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Background: Non-celiac gluten/wheat sensitivity (NCGWS) is a syndrome for which pathogenesis and management remain debated. It is described as a condition characterized by gastrointestinal and extra-intestinal symptoms rapidly occurring after gluten ingestion in subjects who have had celiac disease or wheat allergy excluded. To date, the diagnosis of NCGWS is challenging as no universally recognized biomarkers have been yet identified, nor has a predisposing genetic profile been described. However, the research is moving fast, and new data regarding pathogenic pathways, patients' classification, potential candidate biomarkers, and dietary interventions are emerging. Methods: This literature review aims to address the state of the art and summarize the latest updates in this field from 2019 to date. Results and Conclusions: Clinical studies regarding NCGWS in the last five years are reported to shed light on this complex condition and to guide specialists towards a more in-depth, prompt, and objective diagnosis. [ABSTRACT FROM AUTHOR]

Background: Celiac disease (CD) is an autoimmune disease that results from the interaction of genetic, immune, and environmental factors. According to the 2020 European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines, an elimination diet (i.e., excluding products that may contain gluten) is the basic method of treating celiac disease. Following a gluten-free diet is extremely problematic, and patients often make unconscious deviations from the diet. According to the current Oslo definitions for celiac disease, depending on the clinical picture and adequate tests, several forms of celiac disease have been identified: typical, atypical, asymptomatic, potential, and refractory. Objective: The aim of the study was to assess the frequency of conscious diet mistakes and unconscious deviations from a gluten-free diet in a group of patients with long-standing celiac disease and their impact on the frequency of typical and atypical symptoms. Methods: The study included 57 people diagnosed with celiac disease between 1980 and 2010. After verifying the history of the disease according to the ESPGHAN guidelines from 2020, we excluded 19 patients who had Marsh grade 1 at the time of diagnosis or those without HLA DQ2 or DQ8 haplotypes detected. After verification, the study included 38 patients, 30 women and 8 men, with a verified diagnosis of typical celiac disease. The effectiveness of the gluten-free diet was assessed in all participants. Blood was collected to determine IgA anti-tissue transglutaminase II antibodies (anti-tTG) and IgG antibodies against deamidated gliadin peptides by ELISA. All survey participants provided data concerning current gastrointestinal and systemic symptoms, bowel habits, comorbidities, dietary habits, physical activity, and socioeconomic conditions. Results: A total of 25 patients (65.78%) declared strict adherence to the gluten-free diet. However, in this group, seven (18.4%) patients had significantly increased levels of anti-tTG antibodies (mean 82.3 RU/mL ± 78.9 SD at N < 20 RU/mL). Among the patients who consciously made dietary mistakes, six (46.2%) demonstrated increased levels of anti-tTG antibodies. The analysis did not reveal any difference between the frequency of intestinal and extraintestinal symptoms in patients making dietary mistakes and following the gluten-free diet. Conclusions: More than half of celiac patients unconsciously or consciously make dietary mistakes, which indicates an urgent need to increase their general knowledge of CD and the appropriate diet. Regardless of whether the gluten-free diet is followed, both typical and atypical symptoms of the disease have been observed among celiac patients. [ABSTRACT FROM AUTHOR]

Background & Aims: In coeliac disease, the clinical role of the urinary gluten immunogenic peptide is unclear. It has been suggested it can be a non-invasive marker of villous atrophy. Therefore, we present the largest cross-sectional clinical data in patients with coeliac disease to establish the diagnostic accuracy of the urinary gluten immunogenic peptide in identifying villous atrophy. Methods: Patients providing urinary gluten immunogenic peptide were identified between September 2018 and August 2023 at the National Health Service (NHS) England National Centre for Non-Responsive and Refractory CD. In our retrospective study, the results of the urinary gluten immunogenic peptide test collected within 7 days, self-reported adherence to a gluten free diet reported within 3 months, serology collected within 7 days (immunoglobulin A - tissue transglutaminase and endomysial antibody) and histology at the time of endoscopy were compared in individuals with coeliac disease who were either asymptomatic and undergoing remission biopsies (group 1), non-responsive coeliac disease (group 2) and refractory coeliac disease on immunosuppressive therapy (group 3). Associations between dichotomous variables were calculated using chi-squared test. Results: In group 1 the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting villous atrophy were 42.9%, 83.3.%, 64.3% and 67.6% respectively. In group 2 the sensitivity, specificity, PPV and NPV for detecting villous atrophy were 36.2%, 79.0%, 39.5% and 76.6% respectively. In group 3 the sensitivity, specificity, PPV and NPV for detecting villous atrophy were 56.3%, 70.6%, 73.0% and 53.3%. More patients on immunosuppression had a positive urinary gluten immunogenic peptide than those not on immunosuppression (43.3% vs 24.1%, p<0.001). Conclusions: The urinary gluten immunogenic peptide does not have a role in identifying villous atrophy. Therefore, to assess for villous atrophy an upper gastrointestinal endoscopy is still required. [ABSTRACT FROM AUTHOR]

Introduction: Celiac disease (CD) is an autoimmune enteropathy characterized by atrophy of the intestinal mucosa triggered by the ingestion of gluten in individuals with a genetic predisposition. CD manifests with heterogeneous array of symptoms, including a wide range of intestinal and extraintestinal symptoms and manifestations (EIMs). The mechanisms involved in the pathogenesis of EIMs in CD are not only related to intestinal mucosal damage and associated malabsorption but also to systemic inflammation. To date, the only effective treatment for CD is a lifelong gluten-free diet (GFD). Proper adherence to the GFD leads in most cases to a gradual resolution of intestinal atrophy and results in an improvement of the clinical manifestations associated with intestinal damage. Areas covered: This review, based on a Pubmed literature search, describes the extraintestinal complications associated with CD, emphasizing strategies for therapeutic management and responsiveness to the GFD. Expert opinion: CD is associated with different EIMs which can affect different organs. The main clinical interest is if these complications respond to the GFD, which occur at variable rate and not for all disorders associated with CD. Therefore, often complementary additional therapies are needed to achieve optimal symptoms resolution. [ABSTRACT FROM AUTHOR]

Gluten proteins in cereal grains are often considered unsafe for health. Indeed, the dissemination of misinformation through various sources has led to a widespread misconception that the consumption of gluten by healthy individuals results in adverse health consequences and contributes to obesity. In recent years, many health-conscious consumers have started reducing or avoiding gluten consumption without a medical recommendation. Consequently, the adoption of gluten-free diets has expanded significantly. This study compared 39 gluten-free products and their gluten-containing counterparts for energy, sugar, dietary fiber content, and price. We found that, on average, gluten-free products available to United States consumers contained significantly less protein and more sugar and calories. Furthermore, on average, gluten-free products are more expensive than gluten-containing products. Our finding may serve as a guide for dietitians, nutritionists, and legislators in introducing a gluten-free prescription list for individuals with celiac disease, wheat allergy, and non-celiac wheat sensitivity. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusion Non‐responsive celiac disease (NRCD) is defined as ongoing symptoms despite 6–12 months of gluten‐free diet (GFD), the only known treatment for celiac disease (CeD). There is inconsistency in studies describing the proportion of patients having NRCD and its various causes among patients with CeD. We therefore conducted a systematic review and meta‐analysis to determine the prevalence and causes of NRCD.The PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases were searched for original studies reporting the proportion of patients with persistent symptoms after ≥ 6 months of GFD. Studies reporting the etiologies of NRCD were also identified. The systematic review was conducted as per the Meta‐analysis of Observational Studies in Epidemiology guidelines. Statistical analysis was performed in STATA.Of 2965 search results, nine studies met the inclusion and exclusion criteria. Five studies (n = 4414) reported data on prevalence, and seven studies (n = 790) reported the causes of NRCD. The pooled prevalence of NRCD was 22% (95% confidence interval, 11–35%). Among patients with NRCD, inadvertent exposure to gluten was the most common cause (33%), followed by functional gastrointestinal disorders including irritable bowel syndrome in 16%. Refractory CeD type II along with its premalignant and malignant sequelae was observed in 7% of patients with NRCD.One in five patients with CeD may not respond to GFD and would likely be classified as NRCD. Inadvertent gluten exposure was the cause of ongoing symptoms in one‐third of patients with NRCD. Improving adherence to GFD along with developing novel therapeutics to mitigate symptoms due to ongoing gluten exposure is critical. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of gluten-related disorders, mainly celiac disease (CD) and non-celiac gluten sensitivity (NCGS), varies between 0.6% and 13% in the general population. There is controversial evidence regarding the association of both CD and NCGS with extra-digestive manifestations, including recurrent reproductive failure (RRF), which may have clinical implications. Objective: To study the prevalence of HLA susceptibility alleles for CD/NCGS in a cohort of female patients with RRF from a single reference center and to evaluate the effect of a gluten-free diet on reproductive success. Material and methods: A retrospective study was conducted on 173 patients with RRF, consecutively attended at the Reproductive Immunology Unit of San Carlos University Clinical Hospital in Madrid. We collected and analyzed the clinical, analytical, and immunological profiles of RRF patients who presented HLA alleles associated with CD and NCGS (HLA DQ2.2, DQ2.5, DQ8, and DQ7.5). Results: We observed a significantly higher prevalence of HLA alleles associated with CD and NCGS in our RRF cohort compared to the prevalence in the general population (69% vs. 35%–40%, p<0.0001). Only 2.3% of patients met the criteria for a CD diagnosis. In our RRF cohort, HLA-genetic susceptibility for CD/NCGS (HLA-risk group) was associated with a significantly higher rate of hypothyroidism compared to patients without these alleles (HLA-negative group) (48.7% vs. 26.92%, p=0.03). Patients with HLA-genetic susceptibility for CD/NCGS and thyroid disease had a significantly higher success rate in the subsequent pregnancy after management (55% vs. 30%, p=0.002). Two factors were found to be significant in this group: a gluten-free diet (p=0.019) and the use of levothyroxine (p=0.042). Conclusions: In our cohort of RRF patients, we observed a significantly higher prevalence of HLA susceptibility genes for CD/NCGS compared to the general population, also associated with a higher incidence of thyroid alterations. A gluten-free diet and the use of levothyroxine in cases of thyroid pathology had significant beneficial effects on pregnancy outcomes. We suggest that HLA typing for CD/NCGS and a gluten-free diet, in the presence of risk alleles, can improve pregnancy outcomes in RRF patients. [ABSTRACT FROM AUTHOR]

The American College of Gastroenterology revised its recommendations for diagnosing and managing celiac disease in its updated 2023 clinical guideline. Celiac disease is an autoimmune disorder causing malabsorption following exposure to gluten. A wide range of both gastrointestinal and nongastrointestinal signs and symptoms can occur. This article provides an overview of the diagnosis and management of celiac disease, aiding the NP in developing a greater awareness of the condition both to diagnose it and to refer patients as needed to gastroenterology for evaluation. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In different countries, the exact prevalence of people that refer symptoms after gluten ingestion is increasing and the unavailability of reliable laboratory tests to diagnose the condition known as nonceliac gluten sensitivity (NCGS) has opened the door to the spread of survey-based studies to hypothesize a prevalence of this condition with highly discordant results. We aim to describe the attitude toward gluten consumption in a large population of young adults in Italy. METHODS: A questionnaire-based cross-sectional study was conducted in 13 Italian cities to investigate the dietary attitudes of more than 9,400 people distributed throughout the country about gluten consumption. Only those referring to gluten-related symptoms with a frequency equal to "always" or "most of the time" were considered self-reported NCGS (SR-NCGS) patients. RESULTS: Five thousand two hundred thirty-four of 9,432 eligible participants (55.5%) fully completed the questionnaire. Excluding those with previous gastrointestinal diagnoses of celiac disease and wheat allergy, we have finally analyzed 4,987 questionnaires. Four hundred eighty-seven participants indicated gluten-related symptoms always or most of the time (SR-NCGS subjects), while 121 already had a medical diagnosis of NCGS. The minimum prevalence figure of SR-NCGS is 6.4% (95% confidence interval 6.0-6.9), with a higher prevalence in women (79.9%). The most frequent glutenrelated symptoms were bloating, abdominal pain, and tiredness. DISCUSSION: The high prevalence of people reporting symptoms after gluten ingestion requires that the diagnosis of NCGS should be ascertained with a double-blind controlled study to limit the number of people who improperly approach a gluten-free diet. [ABSTRACT FROM AUTHOR]

This case report details the clinical journey of a 16-year-old girl who presented with persistent iron deficiency anemia (IDA) and poor growth since childhood. Despite prior treatments, her condition did not improve, leading to further investigation. Comprehensive physical examination and laboratory tests revealed severe microcytic hypochromic anemia. Subsequent evaluations, including serological tests and a duodenal biopsy, confirmed the diagnosis of celiac disease (CD). The girl was started on a strict gluten-free diet along with iron, folic acid, and vitamin D3 supplementation, resulting in significant clinical improvement. This case underscores the importance of considering CD as a differential diagnosis in patients with refractory IDA. It highlights the need for early recognition and appropriate management. [ABSTRACT FROM AUTHOR]

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The article explores the connection between gluten sensitivity and laryngopharyngeal reflux (LPR), highlighting that gluten sensitivity can exacerbate or mimic LPR symptoms. Topics include the mechanisms linking gluten sensitivity to reflux, diagnostic and management strategies, and the potential benefits of a gluten-free diet for treating refractory LPR cases.

Background: A lifelong gluten‐free (GF) diet to manage coeliac disease is recognised to be challenging. This paper comprises two studies: study one aimed to report the opinions of adults with coeliac disease on review provision and explore factors influencing dietary adherence. Study two aimed to report dietetic provision for adults with coeliac disease. Methods: A cross‐sectional online survey was completed by 722 adults with coeliac disease, including validated dietary adherence, health literacy and quality‐of‐life questionnaires. An online and paper survey designed to capture the provision of dietetic services to adults with coeliac disease was completed by 88 dietetic departments within the United Kingdom. Results: Only 26% of adults with coeliac disease were offered annual reviews. In contrast, 85% considered reviews important, with 62% preferring dietetic provision. Those who considered reviews important had lower health literacy, greater dietary burden, poorer GF dietary adherence and lower GF food knowledge (all p < 0.05) compared with those who did not consider reviews important. GF dietary adherence was associated with health literacy, self‐regulatory behaviours, dietary burden and GF food knowledge; 53% agreed with the 'cost of GF food restricts what I eat'; they had poorer GF dietary adherence compared with those who disagreed (p < 0.001). More than 72% of dietetic coeliac review provision provided content on improving access to GF foods and eating out of the home. Conclusions: A subpopulation of adults with coeliac disease have a greater need for support and guidance, which supports the viewpoint that limited resources should be targeted towards patients with the most need for support to enable successful disease management. Key points: The majority of adults with coeliac disease were not receiving healthcare reviews for coeliac disease, whereas 85% would like to have reviews.Adults living with coeliac disease who had lower health literacy, poorer gluten‐free (GF) food knowledge and poorer GF dietary adherence score rated healthcare reviews as important.A varied provision of dietetic services for coeliac disease reviews was evident across the United Kingdom. [ABSTRACT FROM AUTHOR]

Background: Current markers for monitoring of Celiac disease (CD) and outcome after gluten-free diet (GFD) are limited. Urinary gluten immunogenic peptide (UGIP) has been shown to correlate with gluten intake and mucosal damage in CD. Hence our study objective was to review the evidence of efficacy of UGIP as a biomarker for CD Method: This systematic review was conducted using standards outlined in the PRISMA statement. Databases including PubMed, ProQuest, EBSCOHost, and Google Scholar were searched for relevant studies (randomized controlled trials (RCTs) and observational) up to March 2023. Newcastle Ottawa Scale and Cochrane Risk of Bias were used to assess the quality of included papers. Result: T: Literature search identified 85 studies, and after assessment of eligibility, eight studies were eventually reviewed. UGIP concentration was found to correlate with degree of mucosal damage of CD (Marsh II-III). Although three observational studies found a correlation between gluten intake and UGIP concentration, two RCTs did not find UGIP reliable for determining GFD adherence. In addition, UGIP concentrations did not correlate with antibody titers and clinical symptoms. Conclusion: UGIP may be useful for predicting degree of mucosal damage in CD. However, further studies are needed to evaluate its role in GFD adherence. [ABSTRACT FROM AUTHOR]

Background: Patients on a gluten-free diet (GFD) whose celiac disease (CD) status is unknown may undergo gluten challenge (GC) to clarify their diagnosis. Though this is an established diagnostic practice, the proportion of patients undergoing GC who are diagnosed with CD is unknown. Aims: We aimed to analyze which factors were predictive of having CD in a cohort of patients who underwent GC followed by upper endoscopy with duodenal biopsy. Methods: We identified adult patients at a CD referral center who had been on a GFD and then underwent GC to determine a diagnosis of CD during the years spanning 2006 to 2020. We compared those patients found to have CD (defined as villus atrophy/Marsh 3) on duodenal biopsy with those who did not, using the chi square and Fischer exact tests. Results: We identified 206 patients who underwent GC. Of these 206, 30 (14%) were diagnosed with CD based on post-GC duodenal biopsy. 176 of the 206 (85%) patients reported various gastrointestinal symptoms, including bloating (39%), though these were more common in those without CD (any GI symptoms: 89% vs 67%, p 0.004; bloating: 43% vs 20%, p 0.019). Serology values, when normalized, including pre- and post-challenge TTG IgA (37% vs 1.7%, p 0.001; 23% versus 2.3%, p 0.001), DGP IgG and IgA (57% vs 2.8%, p 0.001; 37% vs 6.2%, p 0.001) were higher in the group of patients with CD. Conclusion: Among patients undergoing GC for diagnostic purposes, only 14% had evidence of villus atrophy corresponding with CD on duodenal biopsy. The presence of any elevated pre-challenge serology was associated with CD. Bloating in combination with low serologies may help risk stratify patients as being less likely to have CD upon GC. [ABSTRACT FROM AUTHOR]

Summary: Wheat is the most important crop in the world mainly because of the feature of its storage protein, gluten, such as stretching and extending, that can hold the produced gas. However, some people have immunoreactivity against wheat gluten, which is generally called gluten disorder. Coeliac disease (CD) and non‐coeliac gluten sensitivity are types of gluten disorders. Several food processing techniques have been used to reduce gliadin immunoreactivity such as using thermal processing, fermentation, high‐pressure processing and pulsed light with different wheat products such as wheat flour, flatbread and gluten suspension. CD is the most known gluten disorder; therefore, this review will focus on the reduction effect of food processing on it. Gluten consists of gliadins and glutenin; the allergic effect of gliadins is well known, and several epitopes were identified, which are usually used to follow gluten immunoreactivity. Till now, consuming a gluten‐free diet is the only way for people who are suffering from gluten disorder. Up to now, all the attempts to reduce the immunoreactivity of gliadin (IRG) by food processing have not fully succeeded. The main techniques used to follow the target epitopes are enzyme‐linked immunosorbent assay (ELISA), western blot, LC–MS/MS, etc. The fermentation process and adding enzymes are the most promising food processing in terms of reducing IRG. Worth mentioning that using different techniques gave different gliadin reductions; beyond that, using different ELISA kits gave different reductions. Combining different techniques is recommended to monitor the IRG reduction by using the most effective method till now. [ABSTRACT FROM AUTHOR]

Background: Coeliac disease (CD) is an immune-mediated disorder, with dietary exclusion of gluten the only current treatment. A good knowledge of CD and gluten-free diet (GFD) is essential for those with CD to support effective self-management. Knowledge assessment with a validated tool helps evaluate understanding and knowledge gaps to better tailor educational resources. This study's aim was to perform a systematic review to identify validated CD knowledge assessment tools. Methods: PRISMA guidelines were followed, and searches were carried out in five literature databases. Papers were reviewed for tool development and testing process and assessed against pre-defined criteria for feasibility, validity, and reliability. Results: Twenty-five papers were included in the final analysis. Studies were from 16 countries, with a range of target populations, study designs, and development processes. Eleven reported pilot testing, and five assessed readability. Content validity was assessed in ten papers and formal content validity testing in one. Many tools contained items affecting generalisability outside the region developed. Conclusions: For a CD knowledge assessment tool to be suitable for use, it needs to be well designed, tested, and generalisable. No papers identified satisfied all requirements, thus highlighting a need to develop an appropriate tool. [ABSTRACT FROM AUTHOR]

Background: Exposure to antigens is crucial for child immune system development, aiding disease prevention and promoting infant health. Some common food antigen proteins are found in human breast milk. However, it is unclear whether gluten antigens linked to celiac disease (CD) are transmitted through breast milk, potentially impacting the development of the infant's immune system. Objective: This study aimed to analyze the passage of gluten immunogenic peptides (GIP) into human breast milk. We evaluated the dynamics of GIP secretion after lactating mothers adopted a controlled gluten-rich diet. Methods: We prospectively enrolled 96 non-CD and 23 CD lactating mothers, assessing total proteins and casein in breast milk, and GIP levels in breast milk and urine. Subsequently, a longitudinal study was conducted in a subgroup of 12 non-CD lactating mothers who adopted a controlled gluten-rich diet. GIP levels in breast milk and urine samples were assayed by multiple sample collections over 96 hours. Results: Analysis of a single sample revealed that 24% of non-CD lactating mothers on a regular unrestricted diet tested positive for GIP in breast milk, and 90% tested positive in urine, with significantly lower concentrations in breast milk. Nevertheless, on a controlled gluten-rich diet and the collection of multiple samples, GIP were detected in 75% and 100% of non-CD participants in breast milk and urine, respectively. The transfer dynamics in breast milk samples were long-enduring and GIP secretion persisted from 0 to 72 h. In contrast, GIP secretion in urine samples was limited to the first 24 h, with inter-individual variations. In the cohort of CD mothers, 82.6% and 87% tested negative for GIP in breast milk and urine, respectively. Conclusions: This study definitively established the presence of GIP in breast milk, with substantial inter-individual variations in secretion dynamics. Our findings provide insights into distinct GIP kinetics observed in sequentially collected breast milk and urine samples, suggesting differential gluten metabolism patterns depending on the organ or system involved. Future research is essential to understand whether GIP functions as sensitizing or tolerogenic agents in the immune system of breastfed infants. [ABSTRACT FROM AUTHOR]

The traditional gut‐centric view of coeliac disease is evolving as immune and genetic insights underscore the central importance of a systemic, T cell immune response to gluten in disease pathogenesis. As the field increasingly recognize the limitations of small intestinal histology as the diagnostic standard, data supporting the accuracy of an immune (serologic) diagnosis of coeliac disease ‐ well demonstrated in children ‐ are growing for adults. Novel biomarkers such as interleukin‐2 that identify the gluten‐specific T cell demonstrate high sensitivity and specificity for coeliac disease and offer the potential for a diagnostic approach that avoids the need for gluten challenge. Asymptomatic disease and manifestations outside the gut pose considerable challenges for diagnosis using a case‐finding strategy and enthusiasm for population screening is growing. The gluten‐free diet remains a highly restrictive treatment and there is a paucity of controlled data to inform a safe gluten intake threshold. Ongoing symptoms and enteropathy are common and require systematic evaluation. Slowly‐responsive disease is prevalent in the older patient diagnosed with coeliac disease, and super‐sensitivity to gluten is an emerging concept that may explain many cases of nonresponsive disease. While there is great interest in developing novel therapies for coeliac disease, no drug has yet been registered. Efficacy studies are generally assessing drugs in patients with treated coeliac disease who undergo gluten challenge or in patients with nonresponsive disease; however, substantial questions remain around specific endpoints relevant for patients, clinicians and regulatory agencies and optimal trial design. Novel immune tools are providing informative readouts for clinical trials and are now shaping their design. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is a chronic autoimmune disorder triggered by the ingestion of glutencontaining food by genetically predisposed individuals. Hence, treatment of CD consists of permanent avoidance of wheat, rye, barley, and other gluten-containing foods. Lifelong adherence to a glutenfree diet (GFD) improves the symptoms of CD, but recent evidence suggests it is also associated with a higher risk for hepatic steatosis and the coexistence or emergence of other cardiometabolic risk factors. Moreover, a higher risk for liver steatosis is also reported by some authors as a potential extraintestinal complication of the CD itself. Recent nomenclature changes designate the association between hepatic steatosis and at least one of five cardiometabolic risk factors as metabolic dysfunction-associated steatotic liver disease (MASLD). An extended network of potentially causative factors underlying the association between MAFLD and CD, before and after dietary therapy is implemented, was recently described. The individualized treatment of these patients is less supported by evidence, with most of the current recommendations relying on empiric clinical judgment. This review focuses on the causative associations between CD and hepatic injury, either as an extraintestinal manifestation of CD or a side effect of GFD, also referring to potential therapeutic strategies for these individuals. [ABSTRACT FROM AUTHOR]

As it appears that we are currently at the cusp of an era in which drugs that are new, re-purposed, or "supplements" will be introduced to the management of celiac disease, we need to reflect on whether the framework is set for celiac disease to be treated increasingly with pharmaceuticals as well as diet. This refers to reflecting on the rigor of current diagnostic practices; the limitations of the current standard of care, which is a gluten-free diet; and that we lack objective markers of disease severity. Investigating these issues will help us to identify gaps in technology and practices that could be critical for selecting patients with a well-defined need for an improved or alternative treatment. Both aspects, circumscribed limitations of the gluten-free diet and diagnostics helping to define celiac disease target groups, together with the guiding requirements by the responsible regulatory authorities, will contribute to defining the subgroups of patients with confirmed celiac disease eligible for distinct pharmacologic strategies. Because many patients with celiac disease are diagnosed in childhood, these aspects need to be differentially discussed for the pediatric setting. In this perspective, we aimed to describe these contextual issues and then looked ahead to the future. What might be the major challenges in celiac disease clinics in the coming years once drugs are an option alongside diet? And what will be the future objectives for researchers who further decipher the mucosal immunology of celiac disease? Speculating on the answers to these questions is as stimulating as it is fascinating to be part of this turning point. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary hemosiderosis is a rare cause of alveolar hemorrhage that is referred to as Lane Hamilton Syndrome when co-occurring with coeliac disease. Although the underlying cause is still unknown, the improvements brought by a gluten-free diet point to a shared pathogenesis. An 18-year-old female underwent bronchoscopy after presenting with complaints of recurrent hemoptysis attacks, revealing hemosiderin-laden macrophages pointing to alveolar hemorrhage. The presence of anti-endomysium IgA in the serum, substantiated by an endoscopic biopsy, was indicative of Celiac Disease. Her symptoms improved dramatically upon starting a gluten-free diet, but the patient subsequently died from an alveolar hemorrhage due to non-compliance with the diet. [ABSTRACT FROM AUTHOR]

Background: Globally, approximately 1.4% of people have celiac disease (CD), induced by gluten sensitivity. If left untreated, it causes small intestinal inflammation and villous atrophy, which can result in failure to thrive, anemia, osteoporosis, malabsorption, and even malignancy. The only treatment option available is a gluten-free diet (GFD). Few studies have looked at the role and perception of telehealth in relation to CD and selective nutrition both before and after the COVID-19 pandemic. Aim: Our goal was to screen and investigate the research conducted both before and after the COVID-19 pandemic concerning the utilization of telehealth applications and solutions in CD and other GFD-dependent circumstances. Methods: We employed a narrative review approach to explore articles that were published in scholarly journals or organizations between the years 2000 and 2024. Only English-language publications were included. PubMed and Google Scholar searches were mainly conducted using the following keywords: telemedicine, telehealth, telecare, eHealth, m-health, COVID-19, SARS-CoV-2, celiac disease, and gluten-free diet (GFD). Manual searches of the references in the acquired literature were also carried out, along with the authors' own personal contributions of their knowledge and proficiency in this field. Results: Only a few studies conducted prior to the COVID-19 outbreak examined the viewpoints and experiences of adult patients with CD with relation to in-person clinic visits, as well as other options such as telehealth. The majority of patients believed that phone consultations were appropriate and beneficial. Video conferencing and telemedicine became more popular during the COVID-19 pandemic, demonstrating the effectiveness of using these technologies for CD on a global basis. In recent years, urine assays for gluten identification have become accessible for use at home. These tests could be helpful for CD monitoring with telemedicine assistance. Conclusions: The extended knowledge gathered from the COVID-19 pandemic is expected to complement pre-COVID-19 data supporting the usefulness of telemedicine even after the emergent pandemic, encouraging its wider adoption in standard clinical practice. The monitoring and follow-up of CD patients and other GFD-dependent conditions can greatly benefit from telemedicine. [ABSTRACT FROM AUTHOR]

Dry eye disease is the most common condition in ophthalmology, which is particularly affecting people with health conditions having underlying inflammation and malnutrition in the pathology. One of these conditions is celiac disease. We aimed to analyse the prevalence of dry eye symptoms and the quality of tear film in celiac disease patients following a gluten-free diet. This is the first stage research for the randomized clinical trial aiming to assess the effect of omega-3 fatty acid supplementation on the tear film quality and dry eye disease in celiac disease patients following a gluten-free diet (ClinicalTrials. gov ID NCT05825978). One hundred celiac disease patients following a gluten-free diet completed general questionnaire, modified Celiac Disease Questionnaire, and semi-quantitative food frequency questionnaire which included foods potentially contaminated with gluten i.e. risky foods. The presence of dry eye symptoms and the quality of the tear film were assessed with two objective (Schirmer test I and TBUT) and one subjective (OSDI test) measurement. Subjective and objective measures of dry eye were lower in celiac disease patients who consumed more risky foods. However, average values for all measurements did not fit the criteria for dry eye diagnosis, but point out the need to educate celiac disease patients of the risks posed on eye health with exposure to gluten, even accidental. [ABSTRACT FROM AUTHOR]

Objectives: Nutritional quality of gluten-free (GF) food products is very important, as patients with celiac disease consume these products for lifelong. There is paucity of data on the nutritional content and cost of GF food products compared with their gluten-containing (GC) counterparts from India (Asia). Design: After a detailed market survey, packaged and labeled GF food products (n=485) and their packaged GC counterparts (n=790) from the supermarkets of Delhi (India) and e-commerce websites were included. Nutritional content and cost/100 g food (in US dollars) were calculated using the information on food label. Results: Gluten-free food products were 232% (range: 118% to 376%) more expensive than their GC counterparts. Energy content of all GF food products was similar to their GC counterparts, except cereal-based snacks (GF: 445 kcal vs. GC: 510 kcal, p<0.001). The protein content was significantly lower in GF pasta and macaroni products (single-grain: GF: 6.5 g vs. GC:11. 5 g, p-0.002; multigrain: GF:7.6 g vs. GC:11.5 g, p-0.027), cereal flours (single-grain: GF: 7.6 g vs. GC: 12.3 g, p<0.001; multigrain: GF:10.9 g vs. GC: 14.1 g, p-0.009) and nutritional bars (GF: 21.81 g vs. GC:26 g, p-0.028) than their GC counterparts. Similarly, the dietary-fiber content of GF pasta and macaroni products, cereal flours, cereal premix and nutritional bars of GF foods was significantly lower than their GC counterparts. Gluten-free bread and confectionary items, biscuits and cookies and snacks had higher total fats and trans-fat content than their GC counterparts. Gluten-free cereal-based snacks had higher sodium content than their GC counterparts (GF: 820 mg vs. GC:670 mg; p<0.001). Conclusion: GF foods are significantly more expensive, contain less protein and dietary fiber and higher fat, trans-fat and sodium than their GC counterparts. Strategies must be developed to reduce the cost and improve the nutritional profile of GF foods. [ABSTRACT FROM AUTHOR]

Background. This article highlights the most important nutritional issues for patients with IgA nephropathy associated with a high titer of celiac antibodies in the blood. The importance of therapeutic nutrition, which is part of the nephroprotective strategy as an integral part of the therapy of nephrological patients, is emphasized. The release of certain clinical practical recommendations of KDOQI (2020) once again emphasized the great importance of non-drug exposure for effective therapy of kidney diseases of various etiologies.Objective. To adapt therapeutic nutrition as a component of a nephroprotective strategy for patients with IgA nephropathy associated with a high titer of celiac antibodies in the blood.Results. Based on convincing data from the world literature, which are consistent with the results of our own research confirming the association of the above conditions (even in the absence of clinical manifestations of enteropathy), the effectiveness of the gluten-free diet in the complex treatment of IgA nephropathy, the therapeutic diet for this category of patients has been adapted according to the necessary chemical composition and energy value.Conclusion. Nutrition modification is an essential element of the complex therapy of nephrological patients. An individual approach to the selection of dietary therapy, including gluten elimination, will not only reduce the immunological activity of the main glomerular disease, but also, possibly, slow down the rate of progression of chronic kidney disease, delaying the development of terminal renal failure and increasing the reserve capacity of the kidneys.

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Background: An increased level of interleukin-17A and interleukin-18 in the serum and intestinal mucosa of celiac disease patients reflecting the severity of villous atrophy and inflammation was documented. Thus, the objective of this study was to evaluate the concentrations of salivary-17A, interleukin-1 beta, and interleukin-18 in patients with celiac disease who are on a gluten-free diet, both with and without periodontitis, and to compare these levels with those in healthy individuals. Methods: The study involved 23 participants with serologically confirmed celiac disease (CD) and 23 control subjects. The CD patients had been following a gluten-free diet (GFD) for a minimum of 1 year and had no other autoimmune disorders. The research involved collecting demographic data, conducting periodontal examinations, gathering unstimulated whole saliva, and performing enzyme-linked immunosorbent assays to measure salivary interleukin-17A, interleukin-1 beta, and interleukin-18 levels. Spearman's correlation analysis was utilized to explore the relationships between CD markers in patients on a GFD and their periodontal clinical findings. Results: The periodontal findings indicated significantly lower values in celiac disease patients adhering to a gluten-free diet compared to control subjects (p = 0.001). No significant differences were found in salivary IL-17A, IL-18, and IL-1B levels between celiac disease patients and control subjects. Nevertheless, the levels of all interleukins were elevated in periodontitis patients in both the celiac and control groups. The IL-1 Beta level was significantly higher in periodontitis patients compared to non-periodontitis patients in the control group (p = 0.035). Significant negative correlations were observed between serum IgA levels and plaque index (r = −0.460, p = 0.010), as well as gingival index (r = −0.396, p = 0.030) in CD patients on a gluten-free diet. Conclusion: Celiac disease patients on gluten-free diet exhibited better periodontal health compared to control subjects. However, increased levels of salivary IL-17A, IL-18 and IL-1B levels were associated with periodontitis. Additionally, serum IgA level was significantly inversely associated with periodontitis clinical manifestations and with salivary inflammatory mediators in CD patients on GFD. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals, affecting 1.4% of the world population. CD induces an inflammatory reaction that compromises small intestine villi, leading to nutrient malabsorption, and gastro and extraintestinal manifestations. Although other treatment approaches are being studied, adherence to a gluten-free diet (GFD) is the only effective intervention to date. Despite this, about 50% of patients experience persistent inflammation, often associated with unintentional gluten ingestion through contaminated food. There are regulations for labeling gluten-free foods which specify a limit of 20 mg/kg (20 ppm). The risks of gluten cross-contamination above that level are present throughout the whole food production chain, emphasizing the need for caution. This review explores studies that tested different procedures regarding the shared production of gluten-containing and gluten-free food, including the use of shared equipment and utensils. A literature review covering PubMed, Scielo, Web of Science, VHL and Scopus identified five relevant studies. The results indicate that shared environments and equipment may not significantly increase gluten cross-contamination if appropriate protocols are followed. Simultaneous cooking of gluten-containing and gluten-free pizzas in shared ovens has demonstrated a low risk of contamination. In general, shared kitchen utensils and equipment (spoon, ladle, colander, knife, fryer, toaster) in controlled experiments did not lead to significant contamination of samples. On the other hand, cooking gluten-free and gluten-containing pasta in shared water resulted in gluten levels above the established limit of 20 ppm. However, rinsing the pasta under running water for a few seconds was enough to reduce the gluten content of the samples to less than 20 ppm. [ABSTRACT FROM AUTHOR]

As one of the most prevalent autoimmune diseases, celiac disease (CD) affects 1% of people globally and is frequently linked to the HLA-DQ2/DQ8 polymorphism and gut microbiota dysbiosis. The possibility of different symptom severities between pediatric and adult populations, as well as the heterogeneity amongst them, might make diagnosis difficult. However, there are currently accessible diagnostic techniques, such as duodenal mucosal biopsies, serological screening for IgA and IgG as transglutaminase 2 specific antibodies, HLA haplotypes DQ8 and DQ2 and endoscopic assessment that is assessed on both healthy and vulnerable individuals. The only effective treatment for CD at the moment is rigorous, lifetime adherence to a gluten-free diet (GFD), which is sometimes a difficult challenge. The symptoms of accidental gluten intake cannot be controlled or mucosal damage prevented by a GFD alone. Additionally, many people may experience long-term consequences. There is hence an unmet demand for further therapies that can contain a reasonable combination of dietary- and non-dietary-based therapies for the management of CD. In this review, while exploring various aspects of etiology, pathophysiology, and nutritional issues related to CD, the latest findings of preclinical and clinical studies related to dietary- and non-dietary-based therapies are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Laboratory Diagnostics / Diagnostyka Laboratoryjna is the property of Index Copernicus International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This study explores the impact of a gluten-free diet (GFD) on regional gastrointestinal (GI) transit times in individuals with celiac disease (CD) and non-celiac gluten sensitivity (NCGS). While a GFD is established for managing CD and wheat allergy, its effects on NCGS remain controversial due to inconclusive evidence. Methods: Utilizing a wireless motility and pH capsule (WMC) to assess regional (measurements of gastric, small bowel, and colonic transit times) and whole gut transit, newly diagnosed CD (n = 12) and NCGS (n = 12) patients underwent evaluations at baseline and 4 weeks after having a GFD. Results: At baseline conditions, individuals diagnosed with CD exhibited prolonged colonic and intestinal transit times when compared to those with NCGS (p < 0.05). Following a 4-week GFD, CD patients experienced significant reductions in both intestinal and colonic transit times, along with enhanced small intestine contractility. NCGS individuals showed improvements in intestinal transit time and contractility with a GFD, although the colon exhibited no discernible effect. The GFD did not significantly impact intragastric, intestinal, or colonic pH. Conclusions: This study, employing WMC for the first time, provides novel insights into the positive effects of a GFD on intestinal and colonic transit, as well as contractility, in CD patients, and to a lesser extent, in those with NCGS. [ABSTRACT FROM AUTHOR]

Gluten-enteropathy affects a significant number of people, making gluten a major concern in the food industry. With medical advancements, the diagnosis of allergies is becoming easier, and people who are allergic to gluten are recommended a complete gluten-free diet. Since wheat provides a major part of the energy and nutrition in the diet, its elimination affects nutrition intake of allergic population. Food scientists are working to formulate products using protein-rich gluten-free grains with quality attributes at par with gluten-containing products. Focused research has been done to provide nutrition and a variety of food to people suffering from gluten-related disorders. Efforts are being made to remove the gluten from the wheat and other gluten-containing grains, while applying different processing/treatments to enhance the properties of gluten-free grains. Hence, the present review summarizes the importance, processing, and products of different gluten-free grains. It also highlights the digestibility of gluten-free grains with clinical trials and gluten elimination strategies for gluten-containing grains. [ABSTRACT FROM AUTHOR]

AbstractWith the improved knowledge of gluten-related disorders, especially celiac disease (CD), the market of gluten-free food is growing. However, the current gluten-free diet still presents challenges in terms of nutrition, acceptability, and cost due to the absence of gluten. It is important to note that gluten-related allergies or sensitivities have different underlying causes. And individuals with mild non-celiac gluten disorder symptoms may not necessarily require the same gluten-free treatments. Scientists are actively seeking alternative solutions for these consumers. This review delves into the various strategies employed by researchers for detoxifying gluten or modifying its main protein, gliadin, including genetic treatment, transamidation and deamidation, hydrolysis, and microbial treatments. The mechanisms, constraints of these techniques, their current utilization in food items, as well as their implications for gluten-related disorders, are discussed in detail. Although there is still a gap in the application of these methods as alternative solutions in the real market, the summary provided by our review could be beneficial for peers in enriching their basic ideas and developing more applicable solutions for wheat gluten detoxification. [ABSTRACT FROM AUTHOR]

Aim: The goal of this study was to investigate the expression levels of microRNAs (miRNAs) (miR-196b, miR-10a, miR-31-5p, and miR-338- 3p) which regulate the genes involved in the proliferation and function of cells functioning in the inflammatory processes in Celiac patients' blood and tissue samples. Celiac disease (CD) is an inflammatory disease which affects people who are genetically predisposed to gluten consumption. The only treatment for this disease is a gluten-free diet. Materials and Methods: The miRNA expressions were determined in blood and tissue samples from 12 pediatric patients with CD and from 8 healthy children using quantitative real-time PCR (qRT-PCR) and SybrGreen dye. The gene expression levels of miRNAs such as miR-196b, miR10a, miR-338-3p, and miR-31-5p were compared between the two groups. Results: There was a significant difference only in miR-10a gene expression levels between the control and patient blood samples. The greatest difference between the tissue and blood samples within the CD group were found in the expressions of miR-31-5p and miR-338-3p. It was seen that the patients’ human leukocyte antigen tissue type was not associated with their miRNA expression profiles. In addition, there was no significant correlation between their Marsh classification and gene expression levels. Conclusion: The significantly low level of miR-10a may be related to CD due to its effect on the immune response. Additionally, miR-10a may have potential as a non-invasive biomarker in the diagnosis of CD. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is an autoimmune gastrointestinal disease triggered by dietary gluten, occurring in genetically predisposed individuals. Currently, a gluten-free diet is the only current evidenced-based treatment for CD. With the growing prevalence of this condition worldwide, adjuvant therapies are needed. We understand that there are several factors that influence the pathogenesis of the condition. There is a complex interplay between genetics, environmental triggers, the immune system and gut microbiota. Recently, there has been a growing focus on the significance of gut microbiota in several autoimmune-based conditions. In particular, there has been much research involving the role of microbial flora and CD. Here, in this mini-review, we highlight the importance of gut microbiota and the symbiotic relationship with the host, introduce key factors that influence the development of the intestinal flora in early colonization, and ultimately explore its role in the pathogenesis of CD. [ABSTRACT FROM AUTHOR]

Gluten, a polypeptide hapten, found in many cereals such as barley, wheat, rye, oats, and others, has been recently implicated in a range of cutaneous disorders ranging from chronic plaque psoriasis through psoriatic arthritis, urticaria (chronic as well as paediatric onset), and angioedema to lichen planus, vitiligo, and rosacea. The evidence for them is still not well reviewed. To generate evidence for the causal role of gluten in various dermatological disorders. The Pubmed, MedLine, and EMBASE databases were searched using the keywords "Gluten" and one of the dermatoses, namely, "Atopic Dermatitis', "Vasculitis", "Psoriasis", "Psoriatic Arthritis", "Acne", "Alopecia Areata", and "Immunobullous disorders". All articles published in English for which free full text was available were taken into consideration. The search strategy returned in a total of 1487 articles which were screened for relevance and elimination of duplicates. Ultimately, around 114 articles were deemed suitable. The data were extracted and presented in the narrative review format. A simple and cost-effective solution to many of these chronic and lifelong conditions is to restrict gluten in the diet. However, the dermatologist would do well to remember that in the vast majority of dermatological disorders including the ones listed here, gluten restriction is not warranted and can even lead to nutritional deficiencies. The evidence varied from Grade I for some disorders like psoriatic arthritis to Grade IV to most disorders like acne, vitiligo, vasculitis, and atopic dermatitis. Herein, we review the evidence for each of these conditions and make practical recommendations for gluten restriction in them. [ABSTRACT FROM AUTHOR]

Resumen: Introducción y objetivo: El tratamiento de la enfermedad celíaca es la dieta sin gluten que debe realizarse en forma estricta y permanente. Los objetivos fueron determinar la adherencia a la dieta sin gluten y los factores de riesgo de no adherencia. Material y métodos: Estudio observacional, transversal y comparativo. Se incluyó a varones y mujeres de cualquier edad, portadores de enfermedad celíaca, que viven en el Paraguay en el periodo enero-abril 2021 y aceptaron completar una encuesta. Se excluyeron los cuestionarios incompletos. Se utilizó un muestreo no probabilístico, por conveniencia. Se midieron las variables demográficas y clínicas. La adherencia se midió con el cuestionario de Leffler. El estudio fue aprobado por el Comité de Ética de la Universidad Privada del Este. Resultados: La muestra se constituyó con 371 encuestados, siendo 322 adultos (87%) con una edad media de 38 ± 12 años y 49 niños y adolescentes (13%) con una edad media de 10 ± 5 años. Hubo un predominio del sexo femenino (85%). La adherencia a la dieta sin gluten se detectó en el 59% de los adultos y en el 73% de los niños y adolescentes. Los factores asociados significativamente a la adherencia fueron pertenecer al grupo etario de los niños y adolescentes, además de llevar más tiempo de diagnóstico: 9 ± 8 años para los adherentes y 7 ± 8 años para los no adherentes. Conclusiones: Este estudio permite conocer la frecuencia de la adherencia a la dieta sin gluten en celíacos del Paraguay. Se recomienda el apoyo psicológico y nutricional a los celíacos sin adherencia a su tratamiento. Abstract: Introduction and aim: The treatment for celiac disease is a gluten-free diet that should be strictly and permanently carried out. Our aims were to determine adherence to the gluten-free diet and the risk factors for non-adherence. Materials and methods: An observational, cross-sectional, comparative study was conducted. It included individuals of both sexes and of any age that presented with celiac disease, lived in Paraguay from January to April 2021, and agreed to participate in the survey. Incomplete questionnaires were excluded. Non-probabilistic convenience sampling was utilized. Adherence was measured using the Leffler questionnaire. The study was approved by the Ethics Committee of the Universidad Privada del Este. Results: The sample consisted of 371 respondents, 322 (87%) of whom were adults, with a mean age of 38±12 years, and 49 (13%) of whom were children and adolescents, with a mean age of 10±5 years. Female sex was predominant (85%). Adherence to the gluten-free diet was detected in 59% of the adults and 73% of the children and adolescents. The factors significantly associated with adherence included belonging to the child and adolescent age group and having had the diagnosis for a longer time: 9±8 years for the adherence group and 7±8 years for the non-adherence group. Conclusions: The present study demonstrated the frequency of adherence to the gluten-free diet in celiac patients in Paraguay. Psychologic and nutritional support is recommended for individuals with celiac disease that do not adhere to their treatment.

In people with a hereditary predisposition, gluten consumption causes celiac disease, a multifactorial autoimmune condition. The ensuing small intestine inflammatory process develops specific antibodies and causes various gastrointestinal and extra-intestinal symptoms with varying degrees of severity. Evaluation of the blood iron profile at various histological celiac disease severity in Iraqi patients was the goal of the current study. Seventy-five Iraqi patients with celiac disease, with a mean age of 18.68± 11.13 years, were the study's participants. These people tested positive for celiac antibodies and experienced gastrointestinal symptoms. Based on the disease histological severity, they were divided into two groups: marsh (III a, b, c) group and marsh (0, I) group. For comparison purposes, 46 people who appeared to be in good health and matched in age and gender to the patients utilized in the study were also included. The levels of iron, transferrin, hemoglobin, ferritin, total iron binding capacity, unsaturated iron binding capacity, and the percentage of transferrin that is saturated with iron were all measured. In comparison to the other patient groups under study, celiac patients (marsh III) group, and particularly those of group (marsh III c), showed a substantial drop (p<0.05) in iron, the percentage of transferrin saturating with iron, the levels of each ferritin and of hemoglobin. The total iron binding capacity and the unsaturated iron binding capacity showed a significant elevation (p<0.05) in (marsh III c) patients' group, meanwhile non-significant differences (p> 0.05) were found in transferrin concentration. Moreover, significant differences (p< 0.05) were obtained in the iron profile between celiac patients who followed strict gluten free diet and those patients with gluten contained diet. [ABSTRACT FROM AUTHOR]

Introduction. Recently, an increased risk of celiac disease or eosinophilic esophagitis has been postulated among patients with either of these disorders, prompting some to suggest a common underlying mechanism, whereas others maintain that their co-existence is coincidental. Methods. We compared clinical and pathological features of 29 patients meeting criteria for both celiac disease and eosinophilic esophagitis to 26 celiac disease and 26 eosinophilic esophagitis controls to determine whether any distinguished study patients from controls. Results. Eight (28%) study patients presented with symptoms of both celiac disease and eosinophilic esophagitis, whereas 14 (48%) had celiac disease symptoms only and 5 had (17%) esophageal symptoms only. Study patients had similar autoimmune and atopic conditions seen in both control groups. Histological severity of disease, including Marsh II-III duodenal histology (study specimens: 87%; controls: 89%), mean peak esophageal eosinophil counts (study specimens: 55/400x field; controls: 80/400X field, P =.1), and presence of eosinophil microabscesses, scale crust, and subepithelial fibrosis were also similar to controls. Gluten-free diet resolved celiac disease-related symptoms (19 of 20, 95%) and histology (10 of 12, 83%), but not esophageal symptoms or eosinophilia in most study patients. Conclusion. Patients with concomitant celiac disease and eosinophilic esophagitis lack distinguishing features compared to controls with celiac disease or eosinophilic esophagitis alone. The occurrence of both disorders is likely coincidental in most cases. [ABSTRACT FROM AUTHOR]

Context Research on the effects of gluten on dyspeptic symptoms has shown conflicting results. Objective The aim of this systematic review and meta-analysis of clinical trials was to assess the effects of gluten on dyspeptic symptoms. Data Sources A systematic search of the PubMed, ISI Web of Science, Scopus, Cochrane, and Embase online databases was performed up to May 2022. Data Extraction Randomized controlled trials (RCTs) and non-RCTs that examined the impact of a gluten-free diet, a low-gluten diet, or a gluten challenge on dyspeptic symptoms, including early satiety, epigastric pain, bloating, and nausea, were selected independently by 2 authors. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework was used to assess the certainty of the evidence. Results were pooled using a random-effects model and expressed as weighted mean differences (WMDs) and 95%CIs. Data Analysis Of the 7641 citations retrieved, 27 articles (18 RCTs and 9 non-RCTs) were included in the systematic review. Of those, 5 RCTs were eligible for the meta-analysis. The pooled results indicated that gluten challenge significantly increased the severity of bloating (WMD = 0.67; 95%CI, 0.37–0.97; I2  = 81.8%; n = 6), early satiety (WMD = 0.91; 95%CI, 0.58–1.23; I 2 = 27.2%; n = 5), and epigastric pain (WMD = 0.46; 95%CI, 0.17–0.75; I 2 = 65.8%; n = 6). However, the effect of gluten challenge on the severity of nausea (WMD = 0.13; 95%CI, −0.17 to 0.43; I2  = 0.0%, n = 5) was nonsignificant. Conclusion Gluten challenge significantly worsened dyspeptic symptoms, including bloating, early satiety, and epigastric pain, but did not affect nausea. These findings suggest that gluten restriction could be efficient in reducing dyspeptic symptoms. Well-designed large RCTs recruiting homogenous groups of patients with functional dyspepsia are needed to clarify the effectiveness of gluten restriction on dyspeptic symptoms. [ABSTRACT FROM AUTHOR]

Hashimoto’s disease is one of the most common endocrine disorders in society. Although the accepted standard treatment is hormone replacement, social media has offered nutritional support based on a gluten-free diet and selenium supplementation. This study aimed to clarify this issue by reviewing the literature for awareness of clinicians. [ABSTRACT FROM AUTHOR]

Coeliac disease (CeD) is a T-cell mediated enteropathy triggered by dietary gluten which remains substantially under-diagnosed around the world. The diagnostic gold-standard requires histological assessment of intestinal biopsies taken at endoscopy while consuming a gluten-containing diet. However, there is a lack of concordance between pathologists in histological assessment, and both endoscopy and gluten challenge are burdensome and unpleasant for patients. Identification of gluten-specific T-cell receptors (TCRs) in the TCR repertoire could provide a less subjective diagnostic test, and potentially remove the need to consume gluten. We review published gluten-specific TCR sequences, and develop an interpretable machine learning model to investigate their diagnostic potential. To investigate this, we sequenced the TCR repertoires of mucosal CD4+ T cells from 20 patients with and without CeD. These data were used as a training dataset to develop the model, then an independently published dataset of 20 patients was used as the testing dataset. We determined that this model has a training accuracy of 100% and testing accuracy of 80% for the diagnosis of CeD, including in patients on a gluten-free diet (GFD). We identified 20 CD4+ TCR sequences with the highest diagnostic potential for CeD. The sequences identified here have the potential to provide an objective diagnostic test for CeD, which does not require the consumption of gluten. [ABSTRACT FROM AUTHOR]

Immunogenic peptides from wheat gluten can be produced during digestion, which are difficult to digest by gastrointestinal proteases and negatively affect immune responses in humans. Gluten intolerance is a problem in countries where wheat is a staple food, and a gluten-free diet is commonly recommended for its treatment and prevention. Enzyme approaches for degradation of the peptides can be considered as a strategy for its prevention. Here, we isolated a gluten-degrading bacterium, Bacillus amyloliquefaciens subsp. plantarum, from wheat grains. The culture conditions for enzyme production or microbial use were considered based on gluten decomposition patterns. Additionally, the pH range for the activity of the crude enzyme was investigated. The bacterium production of gluten-degrading enzymes was temperature-dependent within 25 °C to 45 °C, and the production time decreased with increasing culture temperature. However, it was markedly decreased with increasing biofilm formation. The bacterium decomposed high-molecular-weight glutenin proteins first, followed by gliadin proteins, regardless of the culture temperature. Western blotting with an anti-gliadin antibody revealed that the bacterium decomposed immunogenic proteins related to α/β-gliadins. The crude enzyme was active in the pH ranges of 5 to 8, and enzyme production was increased by adding gliadin into the culture medium. In this study, the potential of the B. amyloliquefaciens subsp. plantarum for gluten-degrading enzyme production was demonstrated. If further studies for purification of the enzyme specific to the immunogenic peptides and its characteristics are conducted, it may contribute as a strategy for prevention of gluten intolerance. [ABSTRACT FROM AUTHOR]

The development of gluten-free bakery products, the quality of which is comparable to the quality of regular wheat-based products, remains a technological challenge. In this study, flaxseed oil cake (FOC), a by-product of flaxseed oil extraction and a source of nutritional and functional compounds, was used as an ingredient in the experimental bread formulation as partial replacement of starches (5%, 15%, and 30%). The gluten-free breads (GFBs) were evaluated for technological parameters, nutritional value, and sensory quality. Compared with the control, all FOC-enhanced GFBs were significantly (p < 0.05) richer in proteins, fat, and dietary fibre, with an increase that was proportional to the concentration of FOC in the formulation. At low-to-moderate levels (5% and 15%), FOC improved the specific volume, texture characteristics (reduced crumb hardness, gumminess, and chewiness), and appearance of GFBs, which allowed us to ameliorate its sensory features, but at 30% of FOC, the quality of the crumb texture decreased significantly (p < 0.005). Among the experimental GFBs, FOC15% exhibited improved technological characteristics and was rated by the sensory panel as the best in terms of overall quality. The results of the conducted research highlighted the benefits of incorporating FOC into GFB as a promising approach to developing a palatable, high-quality bakery product that may be a healthier option for individuals on a gluten-free diet, offering nutritional benefits. Nevertheless, it should be emphasised that the amount of FOC in GFB requires careful regulation. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is an autoimmune intestinal disease caused by intolerance of genetically susceptible individuals after intake of gluten-containing grains (including wheat, barley, etc.) and their products. Currently, CD, with “iceberg” characteristics, affects a large population and is distributed over a wide range of individuals. This present review summarizes the latest research progress on the relationship between CD and gluten. Furthermore, the structure and function of gluten peptides related to CD, gluten detection methods, the effects of processing on gluten and gluten-free diets are emphatically reviewed. In addition, the current limitations in CD research are also discussed. The present work facilitates a comprehensive understanding of CD as well as gluten, which can provide a theoretical reference for future research. [ABSTRACT FROM AUTHOR]