da cicatrização da mucosa. No entanto, a necessidade de reavaliação histológica é um assunto controverso entre “experts.” O objetivo deste estudo foi avaliar doentes celíacos submetidos a reavaliado histológica após o inicio da dieta isenta de glúten, a fim de identificar aqueles com remissão histológica e fatores associados.Estudo retrospectivo, incluindo doentes que concordaram com reavaliação histológica após aparente remissão clínica e serológica, com pelo menos doze meses de adesão relatada à dieta. Em todos os casos, o consentimento informado foi assinado para endoscopia digestiva alta.Um total de 69 doentes foram incluidos. Em 67.9% dos casos, o diagnóstico foi feito no contexto de sintomatologia clássica, 17% de apresentações não clássicas e 15.1 % em fase latente. A maioria (69.2%) dos diagnósticos foram inicial-mente suspeitos com base na serologia. Na endoscopia, 11.8% dos pacientes não apresentavam características macroscópicas sugestivas de doença celíaca, observandole um grau histológico de Marsh Illa-c em 75.5% dos casos. Os achados histológicos normalizaram em 37.7% dos doentes, o que foi associado à presença de menores valores de Marsh no momento do diagnóstico (Mesmo sob uma dieta isenta de glúten, a normalização da histologia na doença celíaca é difícil de obter e parece ser independente da maioria dos achados clínicos e serológicos no momento do diagnóstico. Doentes com níveis histológicos menos graves ao diagnóstico alcançam a remissão mais facilmente, mas representam apenas a minoria da populado.

Background: Celiac disease (CD) follow-up is a relatively underevaluated topic. However, correct adherence to follow-up procedures is central to the early recognition of complicated CD and other conditions typically associated with CD. Establishing whether patients at increased risk of complications follow clinicians’ recommendations has multiple repercussions. Methods: We retrospectively analyzed the records of patients consecutively diagnosed with CD in our outpatient clinic between January 2004 and October 2017 to investigate the factors associated with drop-out from follow-up procedures. Results: Among the 578 patients analyzed, 40 (6.9%) dropped out during the first six months and 272 (50.6%) during the observation period. The median time to drop-out was 7.4 years (95% confidence interval: 6.8–8.0). No factors were associated with early drop-out. Instead, age at diagnosis >40 years (40–59 years, p < 0.001; ≥60 years, p = 0.048) and classical clinical presentation (p = 0.016) were significantly associated with a lower risk of later drop-out. Conclusions: Patients at increased risk of complicated CD are more compliant with follow-up procedures than patients at lower risk, despite being prescribed the same controls. These results indirectly support the hypothesis of tailored follow-up strategies, differentiated according to the risk of complications.

The present work aimed to analyze, through the GlutenFreeDiet digital platform, the evolution over one year of the nutritional status, dietary profile and symptoms present among celiac people on a gluten-free diet (GFD) while receiving individualized dietary advice. Twenty-seven adults and thirty-one celiac children/adolescents participated in the study. This was then followed up by three visits, at diagnosis, and after 3 and 12 months (vt0, vt3 and vt12). Participants filled out dietary and gastrointestinal symptoms questionnaires. All patients received written personalized dietary advice from dietitians who interpreted data from the platform. Results obtained indicated that participants consumed proteins and lipids in excess and carbohydrates in defect. Low intakes of cereals, fruit and vegetables and high meat intakes were observed. However, gluten-free product (GFP) consumption and that of ultra-processed foods was reduced after 1 year in adults. Symptoms decreased after vt3 but recurred in vt12. Changes in ultra-processed foods and GFP intake, but lack of changes in the rest of the parameters suggested that the platform support was not effective enough. Even though the platform represents a useful tool for monitoring celiac patients and giving dietary advice, modules that require more continuous attention and nutritional education of patients should be provided for interventions to be more effective. This research was funded by three grants from the University of the Basque Country, UPV/EHU, (University-Society US15/06, US18/15 and US20/16). The GLUTEN3S research group is supported by a grant (GIU 18/78) from the University of the Basque Country, UPV/EHU, and it is recognized by the Basque Government (IT-1419-19). Gesala Perez-Junkera and Maialen Vázquez-Polo are fellowships of the Basque Government and the University of the Basque Country respectively.

Celiac disease is a chronic immune-mediated multisystem disorder that may affect several organs. Isolated hypertransaminasemia, with mild or nonspecific histologic changes in the liver biopsy, also known as “celiac hepatitis”, is the most frequent presentation of liver injury in celiac disease. Both, histologic changes and liver enzymes reverse to normal after treatment with a gluten-free diet in most patients. Here we report the case of a young boy presenting with asymptomatic and persistent hypertransaminasemia whose etiologic investigation led to the diagnosis of celiac disease that resolved with dietary treatment alone. This case emphasizes the need to screen Celiac disease in patients with cryptogenic hypertransaminasemia, irrespective of the existence of gastrointestinal symptoms. It also exemplifies a particular situation in which a liver biopsy is useful to establish the diagnosis of celiac hepatitis.

Introducció. Resulta d’especial interès estudiar la relació existent entre la Fibromiàlgia i la Sensibilitat al Gluten No Celíaca (SGNC) per la prevalença d’ambdues malalties, pels símptomes extra intestinals semblants i per la resposta a una Dieta Sense Gluten (DSG) objectivada en alguns pacients amb Fibromiàlgia. Hipòtesi. La prevalença de la SGNC seria més gran en pacients amb Fibromiàlgia que l’estimada a la població general, un percentatge de pacients amb Fibromiàlgia superior al 25% respondria a una DSG de sis setmanes de durada, un percentatge de pacients responedors a la DSG superior al 50 % no compliria els criteris diagnòstics per a SGNC i les característiques basals dels pacients s’associarien tant a la resposta a la DSG com al compliment dels criteris diagnòstics de SGNC. Objectius. L’objectiu principal va ser establir la prevalença de la SGNC segons els criteris dels experts de Salerno en una cohort de pacients adults amb Fibromiàlgia d’una unitat hospitalària especialitzada. Els objectius secundaris van ser avaluar la resposta clínica a la DSG de sis setmanes de durada, l’evolució de la simptomatologia intestinal i extra intestinal, el percentatge de pacients responedors a la DSG que no van complir els criteris diagnòstics i les característiques basals que es van associar tant a la resposta a la DSG com al compliment dels criteris diagnòstics de SGNC. Mètodes. Estudi experimental no controlat dut a terme en una cohort de pacients amb Fibromiàlgia d’una Unitat Hospitalària entre Juny de 2018 i Desembre de 2019. Dels candidats a participar a l’estudi, pacients adults que complien criteris de classificació i de diagnòstic per a Fibromiàlgia, es van excloure aquells amb diagnòstics previs d’Al·lèrgia al Blat (AB), Malaltia Celíaca (MC) i aquells que estaven realitzant una DSG. Posteriorment, se’ls va fer una analítica i una fibrogastroscòpia i es van descartar aquells pacients que complien criteris d’AB o MC. Tots els pacients seleccionats van seguir els dos passos dels criteris de Salerno: avaluació de la resposta a la DSG i provocació amb gluten controlada amb placebo a simple cec als responedors a la dieta. Es va analitzar el percentatge de pacients que complien els criteris diagnòstics de Salerno, que responien a la DSG, que milloraven més del 30% i del 50% en determinades variables clíniques després de la dieta, el canvi mitjà en aquestes variables, les diferències en les característiques basals entre pacients responedors i no responedors a la dieta i entre complidors i no complidors dels criteris i els factors predictors de resposta i de compliment dels criteris mitjançant els tests estadístics corresponents. Resultats. 142 pacients amb Fibromiàlgia van ser seleccionats per participar a l’estudi. Es va objectivar una prevalença de la SGNC del 5,6%, similar a l’estimada a la població general. Només un 21,8% dels pacients va respondre a la DSG, preferentment a expenses de millora en la simptomatologia intestinal. No es va observar una millora significativa de la simptomatologia extra intestinal. Un 74,2% dels pacients que van respondre a la DSG no van complir els criteris diagnòstics de SGNC. Els factors predictors de la resposta a la DSG van ser la presència de diarrea i de limfòcitosi intraepitelial i un menor grau d’ansietat. No es van trobar característiques basals associades al compliment dels criteris de SGNC en responedors a causa del baix nombre de pacients que van discriminar entre gluten i placebo. Conclusió. Segons els resultats obtinguts en aquest estudi, no es pot recomanar una DSG de forma sistemàtica a tots els pacients amb Fibromiàlgia, encara que es podria valorar en aquells amb presència de diarrea i/o de limfocitosi intraepitelial per avaluar si es produeixen millores en la seva simptomatologia intestinal. Introducción. Resulta de especial interés estudiar la relación existente entre la Fibromialgia y la Sensibilidad al Gluten No Celíaca (SGNC) por la prevalencia de ambas enfermedades, por sus síntomas extra intestinales parecidos y por la respuesta a una Dieta Sin Gluten (DSG) objetivada en algunos pacientes con Fibromialgia. Hipótesis. La prevalencia de la SGNC sería mayor en pacientes con Fibromialgia que la estimada en la población general, un porcentaje de pacientes con Fibromialgia superior al 25% respondería a una DSG de seis semanas de duración, un porcentaje de pacientes respondedores a la DSG superior al 50% no cumpliría los criterios diagnósticos para SGNC y características basales de los pacientes se asociarían tanto a la respuesta a la DSG como al cumplimiento de los criterios diagnósticos de SGNC. Objetivos. El objetivo principal fue establecer la prevalencia de la SGNC según los criterios de los expertos de Salerno en una cohorte de pacientes adultos con Fibromialgia de una unidad hospitalaria especializada. Los objetivos secundarios fueron evaluar la respuesta clínica a la DSG de seis semanas de duración, la evolución de la sintomatología intestinal y extra intestinal, el porcentaje de pacientes respondedores a la DSG que no cumplieron los criterios diagnósticos y las características basales que se asociaron tanto a la respuesta a la DSG como al cumplimiento de los criterios diagnósticos de SGNC. Métodos. Estudio experimental no controlado llevado a cabo en una cohorte de pacientes con Fibromialgia de una Unidad Hospitalaria entre Junio de 2018 y Diciembre de 2019. De los candidatos a participar en el estudio, pacientes mayores de edad que cumplían criterios de clasificación y de diagnóstico para Fibromialgia, se excluyeron aquellos con diagnósticos previos de Alergia al Trigo (AT), Enfermedad Cedlíaca (EC) y aquellos que estaban realizando una DSG. Posteriormente, se les realizó una analítica y una fibrogastroscopia y se descartaron aquellos pacientes que cumplían criterios de AT o EC. Todos los pacientes seleccionados siguieron los dos pasos de los criterios de Salerno: evaluación de la respuesta a la DSG y provocación con gluten controlada con placebo a simple ciego en los respondedores a la dieta. Se analizó el porcentaje de pacientes que cumplían los criterios diagnósticos de Salerno, que respondían a la DSG, que mejoraban más del 30% y del 50% en determinadas variables clínicas tras la dieta, el cambio medio en estas variables, las diferencias en las características basales entre pacientes respondedores y no respondedores a la dieta y entre cumplidores y no cumplidores de los criterios y los factores predictores de respuesta y de cumplimiento de los criterios mediante los test estadísticos correspondientes. Resultados. 142 pacientes con Fibromialgia fueron seleccionados para participar en el estudio. Se objetivó una prevalencia de la SGNC del 5,6%, similar a la estimada en la población general. Sólo un 21,8% de los pacientes respondió a la DSG, preferentemente a expensas de mejoría en la sintomatología intestinal. No se observó mejoría significativa de la sintomatología extra intestinal. Un 74,2% de los pacientes que respondieron a la DSG no cumplieron los criterios diagnósticos de SGNC. Los factores predictores de la respuesta a la DSG fueron la presencia de diarrea y de linfocitosis intraepitelial y un menor grado de ansiedad. No se hallaron características basales asociadas al cumplimiento de los criterios de SGNC en respondedores debido al bajo número de pacientes que discriminaron entre gluten y placebo. Conclusión. Según los resultados obtenidos en este estudio, no puede recomendarse una DSG de forma sistemática a todos los pacientes con Fibromialgia, aunque podría valorarse en aquellos con presencia de diarrea y/o de linfocitosis intraepitelial para evaluar si se producen mejorías en su sintomatología intestinal. Introduction. It is of special interest to study the relationship between Fibromyalgia and Non-Celiac Gluten Sensitivity (NCGS), for its prevalence, for its similar extra intestinal symptoms and for the response to a Gluten Free Diet (FGD) objectified in some patients with Fibromyalgia. Hypothesis. The prevalence of NCGS would be higher in patients with Fibromyalgia than the estimated in the general population, a percentage of Fibromyalgia patients greater than 25% would respond to a six-week GFD, a percentage of responders to a GFD greater than 50% would not fulfill the NCGS diagnostic criteria and there would be baseline characteristics of the patients that would be associated with the response to a GFD and the fulfillment of the NCGS diagnostic criteria. Objectives. The main objective of the study was to establish the prevalence of NCGS according to the Salerno experts’ criteria in a cohort of Fibromyalgia patients from a Specialized Hospital Unit. The secondary objectives were to evaluate the clinical response to the six-week GFD, the evolution of intestinal and extra intestinal symptoms, the percentage of responders to the GFD who did not fulfill the NCGS diagnostic criteria and the baseline characteristics that were associated with the response to the GFD and the fulfillment of the NCGS diagnostic criteria. Methods. Uncontrolled experimental study in a cohort of patients with Fibromyalgia from a Hospital Unit between June 2018 and December 2019. Of the candidates for the participation in the study, consecutive patients who fulfilled the classification and the diagnostic criteria for Fibromyalgia at least 18 years old, those with previous diagnoses of Wheat Allergy (WA) or Celiac Disease (CD) and those who were already following a GFD were excluded. Subsequently, a blood test and a fibro gastroscopy were performed and those patients who fulfilled criteria for WA or CD were excluded. All the selected patients followed the two steps of the Salerno Experts’ criteria: evaluation of the response to the six-week GFD and placebo-controlled gluten challenge in responders performed by a single blinded procedure. The percentage of patients that fulfilled the Salerno Experts’ Criteria for NCGS, that responded to a six-week GFD, that achieved greater than 30% and 50% improvements in clinical outcomes, the mean changes in these outcomes from baseline, the differences in baseline characteristics between responders and non-responders to the GFD and between criteria fulfillers and criteria non-fulfillers and baseline characteristics associated with the response to the GFD and the fulfillment of the NCGS diagnostic criteria were analyzed using appropriate statistical test. Results. 142 patients with Fibromyalgia in whom CD and WA had been excluded were selected for participating in the study. A prevalence of NCGS of 5.6%, similar to that estimated in the general population (0.6-6%), was observed. Only 21.8% of the patients responded to the GFD, preferably at the expense of improvement in intestinal symptoms. No significant improvement in extra intestinal symptoms was observed. 74.2% of the patients who responded to the GFD did not fulfill the Salerno Experts’ Criteria for NCG. Predictive factors of the response to the GFD were the presence of diarrhea and intraepithelial lymphocytosis and lower levels of anxiety. No baseline characteristics were found associated with the fulfillment of the NCGS criteria in responders to the GFS due to the low number of patients who discriminated between gluten and placebo in placebo-controlled gluten challenge. Conclusion. According to the results obtained in this study, a FGD cannot be systematically recommended to all patients with Fibromyalgia, although it could be evaluated in those with diarrhea or intraepithelial lymphocytosis to evaluate if there are improvements in their intestinal symptoms. Universitat Autònoma de Barcelona. Programa de Doctorat en Medicina

A high quality of knowledge and how it is communicated by healthcare professionals (HCPs) let the patient understand coeliac disease (CD) and result in better adherence to therapeutic recommendations. Therefore, the aim of the current study was to assess the opinion of Polish respondents with CD on the comprehension of CD among Polish HCPs. The analysis was based on 796 responses from patients (the members of the Polish Coeliac Society) with confirmed CD diagnosis (224; 28.1% children and 572; 71.9% adults). The most frequently consulted HCPs regarding CD symptoms in the analysed group were gastroenterologists, and various support groups and associations for CD patients. Furthermore, their comprehension of CD was rated best, as 89.3% (n = 552) of the patients who had contact with support groups and associations classified their knowledge on CD as good. More than a half of the respondents (n = 310, 56.6%) who had contact with general practitioners (GPs) due to their symptoms, rated the doctor’s knowledge on CD as bad. Nurses’ comprehension on CD was classified as bad by 45 (52.3%) respondents who had contact with a nurse. Out of 294 Polish patients with CD who had contact with a dietician, 247 (84.0%) assessed that the dietician communicated their knowledge on CD well. The respondents rated that GPs and nurses communicated their knowledge on CD in the worst manner (60.4% and 58.1%, respectively). Out of 796 respondents, 792 (99.5%) provided information about the number of appointments with GPs due to symptoms that occurred prior to CD diagnosis. The respondents had contact with GPs 13 863 times before obtaining a CD diagnosis due to their symptoms. After the establishment of a CD diagnosis, the number of appointments with GPs decreased to 3850, and the average number of appointments decreased from 17.8 to 5.1. The respondents assessed that the knowledge on CD of HCPs is not satisfactory. The work of support groups and associations on CD, who promote reliable CD diagnosis and treatment methods, should be promoted. The cooperation between various HCPs needs to be encouraged, which may lead to better compliance.

Background: Some local areas in England stopped gluten free prescriptions for coeliac disease. An explanatory mixed methods study investigated the impact of these changes. Methods: A cross-sectional survey with 1697 participants was followed by 24 qualitative interviews. The survey included questions on use of prescriptions and health care services, and the Coeliac Disease Assessment Questionnaire (CDAQ) to assess quality of life. The survey data were analysed by descriptive statistics, analysis of variance and regression analysis and the interviews by thematic analysis. Findings from the interviews guided the survey analysis. Results: Dietary burden was significantly different between prescribing and non-prescribing areas, with little impact on other aspects of quality of life. Survey participants in non-prescribing areas who felt more impacted by the prescription changes reported lower quality of life. Satisfaction with and use of services was lower in non-prescribing areas. Interviews indicated that after initial frustrations, most people adapted to the changed prescription policy. However, there was a clear preference for gluten free prescriptions to be available, in particular for staple foods. Conclusions: The main quality of life impact was on Dietary burden. It is encouraging that most participants in this study maintained a good quality of life. However, issues of worse experiences of care, lower follow up opportunities, and inequity arose, and these should be taken into consideration in decisions on gluten free food prescriptions. The new guidelines for the National Health Service (NHS) in England have retained prescriptions for bread and flour mixes, which is more limited than the range of staple foods preferred in this study.

Celiac disease (CD) is a genetically predisposed, T cell-mediated and autoimmune-like disorder caused by dietary exposure to the storage proteins of wheat and related cereals. A gluten-free diet (GFD) is the only treatment available for CD. The celiac immune response mediated by CD4+ T-cells can be assessed with a short-term oral gluten challenge. This study aimed to determine whether the consumption of bread made using flour from a low-gluten RNAi wheat line (named E82) can activate the immune response in DQ2.5-positive patients with CD after a blind crossover challenge. The experimental protocol included assessing IFN-γ production by peripheral blood mononuclear cells (PBMCs), evaluating gastrointestinal symptoms, and measuring gluten immunogenic peptides (GIP) in stool samples. The response of PBMCs was not significant to gliadin and the 33-mer peptide after E82 bread consumption. In contrast, PBMCs reacted significantly to Standard bread. This lack of immune response is correlated with the fact that, after E82 bread consumption, stool samples from patients with CD showed very low levels of GIP, and the symptoms were comparable to those of the GFD. This pilot study provides evidence that bread from RNAi E82 flour does not elicit an immune response after a short-term oral challenge and could help manage GFD in patients with CD., This research was funded by The Spanish Ministry of Science and Innovation, Agencia Estatal de Investigación (Project PID2019-110847RB-I00), Consejería de Transformación Económica, Industria, Conocimiento y Universidades, Junta de Andalucía (Project P20_01005), and “ERDF A way of making Europe”, by the “European Union”.

The gluten-free diet (GFD) has gained popularity beyond its main medical indication as the treatment for gluten-induced immune-mediated disorders such as celiac disease (CD), dermatitis herpetiformis, gluten ataxia, wheat allergy, and non-celiac gluten sensitivity. However, the diet carries some disadvantages such as elevated costs, nutritional deficiencies, and social and psychological barriers. The present work aims to review indications, proven benefits, and adverse events of a gluten-free diet. Close follow-up with patients following the diet is recommended. More data is needed to assess the effectiveness of the diet in managing mental and cognitive disorders and to establish a connection between the brain and gluten.

The differential diagnosis and treatment of seronegative enteropathy, also termed seronegative villous atrophy (SNVA), is a clinical challenge. Although seronegative coeliac disease (CD) is a frequent cause of SNVA, the aetiology can include immune-mediated, inflammatory, infectious, and drug-related forms. As a misdiagnosis of SNVA can result in patients being unnecessarily placed on a lifelong strict gluten-free diet or even given incorrect immunosuppressive therapy, the aim of this paper is to provide an evidence-based and practical approach for the workup and management of SNVA.

Background: The popularity of the gluten-free diet and sales of gluten-free products have increased immensely. Aims: To investigate whether gluten induces gastrointestinal symptoms, measured by self-reported questionnaires, as well as mental health symptoms in adolescents from a population-based cohort. Methods: The eligible participants (n = 273) were recruited from a population-based cohort of 1266 adolescents and had at least four different gastrointestinal symptoms. Phase one (n = 54) was a run-in phase where the participants lived gluten-free for 2 weeks. If they improved they continued to phase 2 (n = 33), a blinded randomised cross-over trial. Participants were blindly randomised either to start with 7 days of gluten, eating two granola bars containing 10 g of gluten or to 7 days on placebo, eating two granola bars without gluten, followed by the reverse and separated by a 7-day washout period. The effects of the intervention on gastrointestinal symptoms and mental health symptoms were assessed. Results: In total, 54/273 participants entered the run-in phase and 35 were eligible for randomization. A total of 33 were randomised and 32 completed the trial. The median age was 20.3 (IQR 19.2–20.9) and 32/33 participants were females. Compared with a placebo, gluten did not induce gastrointestinal symptoms. The difference in the average VAS was −0.01 (95% confidence interval −2.07 to 2.05). Nor did we find a difference in the outcomes measuring mental health. Conclusion: Compared with placebo, adding gluten to the diet did not induce gastrointestinal symptoms or worsened mental health in adolescents recruited from a population-based cohort. The trial registration number is NCT04639921.

Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease treated with a gluten-free diet. However, the itching and blistering rash alleviates slowly after gluten withdrawal and occasionally persists despite a long-term gluten-free diet. This study investigated the prevalence and factors associated with prolonged (i.e. > 2 years) and ongoing skin symptoms in 237 patients with dermatitis herpetiformis. Data were gathered from medical records and via questionnaires. Among patients with dermatitis herpetiformis, 38% had prolonged symptoms after diagnosis, and 14% had ongoing skin symptoms at follow-up (median duration of gluten-free diet 24 years). A severe rash at diagnosis was associated with both prolonged and ongoing cutaneous symptoms. In addition, patients with dermatitis herpetiformis with ongoing skin symptoms at follow-up had been on the dietary treatment for a shorter time (median duration 16 vs 25 years) and were less often on a strict diet (53% vs 78%) compared with patients with dermatitis herpetiformis without ongoing skin symptoms. publishedVersion

Celiac crisis (CC) is a rare life-threatening course of celiac disease, observed mainly in children. In adults, CK can be the first manifestation of the disease and, very rarely, a relapse that occurs in patients who do not follow the gluten-free diet (AGD). Triggers can be stress, surgery, childbirth, etc. A clinical observation of CC developed in a 49-year-old patient with previously established latent celiac disease with subtotal villous atrophy, stage Marsh III C is presented. The patient did not comply with AHD. After severe angina, she developed anorexia, diarrhea, emaciation, coagulopathy, bilateral pulmonary embolism, infarction pneumonia, and enterogenic sepsis. As a result of intensive therapy with prednisolone, Fraxiparine, antibiotics, fresh frozen plasma and strict adherence to hypertension, remission of the disease was achieved.Целиачный криз (ЦК) редкое жизнеугрожающее течение целиакии, наблюдается преимущественно у детей. У взрослых ЦК может быть первым проявлением болезни и крайне редко рецидивом, возникающим у пациентов, не соблюдающих аглютеновую диету (АГД). Триггерами могут служить стрессы, оперативные вмешательства, роды и др. Представлено клиническое наблюдение ЦК, развившегося у больной 49 лет с установленной ранее латентной формой целиакии с субтотальной атрофией ворсинок, стадии Marsh III С. Пациентка не соблюдала АГД. После тяжелой ангины у нее появились анорексия, диарея, истощение, коагулопатия, двухсторонняя тромбоэмболия ветвей легочной артерии, инфарктная пневмония и энтерогенный сепсис. В результате интенсивной терапии преднизолоном, Фраксипарином, антибиотиками, свежезамороженной плазмой и строгого соблюдения АГД достигнута ремиссия заболевания.

Celiac disease (CD) is a permanent immune reaction to gluten in those with a genetic predisposition. This study was designed to evaluate menopause-associated symptoms, mood, bone quality, and IgA antibody levels in women with CD, untreated and treated with a gluten-free diet (GFD), and with or without resistance exercise. The randomised controlled trial was conducted on 28 Spanish women (>40 years old). Participants were divided into the following intervention groups: personalised gluten-free nutrition plan + exercise (GFD + E); personalised gluten-free nutrition plan (GFD); celiac controls (NO-GFD); and non-celiac controls (CONTROL). The participants responded to the Menopause Rating Scale and the Profile of Mood States (POMS) questionnaires. Bone quality was measured with ultrasound and IgA with a blood test. After 12 weeks of intervention, the GFD + E group showed significant improvement in urogenital symptoms and scored higher on the ‘vigour’ subscale of the POMS. Negative associations were found between the total score on the Menopause Rating Scale and the ‘vigour’ subscale of the POMS questionnaire. Only those women who underwent a personalised GFD nutritional intervention combined with resistance exercise demonstrated significant changes after the intervention Generalitat Valenciana, Concelleria D’ Educació, Investigació Cultura I Esport (GV/2017/112) 5.561 JCR (2021) Q1, 35/144 Food Science & Technology 0.726 SJR (2021) Q1, 69/338 Food Science No data IDR 2021 UEM

Considerable heterogeneity exists across studies assessing intestinal mucosal recovery in celiac (CD) patients on a gluten-free diet (GFD). We aimed at investigating histological and immunohistochemical features in CD patients on a long-term GFD and to correlate them to the GFD duration. Morphometrical and immunohistochemical analysis were retrospectively performed on duodenal biopsies in three groups of children: 33 on a long-term (>2 years) GFD (GFD-group), four of which remained seropositive despite dietary adherence, 31 with villous atrophy (ACD-group) and 76 heathy, non-celiac (CTR-group). Moreover, in the GFD-group, we correlated immunohistochemical alterations to the GFD duration. The villous to crypt (V/C) ratio significantly improved after the GFD and completely normalized in all patients, becoming even higher than in the CTR-group (median value 3.2 vs. 3, p = 0.007). In parallel, the number of CD3+ and TCRγδ+ cells in the epithelium were significantly reduced in the GFD compared to ACD patients, even if they remained higher than in the CTR-group (p < 0.05). In contrast, CD25+ cells in the lamina propria significantly decreased after the GFD (p < 0.05) and become comparable to the CTR-group (p = 0.9). In the GFD-group there was no difference in the immunohistochemical parameters between seropositive and seronegative patients and alterations did not correlate to GFD length. In conclusion, a GFD is able to both restore a normal V/C ratio and reduce inflammation, but the epithelium maintains some stigmata of the disorder, such as an increased number of CD3+ and TCRγδ+ cells. These alterations persist regardless of the duration of the GFD.

Background Adherence to a gluten-free diet (GFD) and food insecurity (FI) may influence health-related quality of life (HRQOL) in individuals with celiac disease (CD). This study aimed to investigate the association between adherence to a GFD, FI, and HRQOL in individuals with CD. Methods This cross-sectional study included 97 adults (mean age: 34 ± 9 years) diagnosed with CD. The participants were on a GFD for more than 6 months. Sociodemographic characteristics and medical history were assessed. Adherence to a GFD, FI, and HRQOL were assessed using validated questionnaires. Results Most participants (73%) adhered to a GFD, and 62% were experiencing FI. Individuals with CD faced difficulty in accessing GF foods due to the high cost (90%) and limited availability (79%). The mean overall HRQOL score was 60. Scores on the physical and mental health domains were 69 and 47, respectively. Adherence to a GFD was significantly associated with FI (P = 0.02), while there was no association between adherence to a GFD and HRQOL measures (P > 0.05). Participants facing FI had lower scores in emotional well-being and mental health domains, and overall HRQOL (P Conclusions The findings of the present study demonstrate that FI influences adherence to a GFD, and that FI is associated with HRQOL in terms of both emotional well-being and mental health.

Background and objective Recently, dietary restriction of fermentable carbohydrates (a low-FODMAP diet) in combination with a gluten-free diet (GFD) has been proposed to reduce the symptoms in irritable bowel syndrome (IBS) patients. Different studies reported that IBS has been associated with dysbiosis in the gut microbiota. Additionally, a few studies have reported inflammation in the gastrointestinal (GI) system of adults with IBS. In this study, we aimed to investigate the effects of low FODMAP-gluten free diet (LF-GFD) on clinical symptoms, intestinal microbiota diversity, and fecal calprotectin (FC) level in Iranian patients with IBS. Design In this clinical trial study, 42 patients with IBS (Rome IV criteria) underwent LF-GFD intervention for 6 weeks. Symptoms were assessed using the IBS symptom severity scoring (IBS-SSS), and fecal samples were collected at baseline and after intervention and analyzed by quantitative 16 S rRNA PCR assay. The diversity of gut microbiota compared before and after 6 weeks of dietary intervention. FC was also analyzed by the ELISA method. Results Thirty patients (mean age 37.8 ± 10.7 years) completed the 6-week diet. The IBS-SSS was significantly (P = 0.001) reduced after LF-GFD intervention compared to the baseline. Significant microbial differences before and after intervention were noticed in fecal samples. A significant increase was found in Bacteroidetes, and the Firmicutes to Bacteroidetes (F/B) ratio was significantly (P = 0.001) decreased after the dietary intervention. The value of FC was significantly decreased after 6 weeks of dietary intervention (P = 0.001). Conclusions Our study suggests that patients with IBS under an LF-GFD had a significant improvement in IBS symptoms severity, with reduced FC level following normalization of their gut microbiota composition. Further rigorous trials are needed to establish a long-term efficacy and safety of this dietary intervention for personalized nutrition in IBS. Clinical Trial Registry Number: IRCT20100524004010N26.

Immune checkpoint inhibitors (ICIs) in the recent times have transformed the landscape of the management of many solid tumors. Unfortunately, many immune-related adverse effects are associated with ICIs, which lead to a negative outcome in cancer treatment. We present a case of a 63-year-old female with metastatic adenocarcinoma of unknown origin, who developed celiac disease during the course of treatment with pembrolizumab. Association of celiac disease with this form of immunotherapy has never been documented before.